Conflict Affected Regions

In this issue of the Red Cross Red Crescent Magazine, contributors outline the global challenges of delivering health care during conflict or other situations of violence and health care after natural disasters. [from publisher]

Thousands of wounded and sick people can be denied effective health care when hospitals are damaged by explosive weapons or forcibly entered by fighters, when ambulances are hijacked and when health-care personnel are threatened, kidnapped, injured or killed. This study is based on an analysis of reports collected over a two and- a-half year period describing 655 violent incidents affecting health care in 16 countries. [from summary]

This report discusses issues related to violence against health workers, patients and hospitals during armed conflict and the impact it has on health workers and the subsequent lack of available health care for those in need.

The nature of armed conflict is changing, putting health workers increasingly in harm’s way. This article outlines the issue and a new campaign that aims to raise awareness and improve conditions on the ground for health workers and facilities in conflict zones. [adapated from author]

The purpose of this paper is to present a comprehensive, engaging, and visible framework of HRH system development. This has been further developed from the lessons distilled from Japanese experiences of supporting HRH system development in three fragile and post-conflict health systems: Afghanistan, the Democratic Republic of Congo, and Cambodia. [from author]

This study looks at how violence affects the delivery of health care including attacks on patients, health-care workers and facilities, and on medical vehicles. It first looks at the general disruption to health care that occurs during conflict and civil strife, before looking more closely at specific types of violence. [adapted from author]

This paper illustrates the process, successes, ongoing challenges and current strategies Liberia has used to increase and improve HRH since the end of a 14-year cival war, particularly the nursing workforce. [adapted from abstract]

This report will address the need to expand the global healthcare workforce and international emergency medical response mechanisms. It will also analyze the current mechanisms and channels that mobilize and coordinate healthcare volunteers in response to international disasters. The report will provide several collaborative pathways through which non-governmental organizations can coordinate their international emergency response efforts with volunteer teams of healthcare providers. [from introduction]

This report is based on findings of a study that analysed the opinions and experiences of Australians who provided humanitarian relief following disasters, in complex emergencies and wars. The issue of human resources within the humanitarian sector is now unquestionably on the agenda, and the identification of important gaps in knowledge within this field is the central thrust for the study which investigated Australian disaster workers from a broad range of health-related fields. [adapted from author]

Task shifting is one avenue for delivering needed health care in resource poor settings, and on-the-ground reports indicate that task shifting may be applicable in humanitarian responses to natural disasters and conflicts. This report evaluates the potential strengths and weaknesses of task shifting in humanitarian relief efforts, and proposes a range of strategies to constructively integrate task shifting into humanitarian response. [adapted from abstract]

In countries where conflict-related and gender-based violence is taking place, the health sector can contribute by providing essential medical interventions and support for survivors, documentation for legal cases, programs that assist in reducing social stigma, and data for effective programming. [from summary]

Nowhere is the global health worker crisis more acute than in fragile states – those countries where the government cannot or will not deliver core functions to the majority of its people. Since the civil war, Liberia has an absolute shortage of health workers. Merlin is working with the government to help train health workers and rebuild the shattered health system. [from author]

With some of the worst health indicators and the least adequate health services in the world, providing health services and rebuilding health systems in fragile states is a complex undertaking. This health and fragile states dossier highlights the challenges and approaches to delivering health services in fragile states. [from publisher]

The Trauma Management Program (TMP) was developed to improve the capacity of local health workers to deliver effective trauma care. This report illustrates a method to increase the capacity of indigenous health workers to manage traumatic injuries. These health workers are able to provide trauma care for otherwise inaccessible populations in remote and conflicted regions. The principles learnt during the implementation of the TMP might be applied in similar settings. [from introduction]

This presentation was from the “Health Service Delivery in Fragile States for US$ 5 perperson per year: Myth or Reality?” conference. It discusses the limited public sector capacity to deliver priority services in fragile states and the opportunities and challenges of using non-state providers to increase coverage. [adapted from author]

This resource is a chapter from Disease Control Priorities in Developing Countries. Despite the best efforts of primary care providers and public health planners, not every emergency is preventable. Actual provision of emergency care may range from delivery using trained emergency professionals to delivery by laypeople and taxi drivers. Developing strategies to meet the range of needs posed by such diverse circumstances will require innovation and a reorientation of public health planning. [from introduction]

This article discusses the requirements for improving the experience of health care workers in fragile states. Efforts are needed to establish performance-management systems, to support promotion based on merit, and to provide wider opportunities for professional development. These efforts must be accompanied by measures to restructure the workforce (in some cases radically), thus matching staffing levels with agreed norms and to redress imbalances between rural and urban areas and between different levels within the system. [adapted from author]

This report describes how the war in Iraq and its aftermath continue to have a disastrous impact on the physical and mental health of the Iraqi people, and the urgent measures needed to improve health and health services. It assesses the current state of the health system, including the impact of insecurity, and the workforce, supplies, medicines and equipment it lacks. It also looks at health information and health policy in Iraq. The report ends with conclusions and recommendations, exploring what needs to happen now in Iraq and what lessons can be learned. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It discusses training Clinical Officers, a cadre of mid-level health professionals, as a method of filling the health worker gap in a post-conflict area.

The challenges inherent in planning, developing and supporting a sustainable health care workforce are all the more difficult in countries where conflict or the aftermath of conflict can impede the implementation of short- and long-term approaches to building human resources for health (HRH). Based on field experiences implementing programs in such situations and supplemented by a carefully targeted literature review, this resource paper explores operational challenges, opportunities and goals common to initiating HRH programs in conflict and post-conflict situations. [introduction]

This paper discusses how Mozambique coped with the health system needs in terms of specialized doctors since independence, in a troubled context of war, lack of financial resources and modifying settings of foreign aid. The Ministry of Health (MOH) managed to make up for its severe scarcity of specialist MDs especially through contracting expatriate technical assistance.

People caught in crisis situations have crucial reproductive health needs. The needs of pregnant women are most urgent. Complications of labor and delivery can be life-threatening when women lack adequate care. Risk for HIV/AIDS, other STIs, and unwanted pregnancy increases, particularly when disorder provides cover for rape and other sexual coercion. Health care providers understand people’s needs and have experience meeting them, but few have worked in humanitarian relief.

The document aims to analyse the health system in Sudan, to identify the new challenges brought about by the new context, and on this basis to present a post-conflict strategic framework for the health sector. Chapter 3 presents an overview of the health sector. Available data on infrastructures and human resources indicate wide inequality across states in resource availability.

Designed to assist in re-establishing health services in a context of political and economical instability, this guide provides practical information and tools for rebuilding a health workforce, as well as examples from post-conflict countries. [publisher’s description]