Armed conflict affects the health needs of at least 630 million women and children

Armed conflicts are becoming more complex and protracted, threatening humanitarian access and the provision of essential health services, with at least 630 million women and children (more than 8% of the world’s population) in 2017. ) Is affected.

Today, according to a new series of four papers revealing the widespread impact of modern warfare on women’s and children’s health. Lancet..

The authors highlight the failure of the global community to prioritize women’s and child health in conflict areas, consensus on frameworks for identifying high-priority interventions, and address political and security challenges. Call for international efforts from humanitarian and donors. Reach out to the most vulnerable women and children with the best possible care.

A series of academic collaborators and partners from the BRANCH (Translational Research and Action in Conflict Environments for Women and Children’s Health) Consortium, with new modeling and insights from various local research partners and humanitarian institutions. Integrate existing evidence. And civil society organizations.

“New estimates are the enormous indirectness of modern warfare caused by easily preventable infections, malnutrition, sexual violence, poor mental health, and the destruction of basic services such as water and medical facilities. It provides compelling evidence of the sacrifice. ”Zulfikar of the Global Child Health Center, a hospital for sick children in Toronto, Canada, and the Global Heath and Development Institute at Aga Khan University, which led the series. Professor Butta says.

He continues. “Today, more than half of the world’s women and children live in countries experiencing active conflicts. The international community cannot continue to ignore their plight. Faced with anxiety, access challenges. It is time to fundamentally rethink our global response to doing so, logistics to provide high-priority interventions for women and children in political, coordinating, and politically unstable and volatile environments. “

The series of treatises are changing the nature of war and conflict, their short-term and long-term health effects on women and children, strategies to identify best responses, and interventions supported by national assessment and research. Is exploring.

Increasing threat of armed conflict to the health of women and children

New estimates suggest that women and children affected by armed conflict around the world as a result of population growth, increased conflict, increased explosive and chemical weapons use in urban areas, increased refugees, and increased refugees. The number has been steadily increasing since 2000. Internally displaced persons.

In 2017, one in ten women (10%) and nearly one in six children (16%) worldwide were either forced to evacuate due to conflict or near conflict zones (ie). I lived dangerously (within 50 km). About one-third of the affected people live in Pakistan, Nigeria, and India.

Evidence shows that the risk of dying from nonviolence increases significantly as we approach more intense and chronic conflicts, with women of childbearing age in Africa dying three times more than women in peaceful areas. Live near the most likely battles. The risk of infant mortality is more than 25% higher.

Six to seven million babies and more than 10 million children under the age of five, born within 50 kilometers of armed conflict, died as an indirect result of fighting in Africa, Asia and the Americas. It is estimated. 1995 and 2015.

It is clear that the indirect effects of armed conflict on women and children are far greater than the effects of actual combat. But the reality may be worse. Unstable and inadequate resources often result in data shortages and poor quality. Much more to enhance data collection and collaboration between humanitarian agencies and local governments to generate better, more easily available and actionable information to improve response to humanitarian crises. It requires a big investment.s. “

Dr. Hara Gatas, Series Co-author Director, Center for Population and Health Research, American University of Beirut

New humanitarian strategies are needed to change the nature of armed conflict

In 2019, 54 state-based armed conflicts were underway in 35 countries, averaging more than 20 years. [3].. Armed conflict, once primarily confined to war nations, is accompanied by clashes between nations and rebel groups that dominate increasingly large geographic areas, lack of respect for international humanitarian law, explosiveness in cities and chemical weapons. Systematic use of, violence against a wide range of sexual women and girls, and hybrid warfare (such as cyber attacks and manipulation of social media).

How the war is fought and who is fighting poses new challenges in humanitarian access, provision of health services, and protection from attacks on humanitarian workers and medical facilities. Responses are further complicated by climate change and new health threats such as the COVID-19 pandemic. At the same time, new medical devices such as modern trauma treatment offer opportunities to improve health delivery.

