Conflict zones are among the most perilous places for human life—not only because of the immediate threat of violence but also due to the catastrophic effects on healthcare systems. Wars obliterate infrastructure, displace millions, and expose vulnerable populations to disease and malnutrition. In countries like Ethiopia, Syria, Yemen, and Ukraine, healthcare itself becomes a casualty, leaving communities without access to essential services. This article examines the multifaceted challenges facing healthcare in war zones, the humanitarian responses to these crises, and the long-term solutions necessary to rebuild and strengthen healthcare in fragile contexts.
Destruction of Facilities and Resources
The targets of war are very often health systems, either as collateral damage or intentionally. Bombings, shelling, and ground attacks level hospitals, clinics, and ambulances. After years of conflict in Ethiopia’s Tigray region, for instance, only 3% of health facilities are fully operational while over 50% of the health centres in Amhara have sustained significant damage.
Looting only increases the suffering. Many medical supplies, hospital beds, and critical equipment have been stolen, thereby rendering health systems unable to operate. In the Amhara and Oromia regions of Ethiopia, ambulances and pharmaceuticals have been widely stolen, crippling the ability of these regions to respond to emergencies.
Since the start of Syria’s civil war in 2011, there have been more than 600 attacks on healthcare facilities. These attacks have all too often been intentional and thus a breach of international humanitarian law, denying civilians access to life-saving services.
This often leaves healthcare professionals little choice but to flee for safety or destruction of the workplaces in a conflict zone. The World Health Organization in Yemen assesses that only 50% of its health facilities are operational, while there is a huge shortage of trained professionals to staff them. Similarly, in Ethiopia, the shortage of health workers has left the facilities incapable of responding to such overwhelming needs of both displaced and malnourished populations.
This migration of health professionals leaves behind legacies that may last for generations. In Syria, medical education and training were set back by several decades due to the decimation of the health workforce, ultimately threatening recovery even after hostilities had ceased.
Women and children face unique health challenges in conflict zones. Pregnant women often lack access to prenatal care, leading to higher rates of maternal and infant mortality. In Yemen, UNICEF reported that a woman dies every two hours from complications related to pregnancy or childbirth. Similarly, in Ethiopia’s Tigray region, the conflict has severely curtailed access to reproductive health services, leaving thousands of women without critical care.
Children in war zones are particularly vulnerable to malnutrition, disease, and psychological trauma. In Syria, UNICEF has documented rising cases of stunted growth among children due to chronic malnutrition, a condition that has long-term consequences for cognitive and physical development.
The Humanitarian Fallout: Public Health Crises
The displaced people, especially, are vulnerable to an outbreak of diseases due to the overcrowding in camps without clean water and proper sanitation, which further heightens the potential for infectious diseases such as cholera, malaria, and measles. Outbreaks of cholera have risen in Ethiopia, where conflict has collapsed already-weak healthcare systems that can prevent such outbreaks.
Vaccination campaigns are common to be halted during the conflict, leaving populations exposed to preventable diseases. In Yemen, just 10% of under-five children have been routinely vaccinated since war started in 2015, and the country has suffered from recurring outbreaks of measles and polio.
Food insecurity continues to be another terrible consequence of war, where millions have to face hunger because of disrupted supply chains, destroyed farmland, and displacement. Eventually, this goes on to lead to malnutrition among affected populations, most especially children and pregnant women, weakening immune systems and leading to worsened conditions related to other health conditions.
In Ethiopia, where northern regions face the specter of famine, humanitarian organizations have reported rampant malnutrition. The truth indeed is that Mobile Health and Nutrition Teams at Project HOPE screened more than 24,500 children and pregnant women for malnutrition, but that their need for food well outstrips the resources available to meet it.
The psychological toll of war is deep. Survivors suffer trauma from violence, the loss of loved ones, and displacement. Despite this fact, mental health services remain among the most underfunded aspects of humanitarian aid. For example, WHO warns of a building mental health crisis in Ukraine, where war has uprooted millions. Anxiety, depression, and PTSD is endemic, but only less than 15% of the afflicted get the care they need. The case of Ethiopia is no different, where in parts of the country affected by conflict, there’s a severe shortage of mental health services.
Mobile health units (MHUs) are critical for reaching populations in remote or inaccessible areas. In Ethiopia, Project HOPE’s MHUs have provided essential care to tens of thousands, offering prenatal services, vaccinations, and treatment for malnutrition. These units are equipped to stabilize patients and deliver medicines, often serving as the only healthcare touchpoints for displaced populations. In Yemen, similar MHUs have delivered life-saving care to communities isolated by conflict, showcasing their flexibility in rapidly changing environments due to the conflict, where the mobile health delivery solution stands as an important interface.
Re-establishment of vaccination programs is crucial in preventing disease outbreaks. In Tigray, after the active hostilities subsided, Project HOPE, in close collaboration with the WHO and USAID, initiated a COVID-19 vaccination campaign with the ultimate intention of protecting the most vulnerable populations.
Restarted polio and measles vaccination campaigns by UNICEF and WHO in Yemen have reached millions of children amid a series of logistical challenges.
Reconstruction of health infrastructures and capacity building of local health professionals are crucial to long-term recovery. In Syria, international agencies are working with local governments to restore hospitals and re-establish medical curricula, but this is proving very slow so far.
In this regard, reconstruction efforts in Tigray and Amhara involve the training of health workers and rehabilitation of supply chains to respond to immediate and long-term needs.
International humanitarian law explicitly prohibits attacks on healthcare facilities and personnel. However, these protections are frequently violated in conflict zones. In Syria, deliberate attacks on hospitals have been documented as part of military strategies to weaken opposition-held areas.
In Yemen, the bombing of hospitals and ambulances has sparked international outrage, yet such violations continue with impunity. Advocacy groups argue that stronger enforcement mechanisms are needed to hold perpetrators accountable and deter future violations.
Strengthening international legal frameworks can help protect healthcare in war zones. The Geneva Conventions provide a basis for prosecuting violations, but enforcement often depends on political will. Organizations like the International Criminal Court (ICC) play a crucial role in documenting war crimes and pursuing justice, but their jurisdiction is limited.
Humanitarian organizations have called for the establishment of independent monitoring bodies to investigate attacks on healthcare and ensure accountability. Such measures could deter violations and provide justice for affected communities.
Written by Sadhika Kari
