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Conflict and healthcare: a complex challenge

Martina explains why the links between healthcare and conflict are complex and inseparable.
Last week, we explored SDG 16, with its focus on peace. You considered how violence is a threat to development and how peace is a weapon to be used in achieving sustainable development. This week, we start by linking SDG 16– peace– with SDG 3, which focuses on health. Peace is a very important determinant of health. Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially for abusing the bodies of man or woman, bond or free.
And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets. This is the Hippocratic Oath. For centuries, those in need of health care and those who deliver it have based their mutual trust on this oath. The privilege of medicine is to care for those who are sick, regardless of politics or creed, and the certainty of the patient is that their doctor will not break their confidence, even in times of conflict. But what happens when the forces of war rend that oath apart?
In 2010 in Bahrain, it was the beginning of the Arab Spring, a revolutionary wave of both violent and nonviolent demonstrations in North Africa and the Middle East, protests that were met with a harsh response. In Bahrain, 20 medics who treated activists wounded in the protests near Suleymaniye Hospital were jailed for five-to-15 years each. The accused, mainly doctors and those they treated, were charged with committing crimes against the state and inciting hatred of the regime, with stealing medicines and with occupying a hospital during an uprising that they insist was peaceful and while doing a job they believed was nonpolitical. The sentences were immediately denounced by medical bodies and human rights groups around the world.
Let us consider what happens when health care becomes a weapon of war, and also how health care can become part of rebuilding the peace. So what does health and health care look like in the context of conflict? The realities of delivering and receiving health care during armed conflict are experienced every day by medics and patients in areas such as Syria, Afghanistan, and Sudan. Where conflict exists, it brings with it multiple emerging problems for the health care system. Governments are often absent or dysfunctional, and may not have the capacity to deliver maternal and reproductive services, vaccination, or child health programmes. Surgical expertise may be overwhelmed, and access to medicines limited and dangerous.
Preventing access to health care can itself become a weapon of war. Examples include delaying access to lifesaving equipment, the deliberate targeting of hospitals and clinics, holding ambulances and supplies at checkpoints, and refusing safe passage to the wounded. Multiple external organisations such as Medecins Sans Frontieres or the International Committee of the Red Cross, as well as state and non-state armed combatants, may be on the ground attempting to deliver services and defend populations. But how can they remain nonpartisan? And how do we begin to understand and separate their motives and objectives when they are working in both the humanitarian and the political context?
According to Safeguarding Health, a group of international non-governmental organisations, health care services and health care workers who provide them are never more desperately needed than when violence convulses a society, but this is also when they are most vulnerable. As we can see from recent conflict situations, however, health care workers continue to be in grave danger, and in fact, they are increasingly targeted. A study by The Lancet documents the weaponisation of health care and shows the multiple impacts of conflict on the health care system. This study reveals that more than 814 medical workers have been killed in Syria since 2011, and that there were more than 200 attacks on health care facilities in 2016 alone.
In 2009, there were nearly 30,000 doctors working in Syria, but over the last six years, about half of them have left the country, and left behind them a major hole in the delivery of health care services. The weaponisation of health care is a concern at this time, when passions of conflict are also changing. The Armed Conflict Location and Event Data Project, or ACLED, initiated by a former researcher at Trinity College Dublin, Dr. Cliona Raleigh, gathers detailed political violence and protest data for developing states with a focus on Africa and Southeast Asia. These data show that while civil wars have decreased, political violence rates have remained high.
As conflict evolves, health care systems will try to respond, and databases like ACLED can help humanitarian organisations to plan their services at a local level, using as much and as detailed information as possible to try and keep their personnel and local population safe. The links between peace and health are complex, but they are inseparable. Health and well-being cannot be achieved without peace, and peace is meaningless if we cannot heal the physical and mental scars of our communities. Health workers deserve protection to do their work in conflict zones, even when health care itself is in danger.
The rebuilding of health systems after conflict is an important marker of peace building, and innovative health care solutions can be brought to bear to strengthen the resilience of the human spirit, even in the aftermath of the most unimaginable trauma. This week, we focus on the health SDG 3. We will explore different contexts for health regardless of the context, from conflict zone to rural community, or from an urban developed setting. Our experiences of health and well-being are a fundamental part of our lived human experience. We will examine what it means to achieve SDG 3– good health and well-being. We will focus in on several key aspects of ensuring healthy futures.
Firstly, we will look at the importance of food security and nutrition to health; then we will look at child and maternal health; and lastly, we will consider emerging trends and the future of health care. Health is something we all have a vested interest in. So how can we ensure the best possible health for all? Let’s start to find out.

Last week we looked at the challenges to achieving peace, and as Martina has explored in the video, the links between healthcare and conflict are complex and inseparable.

This week, we will focus in on several key aspects of ensuring health and well-being, and we will look at the challenges that we face to reach SDG 3. We will first look at the overlap between SDG 2: Zero Hunger, and SDG 3: Good Health and Well-being, and the importance of food security and nutrition to health.

Next we will take a look at child and maternal health, and then we will consider emerging trends and challenges in health and the future of healthcare. Following on we will consider the interactions between the environment and health, which will lead us into next week’s focus on SDG 6: Clean Water and Sanitation.

Consider some of the comments that Martina makes in her video:

  • Health and well-being cannot be achieved without peace.
  • Peace is meaningless if we cannot heal the physical and mental health of our communities.
  • Health workers deserve protection to do their work in conflict zones, even when healthcare itself is in danger.
  • The rebuilding of health systems after conflict is an important marker of peacebuilding.

  • Do you agree with these comments? Why/Why not?
  • Can you think of any other examples of when healthcare and conflict are intertwined?
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