Tag: conflict health

Ebola, Disease Outbreaks, and Inadequate Health Systems

Development, Health

I vividly remember the Kagadi Hospital run by the Ministry of Health. In 2002, I was visiting the communities that would benefit from an ambulance fundraiser project. That evening the need for emergency transportation in the Kagadi-Nakuulabye area of the Kibaale District could not have been made more clear to me. Driving back to our housing one evening, our pickup truck was flagged down to help at the scene of a bicycle accident where two riders had collided head on in the dark. One man was bleeding from his ears and obviously needed advanced medical attention. We drove him, lying in the pickup truck bed, to the Kagadi Hospital only to be turned away because the staff said they didn’t have any supplies to treat the man. I remember looking into the hospital windows and seeing nothing but empty walls.

It came as a shock to read news of the Ebola outbreak in that very same area where I had visited 10 years ago: Kagadi, Kibaale District. My first thought was that the health care system couldn’t possibly respond quickly enough, but hopefully things had improved over the last decade. Reports noted that the Red Cross, Doctors Without Borders, CDC, and the World Health Organization (WHO) were assisting with the response. This was a positive sign since the area is rural, difficult to travel to, and as far as I knew lacking a strong health care system.

“This outbreak is occurring in the same area where the Red Cross is already responding to the growing crisis caused by the influx of Congolese refugees fleeing violence in their country” said Charlie Musoka, Regional Operations Coordinator for the International Federation of the Red Cross.

On top of dealing with the Ebola outbreak, the Ugandan Red Cross was also managing the influx of refugees into the country. My initial thought was that Ebola is easily transmitted by close contact between people and usually kills 90% of those infected. With the regular movement of people across the Uganda/ DRC border it could be just days before an Ebola outbreak occurs in the DRC.

Shortly after the Ebola outbreak, news broke that the Ugandan Ministry of Health needed Sh3 billion to be able to contain and manage the disease and necessary health care facilities. I was also contacted by the local health center in Kagadi and told that were having difficulty responding to the outbreak as well. My fears seemed to have been true and the health system was feeling the pressure of responding to an Ebola outbreak in an area where there was very little health care capacity.

Roughly, two weeks after the request for supporting funds by the Ugandan Ministry of Health, the Ebola outbreak is reported as contained in Uganda and a Ugandan team would be sent to the DRC to help contain the new outbreak there. Reports said that it was a different strain of Ebola, but the first reports were in a Uganda/DRC border town that is a regular crossing point between the two countries. I had worried about the lacking health care system in Uganda, but the health care system in the DRC is in an even more strained. There are limited health care workers and facilities, which are usually filled by casualties from the ongoing violent conflict in the region.

Early this month, the WHO declared Uganda Ebola free after there were no new cases reported after August 3rd (24 confirmed cases, 17 deaths). The facilities in Kibaale District remain on alert, but the larger Ebola crisis is in the DRC. The WHO confirmed the Ebola outbreak is a different strain (see map above) and not connected to the Ugandan outbreak, however there have already been 72 confirmed cases and 32 deaths. Health workers were reported infected in the Ugandan outbreak, but in the DRC so far 23 of the 32 deaths have been health care workers. Representatives of Medicines sans Frontiers note that the death of health care workers at hospitals scares people away from seeking treatment and they are more likely to continue the spread of Ebola. It seems that the DRC has been less equipped to deal with the Ebola outbreak or its just the nature of the area where the outbreak occurred that made it easier to spread.

Both of these examples of Ebola outbreaks in a remote region of Uganda and in a transit town in the DRC demonstrate the critical need for adequate health care systems and health care workers. Before conflict started in the DRC, the health care system was already underfunded and in need of investment. The United Nations reported that militias raided almost all of the health care facilities in rural areas where 70% of the populations lives. The conflict also disrupted transportation and everyone must travel by foot to get treatment. NGOs have tried to invest in the health care system, but Doctors Without Borders report regular attacks on their compounds. In Uganda, there has been similar conflict, but greater investment in the health system. However, a recent report highlighted the inadequate staffing and space in many key hospitals. In some areas there is 1 doctor for every 178,000 people. Due to financial constraints the Ugandan government has banned recruitment of health care workers.

