Conflicts, wars and health systems

Abdul Sattar
Sunday, Dec 03, 2023

The writer is a freelance journalist who can be reached at:

After having witnessed the ruthless bombardment by Israel in response to the October 7 Hamas attack, Gazans are now facing another threat. This time the risk of death is not by terrible aerial strikes but by the catastrophic impacts of the ongoing conflict on the health of residents.

The conflict that has already displaced more than 1.3 million – or 1.8 million, according to other estimates – is likely to continue haunting the people of Gaza. More than 80 per cent Gazans already had no access to pure drinking water before the war erupted. Now, the massive destruction caused by the Israeli bombardment could triple the health issues of the residents.

Unicef spokesperson James Elder says that everything in the war-torn region is emergency care. It is claimed that the population is so ravaged by hunger, bombing and the lack of clean water that deaths from disease could outstrip those from war.

The UN estimates that 1.8 million people in Gaza have fled their homes – nearly four in five residents – with children making up half of those crowded into shelters, given shelter by relatives, or living in tents or cars. According to the World Health Organization, 36 health facilities including 22 hospitals have been damaged since the war began, and only a handful are now still operational.

Such destruction is likely to have catastrophic impacts on the health of the residents. WHO spokesperson Margaret Harris says that in Gaza the rate of diarrhoea has increased by 45 times compared with the same period last year, and other communicable diseases – from respiratory infections to hygiene issues such as lice – have also risen. This is in addition to the trauma of hundreds of thousands of children who witnessed terrible destruction and the loss of their parents or relatives. The scars of such trauma are not likely to be healed for decades.

Gaza is not the first conflict area where diseases and epidemics are set to wreak havoc on the lives of people. Wars, conflicts and military expeditions always bring deaths in another form. Throughout history, wars and military conflicts have been one of the biggest sources of human decimations. First people get killed because of attacks or armed skirmishes and later by its devastating impacts on health.

According to The Lancet, during the Napoleonic wars, eight times more people in the British army died from disease than from battle wounds. The journal notes, “In the American civil war, two thirds of the estimated 660 000 deaths of soldiers were caused by pneumonia, typhoid, dysentery, and malaria, and this death toll led to a two-year extension of the war. These diseases became known as the ‘third army’.”

Not only are soldiers and military personnel threatened by the risk of death but the ominous shadows of fatality also chase millions of people who have nothing to do with the decisions of their ruling elites that impose wars and conflicts on them. Such conflicts not only impoverish the population but also trigger massive displacement of people that complicate health situations.

Such conflicts have especially affected parts of the Global South. For instance, Africa has been plagued by armed skirmishes several times during the past seven decades. A report by The Lancet says that more than 25 countries are affected by conflict needing humanitarian assistance, mostly in sub Saharan Africa, in which respiratory tract infections, diarrhoeal diseases, measles and, in endemic areas, malaria are major causes of death and disease.

It adds, “It is estimated that infectious diseases cause up to 70 per cent of all deaths in these countries. Epidemics of cholera, dysentery, meningitis, relapsing fever, and typhus have caused high mortality, and tuberculosis and HIV/AIDS are becoming increasingly important.”

Conflict in Syria killed more than 555,000 people besides rendering around 11 million people homeless. The civil war that witnessed the destruction of the country’s infrastructure also affected its health system. The country that spends around 2.0 per cent of its GDP on health is facing a shortage of health staff, making it difficult for the government to deal with the health challenges caused by the conflict.

The ISIS insurgency is one of the factors contributing to the contamination of water posing serious health challenges to people. Cholera and other diseases are becoming more frequent. As of February 28, 2023, the most affected governorates by cholera were Idlib, with 27,683 cases (30 per cent), Aleppo, with 22,123 cases (23.9 per cent), Deir ez-Zor, with 20,671 cases (22.3 per cent), and Ar-Raqqa, with 17,578 cases.

Iraq used to have one of the best health systems in the 1970s and 1980s in the region, but this started changing over the years with the Iraqi invasion of Kuwait and the US attack on Iraq. After the US invasion, around 7.0 per cent of the hospitals in Iraq were partly destroyed, and 12 per cent were looted in the chaos that followed. According to an article by Dr Ahmed Aber, a member of the Royal College of Surgeons of England, the health system of Iraq started facing a number of challenges years after the invasion.

He says that by 2016 the situation was very disappointing with most of the country’s 1,717 primary healthcare centres having no running water or electricity. After the US withdrawal, it was claimed that 40 per cent of the 900 essential drugs were out of stock in hospitals.

The conflict lasting years left around 3.0 million people internally displaced with 6.9 million Iraqis needing immediate access to essential health services.

The occupation of the country also triggered an exodus of medical staff with nearly 75 per cent of doctors, pharmacists and nurses leaving the country since 2003. According to Dr Aber, in 2016 as few as 9,000 doctors and 15,000 nurses were serving nearly 28 million Iraqis, which means nearly six doctors and 12 nurses for every 10,000 citizens. For a similar population in the UK, there were 23 doctors and 88 nurses.

Yemen is another place where an insane conflict battered the entire health system. Dr Annette Heinzelmann from WHO in Yemen revealed in April that the country’s health system was on the verge of collapse. She said that around 12.9 million Yemenis have urgent humanitarian healthcare needs, with 540,000 children under five, currently suffering from severe acute malnutrition “with a direct risk of death”.

It is estimated some 46 per cent of health facilities across the country are only partially functioning or completely out of service, due to shortages of staff, funds, electricity, or medicines.

Given these terrible consequences of wars and conflicts on health systems, it could be said that extending emergency assistance after the eruption of a conflict and destruction of the health system is not enough. The need is to prevent regions, states and continents from plunging into insane armed collisions that have been wreaking havoc on millions of masses.

Such conflicts have not only displaced over 38 million people globally but are also causing immense hardships for health staff which ultimately affect the people at the end of the day. If conflicts cannot be stopped easily then at least those responsible for targeting water streams, rivers, dams and health infrastructure should be prosecuted under war crimes.

Those responsible for contaminating underground water or causing massive damage to civilian infrastructure should also be made to pay reparations for the reconstruction of such places. Only such reparations and prosecution could serve as a deterrent, prompting mighty states to be mindful of the consequences before creating any humanitarian catastrophe.