CMPH Journal

Definition and Introduction of Global Health Security

Global Health Security is defined by (World Health Organization) WHO as “the activities required, both proactive and reactive, to minimize the danger and the impact of acute public health events that endanger people’s health across geographical regions and international boundaries”.

Global Health Security is defined by (Centers for Disease Control and Prevention) CDC as “the existence of strong and resilient public health systems that can prevent, detect, and respond to infectious disease threats, wherever they occur in the world”. Therefore, achieving Global Health Security aims to close gaps in preparedness and accelerate progress toward a world safe and secure from infectious disease threats.

Thus, per the Department of Health and Human Services (HHS), Global Health Security ensuring the health and well-being of populations globally.

The tasks that Global Health Security focuses on to achieve:

• Disease surveillance and outbreak response.
• Emergency management.
• Safe laboratory systems and diagnostics.
• Developing the workforce.

Impact of the Conflicts on Global Health Security

The World Health Organization (WHO) estimated that in 2002 alone, war resulted in the deaths of 172,000 individuals worldwide. Additionally, 601,000 deaths attributed to violence during the Iraq war, spanning from March 2003 to July 2006. Moreover, a significant increase was found in the crude mortality rate during the conflict, surpassing the previous rate by more than twofold (from 5.5 deaths per 1000 people to 13.3 deaths per 1000 people).

In addition to the direct consequence, conflict also indirectly deteriorates the health of the population by causing breakdown of the health system, shortage of medical supplies and displacement of healthcare workers, as well as disruption of food and clean water supplies.

Key points regarding the impact of conflicts on global health security:

1. Disruption of Healthcare Services.
2. Displacement of Populations.
3. Spread of Infectious Diseases.
4. Impact on Mental Health.
5. Challenges in Disease Surveillance.
6. Access to Medications.
7. Humanitarian Access: In conflict zones, it can be challenging for humanitarian organizations to gain access to providing essential health services and aid.
8. Long-term Health Consequences: The long-term health consequences of conflicts can be severe, with generations affected by physical injuries, psychological trauma, and chronic diseases.

Health Security in Conflict Zones

In 2021 and 2023, the World Bank estimated that two billion people are living in fragile and conflict-affected regions. Severe, long-standing conflicts present a serious challenge to universal healthcare, as the impacts are indiscriminate across the health system. Armed conflict is a global health issue in which it means extreme violence, displacement, destroyed infrastructure and institutions, and professionals and facilities that are under violent attack.

The breakdown of healthcare system due to the conflict dramatically affects people with physical injury. This is one of the major and extensive issues in conflict zones [1].

Examples

In Syria, around 25,000 people were injured each month in 2016. Where the International Rescue Committee found that 68% of healthcare workers reported being inside a facility during an attack and 49% of civilians were frightened to access healthcare for fear of an attack [1].

The ongoing humanitarian crisis in Yemen leaves many without access to essential care. Because of this, non-communicable diseases now account for over half of all deaths caused by illness in Yemen [1].

In Iraq, the conflict has destroyed the primary healthcare services, disease control and prevention services, and health research infrastructure. Attempts to revive the healthcare system continue to be hampered by several factors, including fragile national security and a lack of facilities such as water and electricity.

Due to the war in Ukraine, the health system is under severe pressure. The World Health Organization (WHO) has increased its presence in Ukraine and in countries hosting displaced Ukrainians to help meet the escalating health needs. The war has led to an increased demand for health care while simultaneously reducing the system’s ability to provide services, particularly in areas of active conflict. As of 2nd June 2022, there have been 269 verified attacks on health professionals, resulting in at least 76 deaths and 59 injuries. These attacks are unjustifiable and must be thoroughly investigated. Health professionals in Ukraine are delivering care under extremely challenging conditions, and their dedication is commendable [2].

The Democratic Republic of Congo (DRC) has faced significant challenges to health security due to ongoing conflicts. Outcomes include Healthcare Access Impediments, Violence Against Health Care, both Humanitarian Crisis and Displacement, both Child Labor and Gender-Based Violence, and Displacement Statistics. Multiple conflicts across the DRC have impeded access to healthcare for more than 8.9 million people, especially in remote and conflict-ridden areas. Over 4.5 million people have been internally displaced, with significant numbers from Ituri, North Kivu, and South Kivu provinces. However, the situation in the DRC remains complex, and addressing health security requires urgent attention and humanitarian assistance [3].