No one can afford to not invest in health care capacity building. In these two countries it seems that health crises need to be managed by outside NGOs with additional funding. How can the international community better work to build the capacity of individual country’s health care systems?

dictators and democracies for health

Health

Politics can have serious consequences for health. We need look no further than the US legislature for examples of the politics of health. The recent deeply partisan budget cuts threatened women’s health across the country and debates over the Health Care Bill easily demonstrates a democracy’s inability to provide basic health for everyone in its population. Other examples come from the USDA’s support for corporate farms over the population’s health needs amidst the growing obesity epidemic. Some of the best examples of health being politicized come from our own government, yet we rarely have to think about how the form of our government and political system has an impact on our health.

Whether it is a democracy or a dictatorship, politics influences health. Cuba has long held a spot as one of the top national health care systems as well as one of the top countries for medical education. Their system is completely government-run with no private companies controlling hospitals or clinics. Cuba has been innovative with their computerized system for blood banks, patient records, etc. However, their government is a dictatorship and this has created some negative effects on health (depending on who you talk to). During the 1990s, the loss of Soviet subsidies combined with other political and economic factors created a countrywide famine. Manuel Franco describes the Special Period as,

“the first, and probably the only, natural experiment, born of unfortunate circumstances, where large effects on diabetes, cardiovascular disease and all-cause mortality have been related to sustained population-wide weight loss as a result of increased physical activity and reduced caloric intake”.

Recently we have seen the horrifying impacts of dictators and authoritarian regimes crushing their own health care systems at the expense of their populations. In Libya, health workers have been shot at, ambulances have been bombed, and hospitals have been razed. Gadhafi has ruled Libya since leading a bloodless coup d’etat against the then King of Libya.

In nearby Syria, similar atrocities have been committed. A recent video from the protest against the Syrian government showed a pro-government Doctor beating an injured protester out of an ambulance. The main hospital in Deraa has reportedly received 37 bodies of protesters killed. Syria is officially a republic with a constitution and elected leaders. The real story is of a country run by one party handed from father to son that has been governed under “The Emergency Law” which suspends constitutional protections since 1963.

Chris Albon, author of Conflict Health, wrote an informative piece on how the protests in Bahrain are centered on the health care system. Protesters seeking refuge in the hospitals have been denied treatment by government troops and ambulances have been blocked. He notes a new report from Doctors without Borders that says, “the government has attacked and militarized the health system, making protesters and bystanders afraid to seek treatment.” Bahrain is a constitutional monarchy where people have long protested over their lack of personal rights and freedoms.

In another example of the difficulties of democratic politics to support health, Nigeria’s recent elections have fueled intense fighting across the country. Hospitals reported that over 300 people were seen for bullet wounds. The ethnic and religious divisions in Nigeria have long plagued efforts to build a unified democracy. Nigeria’s history of military rule and oil wealth has also exacerbated these divisions. When a democracy can’t hold elections without widespread violence, how can they provide health for their people?

Both dictators and democracies have the potential to instigate situations that have serious health impacts. Whether it is frivolous debate or armed conflict, the politicization of health has lead to serious health deficits around the world. No matter what country you live in there is always room for development when it comes to providing for the health of a population.

Featured on the American for Informed Democracy Blog, where I’m writing as a Global Health Analyst.

when conflict health becomes military tactic?

Featured, Health

From refugee situations to border disputes, health crises that arise as a result of conflict are unfortunately quite common. Conflict health disrupts the ways that people access resources like food, water, and medicine. On the other hand, conflict health creates the circumstances where diseases spread, people are needlessly killed, and others are critically injured. These horrible results of conflict health are compounded by the destruction of infrastructure: roads, hospitals, etc.

What happens when conflict health becomes a military tactic? Since Medieval times (and before) armies attacking opposing castles would launch disease infested animal carcasses over the walls. In the 1800s, the US military gave smallpox blankets to indigenous North American groups in order to destroy their health and kill their populations. During apartheid in southern Africa, South African forces supporting RENAMO in Mozambique targeted health clinics and hospitals to cripple the health and infrastructure of the population.

