Healthcare Challenges due to Global Conflict Escalation Amid the Pandemic, Climate, and Economic Dilemmas

Introduction

Objective of the Study and Social Implication

Methodology

A Brief Review of Present Global Situation

A.

Climate Issues over Public Health

B.

The Global Economy and Public Health are Being Impacted by a Pandemic

C.

Man-Made Catastrophes

D.

Present Global Economic Crisis: Fact is Stranger Than Fiction

E.

Global Conflicts over Health Economics: Adding Insult to Grave Injury

[1].

Russian Aggression against Ukraine

[2].

China’s Multiple Disputes including Trade War

[3].

Civil unrest in Asian or Eurasian countries

(a)

The Nagorno-Karabakh conflict (Between Armenia and Azerbaijan)

(b)

Kyrgyzstan-Tajikistan border Conflicts

(c)

Sanctions and Anti-regime protests in Iran

(d)

The War-weary Afghanistan

[4].

Arab and Middle East Unrest

(a)

The Syrian Arab Republic has remained a civil warzone for over a decade. Killing, sexual offenses, multiple healthcare crises followed by daily life struggles, a cholera outbreak among refugees, and damage to 42% of hospitals are the consequences of this war (Ahmed & Nashwan, 2022). Physicians for Human Rights' (PHR) June 2022 report shows that violence caused the deaths of more than 90% of medical personnel in the Assad regime, and a severe fear of healthcare worker shortage occurred when 70% of them fled (Alhaffar & Janos, 2021; Butt et al., 2022). Syrian refugees have affected Jordan’s economy, labor market and society through different aspects. According to Ministry of Planning and International Cooperation (MOPIC), the direct and indirect cost of hosting Syrian refugees reached approximately $8 billion (Khawaldah & Alzboun, 2022) (Figure 6) and each refugee cost the Jordan government almost $3,750 (Al Qaralleh, 2022).

(b)

Yemen has been dealing with the worst humanitarian crisis for seven years, where more than 80% of the population requires aid (Al-Ahdal & Farahat, 2022). According to the UN report July 2022, more than four million Yemenis have been internally displaced since the crisis began, making up nearly six million people who have been forced from their homes (UNHCR, 2022a). A World Bank, UNICEF, and WHO partnership study reveals that almost 40% of the population living more than two hour from comprehensive emergency obstetric and surgical care (Garber et al., 2020). More than 50% of Yemen’s population had to face hunger in 2021 (Hashim et al., 2021). Around 90% foods are imported and Norwegian Refugee Council reported that more than 90% families have cursed COVID-19 for food and other necessity inflation (Rahmat et al., 2022). Nearly 70% of additional deaths between 2015 and 2019 were related to violence in armed conflict (Guha Sapir et al., 2022) (Figure 6). Nearly 2,50,000 people have died as a direct or indirect result of the conflict during this time, including over 12,000 civilians who were killed in targeted attacks. Additionally, 60% of the deceased are children under the age of five (AlKarim & Attal, 2021). Early in 2020, the WHO reported that less than 50% of Yemen's medical facilities were fully operational due to the country's ongoing civil war, which was accompanied by seasonal outbreaks of cholera, dengue fever, malaria, chikungunya, and diphtheria (Saleh et al., 2022). Around 65% of diphtheria patients were under the age of 15, and nearly 50% of those cases had never received the diphtheria vaccine (Dureab et al., 2019).

(c)

Lebanon has been without a president for over a month (Chehayeb, 2022) and banks are remained closed for clients (England & Jalabi, 2022). After decades of war, Lebanon and Israel/Occupied Palestinian Territory agreed to resolve conflicts over maritime boundary (Reuters, October 2022). With a population estimated at around 6 million, Lebanon is home to the largest number of refugees per capita in the world. Around 30% of its population is made up of Syrian refugees (Figure 6). Being hit by a long-running economic and financial crisis, a pandemic, and a Beirut food grain store blast in 2020, more than 50% of the population in the country lives below the poverty line (Dahham et al., 2022; UNHCR, 2022b). According to the World Bank's recent data, Lebanon was one of the top four countries with the highest food inflation in 2012 (Daily Mirror, 2002). In real terms, it had experienced 122% food inflation YOY (Inman, 2022) (Figure 6). As the outbreak in Syria has grown, cholera has spread to neighboring Lebanon (Gebeily, 2022).

