Health in Conflict Zones

A few weeks ago I attended ‘Heal The Word: Many Disciplines, One Goal’ conference hosted by UCL Medsin. One of the central plenaries was titled ‘Health in Conflict Zones’ which afforded a useful sounding board for thoughts and reactions I have received second-hand from professionals with experience in active and post-conflict areas. Conflict is here identified as any singular or succession of events that threatens the well being and physical or psychological health of a population, whether pertaining to an internal or external cause.


Conference location: The Cruciform building overlooking UCL Main Quad

There were two remarkably insightful responses to this theme from namely:

Dr Ang Swee Chai who asked: ‘who is it that defines [terror and a] terrorist’? Based on her experiences as both an orthopaedic surgeon at St. Bartholemew’s Hospital, London and the conflict zone of Gaza in the State of Palestine, Swee Chai reflected that war is constructed by air (‘bomb the hell out of everyone’) with a secondary wave of territorial invasion. She went further, asking whether it is a doctor’s job to speak up in a conflict situation. One school of thought asserts that health personnel are there to be passive providers, avoiding any self-expression that might jeopardise their ability to provide healthcare and relief aid. She argued that, as advised by the principle of ‘témoignage’ advocated by Médecins Sans Frontières (MSF) amongst others, that yes, they absolutely should.

Based on discussions I have held with professionals engaged in both preventative and crisis relief work, I would concur in most instances because global awareness of the truth and reality of what is going on in notoriously under – or worse, falsely – reported conflict situations, will invariably mobilise greater humanitarian and political action than keeping one’s head down and functioning to the best capacity within a framework of oppression and censorship. Kate Winslet’s performance in Contagion (2011), while remarkable for its artistic performance, is a creative engagement with these often contradictory pressures of vision and action. Swee Chai considered the anthropocentric quality of medical professionals, noting that the future heralds robots and technology that can practically carry out the same technical job, to a possibly better standard, than health professionals currently can. What these artificial doctors will lack is both the human heart and compassion to identify and raise awareness in instances where human rights are violated. 

Dr Ang Swee Chai. Image reproduced with permission from Tarek Charara/Kaleidos.

Dr Ang Swee Chai. Image reproduced with permission from Tarek Charara/Kaleidos.

Meanwhile, ex MSF doctor Dr Ana García Mingo asked when humanitarian organisations should intervene in zones identified with a conflict status. I would argue that any intervention should coincide with a recognition that the health or survival or a specific population is threatened. Importantly, García Mingo reminded us that the first thing that stops after any crisis is preventative care, notably routine vaccination programmes. So too, as Daniel Flecknoe, a former emergency care nurse dispatched by MSF to North Darfur at the end of 2008 (he speaks to MdM in a forthcoming post) identifies, local health professionals and staff that are citizens of these zones are often unfairly overlooked and their efforts receive sparse coverage.

Moreover, these individuals are invariably volunteers rarely receiving monetary compensation for their time and efforts because they are problematically acting within country for a third-party aid organisation. The 2009 film ‘Living in Emergency’ features some of these figures. Focusing in particular on settlements of both internally displaced persons and refugees, Mingo further highlighted the critical difference between these very peoples: across borders and between them and, by extension, the difference in the nature of refugee camps and the access of those who cluster in them to both healthcare (from medicines to vaccines) and technology (Internet connectivity and mobile reception).

'Living in Emergency' (2009). Image reproduced with permission from Doctors without Borders.

‘Living in Emergency’ (2009). Image reproduced with permission from Doctors without Borders.

As will be highlighted in my interview with Flecknoe, provision of healthcare in conflict zones is not as straightforward as applying a metaphorical bandage to temporarily stem the flow of chaos, bloodshed and political unrest. There must be a sustainability to any aid provision, with a careful balance that manages the governing factions of any such crisis while consistently focusing on the bigger picture. This large-scale world view will, in the long-term, safeguard lives even if in the short-term it appears to threaten the acute activity of damage control of lives, peoples and places.

Image Credit: UCL Medsin.

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