What are the healthcare needs of countries emerging from conflict? How does the international community respond to these needs? A conference organised by the Canadian Public Health Association and the London School of Hygiene and Tropical Medicine brought together northern NGOs and African and Balkan health agencies to discuss healthcare problems in the aftermath of war.

War exacerbates health problems and reduces a country’s capacity to provide healthcare. Although international agencies attempt to fill this gap, their efforts are often poorly co-ordinated or insensitive to local contexts. A new over-arching policy framework must be developed, involving key stakeholders and addressing local concerns.

Health problems are often much worse in a post-conflict society. During and in the aftermath of war, children may die from malnutrition, infectious diseases and diarrhoea. Adults have an increased risk of HIV, sexually transmitted infections and other communicable diseases. Psychological distress and violence, particularly against women, may be widespread. Mortality rates are high.

Despite this great need, it is very difficult to plan and introduce health policies immediately after a war. This period is fraught with uncertainty and chaos as rival groups and politicians compete for power and influence in the new society. There is a decision-making vacuum in the absence of political control.

Health systems face many strains in the aftermath of war. In Bosnia-Herzegovina, one million unexploded landmines present an ongoing risk to the population. Impassable roads and the reluctance of health workers to leave the main towns hampered the rebuilding of rural clinics destroyed during the war in Mozambique. Shortages of health professionals are also common: in Rwanda many health workers fled and became refugees or were killed. Of 250 doctors in the country, only 60 remained following the 1994 genocide. Many people in Sierra Leone migrated to ‘more secure’ towns, putting a huge burden on local health services.

The conference participants highlighted several problems with the approach of international organisations:

• Relief agencies take over the work of poorly-operating health systems after a war. However they often do not prepare local health organisations to continue the work when foreign assistance is withdrawn.
• There may be poor co-ordination between different relief agencies.
• Outside organisations often impose solutions with little input from local health professionals and civilians.
• The international community expects a speedy return to normality without understanding the enormous damage that conflict causes to the social fabric of a country.

The conference concluded that health agencies working in post-conflict situations should:

• consider how the health sector can contribute to promoting a more stable and peaceful new society
• rebuild trust by bringing together different groups to develop a fairer health system
• avoid tensions by treating ethnic groups equally
• recognise the importance of local participation in making any project successful
• ensure that projects address specific local concerns
• focus on personnel and training to fill the shortage of trained staff at all levels
• assist governments in the formulation of their own recovery plans.

There is a need to gather together and document experiences, good practice and effective strategies for managing transition periods. This agenda is being actively addressed.

Source(s):
'Symposium on post-conflict health and health systems: issues and challenges' Ottawa, Canada (2000)

Funded by: UnknownCanadian International Development Agency; IDRC

id21 Research Highlight: 30 July 2001

Further Information:
Anthony Zwi
Health Policy Unit
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0)20 7927 2663
Fax: +44 (0)20 7637 5391
Contact the contributor: anthony.zwi@hotmail.com

London School of Hygiene and Tropical Medicine, UK

Other related links:
The World Bank Post-Conflict Reconstruction Unit website carries a variety of online resources.

See the WHO's World Report on Violence and Health.

The WHO Emergency and Humanitarian Action site has country-specific information.