Health care in conflict zones: a VaccinesWork guide

This week VaccinesWork is shining a light on the consequences that conflict and fragility have on health, as well as the health care heroes braving some of the world’s most challenging conditions to keep communities safe.

  • 14 October 2024
  • 3 min read
  • by Maya Prabhu ,   James Fulker
A group of women and girls outside at an internally displaced person's (IDP) camp in the Bonder district of Mogadishu, Somalia. Credit: Gavi/2017/Karel Prinsloo
A group of women and girls outside at an internally displaced person's (IDP) camp in the Bonder district of Mogadishu, Somalia. Credit: Gavi/2017/Karel Prinsloo
 

 

In the middle of a war zone, a functioning health system may seem like it would come pretty far down the priority list. But throughout history the biggest killer in conflicts has always been what was known as ‘the third army’: disease.

During the Napoleonic wars, eight times more people in the British army died from disease than their battle wounds. In the American civil war two-thirds of total deaths were caused by pneumonia, typhoid, dysentery and malaria.

Today the World Health Organization estimates that countries that host fragile, conflict-affected and vulnerable settings are home to nearly a quarter of the world’s population, yet host more than 70% of cases of epidemic-prone diseases, such as cholera, measles and meningitis, as well as more than half of deaths in children under five. 

War and pestilence still march side by side.

When we talk about reaching the most vulnerable, the ‘zero-dose’ children, the communities unreached by health systems, these are – increasingly – the populations we need to focus on.

Nearly half of countries eligible for Gavi funding are now classed as fragile or conflict-affected, with a proportion of unimmunised children three times higher than the rest of the world. Gavi is now aiming to raise US$ 9 billion for the 2026–30 period to continue its work in these regions, working with new partners and new approaches to reach the very hardest to reach.

The consequences of inaction can be global as well as local. It is no coincidence that the mpox outbreak currently spreading throughout Africa had its origins in a region that has been beset by decades of conflict, where we have also seen Ebola, cholera and measles outbreaks in recent years.

But alongside the gloomy statistics come stories of unimaginable bravery, ingenuity and hope. In the Horn of Africa, humanitarian negotiators are joining vaccinators to ensure no child is forced to go without access to vaccines.

Seventy-four “vaccination ceasefires”, in which both sides of an active conflict agree to stop the fighting to allow for a vaccine campaign, were recorded from 1985–2018 in conflicts from Afghanistan to Sri Lanka. The most recent example, of course, took place in Gaza last month.

This week on VaccinesWork, we’ll be looking to highlight the stories of the people trying to prevent disease in communities who have already suffered enough, as well as looking at the consequences conflict and fragility can have on people’s health.

In the meantime, here’s a list of some of our favourite stories from the archive.

- The Editors

Amid war, and on camelback: how Sudan’s vaccinators are delivering a dose of hope

With one of the world’s worst ongoing conflicts exploding around them, Sudan’s vaccinators are not giving up their mission.

Read story
 

Where delivering health care means facing down armed bandits

In northwest Nigeria, many of Abubakar’s friends left when bandits began to attack his town. He, however, decided to stay, to continue his work protecting the health of his community.

Read story
 

Haiti: rising vaccination rates despite socio-political unrest

Despite rising tensions and heightening violence, Haiti’s vaccination coverage rose by an estimated 10% between 2022 and 2023. How did they do it?

Read story
 

The devastating impact of war on antimicrobial resistance

Could conflict be helping to spread drug resistance? VaccinesWork spoke to the Ukraine Country Director of the US Centers for Disease Control and Prevention (CDC) to find out the impact the war there is having on AMR.

Read story
 

Where routine immunisation is anything but routine: vaccinating Rohingya children in Bangladesh

Back in 2022 we visited the world’s largest refugee camp to see how local authorities were working hard to ensure Rohingya children didn’t miss out on their routine vaccinations.

Read story