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OPINION: Dealing with COVID-19 in conflict zones needs a different approach

Monday, 30 March 2020 08:00 GMT

A member of the South African National Defence Force checks documents of a resident as they patrol in an attempt to enforce a 21 day nationwide lockdown, aimed at limiting the spread of coronavirus disease (COVID-19), in Alexandra township, South Africa, March 28, 2020. REUTERS/Siphiwe Sibeko

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* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.

Pandemics can be weaponised for political gain, while healthcare access is often severely limited

The image of the Italian military transporting hundreds of coffins out of the Bergamo area speaks of the seriousness of the virus. This is in a context with functioning and effective healthcare, authorities with the ability to enforce restrictions on movement in non-discriminatory ways, and digital connectivity to convey science-based messaging about the virus. But in areas of conflict, the situation is markedly different.

Conflict zones are fraught with various forms of discrimination between people on the basis of their political, religious, economic and/or ethnic background. Such discriminations pose additional challenges to fighting Covid-19 compared to other contexts with stable functioning governments. Drawing on our work on conflict and hazard-related disaster response in conflict zones, we outline four areas that warrant close attention by humanitarians and politicians alike. 

First, conflict zones are not conducive to coordination and collaboration between different parties which is essential to fighting a pandemic. Pandemics can be weaponized for political gain. It is not unusual for there to be no fully functioning national authority for disaster management in conflict and post-conflict contexts, even in sub-Saharan African countries, despite prevalence of cyclical and annual disasters – including recent experience with biological hazards such as Ebola.

Signs of the weaponization of Covid-19 between warring parties are already visible. In Yemen and despite that there are not confirmed cases yet, the Houthis have already restricted the movement of people between areas under their control and those under the government’s. This is to consolidate their power further in Sanaa and to assert their legitimacy under the guise of fighting Covid-19. In Libya, forces affiliated with General Haftar’s forces in the eastern region have launched attacks on Tripoli, breaking what would have been a humanitarian pause to the conflict to prevent the spread of the virus.

Second, conflict zones usually have weak services and infrastructure and as a result, healthcare facilities are incapacitated. In Burkina Faso, for example, health infrastructure severely undermined by ongoing violent conflict has seen 1.5 million people have their access to healthcare cut since 2019. The country has just three healthcare facilities have capability to carry out Covid-19 testing, and international news reports already show medical staff treating patients with inadequate personal protective equipment (PPE) across west and central Africa. This puts their health at risk and the longer-term viability of providing medical care.

Experience of increased incidence or reemergence of diseases in conflict zones provides stark warning that dealing with the current pandemic exposes underlying deficiencies in basic health and social services, security and risk governance. In Syria in 2013, for example, polio remerged, and dracunculiasis remains rife in areas of violence in Chad and South Sudan despite effective measures for its eradication elsewhere.

Third, conflict zones are areas of deep inequalities which means that access to healthcare, if present, is not available to all. Underinvestment in the healthcare system in areas of violent or armed conflict, or in areas in opposition to the ruling party, often reflects the fault lines in society, with inequitable distribution of resources, particularly to those governments do not feel responsibility to protect, be they citizens, undocumented migrants, refugees or others. Migrants and refugees are particularly vulnerable. In Libya, witnesses are already reporting heightened discrimination against migrants and refugees with the fear of a pandemic looming large.

Fourth, transparency in the provision of information and data tends to be limited in conflict zones, which is essential to track and contain the spread of the virus. Data challenges have long inhibited governments and agencies from garnering a complete picture of the impacts of hazard-related events – including biological hazards such as Sars, Ebola and Covid-19, in contexts mired by violent and armed conflict. And yet evidence points to disaster risk and vulnerability being highest in fragile and conflict affected contexts.

The manifestation of Covid-19 in conflict contexts raises numerous challenges for healthcare professionals and governments alike. This includes the lack of diagnostic testing, which is needed to advance epidemiology, track the spread, inform health management, and suppress transmission. Even with more robust data on the scale of the pandemic, communication of response measures requires a high degree of local contextualization - to increase the likelihood of protocols being adhered to. This was learned the hard way in the Ebola response.

In the context of Covid-19, conflict zones usually have heightened localism and less individualism, meaning that social distancing could be harder to establish. Moreover, in contexts where individuals have historically had their freedom of movement restricted, measures such as social distancing may be interpreted with heightened social and political meaning.

Given global interconnectivity, failure to tackle the pandemic in conflict zones will ultimately undermine all our efforts to minimize the spread of the virus. Relatedly, failure to take account of the context specificities of conflict zones will undermine the viability and effectiveness of Covid-19 mitigation and response measures. Time is not on our side. Conflict and disaster responses offer valuable insight into the darker side of dealing with Covid-19 in conflict zones, and must be learned from.