Women and children in conflicted areas need health interventions


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About 630 million women and children—or more than 8% of the global population—are impacted by armed conflict and missing out on their health needs.

The problem, which is the topic of a new four-part study series in The Lancet, is getting worse due to population growth, more conflict, the usage of explosive and chemical weaponry in cities and a rise in refugees and displaced people. Current global challenges like climate change and the COVID-19 pandemic have further exacerbated the direct and indirect health effects of armed conflict.


Without prioritizing the health of women and children, up to 10 million children aged 5 and younger could die over the next 20 years, researchers found.

“The new estimates provide compelling evidence of the enormous indirect toll of modern warfare caused by easily preventable infectious diseases, malnutrition, sexual violence and poor mental health, as well as the destruction of basic services such as water and medical facilities,” wrote series lead author Zulfiqar Bhutta, MBBS, PhD, of The Hospital for Sick Children in Toronto, Ontario, Canada.

Study highlights:

  • 16 million women and 36 million children were displaced in 2017.

  • 265 million nondisplaced women and 368 million nondisplaced children lived “dangerously close” to armed conflict areas in 2017, a significant uptick from 2000.

  • Conflict caused 10 million deaths in children younger than 5 years over a 20-year period.

  • Mortality rates for women of reproductive age who live near conflicts are three times higher than women who live in areas with no conflict.

  • The mortality risk for women and children from indirect causes “increases substantially” if there is conflict nearby.

  • The more intense the conflict, the greater the mortality rate.

In spite of grim realities, there is hope if all authority players, from global leaders and humanitarian organizations to local communities, cooperate in the effort to bring health care to vulnerable populations.

The researchers evaluated case studies of health interventions in 10 conflict-ridden countries, including Afghanistan, Colombia, Democratic Republic of the Congo, Mali, Nigeria, Pakistan, Somalia, South Sudan, Syria and Yemen. The researchers found that in the countries who had armed conflict, services for newborns, adolescents and reproductive aged women were limited. Prenatal care, obstetric care, childhood vaccinations and feeding care for infants and children were given priority, the researchers noted.


Many of these countries face severe healthcare challenges that limit access to care, including attacks on and kidnappings of health workers, a lack of skilled healthcare workers and limited funding. As a result, governing bodies and humanitarian organizations have had to think outside the box by employing nontraditional workers, such as birth attendants or utilizing technology and messaging applications to provide remote care.


“Although these solutions need more rigorous evaluation, they have the potential to provide a timely response to current implementation challenges and remind health authorities of their responsibility to deliver basic health services to the whole population,” said co-author Isabel Garcés-Palacio, DrPH, MPH, from the Universidad de Antioquia in Colombia, in the same statement.


To be successful in providing basic health services to women and children in conflict zones, cooperation across various entities is required. Governing bodies and humanitarian organizations should determine the causes of increased disease and death among women and children, assess the recommended interventions needed to combat these problems and identify how to deliver the interventions using a minimum level of care.


“It is imperative that the world make more concerted efforts to reduce the risk of conflict, but until that happens, improving the delivery of health and nutrition services for women, children, and adolescents affected by conflict remains an ethical and moral responsibility,” said co-author Neha Singh, PhD, MPH, co-director of the Health in Humanitarian Crises Center at The London School of Hygiene & Tropical Medicine in the U.K.