The Intersection of Healthcare and Conflict

Today, the world is facing the highest number of violent conflicts since the Second World War. According to the United Nations, 2 billion people — a quarter of humanity — live in places affected by such conflict. Conflict has a unique capacity to emotionally impact people around the world. The toll conflict has on innocent civilians, societal structures, economies, and on our fragile system of international relations is hard to measure in one metric as the impact cuts across almost all sectors of human activity.

One of the most vulnerable sectors is healthcare. Conflict tests the resilience of systems as clinics and hospitals are destroyed, professionals are forced to flee, and supply chains are disrupted. This not only directly impacts the country in conflict but can implicate surrounding regions and global diaspora. Today, conflicts from Sub-Saharan Africa to the Middle East to Eastern Europe to South Asia all are seeing massive interruptions in local health service delivery, as well as strains to surrounding countries’ health systems as refugees flood across borders and supply chains are interrupted with security concerns.

As governments and health systems are no longer able to provide their citizens with healthcare in highly dangerous conflict situations, the work of external organizations becomes invaluable. Bodies such as the International Red Cross (IRC), Medecins Sans Frontiere (MSF), UNICEF, and many more work tirelessly to delivery essential aid to those in need. To understand healthcare during conflict, we can look first at the mission of such organizations:

·        Red Cross -- ‘’protect the lives and dignity of victims of armed conflict and other situations of violence and to provide them with assistance’’.

·        MSF -- “We provide care based on needs alone, and work to reach those who require medical attention, regardless of which side of the frontline they happen to be.”

Despite these missions to provide impartial care, there remain many attacks, abductions, and murders of humanitarian and medical workers abroad. In 2022 alone there were 235 incidents, and 444 aid worker victims. Health workers are being threatened, assaulted, intimidated, and blocked from receiving or providing care. Health Infrastructure is being burned, bombed, facilities are being looted, blocked or occupied. 

This all happens under the context of attempts at providing lifesaving, essential, care.

The 4^th Geneva Convention established in 1949 highlights the importance of healthcare. Article 14 says that hospital and safety zones must in fact be established for groups such as the injured, sick and pregnant women; Article 18 states civilian hospitals and their staff must be protected.

MSF has stated that “war weakens the national immune system.” It interrupts service by destroying infrastructure and limiting personnel. It reduces access to care either by making it geographically unsafe to access or hindering the supply chain of medications. It causes explosions in public health concerns such as malnutrition, infectious disease, and mental health. Finally, it increases inequalities as conflict tends to disproportionately burden individuals of lower socioeconomic status and humanitarian agencies struggle to access rural areas.

Because of the detrimental impact it can have, attacks on health care violate International Law.

Health organizations are often concerned about traumatic injuries, mental health, maternal health, child health and the massive breakdown of infrastructure. Other indirect impacts include massive population displacement (including assault and trafficking of women and children), food shortages and the malnutrition and violence that comes with this, increasing military budgets that take away from health systems, and reduced international cooperation that adversely effects public health and scientific research.

To summarize, why should we care?

Overall, attacks on healthcare are arguably against international Law. They disproportionately impact the most vulnerable populations as the breakdown in infrastructure means an inability to deliver medication. This undermines the human right to health and causes injuries, illness and death. This leads populations that are already suffering to be met with declining health and no relief.  

In the realm of health impact beyond the conflict zone, attacks on healthcare sow the seed for epidemic outbreaks. The spread of diseases due to compromised vaccination programs, dense and unsanitary living conditions, mass population movement, and disruption of disease surveillance can have major global health implications as it increases the spread of disease.

And what can be done?

There is a wide array of research initiatives that study the problems of violence against civilians, terrorism events, security, and security of humanitarian organizations. This research is essential to increase advocacy, force accountability, and improve data collection that supports research. This research identifies vulnerabilities which allows for better development of security strategies. Advocacy leads to more shaming of perpetrators and thus increased accountability. Finally, assessing the scope of attacks and their burden helps organizations build back better infrastructure and health systems.

In 2020, this led to a joint statement by 22 civil society organizations, calling for action by the UN to protect civilians in situations of armed conflict. 

Alongside efforts to keep healthcare workers safe, it’s important to explore how better to deliver critical health care in the midst of conflict. Here, new technologies and designing for the stress of conflict zones can be the way forward. Injectable medicines are a challenge to manage in high stress conflict zones where health care is often delivered by less trained personnel in less-than-optimal conditions. Innovations such as single-dose prefilled syringes can enhance the safe delivery of essential medicines as they’re easy to administer and the plastic container makes them less breakable and lighter than glass. Care of newborns is one of the most vulnerable health care services in conflict as newborn incubators are extremely difficult to move and require electricity.  Innovative new devices such as mobile low-energy incubators can drastically improve care for newborns.

Finally, investment in better health facilities and medical supply chains that can withstand disruption is beginning to show more promise. Resistant containers for medications and facilities equipped with better tools to help providers trying to deliver care during conflict and even mobile, shock-resistant containers for housing healthcare clinics are innovations that can have a massive impact on critical care during conflict.

Attacks against healthcare workers, healthcare facilities and health systems cannot be allowed under any context. Access to proper health care is a human right and must remain a top priority. Moreover, it is an investment in global health for all in the fight against disease outbreaks. By drawing international attention towards improving delivery of care in conflict situations we are making an investment for all.

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