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

Social determinants of health in countries in conflict 53
improve the Ministry’s ability to influence policy-makers and deliver a sustainable and
equitable service delivery system in more peaceful times [121].
Where many health facilities have been destroyed or severely damaged, and many
health staff have fled, it is essential to rebuild and refurbish facilities and ensure that
they are staffed by trained health workers. Regional Office technical support to nurses,
midwives and other cadres, in collaboration with partners, includes support for institutes
of health sciences and nursing/midwifery in Somalia, Afghanistan and Sudan, plans of
action on nursing and midwifery in Iraq and Somalia, and curriculum development in
Afghanistan and Somalia.
In Somalia, the Regional Office is supporting collaborative programmes to
strengthen nursing schools to provide nurses and midwives for all three zones of
Somalia: in Bossaso, Mogadishu, and Garawe and at the Institute of Health Sciences in
Hargeisa. The need for such services was illustrated by a May 2007 assessment in the
Sanaag Region which found that most health posts were closed except for those run by
the Somali Red Crescent Society; the last training of trained birth attendants took place
5 years ago; and all deliveries took place at home with unskilled birth attendants [122].
In Afghanistan, technical support is being provided to institutes of health sciences and
the community midwifery programme. Currently, there is a serious shortage of female
health workers due to security problems and restrictions on women's education and work;
as of July 2006, 90% of trainee nurses were male [123].
The north-west zone of Somalia is making an attempt to rebuild the health system
following widespread destruction of health facilities and mass migration or death of health
workers. International linkages, specifically with institutions in the United Kingdom,
support rebuilding facilities, staffing and especially professional education [124]. This
effort is quoted as a “rare success story of post-conflict reconstruction” [125].
In the West Bank areas affected by the separation wall, as of early 2005 (before the
crisis of 2006), mobile clinics operated jointly by the Ministry of Health and UNRWA
provided the full package of primary health care services, including vaccination,
antenatal care and care for chronically-ill people. These clinics were part of the
emergency response project and became more important after the extension of closures
and the construction of the separation wall. In early 2005, these clinics served more than
26 000 beneficiaries in 135 remote locations, reducing the percentage of the population
not receiving health care from 70% to 50%. Funds and coordination provided by the
European Union and European Commission Humanitarian Office (ECHO) were crucial
in supporting this system of mobile clinics. According to the Palestinian civil society
report: “Mobile clinics represent a success story in coordination, resource use and human
intention, as mobile clinic staff put their lives at risk to serve the Palestinian population
and provide it with the opportunity to live a healthy life.”
SDH-chapters-countries in conflict-7 Oct.indd 53 08/10/2008 14:24:53