Resilience of health systems in conflict affected governorates of Iraq, 2014–2018

Abstract

Objectives The objective of this study was to assess the resilience of health systems in four governorates affected by conflict from 2014 to 2018, and to convey recommendations. Methods Health managers from Al Anbar, Ninawa, Salah al-Din, and Kirkuk governorates discussed resilience factors of Primary Health Care services affected by the 2014–2017 ISIS insurgency in focus groups, and general discussions. Additional information was gathered from key informants and a UNICEF health facility survey. Three specific aspects were examined: (1) meeting health needs in the immediate crisis response, (2) adaptation of services, (3) restructuring and recovery measures. Data from a MoH/UNICEF national health facility survey in 2017 were analyzed for functionality. Results There were many common themes across the four governorates, with local variations. (1) Absorption The shock to the public sector health services by the ISIS invasion caught health services in the four governorates unprepared, with limited abilities to continue to provide services. Private pharmacies and private clinics in some places withstood the initial shock better than the public sector. (2) Adaptation After the initial shock, many health facilities adapted by focusing on urgent needs for injury and communicable disease care. In most locations, maternal, neonatal, and child health (MNCH) preventive and promotive PHC services stopped. Ill persons would sometimes consult health workers in their houses at night for security reasons. (3) Restructuring or transformative activities In most areas, health services recovery was continuing in 2020. Some heavily damaged facilities are still functioning, but below pre-crisis level. Rebuilding lost community trust in the public sector is proving difficult. Conclusion Health services generally had little preparation for and limited resilience to the ISIS influx. Governorates are still restructuring services after the liberation from ISIS in 2017. Disaster planning was identified by all participants as a missing component, as everyone anticipated future similar emergencies.

Enterobius vermicularis infections in Iraq

“…ISIS signifi cantly infl uenced a health system that had already been damaged by years of strife and underfunding. Despite the fact that ISIS had been operating in several areas for some time, many health facilities had little notice of the imminent attack (Ibrahim et al,2021). Most cases were detected in female individuals compared to males.…”

“…ISIS directly affected the health system. This could cause the spread of some diseases, especially parasitic diseases ( Ibrahim et al, 2021 ). Many studies have documented the epidemiology of E. vermicularis in Iraqi populations from various regions.…”

Terrorism’s impact on low and middle-income countries’ healthcare services: A perspective

“…Iraq, Afghanistan, and Nigeria), healthcare systems face significant setbacks due to reduced tax revenues, increased healthcare costs to provide emergency care coverage, and decreased funding from international aid agencies and other donor organizations due to security concerns and a perceived lack of stability in the affected region. [20][21][22][23] Some reports have also demonstrated that healthcare workers are unpaid where services are chronically underfunded, leaving no medicofinancial exponentiation to facilitate productivity. 20,22 These issues highlight how it is arduous to procure basic healthcare services for those in need, exacerbating the already dire consequences of terrorism.…”

Minimal resilience and insurgent conflict: qualitative analysis of the resilience process in six primary health centres in central Mali

“…21 22 Other research in deteriorated security context has primarily focused on the attacks on health systems, 23 24 and the experience 25 and coping strategies deployed by health professionals. [26][27][28][29][30][31][32] Maternal and child health have been extensively studied. [33][34][35] Studies in Yemen and Syria, in particular, offer a stimulating comparative perspective as they relate to high-intensity conflicts involving considerable means of destruction and weaponisation of healthcare (ie, the use of the destruction of the health system as a component of the military strategy 31 ) unknown in Mali at the time of this study.…”

“…30 In Iraq, a study also points out that the adaptability of health centres is very limited, especially when they are cut-off from the support of the Ministry of Health or supplies. 32 However, the comparison with Syria suggests that the health system had more resources at the beginning of the conflict, which enabled it to develop more ambitious adaptation strategies despite a conflict of higher intensity. 27 Typology of resilience process components A limit to the concept of health system resilience seems to be semantic.…”