Fiona Downey

The World Health Summit has been held annually in Berlin since 2009. The summit hosts dignitaries and experts from politics, academia, and the private sector to discuss the current state of global health. The central topics of the 2016 summit included migration and refugee health, infectious diseases, health development goals, and technological innovation.

On October 9^th, the “Conflict and Health” workshop was held to discuss the crisis of health provision in regions of conflict. The workshop was chaired by Dr Seema Biswas, Editor-In Chief of British Medical Journal Case Reports and Dr Esperanza Martinez, the Head of Health in the Assistance Division at the International Committee of the Red Cross. The speakers were Katri Bertram, Head of Advocacy and Policy at Save the Children Deutschland, Virginia Comolli, Senior Fellow, Security and Development at the International Institute for Strategic Studies, and Dr Anke Hoeffler, Research Officer at the Centre for the Study of African Economies at Oxford University. The following article details the issues and recommendations of the workshop, as well as my subsequent meeting with Dr Biswas.

“One of the first victims of war is the health care system itself.” Marco Baldan, Chief War Surgeon, International Committee of the Red Cross

The safety of healthcare workers in conflict zones has deteriorated. This loss of neutrality has come at a time of crisis, with changing rules of engagement for warring factions. War is no longer a distinct two-state affair bookended with a clear beginning and end. War is increasingly occurring within countries, and between multiple factions. Combatants live and hide amongst civilians in prolonged wars that find funding and support from regional or global powers.

These developments in modern warfare have led to what Virginia Comolli of the International Institute for Strategic Studies terms the “hybridization of conflict.” The first component of this framework is the interconnected nature of modern societies. This aspect has allowed violent, ideological groups to disseminate ideas, contraband, and funding to one another. Second, underdeveloped states are plagued by weak governance and unrepresentative leadership, giving further rise to criminal, non-state actors taking control of underfunded and unsupported regions. This reality is exacerbated by the third tenet: urbanization. Despite greater numbers of people moving to urban regions, the government is unprepared to provide services, creating large areas that fall outside the rule of the national government. This allows these ideological groups to exert their control in these regions, influencing and targeting greater numbers of people.

Though wars in these unstable regions may be initiated by these insurgent factions or volatile governments, they are also driven and sustained by the provision of funding from external actors. Outside money promotes the interests of state and non-state actors who have a stake in the outcome and stand to benefit politically. These groups buy oil and drugs while pouring money and arms into the chaos, which has led to the use of sophisticated technology by state and non-state actors embroiled in war. In turn, the number of casualties skyrockets as a war of attrition begins with no heed paid to the lives of the innocent.

This reality has complicated the provision of health services to populations in need, and was the focus of much of the WHS workshop. It is more difficult for aid workers to safely operate in conflict zones. The flight of local healthcare personnel and the destruction of healthcare facilities (deliberately targeted in several instances) leaves populations without immediate care or essential medicines. Most alarmingly, medical care in recent conflict situations has been declared a criminal act. In an analysis carried out between January 2012 and December 2014 in 11 countries, 2,398 attacks on medical workers, facilities and ambulances were recorded. The World Medical Association has condemned this, opposing all government intrusions in healthcare work and any criminalization of the practice of medicine.

Civilians caught in warfare are not only directly injured or killed by weapons; patients with pre-existing conditions can no longer receive their routine follow-up or medicines. Routine medical emergencies like heart attacks, strokes, or appendicitis go without treatment. The inability to treat these incidents creates the indirect casualties of war. Furthermore, the loss of medical facilities leads to the decline in the overall health of the region. Doctors and advocates at the workshop reported increased incidents of malnutrition; outbreaks of measles, polio, and infectious diseases; cases of diabetic comas; and dramatic falls in immunization.

The workshop emphasized that there are steps that can be taken to push for better care and greater protection. First, doctors and aid workers must ensure the collection and use of accurate, contemporaneous data, as this data advocates for better access to aid agencies and medicines for vulnerable communities trapped in conflict. Second, doctors must push for the respect of to protect both doctors and patients. Dr Martinez drew attention to the Health Care in Danger project, which is a public awareness campaign aimed at bringing attention to the need for unhindered provision of healthcare in conflict zones. It seeks to be a catalyst for implementation measures and domestic laws across states to reduce violence against healthcare workers and their patients.

Together, the international community can do more to prevent the outbreak of conflict in fragile states, and bring an end to conflict so that populations may recover and economies may begin to grow.

Humanitarian solutions cannot resolve political conflict. However, the workshop panel believed the international community can work together to protect medical facilities, ambulances, and medical personnel. International humanitarian law and the Geneva conventions must be respected and observed, and more action must be taken to keep civilians from harm. Together, the international community can do more to prevent the outbreak of conflict in fragile states, and bring an end to conflict so that populations may recover and economies may begin to grow.

Finally, Dr Seema Biswas emphasized the importance of individual human life to conclude the presentation. Today, our television, computer, and cell phone screens bombard us with exponential numbers of casualties and fatalities, heart-breaking photographs, and complex justifications. The effect is overwhelming. Society cannot lose sight of the individual in the clinic or on the operating table, whose family has been lost and life has been irrevocably altered. For these patients, conflict is now the everyday reality of life. They are living without basic amenities or income, with their homes and neighborhoods destroyed and their children unable to attend school, under the constant fear of attack. No one should have to live like this.

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Fiona is originally from North Vancouver, BC and completed her undergraduate degree at Queen’s University. Although she has grudgingly come to love Toronto, Fiona is currently studying abroad in Berlin and trying to grasp the German language. When she is not harping on about issues of social justice, human rights, and women’s health policy, you can mostly likely find her trying to ignore the Canucks’ most recent loss.