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

30 Social determinants of health in countries in conflict
5.2 Other intermediate determinants
Guidance for actions and interventions to improve health outcomes requires an
analysis of the health and social status of groups usually regarded as vulnerable, such
as children, women or older people. But in conflict settings everyone, in one way or
another, is vulnerable. Depending on the setting, members of these groups are vulnerable
to violence as actual or perceived combatants or as bystanders; to malnutrition; to lack
of social capital; to loss of livelihoods and meaningful activities; and to lack of access
to health care.
5.3 Early childhood
In emergency settings, children under 5 years of age are most vulnerable, very often
living and dying without adequate nutrition and health care in unhygienic environments.
The commonest causes of death and illness are the same as those usually experienced
in low-income countries: diarrhoeal diseases, respiratory infections, measles and
malnutrition. Children and young people often comprise the highest proportion of the
population in refugee and IDP camps, and are exposed to risks over which they have
little control [47,73].
The social determinants affecting children in crisis settings are the same as those
affecting children in low-income countries: (1) lack of safe water and sanitation; poor
quality housing; (2) poor nutrition; and (3) lack of access to health services. In conflict
settings, these social determinants influence the health, opportunities for social and
intellectual development and quality of life of children even more, as they operate in an
environment in which the basic rights of children have deteriorated due to:
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lack of security and family support, so essential during the first 5 years in
providing a stable foundation for the rest of life;
immediate threats to security during occupation, fighting, etc.; experience of
traumatic events;
lack of opportunity to learn social skills through social interaction with family and
peers;
lack of opportunity to play as a way of developing social and motor skills.
Conflict may result in the breakdown of the family unit, which has a negative impact
on the development of children. As the social fabric of society breaks down, especially
at the level of the family, children are denied lasting relationships with parents and
other carers, siblings and other kin, which impedes their normal development, in terms
of forming social relationships based on trust. Children taken in by extended family
members or who have even one immediate family member are less likely to experience
SDH-chapters-countries in conflict-7 Oct.indd 30 08/10/2008 14:24:50