Addressing the humanitarian challenge

The International Committee of the Red Cross works to bring UHC to victims of conflict, but meaningful political action
is also needed

By Peter Maurer, International Committee of the Red Cross

Delivering health services to victims of conflict without distinction or discrimination is an increasingly complex challenge in contemporary conflicts. A political environment in which professional and ethical solutions can flourish is vital so that health care is not tainted by political or military considerations, and the sanctity of health care is upheld.

The International Committee of the Red Cross has observed over many years the devastating impacts when health care is politicised, used as a tactic of war or directed to control populations, resulting in large sections of communities cut off from help. These tactics also impede the achievement of universal health coverage, which relies on full access, quality and impartial service delivery to all segments of the population, and health facilities and personnel protected from attack.

People’s health outcomes depend on other systems, such as sanitation, infrastructure, food, education and security. A breakdown of water and sanitation infrastructure is often the origin of water-borne diseases; food insecurity heightens the risk of mortality for the most vulnerable; and low education levels often present a roadblock for effective public health measures.

The international community, states and local actors cannot take their eyes off the achievement of universal health coverage. A crucial first step is ensuring full access to, and the protection of health care in, areas affected by conflict and violence.

Access is an encompassing concept: it means healthcare workers can access communities and that patients can freely access services.

Attention should focus on reaching those who face particular challenges in accessing health care and making the invisible visible. This may include women, children, the elderly, survivors of sexual violence, persons with disabilities, those dealing with mental health conditions and detainees. They all require specific approaches from trained and skilled health workers.

APPROACHING THE ISSUES

The ICRC has a unique needs-based approach in its humanitarian delivery, which allows for several health determinants to be addressed at once. For example, the multidisciplinary programme for survivors of sexual violence involves clinical care, mental health and psychosocial support as well as economic security support and protection measures.

Another example is ICRC’s training of community health workers in primary health care to identify signs of high-risk pregnancies. Improving pregnancy outcomes might involve antenatal consultations and vaccinations at the primary healthcare level, training and essential supplies packages for traditional birth attendants or negotiations with fighting factions to allow for the rapid referral of women requiring hospital care.

Anchored in our field experience, these programmes highlight the reality that health care is as much of an urgent short-term need as a long-term investment. It would be futile to design treatment for persons with mental health issues if there is no continuum of care, or if there is no system in place with an adequately trained health force. It is also impossible to conceive of the proper management of non-communicable diseases in fragile settings in the absence of evidence-based research of what works in these settings.

These activities take time and should prompt governments, donors and agencies to consider health care in humanitarian settings as a part of a long-term investment to providing a continuum of care for people affected by conflict (in all of its phases) and violence.

Finally, another crucial step towards achieving universal health coverage is the common effort in preventing the total collapse of healthcare systems amid crisis.

In this regard, the ICRC works to support and safeguard key health system pillars in conflict areas where other agencies have restricted access, to keep them functioning even when other systems seem to be collapsing. This effort, however, should be shared with governments and other actors, who must take all feasible measures to limit the destruction of health.

The protection of health in armed conflicts is a political choice – choices that determine humanitarian realities, that affect people, communities and systems. The ICRC, as a neutral, impartial and independent humanitarian organisation, does not exist to help authorities further their political objectives, but it works to help them live up to their obligations under international humanitarian law. Modern international humanitarian law in fact originated from the idea that enhancing the protection of the medical mission was an essential step to better assist and protect victims of armed conflict.

The ways in which parties to conflict comply – or not – with their obligations under international humanitarian law to protect civilians and civilian infrastructure have real and long-lasting consequences on the ability of health and other systems to withstand and recover from conflict.

Even though the humanitarian principles that guide ICRC’s work are, by themselves, drivers to reach universal health coverage, its full realisation depends on balanced political decisions.