Armed conflicts

Armed conflicts deprive 630m women, children of health services

KABUL (Pajhwok): The world is failing to address health needs of 630 million women and children affected by armed conflicts, said a new four-paper series published on Tuesday. Published in The Lancet, the series said armed conflicts were becoming increasingly complex and protracted and a growing threat to humanitarian access and to the delivery of essential health services, affecting at least 630 million women and children—over 8% of the world’s population—in 2017.

The authors highlight the failure of the global community to prioritise women’s and children’s health in areas of conflict, and call for an international commitment from humanitarian actors and donors to confront political and security challenges, together with consensus on a framework for identifying high-priority interventions to reach the most vulnerable women and children with the best care possible. The Series led by academic co-investigators and partners affiliated with the BRANCH (Bridging Research & Action in Conflict Settings for the Health of Women & Children) Consortium synthesises existing evidence with new modelling and insights from a range of local research partners, humanitarian agencies, and civil society organisations.

“The new estimates provide compelling evidence of the enormous indirect toll of modern warfare caused by easily preventable infectious diseases, malnutrition, sexual violence, and poor mental health, as well as the destruction of basic services such as water and medical facilities”, says Professor Zulfiqar Bhutta from the Centre for Global Child Health, The Hospital for Sick Children in Toronto in Canada and the Institute for Global Health & Development, The Aga Khan University, who led the Series. He continues, “Today, more than half of the world’s women and children are living in countries experiencing active conflict. The international community cannot continue to ignore their plight. It’s time for a radical rethink of the global response that confronts challenges to insecurity, access, politics, coordination, and the logistics of delivering high-priority interventions to women and children in politically unstable and insecure settings.”

The Series papers explore the changing nature of war and conflict, its short- and long-term health effects on women and children, strategies for identifying best responses, and interventions supported by in-country assessments and studies. New estimates suggest that the number of women and children affected by armed conflict around the world has risen steadily since 2000, as a result of population growth, more conflicts, increasing use of explosive and chemical weapons in urban areas, and growing numbers of refugees and internally displaced people.

In 2017, one in 10 (10%) women and almost one in six (16%) children worldwide were either forcibly displaced by conflict or living dangerously close (ie, within 50 km) to conflict zones. Around a third of those affected live in Nigeria, and India. Evidence suggests that the risk of dying from non-violent causes increases substantially with proximity to more intense and chronic conflicts, with women of childbearing age in Africa living near the highest-intensity fighting three times more likely to die than women in peaceful areas, and the risk of death among infants higher by more than 25%.

Between 6·7 and 7·5 million infants, and more than 10 million children under 5 years of age, born within 50 km of armed conflict are estimated to have died from the indirect consequences of fighting across Africa, Asia, and the Americas between 1995 and 2015. “It is clear that the indirect effects of armed conflict on women and children are far greater than the effects of actual fighting”, says Series co-author Dr Halla Gattas from the American University of Beirut, Lebanon. “But the reality could be much worse. Insecurity and insufficient resources mean data are often scarce and poor quality. Far greater investment in strengthening data collection and collaboration between humanitarian agencies and local authorities is needed to generate better, more readily available, and actionable information to improve the response in humanitarian crises.” [1]

In 2019, there were 54 ongoing state-based armed conflicts in 35 countries, averaging 20 years or more [3]. Once mostly confined to warring nations, armed conflict increasingly involves clashes between nations and insurgent groups in control of large geographical areas, and is characterised by a lack of respect for International Humanitarian Law, the systematic use of explosive and chemical weapons in cities, pervasive sexual violence against women and girls, and hybrid warfare (eg, cyberattacks and the manipulation of social media). The Series also assessed the provision of proven health interventions for women and children in 10 conflict-affected countries in different stages (eg, acute, protracted, post-conflict) of conflict and geographical, political, and economic conditions—Afghanistan, Colombia, Democratic Republic of the Congo, Mali, Nigeria, Somalia, South Sudan, Syria, and Yemen.

In Afghanistan, mobile clinics are used to deliver health services to remote areas, and in South Sudan, donors made emergency funds available to stock up on medical supplies to ensure rapid respond to future disease outbreaks (eg, cholera). Professor Isabel Garcés-Palacio from the Universidad de Antioquia in Colombia says, “Although these solutions need more rigorous evaluation, they have the potential to provide a timely response to current implementation challenges and remind health authorities of their responsibility to deliver basic health services to the whole population.”

As a first step towards filling the guidance gap, the authors call for humanitarian health actors including global and local agencies and NGOs, and academia working in conflict settings to establish a decision-making framework to guide the selection of priority interventions and improve accountability. “While the needs of communities facing ongoing conflict are great, the voices of these communities are also often unheard”, says Series co-author Assistant Professor Neha Singh, Co-Director of the Health in Humanitarian Crises Centre at The London School of Hygiene & Tropical Medicine, UK. “The world must make more concerted effort to reduce the risk of conflict, but until that happens, improving health and nutrition service delivery for women and children affected by conflict remains an ethical and moral responsibility.”

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