Kamala Sarup: Conflict Is Direct Threat To Health

Investing in the health sector makes good sense for conflict prevention as well as for socio-economic development. Conflict is a direct threat to life. For thausends of people in Asia, surviving war is the predominant objective in their daily existence.

The region has the highest maternal and infant mortality rates. The health infrastructure does not exist any more in many areas. It is destroyed, which is why the country is in this critical health situation. Even people are dying in large numbers from mainly five causes: malaria, acute respiratory infections, intestinal parasites, anaemia and acute diarrhoea.

Many of the factors that contribute to a rapid rise in infection rates currently exist in Asia - a highly mobile population, deep poverty, armed forces, inadequate health services for treating other sexually transmitted infections, and social stigma related to discussing or coming out publicly with HIV/AIDS.

"Declining nutrition in children, an increasing rate of tuberculosis, and a high prevalence of other infectious diseases among women and children. It is known that forced migration completely disrupts normal delivery patterns of health services, including immunizations.

"What is definitely known is that violent conflict and war affect human health both directly - through the violence of bombs and bullets - and indirectly, by disrupting economic and social systems that address health needs. Recent research shows that increases in diseases such as malaria, tuberculosis, AIDS and bubonic plague among others are associated with conflicts. There is a need for better understanding of the full impact of war on health and the environment". Sonal Singh said.

Directly, war kills and wounds people and that is unhealthy for them. Indirectly, war redirects money from health pursuits to war pursuits, so the health of people suffers. However, people who make more money by working in war-related industries make more money, so their health increases.

On balance, considering the value of one person to be the same as any other person, the war impairs the overall health of the population; that is, more people suffer than benefit. Of course, when future benefits are considered, such as security for later generations, then it can be argued that the health losses today are more than offset by the security benefits later, so war still can be justified.

"While the international medical community is slowly waking up and beginning to understand the complex relationships between conflicts and health ,initiatives such as " Peace Through Health" (launched by the Physicians for Global Health Canada and supported by Lancet-McMaster peace conference) advocate for greater role for health professionals in promoting "health as a bridge to peace ". This practice is still to catch on in Nepal ". he further argued.

The rural areas in Asia have been badly affected by the internal war so they are suffering from livelihood insecurity which manifests itself through a lack of food, shelter, employment and access to basic services. In most rural areas in Asia, there is hardly any government personnel. So, the government will require assistance, both financial and technical. Both government and donors need to recognize that civil society particularly international and national NGOs has much to contribute. The strengthening of national civil society will contribute in the long term to ensuring greater accountability and transparency.

Besides, remote areas have still no access to roads and health facilities. Japanese Encephalitis in the regions, is a serious threat. More so, because of lack of medicines and timely treatment. In many key health indicators, such as mortality rates and disease prevention and eradication, Asia ranks among the worst countries in the world, and this is directly linked to the war. Rural areas have several other immediate needs. These include access to clean water and health care.

In most rural areas, for example, health posts have been destroyed or abandoned. They need to be repaired, re-equipped, re-stocked with medicines, and staffed. Many of the health care staff need refresher training. And communities need to be involved and trained in the management of their health care systems. Clearly, a family in poor health is not going to be able to achieve food security.

" Even from my understanding of the issues it seems that several countries have been able to make advances in health despite years of conflict (like Sri-Lanka). They have done so by investing in education especially of women and children and primary care and not in sophisticated medical equipment.

Some observers might feel surprised that some people in the Maoist affected areas feel that international organisation working in Nepal may have actually contributed to the conflict by perpetuating the same inequalities that gave rise to the conflict in the first place. Nepal will have to find its own answers. This knowledge of what keeps a population healthy is really nothing that the west can export because we don't know about this ourselves here!" he said.

People clearly want to see more commitment from the government, particularly investment in the area of human and social capital development. The government should have to do something. Government should know much more money needs to be allocated to health, education and other basic services, particularly in ways that benefit the poor.

In 1998, the 51st World Health Assembly in May 1998 accepted the role of the Organization in health as a bridge for peace in the Health for All in the 21st Century Strategies. This year, WHO Director General's Address to the 53rd World Health Assembly carried a specific mention of the role on health partners in armed conflict and of the importance of "staying to the end and to come in early" and that rehabilitation should guide Health action from the start of relief.

Only peace reveals all health needs. Furthermore, cease-fire arrangements, even if precarious, need special health support: for demobilisation of soldiers, de-mining and return of refugees and internally displaced persons. The health sector is required to re-establish coverage, since equitable access to care is rightly perceived as a major factor of social stabilisation and peace-building.

Basic education, on disease control and general health care, would be a major component of the intervention of the aid agencies, as lack of knowledge had been discovered as a major contributory factor to Asia's health crisis. But funding problems threaten to hinder the emergency health intervention programmes the government and aid agencies have embarked on to tackle the health crisis.

As a result of armed conflicts, thausends children have been killed, many have been seriously injured or permanently disabled, and countless others have witnessed or taken part in violent acts. The destruction of food crops, water supplies, health services, families and communities takes a heavy toll on children.

The governments in the region have even failed to add to the number of doctors in the public heath sector. Despite great potential natural wealth, war has left Asia as one of the poorest region on earth, leaving its citizens prey to famine, disease, and widespread human rights abuses.

(Kamala Sarup is editor to http://peacejournalism.com/)

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