Neglected health systems research: Health policy and systems research in conflict-affected fragile states

As a result of their extremely poor health indicators, fragile states have recently become prominent on the international health agenda. These countries are furthest from reaching the MDGs, and continue to lag far behind other comparable countries. Whilst they are home to only 20% (or 1 billion) of the world’s population, they contain a third of the world’s poor, a third of the world’s maternal deaths and a third of those living with HIV/AIDS (World Bank, 2007). They have very high rates of under-5 mortality, and very low levels of government health expenditure compared to other low-income countries. This briefing note focuses on the four-fifths of fragile states which have been or are still engaged in conflict, all of which have disrupted health systems.