Armed conflict and the right to health

When most of us speak of war, we think of it as a singular event. Something to be won or lost, part of history, not connected to the present unless we are “at war.” Our time horizons are so short and truncated. And yet the reality of war is that it continues to ripple through the memories of the affected lands and their peoples.

Vince Aletti describes the exhibit “War/Photography: Images of Armed Conflict and Its Aftermath,” currently being held at the Brooklyn Museum, as “presenting war not just as a battlefield or a strike zone but as a process — sometimes a frighteningly open-ended one.” He continues: “The result is at once brutal and humane. Images of conflict are bookended by sections about preparation (recruitment, training) and aftermath (executions, shell shock, the impact of war on civilians).”

Conflict seems to be a part of the human condition. One can say it is because of external conditions such as economic strife, or cultural or religious differences. Jean Vanier placed the root closer to home when he wrote, “[T]here seems to be a need in human beings to see evil and combat it outside oneself, in order not to see it inside oneself.”

Whatever the cause(s), when conflict leads to violence, particularly in the case of widespread armed conflict within a country or between countries, the effect upon the right to health is devastating and long-lasting. While I am not surprised by this conclusion, I am somewhat surprised and embarrassed that I did not fully comprehend this before. My daughter would describe this as the blindness of privilege.

In his report to the United Nations General Assembly presented on Oct. 24, 2013, Anand Grover, special rapporteur on the right to health, focused on the effects of armed conflicts.

He wrote:

“Conflicts pose immense challenges to the realization of the right to health. Some 1.5 billion people currently live in conflict-affected areas or fragile states, which face levels of child mortality and malnutrition twice as high as countries that are not affected by conflict, have poverty levels that are 21 per cent higher, and are furthest away from achieving the Millennium Development Goals.

. . .

Conflict affects health not only through direct violence, but also through the breakdown of social structures and health systems, and lack of availability of underlying determinants of health. This leads to a high incidence of preventable and treatable conditions including malaria, diarrhoea, pneumonia and malnutrition. These health effects often persist well after the end of active hostilities, and negatively impact health indicators for years thereafter.”

The Safeguarding Health in Conflict Coalition, which includes human rights and health professionals and NGOs, commended the report and highlighted those sections urging states and non-state actors to protect health workers and medical facilities during conflict, to stop attacks against health workers, and to punish those who violate the law.

The coalition’s web site notes the following recent examples of attacks on health workers and facilities by both state and non-state actors reported by Human Rights Watch:

•    In Syria, 32 of the country’s 88 public hospitals have closed because of the ongoing conflict, and government and pro-government forces have arbitrarily detained, tortured, and killed hundreds of health workers and patients.
•    In Turkey and Bahrain, state security forces have harassed, detained, and physically assaulted physicians providing care to anti-government demonstrators.
•    In the Central African Republic, non-state armed groups and fleeing government forces have systematically targeted health facilities and medical non-governmental organizations.
•    In Nigeria and Pakistan, armed Islamist groups are alleged to have targeted and killed polio vaccinators.

A move away from accepting the inevitability of war and the long-term negative health consequences it causes is required by those who have power and privilege. When we go to war, we need to understand that we are condemning people to health insecurity for years to come. Not just because armed conflict inflicts bodily harm, hurts infrastructures that support health care, and damages the environment, but also because it drives future health-care workers out of the affected areas.

We need to expand our view of the right to health to encompass both international development and security policies so it can have real meaning in the global south.

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