Consequences of war for people: destroyed continuity of care now, lack of care provision later
Since 24th February 2022, we have all seen the images from Ukraine. At the International Foundation for Integrated Care (IFIC), our thoughts are with the Ukrainian people and most particularly with people living with long-term care needs, their family, carers and health and care practitioners, all continuing to care in unimaginable circumstances. We extend our message to people in all conflict zones around the world.
The breakdown of existing health and social services particularly those outside of hospitals creates an invisible and often silent crisis for children and adults living with chronic and long-term conditions. The disruption of the continuity of care, as well as treatment supply and access, leave people with long-term conditions without any chronic care and support. We know that some of these people are being evacuated from war zones, but the interruption of the care can have a devastating impact on short- and long- term health and wellbeing. We are aware that the pressure placed on the health and care systems and communities of bordering countries receiving refugees will be huge. Health and care services around the globe are already in crisis due to the COVID pandemic. So, for those countries bordering Ukraine, their health and care systems are likely to struggle to respond to the needs of the huge number of war refugees. For that reason, we fully support the call for European Union solidarity with these countries providing resources to meet the health and care needs of the incoming population.
Wars lead to a major public health crisis beyond direct injuries and death, and long-term effects can last years after the end of the conflict period.(1-2) There is little discussion of the fact that wars have dramatic consequences on the populations’ health and wellbeing. In addition to direct violence resulting in injuries and death, people are exposed to incalculable distress and suffering, all types of atrocities and loss, basic hygiene and sanitation are not available, water and food access insecurity, education is suspended for children, and women’s and children’s care is stopped. As a consequence, chronic care conditions and mental health issues increase during and after war, disability and adaptation problems arise. At the same time the capacity of the communities and the systems to support them have been taken away.
The interruption of health and care services affect people with long-term needs most. The effect on them will not be evident in most statistics and numbers reported in Ukraine now; but in the years to come, the effect will become evident just as it has done for people and communities exposed to other conflicts worldwide.(3-6) Adults and children in need of support, with disabilities or long-term conditions will suffer most, their quality-of-life and survival options will decrease, and the consequences for them will be life-long in many cases.(7-10)
Providing the adequate care to displaced communities and refugees poses a significant challenge, particularly to those with chronic conditions, whether they have received asylum in another country or live in refugee camps. The stateless and homeless situation for refugees can perpetuate the lack of access to health and care services in the host countries. What is more, even in the cases of high political willingness, displaced populations may face fragmented healthcare systems in the host countries that may not have the necessary resources to respond to the physical, mental, social, spiritual and cultural needs of this displaced population.(11) The international community need to prioritise the health, care and support needs of all refugees, particularly those of children and people living with chronic conditions.(12-17)
Looking to the future post-conflict, the reconstruction of the health and care after the end of the armed conflict needs a long-term commitment. Over recent years, Ukraine had been making some steps towards the reform and strengthening of its health and care system in the different Oblasts (provinces), improving effectiveness, access, and quality of primary and secondary healthcare services. This has now come to a halt and the return to this promising reform path may not be automatic after the war. In the context of a destroyed country and disrupted economic activity, resources may need to be diverted to other priority areas which may delay the capacity of the country to provide long-term care and support that the population will need after war. In this regard, the lack of health and care workforce needs to be taken into consideration too, as they are frequently targeted during the armed conflicts or displaced to other countries.
These are hard and sad times, but we need to remember that hard times will continue after the end of the conflict, which we hope will happen sooner rather than later. As an international community the Foundation and its network are aware of the long-term impact of armed conflicts. When institutions and infrastructure fail or are destroyed, it is the innate resilience of people and their communities that provide the primary means to survive and endure. In these situations, resilience does not stand in isolation; people organise themselves and collaborate to pool resources and provide mutual support based on solidarity, common interests, and shared identity as human beings.(18)
The international community needs to do everything in its hands to prevent armed conflicts, care for all refugees, and support the reconstruction of the regions after war, prioritising the prompt continuity of education and health and care systems.
The Foundation stands with individuals and communities from across the globe in calling for an end to the war, for peaceful resolution and the restoring of order and prosperity in the Ukraine.
- Murray CJL, King G, Lopez AD, Tomijima N, Krug EG. Armed conflict as a public health problem. BMJ. 2002 Feb 9;324(7333):346–9.
