Health in Conflict and the Fragile States

For the longest time now, the perennial conflict and civil strives have led to the deterioration of standard ways of living among the affected societies, and the effects have trickled down to their neighbors. A conflict makes the country lose both tangible and intangible resources making it, to some extent, ungovernable, and the consequences are long-term. The most affected areas are in the Middle East with notable examples of Afghanistan and Africa where countries like South Sudan and Somalia come to mind. In spite of the international community and more so the non-state providers (NSPs) being willing to help, the economic and political context complicate the operations. Health is a critical aspect of everyone’s life and in times of conflict the affected populations are denied their right to medical access amidst the outbreak of diseases and injuries. Commins states that "In the health sector, poor clinical outcomes are common among fragile states, with higher morbidity and mortality rates, compared to other low-income, stable states” (594). It is evident that there is the need to look into the health situation in conflict and fragile states. This essay seeks to establish the extent of the healthcare problems during and after conflicts, the most affected members, causes of this situation and its repercussions as well as possible solutions that would curb its effects.

During and Post-Conflict Situation

According to Commins, the situation in the fragile states can be described as being desperate (596). They represent nearly 15 percent of total world population exhibiting the poor health indicators. For instance, near maternal death stands at 30 percent, about half of children in these countries die before their fifth birthday, and almost a third of the world’s HIV and AIDS infections are recorded in these fragile states. It has also been highlighted by High-Level Forum that it would not be possible for these countries to realize the Millennium Development Goals and, therefore, a great need to address these issues is obvious. The necessary assistance should be accorded to these states since they experience deficit in governance during and even after the conflict situation. During battles, most of the daily activities aimed at the development come to a standstill due to continued destruction of infrastructures meant to enhance the delivery of services. In this situation, as it is alluded by Commins, "There is inadequate inability or willingness to put preconditions targeting long-term development” (595). The society focuses on the short term basic needs since the prevailing conditions do not attract long-term investment. It is out of these vulnerable deteriorating circumstances that the locals find it difficult to cope with the declining resources at their disposal.

When it comes to conflicts, everyone in the community is affected with children and the elderly being affected the most. Children are vulnerable due to their innocence and dependence on their mothers while the old face challenges when it comes to morbidity. They are unable to get out of the harm’s way and, at the same time, they find it hard to access the medical support. The reason is that, in most cases, most of the humanitarian medics are based at the refugee camps, and only those who are in a position to get into these camps are in a better position to survive. According to Salama et al., “As from the 1990s onwards, mortality rates decreased in camps as it increased in non-camp situations” (1803). For example, Salama et al. point out that in 1998 in Southern Sudan, the highest mortality rate occurred among the population out of the refugee camps. It was above the entire emergency threshold in the range of between 20-30 folds. Additionally, it was of the magnitude order in Goma, Zaire in 1994 during the Shigella dysentery and cholera outbreak that contributed to the highest mortality rate recorded (Salama et al. 1803). Most of these fatalities were as a result of poor health exuberated by poor hygiene and sanitation.

Causes and Effects of Strained Health Delivery in Conflict Situations

Conflicts mostly cripple the necessary lifelines regarding infrastructures, finances, and human resources. Due to conflicts, the country's structure is disrupted such that even the non-state donors find it difficult to provide the much-needed assistance. For example, the prolonged civil war in Afghanistan that involved the various militias and the government with the aid of the Soviet led to the devastation of the health system. Commins points out that the war led to a lack of health delivery and managerial capacity within the health department, inadequate health personnel and infrastructures as well as reduced human and financial resources distribution, and all this caused the uncoordinated operations among the non-states providers that had come to intervene in alleviating the health situation (597).

As stated by Commins “While NSP's boast of providing most of the ground work, the task of contracting out responsibilities and monitoring outcomes are key roles of the state, which is mandated to ensure equity or responsible service delivery" (599). The government has a responsibility of providing service delivery to its citizens, and thus it has to come up with ways of ensuring support to the non-state providers by making the department of health and contracting human resource complement their work to help those in the dire need of the medical assistance. If this is not done, the situation will continue deteriorating and hence leading to high mortality rate, low immunization coverage that may result in the massive death of children and little coverage of productive health services.

