global conflicts
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Health system victims of a ‘perfect storm’

For vulnerable populations in sensitive and conflict-affected and fragile situations, ongoing crises can derail years of healthcare progress

Sistema de Salud
Naz, a 20-year-old Afghan woman, has her blood pressure taken at the Kadakhstan Comprehensive Health Center in Herat, western Afghanistan, August 20.Mark Naftalin (Unicef)

2023 has been described as a pivotal year for global action in the field of health care. A few weeks ago, representatives from government, the scientific community, the business world and civil society organizations convened in Berlin to draw up an agenda for better health services in the future.

Focusing now on possible steps to take is critical in a world where the vulnerabilities of health systems are being exposed as a result of climate change, conflict, the continuing evolution of Covid-19, the cost-of-living crises and debt. For vulnerable populations in volatile and conflict-affected situations, these ongoing crises can create a perfect storm that can undo years of healthcare progress.

In recent days, the humanitarian crisis in Gaza has tragically exposed the extent of the pressures that conflict exerts on health systems. Attacks on healthcare facilities, the lack of energy, water or supplies simply mean that hospitals are unable to save lives.

The September floods in Libya depicted another tragic picture: thousands of people lost their lives, many more were displaced, and communities were deprived of access to basic services and health care. Years of conflict and political instability have impaired critical infrastructure and crippled health systems, while the effects of climate change have made storms more likely and more intense.

Unfortunately, this is not and will not be an isolated emergency.

Nearly a quarter of the world’s population now lives in areas stricken by conflict, displacement and natural disasters. Of the 25 countries most vulnerable to climate change and least prepared to adapt to it, most are also affected by armed conflict. In addition, the health-related consequences of climate change prove costly. Direct damage to health systems is estimated to cost between $2 billion and $4 billion per year (approximately €1.9 billion to €3.7 billion) by 2030.

Conflict has far-reaching impacts on the health of individuals and communities, ranging from direct injuries and violence to displacement and mental and psychological trauma. Conflicts also hit health systems, damaging key infrastructure, disrupting the supply of essential medicines and hampering access to clean water and sanitation facilities, all of which contribute to exacerbating health conditions. In addition, the climate crisis is compounding existing fragility — natural disasters, heat stress, air pollution and the spread of infectious diseases — hampering the supply of essential health services where they are most needed.

In this context, resilient health systems are critical to fulfilling the promise of leaving no one behind, as countries agreed to do when they pledged to support the Sustainable Development Goals in 2015.

How can we design, build and maintain healthcare facilities that can withstand weather-related disturbances? How can we ensure that healthcare facilities have access to clean, reliable energy for their functioning? How can we ensure that these facilities have the supplies they need to work? How can we ensure that they are adequately staffed? And that these health workers are adequately trained and remunerated?

These issues and many others are often encountered by my UNOPS colleagues.

We work closely with UN agencies with mandates in health and humanitarian action, and we implement health projects and programs in some of the most challenging environments around the world. Indeed, the health sector constitutes our largest area, as well as one-third of our total implementation volume since 2016.

We have learned numerous lessons about practical solutions that can improve access to health services, even amid ongoing conflict. As an example of this can be seen in Yemen, where years of conflict have severely disrupted the health system and left 20.3 million people without access to basic health services. In response to this situation, a UNOPS project (a UN logistics agency supported by Germany has been working to improve access to health care by rehabilitating and equipping essential public health services) benefiting some 3.4 million people is rehabilitating hospital facilities and wards, improving water infrastructure and increasing energy efficiency, while also integrating gender considerations. It also trains personnel in the management and maintenance of medical equipment to ensure consistency. The aim is to make medical facilities more efficient and adaptable to respond to outbreaks and epidemics. However, far more is needed, as the requirements are immense. Approximately half of Yemen’s health facilities are partially functioning or non-functioning due to lack of staff and funding as well as power shortages and a lack of drugs, supplies and equipment.

In Ukraine, in the midst of the ongoing conflict, work is being done to improve the efficiency of medical services by providing reliable energy sources and acquiring and supplying essential medical equipment. This falls within a broader effort to support the emergency response and early recovery and reconstruction efforts that the UNOPS is conducting in close collaboration with the Ukrainian local, regional and national authorities, the United Nations and many other partners. Once again, the challenge is to maintain a long-term focus on establishing more resilient health systems that can withstand shocks and stresses, while responding to immediate needs. The lesson learned is that we should not wait until the conflict is over to begin the process of rehabilitation and reconstruction.

There can be no development without good health. In the case of vulnerable populations in volatile and conflict-affected areas, action and investment to improve access to health care must come immediately. These measures must respond to current requirements and provide the basis for a resilient, inclusive and sustainable future.

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