Healthcare in war zones: 10 things to know

What healthcare looks like before, and after, war.

Foreign conflict has dominated the news cycle this week, with escalating conflict between Israel and Hamas in Gaza and increased tensions between the U.S., Ukraine and Russia following the downing of Malaysian Airlines Flight MH17, suspected to have been targeted by pro-Russian separatists occupying eastern Ukraine.
As a result of these conflicts, thousands have been injured and killed. Recent estimates place the number killed in Gaza at 655, with more than 4,200 injured. How are these injured cared for? This question piqued our curiosity at Becker's, so we did some investigating. Here are 10 things we found out about providing healthcare in war zones and how clinicians and resources are deployed war-torn areas.
1. Humanitarian groups are often needed to maintain access to care. Not surprisingly, access to healthcare decreases significantly during times of conflict. Yet, access becomes more important than in times of peace, as clinicians are needed to treat injuries as well as the infectious and noninfectious diseases that can become more prevalent in times when individuals are living in cramped quarters under worse-than-usual living conditions. Access issues are further exacerbated during active air strikes and when relief workers must be removed from areas due to safety issues. Existing healthcare facilities (usually part of state-run systems) are often unable to meet demand or even operate, making humanitarian aid the only way to provide care. Even after a conflict ends, the healthcare infrastructure will take some time to rebuild. For example, one recent study of Iraqis found that 50,000 to 100,000 travel each year to Lebanon, Jordan, Iran and Turkey, and India to receive care, despite the existence of a state-run system.
2. United Nations workers and humanitarian groups provide the majority of healthcare services to civilians during foreign conflict. The UN works to negotiate "zones of peace" with those leading the conflict, and then directs aid to these areas using its own workers or by bringing in multinational humanitarian groups, like the Red Cross, Oxfam and Doctors Without Borders. The humanitarian and disaster-relief efforts of the UN are overseen and facilitated by the Office for the Coordination of Humanitarian Affairs, led by the United Nations Emergency Relief Coordinator.
3. One of the largest international humanitarian movements is the International Red Cross, which dates back to the founding of the IRC Committee in Geneva, Switzerland, in 1863. In 1864, the First Geneva Convention issued protecting the war wounded and identifying the red cross on a white field as a neutral protective emblem. In 1881, Clara Barton established the American Red Cross.
4. Another notable humanitarian effort is Doctors Without Borders, which was founded in 1971 and provides emergency medical care to people in crises in 70 countries, including armed conflicts, malnutrition crises and natural disasters. There are more than 30,000 physicians, nurses or other types of humanitarian workers on site on any given day. DWB staff must dedicate nine months to a year to the program once they are assigned.
5. Relief workers put their lives at grave risk to provide care. In 2013, 155 relief workers were killed, 168 injured and 132 kidnapped. In January, five Doctors Without Borders workers were kidnapped in Syria. The group's workers, who were operating six hospitals in Northern Syria, were released after five months in captivity.

6. Much war-zone relief work is funded by individuals, not companies or governments. Ninety percent of Doctors Without Borders funding comes from individual donors who give small donations. The Red Cross is funded largely by individual donations and a combination of government and private grants.
7. The leading causes of death in war-torn areas might surprise you. Heart disease and respiratory infections were the leading cause of death in the Arab world from 1990-2010, according to a study in The Lancent funded by the Bill and Melinda Gates Foundation. With nutritional issues and communicable diseases no longer the top cause of death, this "change in the burden of disease" will challenge both existing healthcare systems and humanitarian aid workers to adjust their approach to providing care.
8. Under the Geneva Conventions, hospitals or mobile medical units are in no circumstances to be attacked in a conflict. But alleged attacks on hospitals in the Gaza Strip have made headlines in the past few days. There have been several reports of hospitals hit by the Israeli military, which has claimed Hamas uses schools and hospitals to hide weapons and coordinate attacks, according to the Washington Post.
9. Regardless of why the hospitals were struck or whether the attacks were intentional, the damage and ongoing conflict has an immense effect on Gaza's healthcare capabilities. As of July 20, Amnesty International reported that at least 13 health facilities were forced to close amid the conflict, along with 84 schools. The region is also experiencing a "serious shortage" of medicine and other medical supplies across its hospitals, not to mention a power shortage necessitating the use of "old-fashioned power generators," according to a Gulf News report.

"If Gaza hospitals are not immediately supplied with intravenous fluids, anesthesia and the medicines needed in the intensive care units, along with other basic medical needs like gauze and intravenous drip supplies, medical services in Gaza will be automatically suspended," Nasser Al Qedrah, MD, spokesperson for the Gaza Health Ministry, said in the Amnesty International report.
10. Relating to hospital bombings, similar destruction as part of the civil war in Syria has left the country's healthcare system collapsed. Last year, government forces bombed and shelled hospitals in rebel-held areas last year as a way to withhold healthcare as a "weapon of war," according to a Reuters report. A report from international charity group Save the Children found 60 percent of Syria's hospitals were damaged or destroyed, drug production fell by 70 percent and nearly half of the physician workforce fled the country, according to a NewsHour report.


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