Dr. Micheleverly, co-author of the series, Senior Associate Dean of Global Health, Stanford University School of Medicine and Director of the Center for Global Health Innovation, said: “Given the changing nature of armed conflict, this series is a humanitarian response that includes empowerment of local communities and leaders that are ideal for providing services that rely on life-saving services, community capabilities, awareness and trust.”

Lessons learned from 10 conflict-affected countries

The series also includes proven health interventions for women and children in 10 countries affected by conflict and conflicts at various stages of geographical, political and economic conditions (eg, acute, long-term and post-conflict). Evaluated offerings-Afghanistan, Colombia, Democratic Republic of the Congo, Mali, Nigeria, Pakistan, Somalia, South Sudan, Syria, Yemen.

Various interventions, including prenatal care, emergency obstetric care, childhood vaccination, and feeding of infants and toddlers, are generally prioritized, but evidence shows most sexual, reproductive, neonatal, and adolescents. Health services are limited, suggesting the provision of many life-saving services, including.

The authors write that humanitarian agencies and national authorities are responsible for deliveries, from shortages of limited funding and skilled health workers (such as midwives and nurses in Pakistan and Syria) to anxiety (eg health attacks and abductions). We recognize that we are facing various barriers. Colombian and Somali workers), and distrust due to the politicization of aid.

But these challenges also add to the extraordinary creativity in humanitarian response. Innovative approaches include: Sharing tasks and hiring other types of community health workers (eg traditional healers and midwives). Use new delivery modes such as remote management (that is, subcontracting to local organizations) and technologies like WhatsApp. Establish reserves for emergencies.

For example, in Afghanistan, mobile clinics are used to provide medical services to remote areas, and in South Sudan, donors stockpile medicines to respond quickly to future outbreaks of illness (such as cholera). Made emergency funds available for you. In Pakistan, senior health care workers in the middle of the Keich district visit remote areas for a week each month to address labor shortages.

Professor Isabel Garcés-Palacio of the University of Antioquia, Colombia, said: “These solutions require more rigorous assessment, but can timely address current implementation challenges and remind health authorities of their responsibility to provide basic healthcare services. Overall population. . “

However, humanitarian systems also have a wide range of issues that need to be addressed. “Predefined packages of priority medical services for women and children are generally not agreed. Instead, international donors influence what, where and how interventions provide. Will continue to be a major driver of giving, “explains Dr. Jidas ​​of the University of Agakhan, Pakistan. “While there are technical and operational guidance to promote the health of women and children in humanitarian crises, they are not specific to the conflict environment and face a variety of emergencies, including natural disasters and epidemics. It was developed as a wide range of support. “

How to move forward

As a first step in bridging the guidance gap, the author guides humanitarian health professionals, including global and local institutions and NGOs, and academia working in conflict environments to prioritize intervention choices and accountability. Call for the establishment of a decision-making framework for improvement.

“While the needs of conflict-affected communities are great, their voices are often unheard of or overlooked, so when making decisions about them, they sit at the table and are humanitarian supporters. It is imperative that they listen to them, “said Associate Professor Nehasin, co-author of the series and co-director of the Humanitarian Crisis Center at the London School of Hygiene and Tropical Medicine in the United Kingdom. “It is imperative that the world make more coordinated efforts to reduce the risk of conflict, but until that happens, improve the provision of health and nutrition services to conflict-affected women, children and adolescents. Remains ethical and moral responsibility. “

In a linked comment, Helen Clark, chair of the Maternal and Child Health Partnership (PMNCH) and former New Zealand Prime Minister (who was not involved in the series of treatises), wrote: Children and adolescents must be at the center of all humanitarian, development and peacebuilding efforts, in line with the concept of conservation centrality.

Doing this is not the responsibility of any particular sector or stakeholder group, and all stakeholders have greater coordination, investment, and politics for women, children, and adolescents trapped in conflict zones. You must agree to and request caution. Only then can the unequal burden of preventable morbidity and mortality in the most difficult regions of the world be addressed in a way that leaves no one behind. “