- Ghobarah HA, Huth P, Russett B. The post-war public health effects of civil conflict. Soc Sci Med. 2004 Aug;59(4):869–84.
- World Health Organisation (WHO). Mental health conditions in conflict situations are much more widespread than we thought [Internet]. [cited 2022 Mar 9]. Available from: https://www.who.int/news-room/commentaries/detail/mental-health-conditions-in-conflict-situations-are-much-more-widespread-than-we-thought
- Dar AA, Deb S. Mental Health in the Face of Armed Conflict: Experience from Young Adults of Kashmir. Journal of Loss and Trauma. 2021 Apr 3;26(3):287–97.
- Valand P, Miles J, Pandya AN. The deleterious effects of war and conflict on the provision of health care for vulnerable populations and the potential effects of COVID-19 on vulnerable populations in conflict zones. IJS Global Health. 2020 Nov;3(6):e36.
- Natasja Sheriff. The Silent Suffering of Syria’s Chronically Ill [Internet]. The New Humanitarian. 2016 [cited 2022 Mar 9]. Available from: https://deeply.thenewhumanitarian.org/syria/articles/2016/07/08/the-silent-suffering-of-syrias-chronically-ill
- Office of the Special Representative of the Secretary-General, for Children and Armed Conflict. The Six Grave Violations Against Children During Armed Conflict: The Legal Foundation [Internet]. 2009 [cited 2022 Mar 9]. Available from: https://childrenandarmedconflict.un.org/publications/WorkingPaper-1_SixGraveViolationsLegalFoundation.pdf
- Imperial College London. Long-term health effects of armed conflict could last years after bombs stop falling [Internet]. ScienceDaily. 2019 [cited 2022 Mar 9]. Available from: https://www.sciencedaily.com/releases/2019/05/190528193036.htm
- Médecins Sans Frontières (MSF) International. War and conflict in depth [Internet]. Médecins Sans Frontières (MSF) International. [cited 2022 Mar 9]. Available from: https://www.msf.org/war-and-conflict-depth
- Bendavid E, Boerma T, Akseer N, Langer A, Malembaka EB, Okiro EA, et al. The effects of armed conflict on the health of women and children. Lancet. 2021 Feb 6;397(10273):522–32.
- Riza E, Karnaki P, Gil-Salmerón A, Zota K, Ho M, Petropoulou M, et al. Determinants of Refugee and Migrant Health Status in 10 European Countries: The Mig-HealthCare Project. International Journal of Environmental Research and Public Health. 2020 Jan;17(17):6353.
- Terasaki G, Ahrenholz NC, Haider MZ. Care of Adult Refugees with Chronic Conditions. Med Clin North Am. 2015 Sep;99(5):1039–58.
- Mikolajczyk RT, Maxwell AE, Eljedi A. Quality of Life and Chronic Illness among Refugee Populations. In: Preedy VR, Watson RR, editors. Handbook of Disease Burdens and Quality of Life Measures [Internet]. New York, NY: Springer; 2010 [cited 2022 Mar 9]. p. 3397–412. Available from: https://doi.org/10.1007/978-0-387-78665-0_196
- Al Rousan T, Schwabkey Z, Jirmanus L, Nelson BD. Health needs and priorities of Syrian refugees in camps and urban settings in Jordan: perspectives of refugees and health care providers. East Mediterr Health J. 2018 Mar 1;24(03):243–53.
- Bardenheier BH, Phares CR, Simpson D, Gregg E, Cho P, Benoit S, et al. Trends in Chronic Diseases Reported by Refugees Originating from Burma Resettling to the United States from Camps Versus Urban Areas During 2009-2016. J Immigr Minor Health. 2019 Apr;21(2):246–56.
- Doocy S, Lyles E, Roberton T, Akhu-Zaheya L, Oweis A, Burnham G. Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan. BMC Public Health. 2015 Oct 31;15(1):1097.
- Naja F, Shatila H, El Koussa M, Meho L, Ghandour L, Saleh S. Burden of non-communicable diseases among Syrian refugees: a scoping review. BMC Public Health. 2019 May 24;19(1):637.
- Joan Barceló. The long-term effects of war exposure on civic engagement [Internet]. PNAS. 2021 [cited 2022 Mar 9]. Available from: https://www.pnas.org/doi/abs/10.1073/pnas.2015539118