Approaches to protect and maintain health care services in armed conflict – meeting SDGs 3 and 16

Druce, Philippa; Bogatyreva, Ekaterina; Siem, Frederik Francois; Gates, Scott; Kaade, Hanna; Sundby, Johanne; Rostrup, Morten; Andersen, C B; Rustad, Siri Aas; Tchie, Andrew; Mood, Robert; Nygård, Håvard Mokleiv; Urdal, Henrik; Winkler, Andrea Sylvia

doi:10.1186/s13031-019-0186-0

Cited by 40 publications

(30 citation statements)

References 3 publications

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“…Medical professionals may not be punished for treating those in need of help (ICRC , 1977. Despite legal protections, health care has been targeted in many armed conflicts (Briody et al 2018;Druce et al 2019;Rubenstein and Bittle 2010;Footer et al 2014;Lafta and Falah 2019;The Safeguarding Health in Conflict Coalition 2020).…”

Section: Introductionmentioning

confidence: 99%

Caught in crossfire: health care workers’ experiences of violence in Syria

Kallström

Häkkinen

Al-Abdulla

et al. 2021

Medicine, Conflict and Survival

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Health care is attacked in many contemporary conflicts despite the Geneva Conventions. The war in Syria has become notorious for targeted violence against health care. This qualitative study describes health care workers' experiences of violence using semi-structured interviews (n = 25) with professionals who have been working in Syria. The participants were selected using a snowball sampling method and interviewed in Turkey and Europe between 2016-2017. Analysis was conducted using content analysis. Results revealed that the most destructive and horrific forms of violence health care workers have experienced were committed mostly by the Government of Syria and the Islamic State. Non-state armed groups and Kurdish Forces have also committed acts of violence against health care, though their scope and scale were considered to have a lower mortality. The nature of violence has evolved during the conflict: starting from verbal threats and eventually leading to hospital bombings. Health care workers were not only providers of health care to injured demonstrators, they also participated in non-violent anti-government actions. The international community has not taken action to protect health care in Syria. For health workers finding safe environments in which to deliver health care has been impossible.

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Section: Introductionmentioning

confidence: 99%

Caught in crossfire: health care workers’ experiences of violence in Syria

Kallström

Häkkinen

Al-Abdulla

et al. 2021

Medicine, Conflict and Survival

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“…Studies have also revealed the negative impact of conflict on access to health services. As a result of violence, targeted attacks on infrastructure and providers, displacement, security concerns, and resource shortages citizens are unable to access the care they need 1,8–10 . Furthermore, prolonged violence within these contexts often becomes normalized resulting in increased gender‐based violence, sexual assault, and prostitution.…”

Section: Introductionmentioning

confidence: 99%

“…As a FCAS, the healthcare system in Burundi is likely to have a decreased capacity for equitable health care delivery with the healthcare system that exists being fragmented and containing silos rather than continuums of care 1,5 . Barriers to accessing health facilities also increase with security concerns for both users and practitioners as pregnant women may feel that it is unsafe to travel to healthcare facilities and healthcare workers are at risk of attack 1,8 . The result of conflict in this context is a shortage of healthcare workers who are able to provide ANC and assistance during childbirth to women.…”

Section: Introductionmentioning

confidence: 99%

Antenatal care and skilled birth in the fragile and conflict‐affected situation of Burundi

Ziegler

Kansanga

Sano

et al. 2021

Health Planning & Management

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Burundi is a fragile and conflict‐affected state characterized by persistent conflict and political violence. Amid this conflict, Burundi has one of the highest maternal mortality rates globally—548 per 100,000 births as of 2017, such deaths could be prevented with antenatal care (ANC). This cross‐sectional study aimed to examine the association between conflict and ANC and skilled birth attendant (SBA) utilization. Logistic regression analysis was conducted using the 2016–2017 Burundi Demographic and Health Survey (n = 8581), as well as a Near Analysis Geographic Information System exploration. Results show that women in extremely high conflict regions were less likely to have four antenatal visits (odds ratio [OR] = 0.79, p < 0.05). However, they were more likely to use a SBA (OR = 2.31, p < 0.001) and to deliver in a hospital (OR = 1.69, p < 0.001). As well, gender equality, education, and watching television were correlated with an increased likelihood of utilization. In contrast, unwanted pregnancies and increased parity were correlated with decreased use. Moreover, with renewed violence erupting in 2015, uptake of care has likely further stagnated or declined. If Sustainable Development Goal 3.1's objective of reducing maternal mortality globally is to be achieved, women's access to maternal healthcare services in conflicted‐affected areas such as Burundi must be improved.

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“…Asides from general physical and mental health consequences, con icts worsen health provision, and complicate health services operations and processes (6). These effects are a consequence of direct damages to health facilities and health care infrastructures, con ict-related threats to health professionals, or structural problems such as inadequate institutions for promoting people's rights and opportunities (7). Health services may be forced to stop or to operate under challenging circumstances, which, in the long run, may lead health services to be unstable or rugged to maintain operations overtime (8).…”

Section: Introductionmentioning

confidence: 99%

Inequalities in Catastrophic Health Expenditures in Conflict-Affected Areas and the Colombian Peace Agreement: An Oaxaca Blinder Change Decomposition Analysis

León-Giraldo

Cuervo-Sanchez²,

Casas

et al. 2021

Preprint

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BackgroundThe present study analyzes inequalities in catastrophic health expenditures in conflict-affected regions of Meta, Colombia and socioeconomic factors contributing to the existence and changes in catastrophic expenditures before and after the sign of Colombian Peace Agreement with FARC-EP guerilla group in 2016.MethodsThe study uses the results of the survey Conflicto, Paz y Salud (CONPAS) conducted in 1309 households of Meta, Colombia, a territory historically impacted by armed conflict, for the years 2014 and 2018. We define catastrophic expenditures as health expenditures above 20% of the capacity to pay of a household. We disaggregate the changes in inequalities in catastrophic expenditures through the Oaxaca-Blinder change decomposition method.ResultsThe incidence of catastrophic expenditures slightly increased between 2014 to 2018, from 29.3–30.7%. Inequalities in catastrophic expenditures, measured through concentration indexes (CI), also increased from 2014 (CI: -0.152) to 2018 (CI: -0.232). Results show that differences in catastrophic expenditures between socioeconomic groups are mostly attributed to an increased influence of specific sociodemographic variables such as living in rural zones, being a middle-aged person, living in conflict-affected territories, or presenting any type of mental and physical disability.ConclusionsConflict-deescalation and the peace agreement may have facilitated lower-income groups to have access to health services, especially in territories highly impacted by conflict. This, consequently, may have led to higher levels of out-of-pocket expenditures and, therefore, to higher chances of experiencing catastrophic expenditures for lower-income groups in comparison to higher-income groups. Therefore, results indicate the importance of designing policies that guarantee access to health services for people in conflict -affected regions but also, that minimize health care inequalities in out-of-pocket payments that may arouse between people at different socioeconomic groups.

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Approaches to protect and maintain health care services in armed conflict – meeting SDGs 3 and 16

Cited by 40 publications

References 3 publications

Caught in crossfire: health care workers’ experiences of violence in Syria

Caught in crossfire: health care workers’ experiences of violence in Syria

Antenatal care and skilled birth in the fragile and conflict‐affected situation of Burundi

Inequalities in Catastrophic Health Expenditures in Conflict-Affected Areas and the Colombian Peace Agreement: An Oaxaca Blinder Change Decomposition Analysis

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