Healthcare in times of violent conflict

Violent Conflict and the Demand for Healthcare

Wars have devastating consequences. In a new study Max Schaub has analyzed violent conflicts and the demand for healthcare in African Countries from the early 2000s on. While researches have good evidence that factors such as the destruction of infrastructure, political neglect, and the out-migration of health workers negatively affect health outcomes, we know much less about how violence shapes the attitudes and behavior towards healthcare use among civilians exposed to violent conflict.

The analysis covers 22 conflict-affected African countries —representing all major regions of Africa from the early 2000s to around 2017. The researcher combined information from over 80,000 interviews conducted in Africa with individual and context-level measures of exposure to violent conflict.

Max Schaub shows that exposure to violence is associated with significantly lower levels of political trust and increased fear of future violence, which in turn predict lower healthcare utilization, lower immunization rates, and higher infant and child mortality. Knock-on effects are lowered vaccination rates, and, ultimately, higher levels of infant and child mortality.

To fully address the health consequences of armed conflict, the study shows that it is essential to better understand the attitudinal and behavioral correlates of exposure to violence. Trust-building measures are already a well-established component of post-conflict reconstruction and peace-building programs. These programs could be modified to consider health as an explicit area of activity. The provision of ‘hard security’ also matters. The fear of victimization, which is consistently associated with higher levels of fear, is a major driver of detrimental adjustments in health-seeking behavior.

Measures that contribute to providing physical security in conflict and post-conflict settings—be they in the realm of security-sector reform, or in the realm of welfare policy—can therefore also likely benefit population health and reduce child mortality.