(d)

Afro-Arab Sudan faces 'generational catastrophe'--floods, militia raids and hunger mean a third of children are not in school at all (Salih, 2022). Among the most internally displaced people on the African continent, Sudan is home to over 1.1 million refugees, the majority of whom are fleeing South Sudan (UNHCR, 2022c) (Figure 6). The country has been in the midst of a political crisis ever since long-time leader Omar al-Bashir was overthrown there in April (Sirgany et al., 2019). In addition, Sudan has endured a number of humanitarian and economic crises, including a 22-year civil war and the Darfur genocide in 2003, which caused over two million deaths, four million displacements, food shortages, and famine, and for which an estimated 7 million people urgently require life-saving assistance (Shoib et al., 2022b; UNHCR, 2022d). Additionally, the COVID-19 pandemic, severe health risks, malnutrition, poor transport infrastructure and a severe lack of funding for essential services all plague South Sudan (Lutwama et al., 2022). In addition, the country has less than 30% healthcare access and less than 50% vaccination coverage (Anib et al., 2022). The climate crisis and displacements, malaria cases in Sudan nearly doubled between 2015 and 2019 (Elagali et al., 2022). More than 70% of people use mobile phones, but the country’s telemedicine coverage is still facing challenges (Elahssan et al., 2022).

(e)

Libya has experienced decades of armed conflict and political instability. During the Gaddafi regime, oil-rich Libya enjoyed free education, electricity, and health facilities (John, 2008). Libyan health-care infrastructure continues to deteriorate due to civil war, inadequate human and financial support, and inadequate health facilities. More than 37 attacks reported over health facilities and medical personnel after violence began in April, 2019 (Raghavan, 2019). Libya's health system is on the verge of collapse, with three-quarters of primary health care facilities closed due to a lack of medical personnel, supplies, medication, and equipment (Iwendi et al., 2021). Only 40% of hospitals’ inpatient beds are adequately functioning with an overall bed capacity of 15 per 10,000 (Elhadi & Msherghi, 2020). According to data from Trading Economics, food inflation in Libya averaged 9.87% from 2005 to 2022 and peaked at 52.64% in December of 2017. Over 80% of all deaths and 78% of years with a disability-adjusted life expectancy in Libya are due to non-communicable diseases, which are particularly susceptible to long-term breakdowns in health services and policymaking processes (Allen et al., 2022).

(f)

The conflict between Palestine and its occupiers/Israel is a century-old issue. The occupiers have also experienced bereaved displacement as a result of persecution in Europe during World War II's Holocaust (BBC News, 2022). They have launched over a thousand airstrikes in Syria and dropped 5,500 bombs in Arab countries since 2017, facing new threats on various fronts (Ahronhem, 2022; The New Arab Staff, 2022) (Figure 6). It is a perfect example of “fostering recurring cycles of conflict” as depicted earlier. However, for a noble cause, two authorities signed an agreement to transfer vaccines for the COVID-19-afflicted people in June 2021, as the vaccination rate was below 10% in Palestinians (Dahdal et al., 2021). Afterwards, the donor withheld vaccines for the Palestinian population due to the escalation of conflicts and violence, which increased the risk of COVID-19 transmission and damage to health facilities—including COVID-19 diagnostic testing facility. Close to 40% of patients admitted in ICUs during the escalations had complications related to COVID-19 (Alkhaldi et al., 2022). In the West Bank and Gaza Strip in 2018, there were an unprecedented 432 attacks on healthcare facilities (WHO, Occupied Palestine Territory, 2019) (Figure 7). In just 13 days in May 2021 alone, the WHO reported 117 attacks on healthcare facilities in Gaza and the West Bank (Asi et al., 2021).

[5].

War and Conflicts in African Countries

(a)

Ethiopia's Tigray conflict

(b)

Democratic Republic of the Congo–Rwanda Conflict

[6].

