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

28 Social determinants of health in countries in conflict
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attacks on health care providers and patients;
attacks on medical convoys and ambulances;
barriers, checkpoints and barrier walls that obstruct access to care;
the politicization of health services, resulting in discrimination in the provision of
health care on the basis of social identity.
In Iraq, many other breaches of medical neutrality have been recorded. Armed men
have entered hospitals, demanded treatment for their injured comrades or have randomly
attacked health staff. Like teachers and university professors, health staff are captured for
ransom, they are assumed to belong to families who can pay the ransom and are targeted
also because they work for the government. Iraqi Red Crescent employees have also
been attacked [37,59,60].
In the occupied Palestinian territory, the Red Crescent Society is the main provider
of ambulance services. Between 29 September 2000 and 31 December 2005, they
reported that 1905 ambulances were prevented from reaching hospitals, 36 drivers and
medical personnel were killed and 457 injured, and 351 health facilities were attacked
[61]. Furthermore, according to the civil society report, the blockade on goods entering
occupied Palestinian territory seriously affects Palestinian health services, making it very
difficult for the Ministry of Health to import raw materials for local manufacture or to
procure medicines from outside the occupied Palestinian territory.
Stress, distress and disease
The progression from stress to distress to disease is seen as the third major
determinant, an intermediate determinant that results from constant, unremitting
exposure to life-threatening situations, the final outcome of which is a disabling mental
health problem. Mental health in conflict settings deserves a prominent place in analysis
as it is linked to extreme stress, especially as deriving from the structural determinant,
the loss of human rights to security and basic needs. Poor mental health and the inability
to cope with daily life are the cumulative result of deprivations found in all countries
in conflict situations. As there is no universal response to conflict and its deprivations,
there is no universal measurement of mental health [19].
In Iraq, in June 2005, after 12 years of economic sanctions and two wars, there
were approximately 5 million people (20% of the population) experiencing “significant
psychological symptoms” and at least 300 000 people suffering from “severe mental
health-related conditions” [62]. Of the 2000 people interviewed in 18 provinces of Iraq
in late 2006—a period of increasing insecurity for the civilian population—92% feared
being killed in an explosion and 60% said that the level of violence had caused them to
have panic attacks [63]. Such high levels of mental distress are likely to affect people
for many years to come.
SDH-chapters-countries in conflict-7 Oct.indd 28 08/10/2008 14:24:50