• Text size Normal size text | Increase text size by 10% | Increase text size by 20% | Increase text size by 30%
  • Also available in French

Lancet article calls for changes in health care practice for conflict-afflicted

News Stories, 22 January 2010

© UNHCR/F.Courbet
A doctor examines a Somali refugee at a UNHCR-funded clinic in Ethiopia.

GENEVA, January 22 (UNHCR) – An article in The Lancet medical journal, co-authored by a UNHCR expert, says health care for people in conflict settings needs to be updated. It calls for changes in four key areas: delivery of health services; treatment of chronic diseases; development of health services in urban areas; and surveillance, measurement and monitoring.

The report authors, led by Paul Spiegel, chief of UNHCR's Public Health and HIV Section, argue that governments, UN agencies and international organizations have been slow to adapt to changes in the operating environments in which they help the conflict-affected, including refugees and internally displaced people.

While acknowledging that substantial progress has been made in responding to the health-care needs of conflict-affected populations in recent decades, they note that the provision of such care has been compromised by shrinkage of the humanitarian space – the areas in which civilians can seek shelter and aid workers provide assistance in safety.

The article in the authoritative British journal says health care in conflict settings is still based on a model developed during the 1970s and 1980s, the last decades of the Cold War, when direct armed clashes between rival states were more common and "conflict was usually synonymous with overcrowded refugee camps sheltering young populations from developing countries."

But the "old paradigms for developing countries with large, camp-based refugee populations with infectious diseases and malnutrition do not address the complexity of present and future conflicts," the report notes.

Today, "most contemporary wars are of protracted duration, intrastate, fought by irregular armed groups and fuelled by economic opportunities and ethnic rivalry. Direct armed clashes are often infrequent, but violence against civilians, including rape, is pervasive. This violence takes place against a backdrop of increasing urbanization and ageing populations," says the article.

Moreover, intrastate conflicts have swelled the number of internally displaced people, as refugee populations have gradually decreased. More than half of the refugees of concern to UNHCR live in urban areas, where providing health care is often complex.

Health system issues are becoming of great importance. They include health financing in protracted crises; barriers to access because of user fees; and the need to integrate services within the formal health system, partly to prevent inequity between beneficiaries and host populations when both have similar needs and vulnerabilities.

Meanwhile, non-infectious chronic diseases are increasingly prominent in conflict settings. This pattern will probably continue as populations age further and incomes increase. And evidence from conflicts and natural disasters shows that much excess morbidity and mortality results from the exacerbation of non-infectious diseases such as hypertension, diabetes and cancer.

These developments, and others, "are profoundly changing the demographics and disease burden of conflict-affected populations," The Lancet article says, while calling for new health-care priorities and recommendations to respond appropriately to future conflicts.

To assist with the orientation of future health strategies, policies and interventions, the report authors propose a matrix of three types of settings (camp-like, urban and rural-dispersed) and two income and life-expectancy categories (low and medium to high). Within this framework they propose changes in the four key areas mentioned above.

Spiegel and his colleagues say new strategies are needed to deliver health services to dispersed, intermittently accessible populations in low-income settings with a continuing high burden of infectious diseases and neonatal disorders; chronic diseases should be addressed more systematically in all conflict settings, irrespective of income and life expectancy; creative approaches to ensure adequate health coverage and access for conflict-affected people living in urban areas should be developed; and crucial challenges in measurement and surveillance need to be addressed. The authors include related key recommendations.

Read the full article in The Lancet.

• DONATE NOW • • GET INVOLVED • • STAY INFORMED •

 

Related Stories

more documents

Public Health

The health of refugees and other displaced people is a priority for UNHCR.

Colombia: Life in the Barrios

After more than forty years of internal armed conflict, Colombia has one of the largest populations of internally displaced persons (IDPs) in the world. Well over two million people have been forced to flee their homes; many of them have left remote rural areas to take refuge in the relative safety of the cities.

Displaced families often end up living in slum areas on the outskirts of the big cities, where they lack even the most basic services. Just outside Bogota, tens of thousands of displaced people live in the shantytowns of Altos de Cazuca and Altos de Florida, with little access to health, education or decent housing. Security is a problem too, with irregular armed groups and gangs controlling the shantytowns, often targeting young people.

UNHCR is working with the authorities in ten locations across Colombia to ensure that the rights of internally displaced people are fully respected – including the rights to basic services, health and education, as well as security.

Colombia: Life in the Barrios

Galkayo: Vulnerable in a volatile land

Galkayo, located in Somalia's Puntland region, is home to more than 60,000 displaced people who fled war-torn south-central Somalia and harsh drought conditions in many parts of the country.

The displaced people are scattered around 21 makeshift settlements in Galkayo. Multiple families often share small, rudimentary shelters made of cardboard and plastic sheets. Despite overcrowding and extreme poverty, it is not uncommon for families to take in abandoned children and elderly people who are on their own.

Squalid conditions and lack of proper health care mean that simple ailments can easily develop into complications. There is little employment in Galkayo and most displaced people find informal day labour, such as collecting garbage or washing clothes for the locals.

UNHCR provides basic assistance to Galkayo's displaced people through vocational training and income generation programs meant to improve their livelihoods. The refugee agency also provides temporary shelter and emergency relief items for vulnerable families.

Galkayo: Vulnerable in a volatile land

Crisis in the Central African Republic

Little has been reported about the humanitarian crisis in the northern part of the Central African Republic (CAR), where at least 295,000 people have been forced out of their homes since mid-2005. An estimated 197,000 are internally displaced, while 98,000 have fled to Chad, Cameroon or Sudan. They are the victims of fighting between rebel groups and government forces.

Many of the internally displaced live in the bush close to their villages. They build shelters from hay, grow vegetables and even start bush schools for their children. But access to clean water and health care remains a huge problem. Many children suffer from diarrhoea and malaria but their parents are too scared to take them to hospitals or clinics for treatment.

Cattle herders in northern CAR are menaced by the zaraguina, bandits who kidnap children for ransom. The villagers must sell off their livestock to pay.

Posted on 21 February 2008

Crisis in the Central African Republic

A Floating Clinic for RefugeesPlay video

A Floating Clinic for Refugees

Medical care is often a luxury that few refugees can afford or access. A new floating clinic launched by local authorities and UNHCR will now bring health care to refugees and locals in a remote corner of Ecuador.