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

56 Social determinants of health in countries in conflict
vulnerability of those who are disadvantaged because of poverty, marginalization and
discrimination.
The WHO Regional Office for the Eastern Mediterranean, individual countries
in the Region and civil society partners expressed concerns that the particular social
determinants of health associated with conflicts in the Region should be identified and
explored. As a result of these concerns the Commission on Social Determinants of Health
requested a review from the Region and through this review three social determinants that
have a bearing on health and which are peculiar to a conflict setting were identified: loss
of human rights, breaches of medical neutrality and progression from stress to distress
and disease. As noted in Chapter 1, the Commission on Social Determinants of Health
identifies several ways of looking at social determinants. The structural determinants of
health in conflict settings include the broad economic, cultural, historical, environmental
and “political” determinants of health at the country and global level. These affect power
relationships that determine the distribution of power, prestige and resources globally
and within a particular country or society, including those needed to maintain health and
social well-being.
The structural determinants are reflected in the intermediate, and strictly more
“social” determinants, the conditions in which people live which affect their health
status. The loss of human rights is the first and most important of the major structural
determinants in conflict settings. The second major structural determinant, breaches
of medical neutrality, is especially relevant for the right to health care, as combatants
attempt to weaken the resistance of civilians by deliberately depriving them of access to
care, especially at the times when they most need it. They are violations of the Fourth
Geneva Convention, Article 18 [29].
Armed conflict results in life settings that produce high levels of mortality, disability
and morbidity (physical as well as mental), directly or indirectly resulting from the
conflict, when compared to health outcomes in otherwise comparable non-conflict
settings. From a social determinants and public health perspective, it is essential to link
together, both conceptually and in practice, the strategies that are needed to work at the
different levels: local, regional and national (see Box 4 for macro-level strategies).
One way of addressing the structural determinants at national level is to look at
the concept of conflict transformation, as an innovative approach to mitigate the health
impact of armed conflict. It starts from the understanding that “conflicts are embedded
in relations at the individual, interpersonal, organizational, community and international
levels, and include psychological, sociocultural, spiritual, political, historical and
economic dimensions” [126]. Conflict transformation incorporates an appreciation of
the value of participation, inclusiveness, empowerment, social justice and healing at the
community level, as well as at regional and national levels. This approach recognizes
the loss felt by people caught in the tragedy of conflict. Above all, it identifies the
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