Healthcare in Conflict

About

As spaces – both in the literal and the figurative sense – of exception, conflict zones tend to create vulnerable settings, particularly for healthcare and medicine. Conflict in the 21st century increasingly focuses on the purposeful destruction and destabilisation of civil society, making non-combatants a main target. It is characterised by disregard for the rules of war, international humanitarian law and human rights. Thus, conflicts have a tremendous impact on healthcare provision and access to healthcare. Medical issues in conflict zones range from non-communicable diseases, communicable diseases, traumatic injuries, mental health issues to issues related to maternal, women’s, and child health. The specific dynamics of each of the issues and the countless conditions they cover can be vastly different. However, the effect that humanitarian emergencies have on these medical issues is similar and the main mechanisms through which humanitarian emergencies have these detrimental effects are the same. One of the key problems that humanitarian emergencies pose is the destruction of health infrastructure, coupled with a lack of health care workers (HCWs) and the potential for increased physical danger to HCWs, as well as limited access to essential medicines. Some issues are further exacerbated. Humanitarian emergencies can directly cause both physical and mental injury, such as blast injuries, injuries linked to debris or inadequate shelter, gunshot wounds and post-traumatic stress disorder. Additionally, humanitarian emergencies can trigger risk factors and risk factor cascades that significantly increase the risk of communicable disease outbreaks.

To give a glimpse of the vast implications of conflict and crises resulting from conflict on health and healthcare it is worth revisiting the Rwanda crisis of 1994, which remains one of the most pivotal humanitarian crises of the last 50 years. Not only was the underlying conflict of a devastating nature but the initial response and lack of coordination also led to additional preventable deaths and in turn to an overhaul of the humanitarian system. Refugees fleeing from violence in Rwanda towards Zaire – now the Democratic Republic of the Congo  – experienced extreme rates of mortality during the summer and autumn of 1994. In early July, a cholera outbreak swept through the refugee population and before the end of this outbreak a shigella dysentery outbreak compounded the situation. Estimates of mortality vary widely, but it is estimated that at the height of the crisis, between 58,000 and 80,000 persons died within the span of one month in a situation of uncoordinated humanitarian response and extremely limited healthcare access.

Why an interdisciplinary network?

The result of the 1994 Rwanda (reponse) crisis have been the development of the Sphere standards and humanitarian charter, and United Nations Cluster response system, all of which acknowledge the interdisciplinary, multi-sectoral nature of response. Similarly, threads towards healthcare in conflict are varied and response, prevention and preparedness in the context of healthcare in conflict cannot be limited to traditional epidemiological and medical concepts but have to be seen as more holistic and transdisciplinary activities that promote conditions that are less advantageous to health risks. They have to draw on disciplines as varied as medicine, epidemiology, sociology, international relations, law and others while also involving practitioners and stakeholders from all of these disciplines, civil society, military, media, healthcare and other stakeholders. Equally, the study of healthcare in conflict has to be and is interdisciplinary in nature. While this can be seen as a strength and even a necessity, this interdisciplinarity also comes with risks, especially in a setting such as Cambridge. An interdisciplinary network, open to all faculties and departments, allows us to break down barriers and explore the wide landscape of individuals and groups working on issues related to healthcare in conflict across and beyond the Cambridge ecosystem, building synergies and learning from each other to ultimately deliver both better and more integrated research as well as response.

Supported by CRASSH