Health care must adapt to help conflict victims – UN expert

A doctor examines a Somali refugee at a UNHCR-funded clinic in Ethiopia

22 January 2010 – Governments, United Nations agencies and others have been slow to adapt to the changing nature of conflict in their efforts to provide health care to those affected by violence, according to a new study co-authored by an expert with the UN refugee agency.

The model of conflict settings that aid workers rely on was solidified during the last decades of the Cold War, when direct armed clashed between rival nations were more common and overcrowded refugee camps were more the norm, according to the authors of the report, led by Paul Spiegel, chief of the Public Health and HIV Section of the UN High Commissioner for Refugees (UNHCR).

But the “old paradigms for developing countries with large, camp-based refugee populations with infectious diseases and malnutrition do not address the complexity of present and future conflicts,” the new study, published in The Lancet medical journal, says.

Most wars today, it says, “are of protracted duration, intra-State, fought by irregular armed groups and fuelled by economic opportunities and ethnic rivalry.”

Direct armed conflicts not as common, but violence against civilians – including rape – is pervasive. “This violence takes place against a backdrop of increasing urbanization and aging populations,” it argues.

Humanitarian space, or areas where civilians can seek shelter and relief workers can provide assistance safely, has shrunk in conflicts in recent years, hindering the provision of health care.

Intra-State clashes have swelled the number of internally displaced persons (IDPs), while refugee populations have seen their numbers dwindle. Most of the refugees of concern to UNHCR now live in urban areas, making reaching them with health care assistance complex.

As a result, the study calls for changes in four key areas: the delivery of health services; the treatment of chronic diseases; bolstering health care in urban areas; and surveillance, measurement and monitoring.


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