Possible Solution

Some government legislations are discriminative in nature and seek to lock some members of the society out of medical access. Even with such bottleneck laws, there is a need for all the health practitioners to stick to their work ethics of saving lives and avoid prejudice based on such legislations that result in the denial of the health services to particular groups of the community. In the handling of the early cases of HIV and AIDs in Pakistan in 2000s, for example, according to Zaidi et al., “Risk groups in most cases operated underground, as health providers denied them care while police officers harassed them frequently” (574). If health workers adhere to their work ethics and offer health services to anyone in need of it, the health situation will be alleviated in the conflict situations and more lives will be saved. Though, to some extent, this solution may be hard to fulfill and hence not work if the health workers’ lives are threatened when they are found to have defied government orders.

The government ought to contract experienced non-governmental organizations (NGOs) in a situation that results in massive loss of necessary medical infrastructures and human personnel. In this case, the service delivery will be availed to help in the prevention of further loss of lives. In doing so, it should only involve those groups that will be willing to offer services while promoting capacity in the community building so that the society can be able to achieve a level of resilient that is good enough to enable it to cope after NSPs are long gone. This process to be successful requires a critical scrutiny of the most experienced NGOs. While explaining the situation that occurred in Pakistan, Zaidi et al. state that “Enforcing contracts were mostly marred by service and quality agreement issues in which just a few NGOs that had gradually gained experience via prior projects showing superiority here” (579). This idea means that only those skilled groups are more likely to offer better services and thus greater care in selection criteria.

According to Commins , "The government should lay out guidelines that help in the in cooperation of NSPs in the already existing partnership between the administration and the donors" (600). It will be easier for the government to offer oversight role and help NSPs to align their support to the already existing programs. It will also provide an excellent platform in which NSPs will share crucial information with the government on the progress of the health situation so that the latter can engage its other department in case the health status escalates. On the contrary, some activities may hinder efforts made towards solving these problems, and one of them is the failure to involve the governments, when the donor groups and NSPs bypass the government and implement their initiatives, the government can frustrate the operation and thus rendering it no beneficial. It is also risky to fail to work in close collaboration with the locals who are well-acquainted with chronic illnesses, demographic distribution as well as the possible diseases suffered by the locals. In this case, both the donors and NSPs get crucial information about the people they intend to help hence making the project a success.

Possible Opposition to the Solutions

Despite the fact that the incorporation of NSPs in an already existing partnership between government and donor can work towards promoting better health in fragile states, Commins points out that “Political issues can pose a significant opposition and thus undermine the cooperation between the government and NSPs" (599). This idea will mean that the solution may not achieve its objective unless the political turmoil is cooled and, therefore, the government needs first to coerce the political class on the need to work together to make a healthy society.

According to Salama et al., “Access to nutritional services and health care can be affected by the vast insecure area which restricts coverage as well as the effectiveness of the health practitioners" (1803). There is a need to ensure the cooperation of the government as well as winning the goodwill of the combatants from both sides to allow the humanitarian medics to offer health services. The affected population should also be encouraged to seek refuge in refugee camps or areas around the refugee camps for convenient access to health facilities.

Conclusion

Conclusively, it is evident that conflict situation deteriorates health in the society as a result of the destruction of the necessary infrastructures thanks to which the government is incapacitated to offer adequate health care to the citizens. It has been noted that the refugee camps prove to be a safer place for the affected population and thus, in case of conflict situations, affected groups should be encouraged to seek refuge in these areas. Afghanistan and Southern Sudan have provided an example of how health can be affected in the fragile states as a result of prolonged conflicts. The role of NSPs has been elaborated with the political issues being put forth as the central premise as to why these groups may fail to alleviate the health situation within a fragile state. Achieving health stability in the fragile states has proven to be an enormous task, but if done right and with a high level of cooperation among the relevant stakeholders, it is possible. Finally, the essay sought to establish the extent of the health problems in conflicts, the most affected members, causes of this situation and its repercussions as well as possible solutions that would curb its effects.