Urgent action needed to protect vulnerable women, children, health workers in Sahel

Women, children and adolescents, and the health and aid workers who provide their care and support, are facing growing challenges and life threatening risks in these times of escalating conflict and humanitarian crises worldwide, according to a commentary published in the British Medical Journal (BMJ) this week to coincide with World Immunisation Week (24-30 April, 2022).

While the recent devastating hostilities in Ukraine have captured the interest of the world, there are a number of other long-standing and growing conflicts that also deserve attention and political mobilisation from the global community.

In 2020, for example, a record 56 active conflicts were documented globally.

In the Sahel region, countries like Nigeria, Burkina Faso, Mali and Niger are subject to violent attacks by extremist insurgents and unidentified armed groups, causing alarming humanitarian consequences.

Armed conflict and attacks on civilians have displaced nearly three million people, nearly one million since January 2019.

Commentary co-authors, the Rt. Hon. Helen Clark, PMNCH Board Chair and Former Prime Minister of New Zealand and Kersti Kaljulaid, UN Secretary General’s Global Advocate for Every Woman Every Child, Former President of Estonia call for a multi-sectoral response to ensure continuity of services for women, children and adolescents in conflict and humanitarian settings.

They also urge global leaders to commit to greater investment in safety and protection measures for health and aid workers who risk their own lives striving to provide services, support and care to vulnerable women, children and adolescents in the most challenging circumstances.

In periods of conflict and in challenging humanitarian settings, even the most basic health entitlements – from accessing safe midwifery services to routine childhood vaccinations – can be denied to vulnerable women, children and adolescents who need them.

The theme of World Immunisation Week 2022, Long Life for All – in pursuit of a long life well lived, provides a timely reminder that while delivering life-preserving vaccines against dangerous childhood diseases remains a global ambition, it has not yet been universally achieved, particularly for those caught up in conflict.

If an armed conflict occurs within 10 km from where a child resides, the odds that a child receives any vaccination are 47.2% lower.

Of the 8.4 million people in the North Eastern states of Nigeria: Borno, Adamawa and Yobe (BAY states) that are estimated to need humanitarian aid in 2022, more than 30% of households report barriers to accessing essential health services.

North Eastern Nigeria also has lower vaccination rates compared to other parts of Nigeria: 42% of children in the Northeast have never received any vaccination, while this is true of only 8% in the Southeast (National Immunization Coverage Survey, 2016/2017).

As a result, many children die from vaccine preventable and other infectious diseases like malaria, acute watery diarrhoea, cholera and measles.

Burkina Faso was declared free of wild poliovirus in 2015, but in 2020 was one of 15 countries on the African continent experiencing outbreaks of paralysis cases related to other forms of poliovirus.

“In chaotic and desperate situations caused by conflicts, in distressing humanitarian contexts, health and aid workers are key players in the protection and assistance system. Their intervention nurtures the hope of the right to health and well-being among victims and affected populations”, says Marleen Temmerman, Director of the Centre of Excellence in Women and Child Health at Aga Khan University East Africa and PMNCH Board Member.

“The harms and losses caused to health and aid workers in conflict zones call for multisectoral and equitable response. It is time to act to protect those who protect the health and well-being of women, children and adolescents, even in perilous security contexts. It is time for all actors involved in the humanitarian field to take concrete and innovative actions so that health and aid workers no longer suffer damage, no longer lose their lives while carrying out their mission.”

Women, children and adolescents in conflict and humanitarian crisis settings face additional threats to their lives and wellbeing.

Ten million deaths in children younger than five years between 1995 and 2015 globally can be directly and indirectly attributed to conflict. Women of reproductive age living near high intensity conflicts are three times more likely to die than women in stable settings.

Health and aid workers also risk their own security, and their lives, trying to maintain service coverage, care and support for vulnerable women, children and adolescents in conflict settings.

They may become casualties of conflict, either as accidental victims of attacks or as deliberate targets of hostile forces. Violence against aid workers claimed 484 individual victims in 2020, 117 of whom died, making 2020 the worst year on record for the second year in succession.

In Mali, the SHCC identified 11 incidents of violence against, or obstruction of, health care workers in 2020. At least four ambulances were damaged in these incidents. A common form of violence against health providers involved ambulances being shot at and damaged by armed groups. These types of attacks often targeted ambulances of aid volunteer organizations and local health care providers.

On December 31, 2021, Burkina Faso’s Ministry of Health reported that 444 health facilities (30·7% of the total) have been impacted by insecurity in the regions most affected by the humanitarian crisis. 149 facilities are completely closed, depriving around 1.8 million people access to health care. Ninety-six per cent of these facilities closed because of direct attacks by unidentified armed groups, forcing health-care workers to abandon their work. 

“To protect those who protect us, there is an urgent need for targeted co-ordination of investments to promote safe service access, including delivery of vaccines and other essential services and commodities through multi-level and multi-sectoral private-public efforts,” write Helen Clark and Kirsti Kaljulaid in the BMJ. (Premiumtimesng)