Health issues facing countries emerging from armed conflict are receiving “scant attention”, according to scientists writing in the World Health Organisation’s (WHO) Bulletin.
The report warns that the issue must be addressed before tobacco, alcohol and food companies take advantage of weakened post-conflict trading systems.
Countries mentioned as particularly vulnerable are Iraq, Afghanistan and Libya, which are all recovering from various conflicts.
The world’s biggest killers
The article makes specific reference to noncommunicable diseases (NCDs), which encompass the world’s leading killer illnesses from heart disease to cancer to diabetes, and are defined by the fact that they are not infectious and caused by other things. Mental disorders are also characterised as NCDs by the WHO.
Research suggests that the number of years of life lost to NCDs in conflict-affected countries such as Sri Lanka and Libya is sometimes up to three times higher than the same for infectious diseases.
Lead author Dr Bayard Roberts from the London School of Hygiene and Tropical Medicine says: “While great attention is rightly paid to infectious diseases, NCDs should also be given attention – especially as the post-conflict environment can provide the perfect breeding ground for unhealthy activities like smoking, drinking and poor diet.
“We are making the argument that if the authorities do not step up to lead the way in developing policies which will benefit public health, then they leave the route clear for companies to step in and serve their own interests.”
A growing global NCD crisis is now killing 36 million people each year, with both high- and low-income countries at risk.
The WHO Bulletin authors argue that the issue of NCDs specifically in the aftermath of conflict has been overlooked by various agencies with a role to play in addressing the problem - from global summits discussing the challenges NCDs pose to international development, to organisations engaged in humanitarian and reconstruction efforts in conflict-affected countries.
NCDs are not only a health problem but a development challenge too. Many argue that they fuel a cycle of poverty in some communities due to the extraordinary cost of lifelong treatment.
A year of conflict
The 2011 Libyan civil war began as part of the Arab Spring revolutions. Scientists say these post-conflict countries must now prioritise arising health issues
Recent months have seen a surge in armed conflicts, from the domino effect of the Arab Spring revolutionsto persistent civil wars like that in Sudan or Somalia. As a result, many countries in the future could be dealing with a large burden of NCDs if they are not appropriately dealt with.
Roberts and his colleagues argue that the “post-conflict period can provide a window of opportunity to undertake fundamental reforms to better address the population’s health needs”. Although this can be challenging, particularly for countries tackling infectious diseases at the same time, the authors suggest that humanitarian organisations should be sought to assist on these policies and programmes.
Deficient mental health provisions
Key changes to the environment post-war could be to blame for the particular impact that NCDs have in these countries. Most notably, countries emerging from conflict have an increased burden of mental illness as a result of exposure to violent and traumatic events such as forced displacement, impoverishment, uncertainty and isolation.
Surveys carried out in a number of countries post-conflict have revealed very high levels of mental illness. For example, according to a 2009 mental health survey funded by WHO and the Iraqi government, the lifetime risk of mental disorders – especially acute anxiety and post-traumatic stress disorder (PTSD) – has substantially increased among young Iraqis in recent years.
The survey, which was based on interviews with 4,300 adults in 2006 and 2007, also found that only a minority of the patients who seek treatment for mental disorders in Iraq receive treatment that is even minimally adequate.
A different survey concluded that comprehensive social and psychological assistance is urgently required in Juba, the capital of the Republic of South Sudan. The research found that among the 1,242 adults questioned, over one-third met symptom criteria for PTSD and half met symptom criteria for depression.
Furthermore, despite continuing conflict and probable high levels of mental disorders, the authors state that there are “no psychiatric professionals or related medications available in primary or secondary health services” in the whole of the self-declared Somaliland.
Roberts and his team noted that without relevant and adequate treatment, an increase in psychological stress can lead to more people engaging in harmful health behaviours, such as smoking and drinking, which can be risk factors to NCDs.
Finally, the scientists argue that this “toxic combination of stress, harmful health behaviours and aggressive marketing by multinational companies in transitional settings requires an effective policy response, but often the state has limited capacity to do this”.
Photos from - United States forces and brqnetwork on Flickr
Bayard Roberts, Preeti Patel & Martin McKee (2012). Noncommunicable diseases and post-conflict countries Bulletin of the World Health Organization, 90 : 10.2471/BLT.11.098863
Webster, P. (2011). lraq’s health system yet to heal from ravages of war The Lancet, 378 (9794), 863-866 DOI: 10.1016/S0140-6736(11)61399-8
Spiegel, P., Checchi, F., Colombo, S., & Paik, E. (2010). Health-care needs of people affected by conflict: future trends and changing frameworks The Lancet, 375 (9711), 341-345 DOI: 10.1016/S0140-6736(09)61873-0
Maher, D., & Ford, N. (2011). Action on noncommunicable diseases: balancing priorities for prevention and care Bulletin of the World Health Organization, 89 (8), 547-547 DOI: 10.2471/BLT.11.091967
Roberts, B., Damundu, E., Lomoro, O., & Sondorp, E. (2009). Post-conflict mental health needs: a cross-sectional survey of trauma, depression and associated factors in Juba, Southern Sudan BMC Psychiatry, 9 (1) DOI: 10.1186/1471-244X-9-7