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Obstacles in Relation to the Health Workforce: Accessibility of Services in Fragile States and Conflict Zones

Author(s): S. T. Ismael1
Affiliation(s): 1Doctors for Iraq, London, Iraq
Key messages:

1 –Shortage, misdistribution and adequate mixture of skills are real challenges to health provision in fragile and arm conflict zones.
2 – Work overload, poor moral and health workers absenteeism are consequences that decrease the opportunity of accessing health care for local community.
3 – The relation between health provider and patient is unique and based on bilateral trust.

Summary (max 100 words):

Approximately 14% of the world’s population live in fragile states were governments are either unable or unwilling in delivering services to the majority of its population resulting in instability and insecurity in such countries; alongside additional fears of the wide spread global economical crunch and food crises manipulating more countries in becoming fragile states. In 2003, prior to the occupation of Iraq, there was a great short-age in the number of health workers, especially doctors, with 1.6 per 1,000 populations decreasing drastically to 0.5 by 2007. To date approx 2,000 doctors at senior level have been killed and 12,000 have migrated to other countries. The Doctor’s migration was not only across borders to Neighbouring countries, but also internally between governorates. Doctors tend to mimic the direction of movement of other sectors in the IDPs, following the logical search for secure and related hosting communities. This two-directional movement resulted in the shortage, uneven distribution and unequal mixture of skills geographically which affected the access of health services between communities in these areas. The shortage of the workforce within the health system is one of the major problems that we are facing today in the humanitarian sphere. Prioritisation, sustainability and balancing short and long term objectives should guide our decisions on how to deal with this obstacle through task shifting, incentives, providing education via chain of short training courses and other practical ways to combat this problem. The relationship between health care provider and patient’s is uniquely built upon trust and accountability. Disruption of this trust will ultimately affect the acceptance of health care services by the patients. Since 2003 the power struggle between the Iraqi political counter parts imposed it self on the society resulting in ethnical tension and division. Unfortunately this ethnical tension has manifested its way trough the health care facilities. Affecting not only the relation between health providers themselves, but also shattering the trust between them and patients. This has created fear and insecurity within Iraqi patients when they are seeking health care. Since the escalation of violence in 2006 towards Sunni Iraqis as a result of the attack on the Shiaa Holy Shrine, more patients have become sceptical on whom and where to turn to when seeking health care. Impartiality in relation to trust are fundamental to create secure system ultimately resulting in fair access to health care for all in conflict zones under attack of ethnical and religious tensions. It is a necessity for this to be addressed and it is our duty to provide education and advocacy of such principles to try and re-build the bonds that have been broken limiting further disruptions within the health care system.

Lessons learned: 1 – Developing and retaining the health workforce in fragile states or conflict zones is a priority even in emergency phase. Task shifting is considered to be a practical solution when trying to tackle the problem of shortage within the health workforce.
2 – Neutrality, impartiality and bond of trust between health care providers and care recipient are very crucial in insecure fragile environments and need to be endorsed between health care providers in conflict zones.
3 – Work overload contributes to a decrease in motivation alongside increasing absences within the health care units.

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