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A doctor examines a Somali patient in Ethiopia © UNHCR/F.Courbet

Geneva, Switzerland (GenevaLunch) – Health care delivery to populations displaced by conflict is outdated, according to an article in the British medical journal The Lancet, co-authored by UNHCR (UN High Commissioner for Refugees) health expert, Paul Spiegel. The authors note that the stereotypical refugee population living in closed camps, mostly young and in low-income countries, is a thing of the past.

Today’s conflict-affected populations are often older, from middle-income countries and located in urban settings or dispersed in rural settings.

“Most contemporary wars are of protracted duration, intrastate, fought by irregular armed groups and fueled by economic opportunities and ethnic rivalry. Direct armed clashes are often infrequent, but violence against civilians, including rape, is pervasive. This violence takes place against a backdrop of increasing urbanization and aging populations,” the authors note.

The margin for humanitarian action has shrunk, too, according to the authors. Political polarization and the perception by belligerents that humanitarian assistance is not impartial results in more restricted access to victims of conflict.  Displaced civilian populations are also increasingly to be found among host populations suffering similar health afflictions, making delivery to only one group contentious.

Recommendations take account of the changing nature of war and the populations affected by conflict. They include:

• expanding medical intervention in new and creative ways by taking advantage of lulls in fighting or negotiating ceasefires “to create humanitarian space for. . . mass campaigns”
• addressing the increasing prevalence of chronic diseases in older populations, including HIV/Aids, tuberculosis, diabetes and cardiovascular disease
• improving health care for affected populations in urban settings by, among other things, improving access to national health systems
• fomenting “changes in surveillance, assessment, and monitoring of conflict-affected populations”.

Links to other sites: UNHCR, The Lancet (requires registration)