By Nathan Douthit

Large-scale destruction of health services is a feature of modern warfare which today tends to be intrastate (civil war) rather than interstate. Whereas at the time of the World War I 90% of the injured were combatants, by the end of the last century 90% of casualties were civilian. The demand on in-country health services is, therefore, profound, and the destruction of these services a humanitarian disaster, as delivery of the most basic in emergency care becomes a challenge.

            Conflict is a major source of humanitarian emergencies. As mentioned above, it has the potential to devastate the public health systems and primary health systems of a country. It can encourage emigration of health professionals, destroy necessary infrastructure, and threaten the security of providers and patients.[1]–[2] This tends to effect the most vulnerable populations, including, “pregnant women, children, the elderly and patients with chronic health conditions[, who] are among the first to be deprived of the essential healthcare, including vaccines and essential drugs.”

According to the International Federation of the Red Cross, “[H]ealth care is most needed where it is most difficult to deliver.”[3] Health care can be imported into these difficult situations, but this intervention is often accompanied by force, which can create its own political and ethical problems.[4] Healthcare professionals must be engaged in finding creative ways to meet the needs of vulnerable populations in areas fraught with conflict.

While the rebuilding of the infrastructure of these countries is the most appropriate intervention, this cannot be done in the midst of an acute conflict. In, “Complications of dysgerminoma: meeting the health needs of patients in conflict zones,” Hayari et al describe how one young patient was treated appropriately despite her home being destroyed by conflict.

            “The treatment of the war wounded in neighbouring countries, not formally engaged in conflict, is not new…. [T]he ICRC operated through field hospitals in Pakistan during conflict in Afghanistan. Turkey, Lebanon and Jordan have received over two million Syrian refugees in need of acute medical attention; the prevention and treatment of infectious diseases and treatment of chronic conditions poses a prohibitive challenge to the healthcare services of these nations…. The potential to offer high-quality care to a most vulnerable population across national borders warrants further examination as the international community seeks solutions to meeting healthcare needs in conflict zones and postconflict zones begin to reconstruct their cancer care facilities.”

Healthcare professionals can make a difference in conflict zones by meeting the needs of patients by innovative solutions. BMJ Case Reports invites authors to publish cases regarding healthcare delivery in conflict zones. Global health case reports can emphasize:

-The methods of identifying and triaging patients in difficult to reach areas.

-Training methods local pracitioners in conflict areas

-Disease spread or exacerbation as a result of conflict

-Successes in healthcare delivery through conflict zones

Manuscripts may be submitted by students, physicians, nurses or other medical professionals to BMJ Case Reports. For more information, review the blog on how to write a global health case report.

Read more about conflict, refugee health and innovative solutions on BMJ Case Reports

– Illegal immigration: the puzzling role of several risk factors for rhabdomyolysis

– Social determinants of health: poverty, national infrastructure and investment

– A Rohingya refugee’s journey in Australia and the barriers to accessing healthcare

Read more about conflict, refugee health and innovative solutions from other sources:

[1] Hoeffler A, Reynal-Querol M. Measuring the costs of conflict. Washington, DC: World Bank. 2003 Apr.

[2] Acerra JR, Iskyan K, Qureshi ZA, et al. Rebuilding the health care system in Afghanistan: an overview of primary care and emergency services. Int J Emerg Med 2009;(2):77–82.

[3] Coupland R, Breitegger A, Nathanson V, et al. Health Care in Danger: The responsibilities of health-care personnel working in armed conflicts and other emergencies. International Committee of the Red Cross. Geneva, 2012

[4] Weissman F, editor.  Introduction: the sacrificial international order and humanitarian action. In: In the shadow of ‘just wars’: violence, politics, and humanitarian action. Cornell University Press; 2004.

Competing Interests

None Declared