In recent years, there has been much research on the impact of conflict on health and health systems. Some qualitative studies have analyzed the experiences of health personnel and individuals in the community. There have also been more or less global descriptive summaries that have explored the effect of widespread violence on the availability and use of health services. Analyses have even been conducted on the effects on morbidity and mortality. However, we still lack many, many concrete details of the effect of attacks on health centers, in a concrete way.
What are the direct consequences of an attack on a healthcare facility?
A new study, recently published, helps to address this knowledge gap. Thus, a group of researchers has studied the quantitative impact on the number of consultations resulting from attacks on health centers. The research has covered health units in Hama, Idleb and Aleppo in Syria that reported data on use and attacks received. They have studied more than three main variables: general outpatient consultations, trauma consultations, and delivery care:
Attacks on health centers and outpatient clinics
Regarding outpatient and trauma consultations, they found a respective significant reduction in 51% and 38% after an attack. This effect, which was seen as early as the day of the attack, lasted for weeks. In the case of general outpatient consultations, the reduction in the use of services did not return to normal until at least 37 days later. This figure is even higher for verified attacks documented by the humanitarian NGO Physicians for Human Rights. In these attacks, the reduction in general and trauma consultations remained up to 68 days.
Attacks on health centers and childbirth centers
In the case of consultations for delivery care, the reduction in their use decreased by an average of 23% and did not return to previous figures until at least 42 days. It is striking that in this case the reduction does not start on the same day of the attack, but on the following day. This, along with the lower reduction in use, could be a consequence of a harsh reality of gender: pregnant women were left with no choice. Even knowing that the health facility had just been bombed or attacked in other ways, for them it was the only possibility to receive assistance during childbirth. Although further research is needed to study this, it seems a plausible theory. In the days and weeks that followed, some women may have had time to find alternatives to the attacked health facility.
The reality could be even worse elsewhere
The team that conducted the research points out an important limitation of the study. The data could be underestimating the impact of attacks on the utilization of health centers. The reason for this is the level of pre-attack preparedness that many of these facilities already had, which is not what most have. The conflict in Syria had started 6 years before the period of data collection and analysis. By then, humanitarian organizations had already developed plans to improve their resilience.
As a result of the preparation actions, many of these centers were fortified or even built inside caves, to increase their protection against bombardment. Moreover, the channels for supplying medicines and other medical supplies had been adapted so that they could be resupplied quickly in case of need. This was, moreover, easier than elsewhere, because of the proximity of these centers to the Turkish border, where there were warehouses free from attack.
This type of information is needed in more humanitarian contexts.
The study has only covered three provinces in Syria, and especially the few health centers with systematic data reporting. However, continuous periodic data on attacks and number of consultations are hardly available in very many other conflict-affected health centers. This gap affects not only Syria, but most countries in conflict.
Being able to establish a direct causal link between attacks and service utilization can be very useful. Not only can it be helpful for resilience preparedness for humanitarian organizations in the face of bombings and attacks. It can also provide quantitative evidence to assist in advocacy actions and to hold armed groups accountable.
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