Under threat: healthcare in conflict zones
13 August 2021
There are two billion people living in conflict-affected regions around the world. What is the impact of this on population health and health services?
According to the World Bank, two billion people are currently living in fragile and conflict-affected regions. Severe, long-standing conflicts present a serious challenge to universal healthcare, as the impacts are indiscriminate across the health system. Armed conflict is a global health issue: it means extreme violence, displacement, destroyed infrastructure and institutions, and professionals and facilities that are under violent attack. Governments, international bodies and humanitarian organisations have made attempts to protect health systems with policy, guidelines and frameworks, but are they prepared to cope at times of armed conflict?
Conflict is a global health challenge
In addition to the immediate impact of conflict, it also has a major effect on those already living with specific long-term healthcare needs, such as non-communicable diseases (NCDs). Most people with NCDs require carefully planned and long-term care, which becomes increasingly hard to access in volatile and insecure environments. In Yemen, the ongoing humanitarian crisis leaves many without access to essential care. Not even half of the health facilities are functioning, and those that remain open are without basic equipment. Because of this, NCDs now account for over half of all deaths caused by illness in Yemen.
Conflict zones can also make NCDs worse, particularly cardiovascular diseases. This is concerning, as not only does a conflict environment increase risk factors for heart disease, but there are few (or even no) services available to manage it.
The ongoing humanitarian crisis in Yemen leaves many without access to essential care. Because of this, non-communicable diseases now account for over half of all deaths caused by illness in Yemen.
The breakdown of healthcare as a result of conflict dramatically affects people with a physical injury. This is a major and extensive issue in conflict zones – in Syria, around 25,000 people were injured each month in 2016. These people require immediate and sometimes long-term care, which can be impossible to access safely.
Mental health care and services also face a major challenge in insecure environments. The vast majority of conflict takes place in low- and middle-income countries, where risk factors such as poverty, unemployment and social isolation already substantially increase vulnerability to psychological distress. Combined with exposure to conflict and violence, they significantly impact the mental health of the population. One in five people living in a conflict zone has a severe mental health condition and 80% of people with symptoms of mental illness do not receive appropriate care.
Health services in conflict zones are under attack
Not only do services become almost impossible to access during conflict, but they are quite literally under attack. Healthcare centres are targeted by airstrikes and subjected to looting and violence that destroys health infrastructure. This prevents access to urgently needed surgical supplies, creates shortages of medicines and healthcare professionals, places a strain on financial resources, and leaves patients and professionals in jeopardy. The protracted civil war in Syria underscores the severity of this situation. The International Rescue Committee found that 68% of healthcare workers reported being inside a facility during an attack and 49% of civilians were frightened to access healthcare for fear of an attack.
The lingering consequences of conflict leave any remaining services severely deprived. In Syria, the conflict has had an unprecedented strain on healthcare. Before the civil war, more than 90% of medications were locally produced, but after years of conflict there is now a critical shortage of life-saving medicines. In some facilities, surgeons operate under torch lights and nurses use their own body heat to warm up fluids before transfusion. It is no surprise then that life expectancy in Syria has declined by 20 years since the conflict began.
Not only do services become almost impossible to access during conflict, but they are quite literally under attack. Healthcare centres are targeted by airstrikes and subjected to looting and violence that destroys health infrastructure.
The impact of conflict on health is long lasting and intergenerational
The combined ramifications of prolonged conflict and poor public health are persistent. Even after conflict ends, it takes decades for the population to recover.
The effects on pregnant women can be felt across generations. Food insecurity, lack of antenatal services, and increased stress and anxiety can all negatively impact unborn babies. Research has found that the growth and development of children born in conflict areas can be impaired as a result of chronic malnutrition, and their mental health and neurological development also suffer.
After a conflict has ended, the environment remains volatile. Chemical and radioactive weapons have a long-term impact, and remnants of other weapons (such as landmines) make accessing any remaining health services dangerous. With health systems and infrastructure all but destroyed, many people are forced to go without healthcare. This is compunded by the economic impact of war, which can delay GDP growth by around 30 years.
Without security, adequate healthcare is not possible
The impact of conflict on health has devastating consequences. For as long as conflicts last, the health of the population in these countries will continue to pay the price. Although it is not straightforward, it is necessary for states and humanitarian organisations to address the challenges that arise from conflict to improve universal healthcare and save lives.