During the World Wars, medics and vehicles with a red cross weren’t supposed to be targeted because they weren’t carrying out military actions. I had thought this idea was fairly widespread and that mercy was shown to health providers in times of conflict.

Recently, we have seen the complete opposite during the Libyan conflict. Libya’s pro-Gadhafi forces have targeted those attempting to provide health services to protestors and the population. In the early days of the protests it was reported that the military was entering the hospital to dump out blood supplies so that injured protestors could not be saved. In similar actions, Red Crescent medics and ambulances have been shot at, Colm O’Gorman, executive director of Amnesty International Ireland, said:

“This was a deliberate attack on medical professionals, who were wearing full medical uniform and arrived in two clearly marked Red Crescent ambulances.”

Ambulances have been bombed, The rebel spokesman confirmed that

“Gaddafi’s forces shoot three ambulances, killing two drivers.”

The Misrata hospital has been a flash point of intense shelling and fighting by Libyan forces. The hospital has been bombed from the air, shelled by tanks, and overrun by pro-Gadhafi troops.One person inside said,

“heavy tanks for Gadhafi troops start attacking the hospital – the bombs falling here 20 meters (66 feet) around us.”

The health of the Libyan people is under seige as much as the repressive dictatorship of Gadhafi. Many countries including Egypt, Morocco, and the UAE have established military field hospitals to be able to help the wounded who are leaving Libya. UNICEF is deeply concerned about the impact of the conflict on children and has distributed emergency health kits which contain enough drugs, medical supplies and basic medical equipment to cover the needs of 60,000 persons.

The conflict in Libya, through the blatant attacks on health providers and facilities, has demonstrated a new level of disregard for the basic health of a population. This is an obvious example that Gadhafi must be removed from power if the Libyan people are to regain their health and livelihoods.

Featured on the Americans for Informed Democracy Blog, where I’m writing as a Global Health Analyst.

the impact of conflict on health

Health

The correlation between violent conflicts and health may seem to be very obvious, but there is more to the issue than what crosses the mind. Everyone can make the simple connection that there is direct impact of conflict on being unbenefittal for the betterment of health. For example it is easy to read this <a href="http://news.bbc.co.uk/2/hi/africa/6590965.stm
“>article and see the obvious connection to artillery shells hitting a hospital in Mogadishu. Internal clashes and conflict creates a more difficult situation for humanitarian operations all over Africa.

Africa represents the highest rates of internal conflict and disease, especially HIV/AIDS. This disease has been used as a weapon in conflict. Many times infected soldiers are sent to the front lines to spread disease and infect the opposition, which generally turns out to be the innocent population. Populations affected by armed internal conflicts end up experiencing severe public health consequences from food insecurity, displacement, and combat. All this ends in a collapse of basic health services which are essential to the survival of the population.

I could not find the article again, but the BBC had reported on the difficulties faced by those bringing humanitarian aid to Darfur, Sudan. They constantly faced issues with the government shutting areas down or denying them entrance. infrastructures for basic health, or created systems for basic health become neglected or destroyed. In many cases the impact of conflict can be felt at the very lowest levels of a population; women are unable to protect their families, fathers just might not be present anymore, children have no access to schooling, and everyone suffers from an absence of basic health – no food, no medications, no stable doctors, and no way to deal with the injury inflicted by the violence of conflict.

With the renewed peace talks for Uganda, the twenty year civil war seems to be coming to a close and the health of the northern Ugandan population may be improving. The rebuilding effort is going to be long and difficult, but there is hope. Many organizations are beginning efforts to improve the health situation and support hospitals and health centers that have been impacted by the conflict.

There are so many topics that can be covered as a result of conflict in a country and its correlation to health. However, I am not here to expound all of the information available, but know that it is out there: sexual violence, psychological impact on children, and especially the toll on health workers. Conflict impacts health plain and simple, but there is so much more as the impact trickles down to the population, the families, and the children. The future of a country in conflict lies in its ability to rebuild and provide aid to their populations after conflict.