Health care systems and conflict: a fragile state of affairs

Health care systems and conflict: a fragile state of affairs

Challenges to adequate and equitable provision of quality health care in fragile states

This paper argues that while health care systems are necessary in all countries, the importance of strong health care systems to fragile nations, and the damage done to these systems during conflict, receive less attention than they should.

The authors note that there are various definitions of what constitutes a fragile country or society, but most agree that a fragile state is one in which the government is unable or unwilling to deliver basic security and public services to the majority of its people, especially to the poor. These countries, the authors argue, are frequently torn by armed conflict and plagued by high rates of poverty, creating a vicious cycle from which it is difficult to emerge.

Key issues raised in this paper are:

  • globally, there are about 30 fragile and conflict-affected states, although this may change in light of recent events such as the secession of Southern Sudan and the ongoing volatile situations in North Africa and the Middle East.
  • the impact of this cycle of violence and poverty on health and health care is enormous, to the extent that no low-income fragile or conflict-affected country has yet achieved a single Millennium Development Goal.
  • people living in fragile states are more than twice as likely as those in stable developing countries to be undernourished and to lack clean water.
  • the mortality rate for children under the age of five is twice as high.
  • although the international community spends billions of dollars each year in aid to these nations, gains have generally been small. Important to note is the fact that without infrastructure and stability, much of this aid is wasted.

Also, the authors report on the development and performance of Afghanistan's health care services between 2004 and 2008, demonstrating dramatic improvements in many areas, especially in health service capacity and delivery of care. In spite of these impressive gains, the authors argue that the future of health care in Afghanistan, and indeed the likelihood of Afghanistan emerging from its fragile status, is far from certain.

In conclusion, the authors argue that adequate and equitable provision of quality health care is a fundamental need in fragile states. They conclude that this need will be met only if health systems and structures are preserved and developed, and if health care personnel have the freedom and safety to provide necessary care to those who need it.

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