Whilst conflict is a major barrier to general health provision in low and middle income countries (LMICs) its effect on maternal and child health is particularly profound. Despite seeing average global maternal and under 5 mortality rates decline over the last 20 years, figures are increasing in areas of conflict.
Global maternal mortality rates in 2015 were shown to be 216 per 100000 births compared to over double that figure (546 per 100000 births) in Sub Saharan Africa (SSA). With regard to child mortality rates, 80% of under 5 deaths globally occur in conflict areas in SSA and Southern Asia. To further reinforce that fact, a study in the Lancet in 2015 across 35 African countries showed that children born within 50km of a conflict zone are 7.7% more likely to die before the age of 1 than those born in the same region without conflict.
The Sustainable Development Goals (SDG) issued by the UN in 2016 attempt to target these issues. SDG 3 states that by 2030 we should aim to reduce:
1. Global maternal mortality rate to less than 70 per 100000 live births
2. Neonatal mortality to at least as low as 12 per 1000 live births
3. Under 5 mortality to at least as low as 25 per 1000 live births.
These targets are also in line with the Lancet commission for global surgery which advocates the need for safe, accessible and equitable surgery worldwide across all patient demographics.
The war in Yemen is the latest conflict to raise concern with regard to maternal and child mortality. Over the last 4 years Taiz Houban and Abs hospitals have been the main centres providing healthcare in this conflict area. They are supported by MSF humanitarian workers. Since 2016 they have recorded 36 maternal deaths and 1529 child deaths (of which 1018 were newborns). More concerning is the fact that in Taiz Houban hospital over one third of these deaths were children and new-borns that were dead on arrival.
So what are the main obstacles that are leading to these alarming figures?
1. Access – this used to be affordable and readily available. However, due to multiple checkpoints and a curfew preventing travel after 6pm, access to the health centres has deteriorated drastically. Journeys that would normally take 10 minutes have now been reported to take several hours as a result
2. Safety – Armed violence at checkpoints can result directly in mortality. 32% of mortalities have involved women and children. In addition, hospital closures in Taiz city secondary to violent clashes and airstrikes have restricted availability of healthcare.
3. Resources – With no community-based clinics providing antenatal care, complicated pregnancies have become more rife since the conflict escalated.
4. Cost – GDP in Yemen has decreased by 29% since 2014. Prior to the conflict most healthcare was provided by the private sector. This is now no longer possible due to procedure and admission costs.
Despite MSF presence in the most challenging areas, rural communities still struggle as a consequence of these factors. Further aid from other international NGOs is required to improve the status quo but how can this process be facilitated? How can humanitarian law be enforced to reduce risk of violence to functioning medical centres? And, arguably most importantly, how can access be improved to such high risk areas?
Lancet commission on global surgery
Organized conflict and maternal health: Local-level evidence from sub-Saharan Africa (G. Østby)
Linking Maternal and Child Health, Aid, and Armed Conflict (E. Bendavid)