Intended for healthcare professionals


Delivering healthcare in situations of conflict or violence

BMJ 2011; 343 doi: (Published 10 August 2011) Cite this as: BMJ 2011;343:d4671

Delivering healthcare in conflict zones: a need for international regulations

Vivienne Nathanson (1) highlighted the three main categories of
threats and vulnerabilities to healthcare following conflict or violence.
Indeed, humanitarian organizations and nongovernmental organizations are
required and often remain the sole actor to offer the basic healthcare to
people in areas. In these contexts of violence, offering healthcare is
difficult even for these organizations. More often, staffs are kidnapped,
and transportation of intrants is hijacked, or drugs and equipments are
stolen. Therefore, in situations of conflicts or violence, life of people
working in humanitarian organization is also threatened.

Due to these threats, in situation of conflicts, healthcare is limited to
area where minimal security can be found, and does not even include a
comprehensive package of activities which can cover the basic needs of the
population, and lastly health staffs are lured away from their previous
posts to work with the humanitarian organization which provides better
working conditions and remuneration. This internal brain drain increases
the human resources shortage, jeopardizing the whole healthcare delivery.
In general, rebuilding the health system after the crisis becomes so
difficult that the humanitarian organization has to stay many years after
the conflict.

There is an urgent need for WHO to propose regulations for ensuring
healthcare interventions in conflict zones. These regulations will contain
procedures to create a secured green zone between protagonists in all
conflicts around the world. In this green zone, health professionals will
deliver a comprehensive package of care to the population. Furthermore,
the regulations must contain a code of best practices for humanitarian
organizations. These best practices include the reinforcement of the
capacity of the local health system, the delivery of a comprehensive
package of care covering the basic needs, and a progressive devolution of
the health care delivery to the local teams. In conflict and post-conflict
areas, health needs are desperately increased (2,3).

Applying these measures will facilitate the delivery of the emergency
healthcare and will contribute to the strengthening of the local health
system required to adequately take care of the population in the longer


1. Degomme, Guha-sapir O. D.. Patterns of mortality rates in Darfur
conflict. Lancet 2010, 375:294-300.

2. Nathanson, V. Delivering healthcare in situations of conflict or
violence. BMJ 343:d4671.

3. Robert B, Damundu EY, Lomoro L, Sondorp E. Post-conflict mental
health needs: a cross-sectional survey of trauma, depression and
associated factors in Juba, Southern Sudan. BMC Psch 2009, 9:9.

Competing interests: No competing interests

13 August 2011
Basile Keugoung
Ecole de Medecine et de Pharmacologie Africaine, Dschang Cameroon; MIRESA