The year 2023 has been described as crucial for global health action. A few weeks ago, representatives from politics, science, business and civil society organizations met in Berlin to draw up a program that should enable better health care in the future.
In a world where the vulnerabilities of health systems due to climate change, conflict, the ongoing evolution of Covid-19 and cost crises continue to be exposed, it is crucial to focus now on the possible actions. Life and debts. For vulnerable populations in fragile and conflict-affected contexts, these ongoing crises can create a perfect storm that reverses years of health progress.
In recent days, the humanitarian crisis in Gaza has tragically demonstrated the great pressure that the conflict is placing on health systems. Attacks on healthcare, lack of electricity, water or supplies simply mean that hospitals cannot save lives.
The September floods in Libya revealed another tragic picture: thousands of people died, many more were displaced, and communities were left without access to basic and health services. Years of conflict and political instability have destroyed critical infrastructure and weakened health systems, while the effects of climate change have made storms more likely and severe.
Unfortunately, this is not an isolated case and will not be.
Almost a quarter of the world’s population currently lives in areas affected by conflict, displacement and natural disasters. Of the 25 countries most affected by climate change and least prepared to adapt to it, most are also facing armed conflict. In addition, the health consequences of climate change are costly: it is estimated that the direct damage to health systems will cost between 2,000 and 4,000 million dollars (approximately between 1,900 and 3,700 million euros) annually by 2030.
Conflict has far-reaching effects on the health of individuals and communities, from direct injury and violence to displacement and psychological trauma. Conflict also affects health systems, damaging key infrastructure, disrupting supplies of essential medicines and impeding access to clean water and sanitation, contributing to worsening health conditions. Furthermore, the climate crisis is exacerbating existing fragility – natural disasters, heat stress, air pollution and the spread of infectious diseases – and making it difficult to deliver essential health services where they are needed most.
In this context, resilient health systems are crucial to fulfilling the promise of leaving no one behind, as countries agreed when they committed to supporting the Sustainable Development Goals in 2015.
How can we design, build and maintain healthcare facilities that can cope with climate-related disruptions? How can we ensure healthcare facilities have access to clean, reliable energy to operate? How can we ensure these facilities have the necessary supplies to function? How can we ensure they are adequately staffed? And that these health workers are adequately trained and paid?
Conflict impacts health systems, damaging critical infrastructure, disrupting the supply of essential medicines and hindering access to clean water
We have learned many lessons about practical solutions that can improve access to health services, even in the midst of ongoing conflict. In Yemen, for example, years of conflict have severely weakened the health system and left 20.3 million people without access to basic health care. To address this situation, a UNOPS (UN Logistics Organization) project benefiting around 3.4 million people is renovating hospital facilities and wards, improving water infrastructure and increasing energy efficiency, while taking gender into account. It also trains staff in the management and maintenance of medical equipment. The goal is to make medical facilities more efficient and adaptable to respond to outbreaks and epidemics. However, much more is needed because the need is enormous: around half of Yemen’s health facilities are partially or non-functional due to a lack of staff, funding and electricity, as well as medicine, supplies and equipment.
In Ukraine, amid the current conflict, work is underway to improve the effectiveness of medical services, provide reliable energy sources, and procure and deploy essential medical equipment. Here again, the challenge is to focus in the long term on building stronger health systems that can withstand shocks and stresses while responding to immediate needs. We have learned that we should not wait for the conflict to end before beginning the process of rehabilitation and reconstruction.
Without health there is no development. And for vulnerable populations in fragile and conflict-affected areas, immediate action and investments are needed to improve access to health care. These actions must respond to current needs and lay the foundation for a resilient, inclusive and sustainable future.
Jorge Moreira da Silva He is Deputy Secretary-General and Executive Director of UNOPS, the United Nations office specializing in infrastructure and procurement. UNOPS works with UN agencies with health and humanitarian mandates and implements health projects and programs in some of the world’s most complex environments.
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