Armed conflict, war, epidemic and bad leadership, directly and indirectly, affect health and health systems in East Africs.
Conflict was responsible for over 2.7 million years of lives lost due to disability in 2019. The war in the Tigray region of Ethiopia and other East African countries, which started in November 2020, has already caused a considerable number of casualties, massive internal displacement and over 70 000 refugees in neighbouring Sudan.A recent report by World Food Program suggests that 91% of the region’s six million people require immediate emergency humanitarian assistance, and 400 000 people had crossed the ‘threshold into famine’. Evidence also revealed that women and girls were subjected to sexual abuse and gender-based violence in this war. In addition, the destruction, vandalisation and looting of health facilities have left millions of people without access to essential healthcare.
The process of restoring and rebuilding East African countries health system will likely be shaped by many factors and take several years. In this paper, we outline three interrelated action points that we think should guide any future effort: health system adaptation; protecting, reskilling and empowering the health workforce and coordinating actors and resources towards creating a sustainable and resilient health system. The priority areas are informed by Ethiopia’s own experience, available global frameworks and country-level evidence on conflict and health.
The presence of IDPs, the destruction of the health infrastructure and the volatile nature of the security situation in the region require health system adaptation to ensure that essential services are provided to the population. Specifically, it requires reorienting service delivery according to location and security level, building capacity for emergency response and rebuilding the system for resilience. In conflict epicentres, where violence is acute and ongoing, the priority should be on a small set of medically urgent life-saving interventions.