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The impact of war on the health of millions of women and children

A comprehensive new report documents the brutal effects of modern warfare on women and children worldwide.

“Today, more than half of the world’s women and children are living in countries experiencing active conflict. The international community cannot continue to ignore their plight,” says Dr. Zulfiqar Bhutta, co-author of a commentary that accompanies a wide-ranging, four-part examination of the human cost of modern warfare published in The Lancet.

The researchers behind the series estimate that in 2017, armed conflict affected at least 630 million women and children globally. They also state that over the last 20 years, warfare has resulted in the deaths of more than 10 million children under 5 years of age, including between 6.7 and 7.5 million infants.

The BRANCH (Bridging Research & Action in Conflict Settings for the Health of Women & Children) Consortium developed the series.

The authors derived their insights from new analysis models and data from numerous humanitarian agencies, local research partners, and civil society organizations.

Dr. Bhutta, who led the series, says, “The new estimates provide compelling evidence of the enormous indirect toll of modern warfare caused by easily preventable infectious diseases, malnutrition, sexual violence, and poor mental health, as well as the destruction of basic services, such as water and medical facilities.”

According to the series, in 2019, there were 54 state-based armed conflicts that had lasted 20 years or more, occurring in 35 countries.

“The nature of armed conflict throughout the world is intensely dynamic,” write the authors of “The political and security dimensions of the humanitarian health response to violent conflict,” one of the articles.

In contemporary conflicts, there appears to be little regard for International Humanitarian Law. There is frequent deployment of chemical and explosive weapons in urban areas, and there is pervasive sexual violence. Combatants also engage in hybrid forms of warfare, including cyberattacks, that disrupt local life.

Residents are often driven from their homes to seek shelter elsewhere in their countries or across international borders as refugees.

In 2017, 1 in 10 women and nearly 1 in 6 children globally were living within 50 kilometers of armed conflict, or it had forcibly displaced them.

For people living in areas with active combat, the danger goes beyond direct violence. Evidence suggests that the risk of dying from nonviolent causes increases substantially with proximity to intense and chronic conflicts.

Women of childbearing age living near intense fighting are three times more likely to die than women living in peaceful settings.

Their infants are also more than 25% more likely to die young.

The series acknowledges the difficulties of providing aid to the women and children that war affects. Aside from the need to avoid fighting, shortages of skilled healthcare workers and funding, as well as the politicization of warfare, hamper humanitarian efforts.

In addition, healthcare workers are at risk of being kidnapped, as has occurred in Colombia and Somalia. SARS-CoV-2 infection concerns are an added complication.

At the same time, the authors of the series note that humanitarian organizations are creatively responding to difficulties with innovative approaches leveraging local resources and technology.

According to Prof. Isabel Garcés-Palacio of the Universidad de Antioquia in Colombia, “Although these solutions need more rigorous evaluation, they have the potential to provide a timely response to current implementation challenges and remind health authorities of their responsibility to deliver basic health services to the whole population.”

“It’s time,” says Dr. Bhutta, “for a radical rethink of the global response that confronts challenges to insecurity, access, politics, coordination, and the logistics of delivering high priority interventions to women and children in politically unstable and insecure settings.”

“While the needs of conflict-affected communities are great, their voices are also often unheard or overlooked, so it is imperative they have a seat at the table — and that humanitarian actors listen to them — when decisions concerning them are made,” adds co-author Dr. Neha Singh.

The series is capped by a comment that the former prime minister of New Zealand, Helen Clark, contributed. Clark concludes:

“The rights and needs of women, children, and adolescents must be placed at the center of all humanitarian, development, and peace-building efforts, in line with the concept of centrality of protection. Doing this isn’t the responsibility of any one sector or stakeholder group, and all actors need collectively to agree on and demand greater alignment, investment, and political attention for women, children, and adolescents who are trapped in conflict zones. Only then can the unequal burden of preventable morbidity and mortality in the world’s most challenging regions be addressed in a way that ensures that no one is left behind.”

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