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

40 Social determinants of health in countries in conflict
marriage and rape. They estimated that drug addiction affects almost 5 million people.
Drugs can be found everywhere, and even security forces are illicitly involved in drug
distribution. (Afghanistan is the world’s largest producer of opium, most of which is
smuggled across its borders to find ready markets in the west.) Mental health problems
were estimated to affect 50% of people; respondents coined the term “continuous stress”
to describe the current situation over anxiety about poverty and obtaining food, and daily
fear and danger. Other problems were identified as:
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malnutrition resulting in the short height of the new generation, and people going
prematurely grey and losing their teeth;
poor access to services was reflected in reports of health services in crisis: many
facilities have been destroyed, others are of low quality, and have few medicines;
there is a shortage of health staff, especially females, and many staff have left the
country;
the deterioration in agriculture, irrigation systems, forests and access to fuel;
scarcity of safe water, even in large cities;
disruption of foodstuff transportation to remote areas;
damage to schools, unavailability of teachers; the lack of teacher training and
education for girls (boys may also be forbidden to go to school).
The consensus was that some groups were especially vulnerable because:
the poor can not afford to flee from danger, especially those near front-line
fighting in Kabul;
youth face death or physical disability;
women receive poorer treatment at health facilities than men, and face
complications of pregnancy and sexual violence;
children suffer from undernutrition, infectious diseases and abuse;
refugees have no access to regular health services, except immunization during
national immunization days (NIDs);
nomads (between one fifth and one seventh of the population) and IDPs are not
covered by existing health services.
Coping strategies were related to individual and family ability. Wealthier people
left the country or moved to safer cities, where health and social services were better.
The most wealthy migrated to the USA, Europe and other developed countries; the
middle class to the Islamic Republic of Iran and Pakistan. Currently, wealthy people go
to Pakistan or India for medical treatment.
SDH-chapters-countries in conflict-7 Oct.indd 40 08/10/2008 14:24:52