Myanmar Military Vs Arakan Army

Result and Discussion

(b)

Malnutrition is still a world health crisis

(c)

Poor health literacy still prevails in wealthy and dominant countries

(d)

27) “Net-Zero Carbon” delayed by decades due to 'collaboration gap'

(e)

Pandemic hits on healthcare system

(f)

Humanitarian crisis over treatment guideline adherence and drug misuse

(g)

War and terrorism hits on healthcare system

(h)

Global transition or a massive work-force redistribution

(i)

Healthcare workforce shortage and transition

(j)

Fears of nuclear war or biological weapons are not entirely false

Figure 7. Humanitarian crisis over global health.

Figure 7. Humanitarian crisis over global health.

• Present health system sustainability challenges in conflict zones and in rest of the world

• Food crisis, malnutrition, lack of health facility access, attacks on health facility structures or medicinal personnel, harder hit by pandemics, violent extremism, violence against women and children, displacements, discriminations and many other nefarious things are common among war or conflict zone (Birn et al., 2017; Daw, 2021; Quinn et al., 2022; Wells & Scheibein, 2022).
• Climate-related challenges have escalated 30 times compared to 20 years ago, which will cost the global economy $224 billion in 2021 alone, accompanied by a precipitation of both chronic and contagious disease burdens. The non-cooperation of two major polluters at COP-27 may be associated with trade war-related privations, an economic crisis due to the pandemic, and fuel and power crisis. Rather, the pandemic and the fuel crisis forced major polluters to return to fossil fuel energy production.
• Climate disasters are not under human control but are not completely beyond human reach. Much less of the money spent on war could have been spent on innovation, food, and the health system (Ikegami & Wang, 2022). The world's medical system is still lacking (Kaiman et al., 2014; Rahman et al., 2020), facing newer types of diseases and challenges and will face more in coming days (Cazzolla Gatti, 2021; Koumoundouros, 2022; Geddes, 2022). Many cancer types, HIV, autoimmune diseases, genetic disorders, antibiotic resistance—solutions of many vexing problems remain to be found.
• Russia's invasion of Ukraine threatens to exacerbate the global inflationary surge, unbalancing oil demand and investment. The triple whammy of pandemic, fuel price shock, and currency depreciation causes economic and financial turmoil in low- and middle-income countries. Medical care and health spending generally increase faster than general inflation (Goss, 2022). Also, rising inflation is associated with infant mortality rise (Bao et al., 2022); child and maternal health compromise (Cader & Perera, 2011); hospital labor expenses per patient (American Hospital Association, 2022); depression, anxiety, frustration and stress (Guerra et al., 2022); cost burdens of chronic illnesses (Jung et al., 2022); less access to assisted-living and independent-living facilities for the elderly population (Ansberry, 2022); low-income households to compromise food quality (Jimenez Rincon et al., 2022); decline insurance coverage (Chernew & Keenan, 2005); worsening clinical labor shortage, lack of potential educators and high turnover (Fleron et al., 2022); lack of clinically necessary pharmaceuticals and supplies, as well as the accessibility of insecticides necessary to control vector-borne disease (Claborn, 2020), are just a few examples of such problems (Figure 8).
• Both conflict and climate crises cause displacements, which bring not only food and health crises but also unhealthy competition and newer conflicts. Pandemics, climate crisis, and economic downturns poses major hit during and/or after a major conflict. Environmental pollution would not cause 26% of mortality in Afghanistan if it had not been a war zone for the last 20 years. The Vietnam War lasted some 30 years and killed three million people or more (Shivakumar, 1995). Following the war, Vietnam was completely dedicated to an economic revolution and did not engage in any significant conflict. Violence was much lower after the Taliban took over, but it is now increasing as the Taliban fights two insurgencies. Azerbaijan and Armenia could resist more against a pandemic induced 5% GDP drop and $1.2 billion in healthcare damage. A noticeable fact is that 700 medical institutions were destroyed at the cost of the Nagorno-Karabakh conflict, and the water crisis in Azerbaijan was a key factor, driven by the climate crisis (O’Lear & Gray, 2006; Kuyumjian, 2021). Medical advances in Iran have boosted the country both domestically and internationally; the country was once known for producing 80% of the world's medicinal herbs (Samadikuchaksaraei & Mousavizadeh, 2008). Conspicuous sanctions and spiraling unrests worsen their health situation, make life-saving drugs unavailable, and make it home to nearly half of the MENA region's injecting drug addicts (Figure 8).