The conflict in Gaza has had severe repercussions on health security considering that previously, Gaza’s health system faced numerous challenges due to a complex geopolitical situation. The war has left the health infrastructure fractured, with varying quality and limited specialized services and technology. Due to the conflict, importing essential medical supplies and equipment has been complicated, leading to frequent shortages. Health care workers in Gaza have remained resilient, but there are human resource gaps, especially in specialty areas like oncology. Last numbers showed that the life expectancy is lower, and both infant and maternal mortality rates are higher compared to other regions. Hospitals face closures, supplies are interrupted, and facilities suffer physical damage because of the brutal conflict [4].

Data Availability

No datasets were generated or analyzed during the current study. However, the datasets used and analyzed during the current review are available at accredited and well recognized resources.

Conclusion and Recommendations

The combined ramifications of prolonged conflict and poor public health are persistent wherever conflicts are. Even after conflict ends, it takes decades for the population to recover [1].

The impact of conflict on health security has devastating consequences. For as long as conflicts last, the health of the population in the countries where conflicts exist will continue to pay the price. It is necessary for states and humanitarian organizations to address the challenges that arise from conflict to improve universal healthcare and save lives [1].

More effective global frameworks need to be designed upon further international meetings to be conducted to address more about the conflicts that are affecting the living circumstances of all the affected communities including their healthcare services to prioritize more important international issues.

Improving health security in conflict zones is a complex challenge that requires a multi-levels approach. Some strategies that can be considered might include:

1. Strengthening Healthcare Infrastructure: By establishing resilient healthcare facilities that can withstand the pressures of conflict, which includes training healthcare workers who are prepared to work in such environments.
2. Ensuring Access to Medical Supplies: By creating reliable supply chains for medicines, vaccines, and medical equipment to maintain health services during conflicts.
3. Enhancing Disease Surveillance: By implementing effective disease surveillance systems to help in early detection of outbreaks to facilitate prompt response.
4. Collaboration with Humanitarian Organizations: By working closely and alongside international organizations to provide necessary aid and support in the conflict-affected areas.
5. Protecting Healthcare Workers: By ensuring the safety and the security of healthcare workers to maintain healthcare services. This includes adherence to international laws that protect medical personnel in conflict zones.
6. Community Engagement: By involving local communities in health security planning to improve the effectiveness of interventions and to ensure that the needs of the population are met.
7. Mental Health Support: By providing psychological support to those affected by conflict via addressing the long-term mental health consequences.
8. Advocacy and Policy: By advocating for policies that prioritize health security in conflict zones and holding parties accountable for violations against healthcare.
9. Education and Training: By educating the population on health risks and training them in basic first aid to empower individuals to take care of their health.
10. Technology and Innovation: By utilizing technology, such as telemedicine, we can help in providing healthcare services in hard-to-reach areas.

These strategies require the commitment of all the stakeholders, including governments, NGOs, healthcare providers, and the international community, to create and establish a coordinated and effective response to health security challenges in the conflict zones.

The consequences of violent conflict extend far beyond political and economic institutions. The concept of human security encompasses the well-being of people living within states, going beyond traditional state-centric notions of security. When evaluating the impact of militarized conflict on populations, it’s essential to consider relevant factors such as democracy, wealth, and public health.

The impact of conflict on health security is multifaceted, affecting both combatants and non-combatants. As we strive for peace and stability, addressing the health consequences of conflict remains crucial for the well-being of societies worldwide.

Funding

The manuscript titled “The Impact of International Conflicts on Global Health Security” is solely authored by me. I have not received any external funding or financial support for this work.

Ethics Approval and Consent to Participate and Consent for Publication

No consent or approval is required from any other individual or organization for the publication of this manuscript.

However, I have done a presentation on this topic for 10 to 20 mins as a speaker during the 9th Global Webinar on Public Health that was held by Global Scientific Guild on 24th and 25th April 2024. I have done a professional project about the effects of conflicts on healthcare system particularly in Iraq as a partial fulfilment of my Master of Science degree with University of South Wales.

Acknowledgements

Special thanks and gratitude to all the available and accredited resources that provided the essential and the important data for the public to see and to be aware of.

References

1. Everett F (2021) Under threat: healthcare in conflict zones. The Health Policy Partnership.
2. World Health Organization (WHO), 3rd June 2022. One hundred days of war has put Ukraine’s health system under severe pressure.
3. ReleifWeb, 20th September 2023. Democratic Republic of the Congo: Violence Against Health Care in Conflict 2022.
4. Johns Hopkins Bloomberg School of Public Health, 20th October 2023. The Humanitarian Health Effects of the Israel-Hamas War Among Civilians in Gaza.