Often, when we think of war and unrest in countries, the first thing that is discussed or thought about is the violence and the immediate resulting casualties. The number of deaths and injuries as a result of violence within a country or area is one of the key determinants for assessing and evaluating the extent of violent crises. While this factor is of paramount significance because of the direct effect on human life, there are additional consequences of war that are also important and require consideration. One such consequence is the threat to health workers and poor access to healthcare that often results from war and long-term political instability. War disrupts healthcare infrastructure and, in countries where healthcare resources are already poor, conflict only serves to further weaken those resources and make access to basic healthcare services even more difficult. Contemporaneously, humanitarian workers often provide a large proportion of health services through the provision of aid in war torn countries. International bodies such as the World Health Organization, Médecins Sans Frontières and the Red Cross play a key role in responding to health care needs. These entities work in partnership with whichever local health workers that the country might have when the peace is disrupted. Depending on the extent of the conflict in a country, these international bodies and their humanitarian workers might be the main providers of healthcare to affected populations. Despite carrying out the worthy task of caring for the sick, healthcare workers and health facilities can subsequently become targets during war. This results in casualties among health workers, destruction of already limited health infrastructure and resources, as well as the inability to control or manage diseases which can spread rapidly in a conflict environment.
As a result of this, there is great concern for the safety of humanitarian health workers working in war torn areas. Simultaneous to the fear of being caught in the violence is the fear that they will be deliberately targeted. A study conducted by the International Committee of the Red Cross reported that violence against health workers in war torn areas is “one of the most crucial yet overlooked humanitarian issues of today.” The Syrian civil war is a prime example of this; the destruction of hospitals in Syria has resulted in many casualties amongst humanitarian health workers and their patients. Even when health workers and health facilities are not targeted, in this brutal conflict they are often caught in the crossfire and otherwise obstructed from functioning properly. In the effort to protect health workers, international aid organisations withdraw personnel when the situation appears too dangerous. An obvious but sad ramification is that they can no longer administer the vital care that is so badly needed. Another case study is the Democratic Republic of Congo; in 2011, it was reported that violence against medical workers led to 40,000 dying per year due to lack of access to medical care in the Democratic Republic of Congo. In the same year, it was reported that difficulties in supplying vaccinations to children in Afghanistan and Pakistan due to conflicts plaguing those countries. More recently, the continuing trouble in the DRC has similarly disrupted humanitarian aid workers and made it extremely difficult to provide the necessary health work to contain and treat Ebola in the eastern part of the country. There were fears that a full scale endemic might occur if the situation could not be controlled properly.
Disruption of healthcare in conflict zones continues to be an intractable problem. Though the safety of humanitarian workers must be an important consideration, leaving the population without sufficient access to medical during a crisis of war is unacceptable. One solution could be for intervening military forces to provide emergency healthcare to where it is too dangerous for international humanitarian organisations to do so. Extending the duty of care beyond military ranks to the local population would offer a last resort option should, as is unfortunately likely, vital healthcare services be compromised during a civil war.
Another solution might be to look to local communities to provide their own care. A recent Harvard Global Health Review suggests that organisations such as the WHO and Médecins Sans Frontières should play a more active role in educating and empowering communities to self-serve emergency healthcare. Critically, the report stipulates, the infrastructure for this must be put in place during times of peace. If successful, this strategy would go a long way in reducing some of the fatalities in violent crises where professional medical services are forced to withdraw.
It is imperative that the problem of medical care in times of war is addressed. The tragedy of war is compounded when survivors do not have the health to rebuild their societies when peace is restored. Whilst conflict claims lives directly, those who suffer because of a breakdown in healthcare infrastructure also deserve consideration. It is high time that strategies are put in place to safeguard these essential infrastructures.