Beyond bullets and bombs, damage to health care is a silent killer

by Yves Daccord, ICRC | https://twitter.com/ydaccordicrc | International Committee of the Red Cross (ICRC) - Switzerland
Friday, 4 March 2016 10:28 GMT

A girl looks on as a health officer injects her with measles vaccine at a school in Yemen's central province of Marib, Jan. 12, 2016. REUTERS/Ali Owidha

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The scale of preventable deaths in fragile environments of conflict, displacement and disaster is unprecedented

Roselyn was a Liberian midwife who throughout her 30-year career helped not only thousands of pregnant women in her hometown of Monrovia, but also – during the darkest days of the country’s devastating civil war in the 1990s – countless numbers of sick and wounded people too. 

When the decimating Ebola virus struck Liberia and some of its West African neighbours in spring 2014, Roselyn – like many other health workers – once again put herself at great personal risk to do what she could to help.

But with meagre healthcare resources in an already fragile system stretched to breaking point and beyond, Roselyn’s own worsening health, related to hypertension, went untreated. She died in September 2014, a terrible loss to her family and to the many people she had helped.

Roselyn’s story is just one among the countless individual tragedies behind the plethora of numbing statistics on preventable deaths in humanitarian settings. Of the 9.4 million people estimated to die of hypertension globally each year, 46 percent are on the African continent – attributed at least partly to the effects of conflict and displacement.

Other recent studies show that more than half of preventable maternal deaths and deaths in children under five occur in fragile settings of conflict, displacement and natural disasters. Worldwide, women and children are up to 14 times more likely than men to die in a disaster.

In countries suffering armed conflict or violence - from Afghanistan, to Syria, Yemen and many more - the crippling longer-term effects of direct, recurrent attacks on healthcare staff and facilities further exacerbate the challenge of ensuring people’s access to emergency and basic healthcare.

While the ICRC documented almost 2,400 attacks against health care (personnel, facilities, transport and patients), by a range of perpetrators, in 11 countries in three years up to December 2014, the wider impact of such attacks is much harder to measure.

Yet to give just one example, following the destruction of one of its hospitals in Yemen’s Saada province in October 2015, MSF reported that at least 200,000 people were left without access to vital medical care. Close to 100 similar incidents against healthcare facilities were reported in Yemen alone between March and November 2015.

Moreover, the generally protracted nature of armed conflict and armed violence - increasingly concentrated in urban areas - is causing a system-wide breakdown of infrastructure and public services, reversing development gains previously made and highlighting the often artificial humanitarian/development divide.

With a cumulative output loss due to non-communicable diseases predicted at $47 trillion over two decades up to 2030, it is no surprise that health features so prominently in the new Sustainable Development Goals.

Put together, these figures and the innumerable heart-rending stories behind them point to a series of health challenges in fragile environments on a staggering scale. Addressing these challenges requires innovative thinking, bold new approaches, and a major concerted effort across sectors.

BRINGING IN BUSINESS

For a humanitarian organisation like the ICRC, this means better collaborating and co-creating innovative solutions with increasingly diverse stakeholders – not least the corporate sector.

While partnerships with the private sector are nothing new, we urgently need to better harness its wealth of innovative ideas, expertise and resources. This will help us to better anticipate future trends, and to find practical solutions to better communicate with and empower the people we are trying to help, to ensure proximity to them and to respond as effectively as possible to their diverse needs.

Corporate partners benefit too: beyond simply demonstrating sound ethical practice and corporate social responsibility, cross-sector engagement in fragile environments offers vast new opportunities in the search for cutting-edge solutions, boosting reputation and competitiveness. Striving to find collaborative solutions to improve the lives of the world’s most needy people – in some of the most challenging humanitarian environments – effectively benefits all sides.

This week, more than 250 leaders from the business, humanitarian, health and academic sectors are gathering in Lausanne, Switzerland, to explore new collaborative solutions – and develop existing ideas – for some of the most pressing issues in the field of health in fragile environments.

Non-communicable diseases, maternal and child healthcare, epidemics and emergency response, and violence against healthcare will be central to the discussions. So too will be the use of mobile technologies in improving access to healthcare in remote and conflict-affected locations, and innovative finance mechanisms for sustainable healthcare delivery.

The aim is to not only come up with great ideas, but to be able to turn them into effective, sustainable and affordable solutions that will reduce preventable deaths in fragile environments – moreover on the scale required. This is a tall order, but not an impossible one.

The necessary elements all exist – the skills, knowledge, research, technology and even the resources. The real challenge is to find the best ways to bring them all together – and to maintain the momentum and energy to push them forward.

Given the enormity and complexity of the healthcare needs of the countless men, women and children living in situations of conflict, violence or instability, the urgency of meeting this challenge is absolutely vital.

Yves Daccord is director general of the International Committee of the Red Cross (ICRC).

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Beyond bullets and bombs, damage to health care is a silent killer

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