Armed conflict is an urgent global health issue and a humanitarian crisis. Civilians are greatly affected, and often every aspect of their lives is disrupted. Violent conflicts have multiple long-lasting, detrimental effects on communities. A coordinated, international response to health needs in conflict zones is lacking, unfortunately, and conflict serves as an important social determinant of health for many populations (Debarre et al., 2020). There are two main ways in which to examine the relationship between armed conflict and public health. First, conflict can negatively impact healthcare structures and systems of care delivery. Conflict zones also face new healthcare demands and exacerbate existing health disparities. It is difficult to determine how these two are intertwined, but ultimately, policies and response to conflict must be sustainable and context specific (Debarre et al., 2020).
Conflict can create a sparse setting for healthcare delivery in multiple ways. A commonly reported impact of conflict is the suspension or closure of healthcare facilities and programs (Afzal & Jafar, 2019). These healthcare facilities may be attacked or lack sufficient personnel and supply to operate. Furthermore, conflict causes loss of healthcare workers, though there is debate of how much of this is due to death/injury versus relocation. There is also often a lack of clean water, electricity, and fuel in conflict zones (Afzal & Jafar, 2019). For example, a center serving thousands of Syrian internally displaced persons has faced barriers as those mentioned above – difficulty accessing a consistent supply of medical equipment and materials, improving infrastructure, and securing a consistent staff (Aburas et al., 2018).
The presence of violence itself also creates increased demands and pressures for healthcare systems and personnel. They may see heavier caseloads, and providers are often forced to decide who should be treated (Afzal & Jafar, 2019). Conflict also creates new healthcare needs and highlights already existing disparities in care. In conflict-affected populations, the rate of mental health issues due to exposure to trauma often increases as well (Aburas et al., 2018). People also are unable to access family planning services and birth control. A study in 2018 found that, after years of conflict, Syrian women had higher rates of poor pregnancy outcomes including increased fetal mortality. There had also been a stark rise in cesarean deliveries (Aburas et al., 2018). Along with women, children are extremely vulnerable during conflict including increased risk of malnourishment, psychological trauma, and preventable infection due to lack of vaccination. For example, polio re-emerged in Syria in 2018 even though 18 years ago it had been eradicated (Afzal & Jafar, 2019). Conflict also diverts resources from primary care to trauma-related services, though it is difficult to determine how many people cannot access primary care for chronic issues and suffer poor health consequences as a result (Afzal & Jafar, 2019).
Ultimately healthcare delivery and access are drastically affected in conflict zones. Limitations in available data make it difficult to understand the full range of impact on the attacks on healthcare in conflict zones (Afzal & Jafar, 2019). Further research should aim to differentiate the impact of conflict on the healthcare system and delivery versus the impacts of conflict on health itself. While there must be a radical shift in how we address conflict as a global health issue, there are numerous ways in which governments, community organizations, and aid groups can better the delivery. Some opportunities for intervention include improving coordination between all relevant actors, developing interventions tailored to a region’s unique needs, and making responses long-lasting (Debarre et al., 2020). These efforts are also relevant for the ongoing conflict in Ukraine.
References
Aburas, R., Najeeb, A., Baageel, L., & Mackey, T. K. (2018). The Syrian conflict: a case study of the challenges and acute need for medical humanitarian operations for women and children internally displaced persons. BMC medicine, 16(1), 65. https://doi.org/10.1186/s12916-018-1041-7
Afzal, M. H., & Jafar, A. (2019). A scoping review of the wider and long-term impacts of attacks on healthcare in conflict zones. Medicine, conflict, and survival, 35(1), 43–64. https://doi.org/10.1080/13623699.2019.1589687
Debarre, A., Moret, E., Gretchen Baldwin, J.S., Lyammouri, R., Sarfati, A., & Nina Wilén, P. D. W. (2020, May 12). “Hard to reach: Providing healthcare in armed conflict.” International Peace Institute. Retrieved from https://www.ipinst.org/2018/12/hard-to-reach-providing-healthcare-in-armed-conflict
WHO, and UNICEF. 2017. “Syrian Arab Republic: WHO and UNICEF Estimates of Immunization Coverage: 2017 Revision.” World Health Organization; United Nations Children’s Fund. Retrieved from https://data.unicef.org/wp-content/uploads/country_profiles/Syrian%20Arab%20Republic/wuenic2017rev-ctry-reports/immunization_2018_syr.pdf