Students@SPM 2024: Global Health Seminar – Conflict and Health

As our group journeyed along the topic of Conflict and Health, we discovered that it is not just a political issue; it is a profound public health crisis with devastating effects. War has historically claimed countless lives and left deep scars on the health and well-being of entire populations. As Nelson Mandela said, “Health cannot be a question of income; it is a fundamental human right.” This is especially true in conflict zones, where healthcare access is severely compromised, and the most vulnerable suffer the most. The Rwandan Civil War claimed a staggering 1 million lives, and the ongoing conflict between Ukraine and Russia has already resulted in over 800,000 deaths. Gaza, under the shadow of constant conflict, mourns over 36,000 lives lost.

It was painful for us to comprehend that beyond the physical injuries, conflict-affected mental health. People living in war zones experience acute stress, crippling anxiety, constant fear, and hypervigilance. This manifested as Post-Traumatic Stress Disorder (PTSD). In post-conflict northern Uganda, 47% of the population turned to substance abuse as a way to cope with the emotional turmoil.

To make things worse, we realised that conflict is also a major driver of acute food insecurity, affecting over 117.1 million people globally. Food insecurity is common, particularly in regions such as Sudan, Syria, Yemen, and Palestine. Crises disproportionately affect children and women, who already face vulnerability due to limited healthcare, education, and protection.

We discerned that displacement forces people to flee their homes and creates dire living conditions. Inadequate shelter, overcrowding, poor access to clean water, and unsanitary living conditions become the harsh reality.

Next, we highlighted on the migration crisis, as it is a critical global challenge, with displacement reaching unprecedented levels. According to the UNHCR, 59.5 million people are forcibly displaced due to persecution, conflict, violence, or human rights violations. In 2022, the global refugee population hit a record 35.3 million, with children comprising 41%. The number of refugees in Malaysia alone reached 187,020 by 2024. They faced physical and psychological issues including injuries, disabilities, hypothermia, malnutrition, infectious and non-communicable diseases, and mental health problems.

Specific groups, such as women, children, the elderly, and disabled individuals, are most vulnerable in conflict zones. They encounter additional health risks like sexual violence, sexually transmitted diseases, unwanted pregnancies, unsafe abortions, and poor maternal health services, leading to child malnutrition and mortality.

As a glimpse of hope, we understood that some international organisations and NGOs played essential roles in mitigating these impacts. Mother Teresa once said, “If we have no peace, it is because we have forgotten that we belong to each other.” This shared responsibility drives organisations like the World Health Organization (WHO), the International Committee of the Red Cross (ICRC), the United Nation High Commissioner for Refugees (UNHCR), and Doctors Without Borders to provide medical assistance, advocate for healthcare worker protection, and support resilient health systems.

In line with the topic given, we had the golden opportunity to meet and interview prominent figures such as:

1. Dr Rabi Abeyasinghe, the current WHO Representative and Head of the WHO Country Office to Malaysia, Brunei Darussalam and Singapore who is based in Kuala Lumpur Malaysia since 22 January 2022. He leads the strategic and policy dialogues with the ministries of health and partners. He has almost 30 years of experience in the control of vector-borne diseases. He was in several high positions in the Ministry of Health of  Sri Lanka including Director of National Malaria Control Programme and Project Director, of GFATM Projects.
   
2. Dr Susheela Balasundaram, the Head of the Public Health Unit of UNHCR has vast experience in leading UNHCR in protecting people who has fled from their homes as well as stateless persons.
   
3. Dr Jason, an Assistant Public Health Officer at the UNHCR, has joined Dr Susheela in her efforts. He echoes the values of UNHCR, such as delivering life assistance services in emergencies, protecting fundamental human rights, and assisting to get long-term solutions for those affected, to finally get a place they can safely call home.
   
4. Dr Collins Santhanasamy is a Malaysian native with a richly diverse international background, anchored by his medical education in Bangladesh. His journey into healthcare began with impactful community health initiatives, spearheading mobile clinics tailored for the urban poor, refugees, and rural populations. Recognizing the challenge posed by high illiteracy rates, he prioritized experiential learning to impart essential healthcare knowledge. Post-medical school, he earned a prestigious scholarship for a joint master’s program in public health and disasters across European universities, further honing his expertise. His professional trajectory includes stints with WHO Ukraine and internships at WHO Geneva, culminating in his current role as a Health Innovation Intern at UNICEF Stockholm. Driven by a fervent dedication to global health equity, he founded Youth4DRR, empowering young minds in disaster risk reduction. Dr Santhanasamy’s tireless pursuit of innovative healthcare solutions underscores his commitment to fostering community resilience on a global scale.
   
5. Brigadier General Dr Muhammad Arshil is celebrated for his valour and leadership, currently serving as the esteemed Dean at the Medical and Defense Faculty of the National Defense University in Malaysia. With nearly 21 years of steadfast dedication to the Malaysian Armed Forces, he epitomizes excellence in both military and medical realms. Dr Arshil’s remarkable journey has seen him at the forefront of numerous conflict and disaster zones globally, where his versatile expertise has played a pivotal role in orchestrating effective communication systems and spearheading vital disaster relief efforts. Notably, his groundbreaking initiatives in Cox’s Bazaar, Bangladesh, including the deployment and operation of a Level Three Field Hospital, have set new standards in humanitarian aid. Beyond his military accomplishments, Dr Arshil’s commitment to public health perspectives underscores a holistic approach to saving lives and alleviating suffering, embodying the true spirit of heroism and earning widespread respect and admiration. Recently, as a distinguished speaker at a seminar, Dr Arshil delivered a compelling talk on One Health, emphasizing the interconnectedness of human, animal, and environmental health. His insightful presentation ignited fruitful discussions, underscoring the importance of collaborative approaches in addressing global health challenges and promoting holistic well-being for all.
   
6. Dr Shahrizal Azwan from the Malaysian Relief Agency had first-hand experience in Gaza, Yemen, and Syria. He talked about the common problems faced in those areas such as overcrowding, lack of clean water and diseases such as cholera and measles. He also emphasized the need to care for refugees in Malaysia as the health effects of conflict may have begun in the areas of conflict, but they often continue long after the victims have left.

Most of them shared that attacks on healthcare facilities and personnel are a disturbingly common feature of conflict zones. The World Health Organization (WHO) established the Surveillance System of Attacks on Healthcare (SSA) to monitor and collect data on these assaults. Medical professionals, who stand as a lifeline during these crises, become frequent victims themselves.

As conclusion, we established that health inequities are exacerbated in conflict settings due to poor access to healthcare, fear of detention, stigma, and discrimination. These inequities created a vicious cycle, worsening the health impacts of conflict and perpetuating poverty and poor health through disrupted education and limited employment opportunities. We understood that a resilient health system is crucial to withstand and adapt to conflict pressures. Martin Luther King Jr. stated, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Thank you for joining us as we explored the urgent need for comprehensive efforts to address the health crises born from conflict aiming to protect and support those affected and work towards a future where health and peace are universally upheld.

We also wish to thank our lecturer, Associate Professor Dr Tharani Loganathan, for giving us such an excellent topic for us to explore on global health in depth, and for being such a vibrant educator in the Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya.