Effects on health-care systems
It seems sensible to assume that humanitarian crises would have a profound effect on the current state and future of a health system, depending on the type of crisis and where it has occurred. But what does this truly mean for the affected nations?
In this step we use two case studies to explore the impacts of a natural disaster, the 2014-16 Ebola outbreak, and a man-made crisis, the Syrian conflict, on the respective regions’ health systems.
The 2014-16 Ebola outbreak
Natural disasters, and in particular biological natural disasters, such as pandemics or epidemics, can have a major effect on the healthcare systems tasked with handling them. As demonstrated by SARS, and the recent Ebola humanitarian crisis, the consequences of infectious disease outbreaks on health systems are often disproportionate, regardless of their overall fatality rates. The most recent Ebola virus outbreak caused 27,443 infected cases and 11,220 deaths, but in addition toppled the healthcare systems of the affected nations in West Africa: Guinea, Liberia, and Sierra Leone1.
Before the Ebola outbreak had even begun, Guinea, Liberia, and Sierra Leone had poorly functioning health systems which limited their capacity for response. Little national or international development had targeted critical areas, such as strengthening the health systems in these countries. All possessed a lack of human resources, poor logistics and infrastructure, poor drug supply systems, and weak health information and surveillance systems2.
During the epidemic, these under-resourced health systems were expected to cope with a massive influx of patients, providing screening, testing, and treatment for the Ebola virus, while at the same time maintaining all other health systems programming and functions. Reduced access to basic healthcare services in the region has resulted in an estimated additional 10,600 lives lost due to HIV, TB, and malaria, as well as increases in maternal mortality3.
All three countries also experienced diminished health worker capacity due to the infectiousness of the disease. Around 800 healthcare workers were infected with Ebola and over 500 of them died3. Beyond the tragedy of their deaths, their vital skills were also lost within communities and the population at large.
In Sierra Leone in particular, citizens exhibited fear and loss of trust in the health system, which resulted in widespread disengagement from it. Although there were many issues with the system, such as drug stock outs and poor communications, communities avoiding healthcare facilities and workers further exacerbated loss of life throughout the crisis4.
The ongoing Syrian conflict
More than five years of conflict in Syria has resulted in an estimated 250,000 deaths and over 11 million displaced peoples. This conflict, which began as anti-government protests in March of 2011, has escalated into a civil war between President Assad, opposing rebel forces, and the Islamic State (IS)5.
Throughout this protracted conflict rockets and missiles have targeted homes and civilian infrastructure, including hospitals, pharmaceutical factories, and healthcare facilities. In 2013 the government began its use of ‘barrel bombs’, explosives which break into thousands of pieces upon impact and result in the destruction of both buildings and civilians caught in the blast6.
Nearly 700 medical personnel have been killed since the beginning of the crisis. In Aleppo alone, more than two-thirds of hospitals have stopped functioning completely, and around 95% of doctors have been killed or fled. Without the necessary infrastructure and human resources, whole populations of Syrians are being denied access to care and treatment7.
The protracted conflict has resulted in interrupted supply chains, and rendered the health system unable to provide care for chronic or non-communicable diseases. Primary health centres (PHCs) throughout the country are lacking basic sanitation systems, including water8,9.
Furthermore, there has been an increase in the number of infectious diseases in the country due to the inability to provide effective vaccine coverage. For instance, Syria is currently witnessing the re-emergence of previously eradicated diseases such as Polio. However, due to the ongoing conflict, the full consequences and impact of these healthcare systems issues cannot yet be fully evaluated10.
We can see how different types of crisis will impact on a healthcare system. In West Africa, the Ebola crisis overwhelmed health systems and caused many avoidable deaths from other diseases that were previously being managed. In Syria, many health centres and hospitals are no longer standing due to deliberate attacks on health facilities, and entire populations now lack access to basic healthcare.
Imagine a humanitarian crisis is unfolding in your country of birth or work. How do you think the health system would respond? Would it be able to cope?
© London School of Hygiene & Tropical Medicine