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

32 Social determinants of health in countries in conflict
now been formally adopted by WHO and UNICEF for all community-based settings
in which children suffer from severe acute malnutrition [80,81,82]. Infectious diseases,
such as diarrhoeal diseases, acute respiratory infections, and, to a lesser extent, vaccinepreventable
diseases, become major causes of morbidity (and mortality) among children
in conflict settings, especially among refugees and IDPs. One camp in Darfur recorded
a 50% weekly attack rate of diarrhoea among children [43]. As noted above, two thirds
of infant deaths in one district of Afghanistan were caused by infectious diseases; in
Afghanistan such tragedies are the result of long-term poverty, compounded by conflict
which destroys the ability of the country to deliver effective health care [51].
In contrast, in occupied Palestinian territory, as of June 2006 (before the July–August
conflict), only 6.6% of infant mortality was caused by infectious diseases. Other health
status indicators also appeared to have held up well. As of mid-2006, the immunization
programme was functioning well, with coverage of more than 95% for diphtheria,
pertussis and tetanus (DPT), hepatitis B and measles, mumps and rubella (MMR) [83].
In the occupied Palestinian territory, in spite of the long-term chronic crisis, child
health trends have improved. This has been attributed to the ability of the health system
to deliver care under difficulties and the high level of motivation of the national staff,
thus contributing to the control of major childhood infectious diseases, the maintenance
of immunization and oral rehydration programmes, and an increase in the number of
deliveries taking place in hospitals. The high educational status of the population has
also been identified as supporting child health. Whether or not these health indicators
can hold up in the long run is a moot point, given recent assaults on health services
and deteriorating security. Recent evidence indicates that chronic malnutrition among
children has been increasing, suggesting that food security problems are affecting
children’s health [83].
5.5 Older children in conflict settings
In emergency settings, children may adopt new roles; no longer in school, they may
be helping to provide food and care for the family or for younger siblings and young girls
may be mothers. Some boys as young as 12 years of age may be abducted or “voluntarily”
join rebel groups and be given arms, and girls have been forced into various forms of
sexual slavery, as reported since early 2004 in Darfur [84]. UNICEF is now working to
reintegrate former child soldiers in southern Sudan into society, and provide them with
education, employment skills and counselling. The resilience of these children was noted
to be remarkable [85]. Yet, it appears that the resilience and strengths of children are
rarely acknowledged in conflict settings, as they undertake what are often seen as adult
roles or are engaged in the fighting. Human rights are not confined to adults; children
too, have the right to be listened to, and to participate in health decisions that affect
them [73]. At the same time, it is important to appreciate the wider context within which
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