The Gendered Burden of Armed Conflict on Public Health
by Polygeia (Cross-posted from here)
Healthcare systems are deliberately or inadvertently targeted by warring factions during armed conflict. This results in the displacement of individuals and groups and irreversible damage to healthcare infrastructure (1) (2) (3). Further, women and children appear to be the greatest victims (2). Despite more men dying in armed conflict, women are at higher risk of being adversely affected by its indirect consequences. The emotional and psychological trauma also persist long after the violence ends, which is why it is so important to acknowledge the indirect consequences of such conflict (4).
Armed conflict greatly affects the number of available health workers. Health workers are integral to an efficient, functioning healthcare system and for the safe delivery of healthcare (5). However, concerns around their safety and livelihood cause health professionals and personnel to migrate, hoping for a better quality of life elsewhere. This results in critical shortages in the workforce (1) and a reduction in the deliverance of acute, preventive and routine care (6). The reduced access to medical facilities negatively impacts women’s reproductive health in particular, leading to increased birth complications.
Armed conflict also poses challenges to the access and supply of health services and essential medicines (1). Warring factions actively target basic infrastructure such as electricity, communications, and water systems to cause chaos and instability. The economic damage in war zones can be devastating. Studies have shown that the lack of necessities for survival affects women the most (7). Healthcare systems quickly become overburdened with the increase in morbidity and mortality as a result of conflict, both directly and indirectly, further undermining their capacity. This also leads to a decrease in preventable services, increasing the prevalence and mortality of infectious diseases such as measles and tetanus. In the longer term, those with chronic non-communicable diseases are also at a heightened risk as they are unable to access medication or treatment for otherwise manageable conditions (8).
As well as structural and economic damage, other consequences of armed conflict are political collapse and the breakdown of social order (10). During periods of conflict, military spending usually absorbs a large proportion of the national budget (11). In some countries, military expenditure often exceeds healthcare expenditure by tenfold (12). Therefore, armed conflict not only increases the burden on the healthcare system but also reduces the level of government funding and capacity for healthcare services, resulting in gaps between the need for healthcare and revenue.
A series of resolutions and guidelines committed to protecting women in armed conflict has been proposed and adopted by the UN and other actors. However, progress and funding have been slow and inadequate (13). The indirect effects of conflict on infrastructure, political systems, and public health leave women disproportionately vulnerable. They face an increased risk in morbidity and mortality, along with long-lasting trauma, which is why it is crucial to address the consequences of armed conflict. Therefore, this research project aims to further examine and understand these effects by synthesising the literature and connected with organisations. Further, this project hopes to propose tangible policy solutions that can be used to help protect public healthcare systems in order to reduce the effects on women.
1. Debarre, “Hard to Reach: Providing Healthcare in Armed Conflict,” Int. Peace Inst., no. December, p. 5, 2018.
2. D. Southall, “Armed conflict women and girls who are pregnant, infants and children; a neglected public health challenge. What can health professionals do?,” Early Hum. Dev., vol. 87, no. 11, pp. 735–742, 2011.
3. T. Martineau et al., “Leaving no one behind: Lessons on rebuilding health systems in conflict- and crisis-affected states,” BMJ Glob. Heal., vol. 2, no. 2, pp. 1–6, 2017.
4. United Nations Commission on Armed Conflict, Armed Conflict and their Consequences (United Nations, 2001), available from ps://www.un.org/esa/socdev/rwss/docs/2001/15%20Armed%20Conflict.pdf
5. World Health Organization. Global strategy on human resources for health: workforce 2030.
6. Urdal, H. and Che, C.P., 2013. War and gender inequalities in health: the impact of armed conflict on fertility and maternal mortality. International Interactions, 39(4), pp.489-510
7. L. S. Rubenstein and M. D. Bittle, “Responsibility for protection of medical workers and facilities in armed conflict,” Lancet, vol. 375, no. 9711, pp. 329–340, 2010.
8. Emro.who.int. 2020. WHO EMRO | Beyond The Bullets And Bombs: Saving The Lives Of Chronic Disease Patients Living In Conflict Settings | News | Emergencies. [online] Available at: http://www.emro.who.int/eha/news/beyond-the-bullets-and-bombs-saving-the-lives-of-chronic-disease-patients-living-in-conflict-settings.html
9. Ashford MW. The Impact of War on Women. War and Public Health. 2008: p193-206
10. Plümper T, Neumayer E. The unequal burden of war: The effect of armed conflict on the gender gap in life expectancy. International organization. 2006 Jul;60(3):723-54.
11. Sidel VW, Levy BS. The health impact of war. International journal of injury control and safety promotion. 2008 Dec 1;15(4):189-95
12. Foege, William H. 1997. Arms and Public Health: A Global Perspective. In War and Public Health, edited by Berry S. Levy and Victor W. Sidel, 3–11. New York: Oxford University Press.
13. UN Women. 2015. Preventing conflict, transforming justice, securing the peace. A global study on the implementation of UN Security Council Resolution 1325.