Conflict, forced displacement and health in Sri Lanka: a review of the research landscape

Abstract

Sri Lanka has recently emerged from nearly three decades of protracted conflict, which came to an end five years ago in 2009. A number of researchers have explored the devastating effect the conflict has had on public health, and its impact on Sri Lanka’s health system - hailed as a success story in the South Asian region. Remarkably, no attempt has been made to synthesize the findings of such studies in order to build an evidence-informed research platform. This review aims to map the ‘research landscape’ on the impact of conflict on health in Sri Lanka. Findings highlight health status in select groups within affected communities and unmet needs of health systems in post-conflict regions. We contend that Sri Lanka’s post-conflict research landscape requires exploration of individual, community and health system resilience, to provide better evidence for health programs and interventions after 26 years of conflict.

Conflict in South Asia and its impact on health

“…Mental disorders most commonly attributed to conflict in the region are depression, anxiety, and post-traumatic stress disorder, with variations across countries (table 1 ). 9 41 42 These variations may be influenced by factors such as the nature of the conflict (ethnic, religious, ideological), its duration (acute, protracted, recurrent), the region (urban, rural), and forced displacement. However, higher prevalence of mental disorder shows a host of similar sociodemographic associations across countries such as older age, female sex, displacement, being widowed/divorced, low income/education, and food insecurity.…”

“…Evidence from Sri Lanka shows an increased risk of infectious diseases such as tuberculosis, polio, malaria, and diarrhoeal diseases; increased war related physical injuries and disability; child health problems such as malnutrition, developmental disorders, and infections; reproductive health disorders and gender based/interpersonal violence; and increased numbers of children and adults with war related mental health problems. 9 Some South Asian countries such as Pakistan and Afghanistan continue to experience chronic conflict, and others such as Nepal and Sri Lanka are yet to recover fully from the lingering effects of protracted conflict on the health of their populations.…”

“…For example, Sri Lanka, despite having developed a robust public health system, still has a significant gap in mental healthcare provision to post-conflict populations owing to the lack of integration of mental health into the primary care system. 9 In 2002, after three decades of conflict that devastated the public health system, Afghanistan's maternal mortality ratio, under-5 mortality, and infant mortality rates were 1600/100 000 live births, 257/1000 live births, and 167/1000 live births, respectively. However, after the introduction of a basic package of health services and an essential package of hospital services by the Ministry of Public Health of Afghanistan, with support from the international community, access to health services and health indicators in the country have improved significantly, reflected in the results of the recent Afghanistan mortality survey.…”

“…For example, the Sri Lankan government has, with the support of international agencies, invested significant financial resources in the health infrastructure of post-conflict areas. 9 In Nepal, non-governmental organisations including international humanitarian organisations have significantly contributed to improve psychosocial services for post-conflict populations. 51 Health service delivery in some provinces of Afghanistan has been contracted out to national and international organisations and is seen as an effective way to expand services to remote and insecure areas.…”

The Impact of Community-Based Rehabilitation in a Post-Conflict Environment of Sri Lanka

“…The long-term impact of the war, for instance, on the psycho-social well-being of the public (Somasundaram, 2010;Siriwardhana et al, 2015;Keraite et al, 2016), including people with forced displacement status (Husain et al, 2011;Siriwardhana and Wickramage, 2014), are reported. In addition, some international organisations, such as the WHO (Siriwardhana et al, 2013), and researchers (Taira et al, 2010) suggest programmes that strengthen the health system in the Northern Province of Sri Lanka, while research underlines the importance of community resilience (Somasundaram and Sivayokan, 2013).…”