Page last updated at 07:09 GMT, Wednesday, 24 September 2008 08:09 UK

Improving health in fragile states

With the spotlight once more on the UN Millennium Development Goals, Michael Jay - the UK's chief negotiator at the 2005 Gleneagles Summit and chair of medical aid agency Merlin - argues that we must address the conflicts that prevent targets on poverty, health and human rights being met.

Two women stand in a hospital in the Democratic Republic of Congo

In countries ravaged by conflict, progress towards the Millennium Development Goals is not only stalling, it is going backwards.

In the Democratic Republic of Congo, maternal mortality doubled during the recent conflict, leaving its residents with no hope of hitting the target to reduce deaths in childbirth by a third by 2015.

The same is true elsewhere - in Zimbabwe, Niger and Sudan. This week's UN summit, attended by world leaders, is an opportunity to reverse this trend.

The MDGs will always be a mirage to Africa and Africans as long as we have the type of attitude the leaders have
Bolu Aladeniyi, Ibadan

During some of the world's bloodiest conflicts - in Sudan, Afghanistan and the Democratic Republic of Congo - many more people were killed by disease and malnutrition than weapons of war.

Long conflicts, often lasting decades, can destroy health systems and set each nation on a path of chronic neglect of its people.

As health workers flee fighting and medical centres close, people succumb to malnutrition and preventable disease.

Weak governments

Mothers remain at home rather than risk taking their children to a health clinic. Progress falters and healthcare stops. It is within these conflict-affected countries that the Millennium Development Goals are most off-track.

A woman in DRC (image by Kate Eshelby, courtesy of Merlin)
Health services can be casualties of conflict. Pic: Kate Eshelby
I saw first-hand the enduring effects of conflict last week, when I travelled to southern Sudan.

Twenty-one years of civil war killed just under two million people and forced four million from their homes here, leaving them exposed to disease and malnutrition.

The bulk of these deaths could have been prevented by trained health workers. But most had fled with their families or were sick themselves. The health system had collapsed.

Three years on from a peace agreement and the lasting damage is evident.

At a hospital in Torit, in Eastern Equatoria, we are trying to train health workers. Staff try to recruit from the local community, but people who have spent years moving between camps have missed out on education. No wonder Sudan is off-track to meet its development targets.

World leaders... must acknowledge that conflict is directly responsible for a lack of progress
Sudan is, alas, not alone but one of 50 fragile states - countries where the government is unable or unwilling to support the needs of its people.

Whether emerging from civil war or recovering from famine or disease, these countries have limited resources to deal with healthcare demands.

The impact is clear: nearly half the women who die in childbirth each year live in fragile states, over half of the children who die before their fifth birthday live in a fragile state.

Ensuring a functioning health system and a trained work-force in this context is difficult, but essential.

Change possible

Many dedicated health workers, both national and international, are working on the frontline, delivering vital health care in Darfur, Afghanistan, Congo, Iraq, despite constant security concerns. They provide a key role in peace-building, helping to build up a tattered social fabric, minimising the effects of war and promoting a peaceful agenda.

And progress is possible. In Afghanistan, 40,000 young children are saved each year, the result of a growing number of skilled birth attendants working despite the insecurity.

In Liberia, a period of stability under President Ellen Johnson-Sirleaf has allowed health workers to deliver more vaccinations, paving the way for a fall in infant mortality.

As world leaders meet to discuss the progress of the Millennium Development Goals, they must acknowledge that conflict is directly responsible for a lack of progress.

If we as a global community are to stand a chance of reaching the targets, we must ensure that those countries most off-track receive particular attention.

Ensuring access to health during conflict and helping to rebuild health systems in the longer term must be a key priority. So must strengthening international systems for preventing conflict in the future, or the gains will be lost.

We need to work now to support countries recovering from conflict and to prevent future conflicts if we are to help millions of the world's most vulnerable people and stand any chance of reaching the 2015 target. World leaders must rise to the challenge.

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