• 80% of all humanitarian needs are also influenced by conflicts. Up to two-thirds of the world's extreme poor will reside in unstable and conflict-affected areas by 2030 (Cieslik, 2020; World Bank, 2022). If the food crisis, inflation, economic stagflation prevails, healthcare will be less focused. And above all, people below the poverty line, facing any sort of discriminations or crisis can easily be engaged in crime, conflict, and chaos by shrewd opportunists. It will further decline the public health facilities. The European race to conquer Africa was fueled by commercial greed, territorial ambition, and political rivalry (BBC World Service). They encouraged Africans to fight each other in order to gain power (Selassie, 2019; Wong, 2022). Gutiérrez-Romero, 2022, stated that a 10% increase in the local price index is associated with a 0.7 percentage point increase in violence against civilians in Africa. The Ukraine crisis contributes 25% of their food insecurity, according to the UN and Red Cross. Furthermore, Christian Aid claims severe economic stagflation will multiply conflicts in the future (Pearce & Andrijevic, 2022). Their health system is also a terrible mess. They may never get rid of this position unless there is a solution to their conflict.
• Approximately 450 terrorist attacks on healthcare facilities, mostly by bomb explosion, have been registered in more than 60 countries over the last five decades. It also raises the question of the credibility of these data, given that over 430 attacks on healthcare facilities in Palestine (WHO, Occupied Palestine Territory, 2019) and more than 800 attacks on medical facilities in Ukraine have already been reported (Bisset et al., 2022; Ваніян, 2022; uacrisis, 2022; Vikhrov, 2022). Also, it is of great concern that victims of oppression are not even safe in hospitals, as are the caregivers and health providers.
• For whatever reason, the total number of displaced persons exceeded 100 million, and there were 32.5 million refugees worldwide as of mid-2022, according to the UNHCR's refugee data finder. They are posing healthcare and economic burden to the already stressed host countries. Like Sub-Saharan Africa, which is facing multiple viral disease outbreaks due to the climate crisis, an intolerable food crisis partially due to the Ukraine war and triple drought, and vaccine discontinuation due to the COVID-19 outbreak, it is now hosting refugees who have become half of its Hepatitis E population. Furthermore, the EU is home to one in every eight HIV patients in the world—more than 25% of Ukraine's population has been displaced and taken refuge in EU countries, where they are already among the highest rankers of HIV, drug-resistant tuberculosis, measles, and hepatitis B and C. Although close to 50% of the Ukrainian war refugees had returned by June 2022 (12.6 million vs. 6 million), their vulnerabilities remained high (People in Need-PIN, 2022; UNICEF, 2022).
• Transition in healthcare is not unusual; the same is happening in other sectors as well. Without sustainable economic growth, skilled workforce development is a myth. A peaceful, independent nation can take this challenge easier than a community under conflict (Yazdi Feyzabadi et al., 2015; Kruk et al., 2018; Takian & Rajaeieh, 2020). In response to an expected Russian attack, the Eurozone increased its arms purchases by nearly 20%, despite the fact that spending on healthcare would be more necessary given the region's severe healthcare shortages, which may cause the region's health system to collapse in the near future (Barber, 2022) (Figure 7). This was the case despite the fact that the global trade in major arms fell by 4.6% (Hasselbach, 2022).
• It is impossible to shelter the population from biological weapons, but possible antidotes or vaccines may have been developed in secret. However, they will not be given away for free, and there will be an option to purchase them at a bargain price. Opportunistic gain is at the heart of all types of mischiefs. If that is the case, the potential for a nuclear attack becomes almost non-existent, because there will be no opportunity for dirty instincts to be satisfied if civilization does not exist. But risk arises when terrorists capture a nuclear weapon through hijacking or, in some cases, misconceptions (Salami, 2022; Williams et al., 2022).

Figure 8. Present multiple crises over global health.

Figure 8. Present multiple crises over global health.

Conclusions

Future Recommendation

Limitation of the Study

Summary

Abbreviations

References

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