Social determinants of health in countries in conflict - What is GIS ...

Social determinants of health in countries in conflict 27
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In conflict settings, the loss of these rights is most acutely expressed as:
lack of security; a daily fear of the next assault on life and dignity; inability to protect
one’s family; vulnerability to bomb attack; rape; absence of water or food;
displacement, movement from “home” place and the familiar; becoming a refugee
or an IDP;
loss of social networks and family structure that comprise the fabric and meaning of
daily life and its social reciprocities; this also involves the loss of social roles that
guide behaviour;
loss of livelihood; and loss of daily activity, access to land and employment opportunities
that provide for daily life and needs, resulting in extreme poverty;
food insecurity due to loss of land and resources for livelihood;
lack of shelter; a plastic sheet, the shade of a tree or a ruined home;
lack of safe water and sanitation;
lack of essential health and other social services, such as education for children;
lack of communication, leading to isolation.
The lack of these rights results in a dependence on others and on aid handouts
which produces a sense of helplessness and a lack of purpose in life. The daily assaults
represent a withdrawal of rights essential for survival—security, shelter, food, water and
health. They also involve a loss of the familiar, accustomed life and way of doing things
which is profoundly disturbing, not only for the most vulnerable groups, but also for
people who were accustomed to coping adequately in their familiar life setting. These
rights were identified by Amartya Sen as “second-generation” rights that support human
capacities to realize the kind of life that people would like to live. Expressed in these
terms, as social, economic and cultural rights, they have been recognized more recently
than human rights related to political expression, the right of free association, political
participation and freedom of expression [6,57,58].
Breaches of medical neutrality
Breaches of medical neutrality comprise a second social determinant specific to a
conflict setting. These are especially relevant for the right to health care, as combatants
attempt to weaken the resistance of civilians by deliberately depriving them of access to
care, especially at the times when they most need it. They are violations of the Fourth
Geneva Convention, Article 18 [29]. In the Eastern Mediterranean Region, examples of
such violations include:
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attacks on health facilities and staff;
SDH-chapters-countries in conflict-7 Oct.indd 27 08/10/2008 14:24:50