The nutritional status of children is strongly related to health conditions and health services. Malnutrition does not result from inadequate dietary intake and poor caring practices only. Communicable diseases, for example, diarrhoea, measles, and malaria also lead to malnutrition. Diseases affect the nutritional status of children in three ways:
Armed conflict threatens the family's food supply and the nutritional status of the child (Section 3.1). This may lead to an increase in micro-nutrient deficiencies, such as vitamin A deficiency, anaemia, zinc, etc., which in turn leads to an increased susceptibility to disease. For example, the frequency of diarrhoeal disease and respiratory infection is associated with Vitamin A deficiency. Improving Vitamin A status reduces both the severity and subsequent episodes of infection and the risk of death (Annex 2).
Conflict seriously obstructs the delivery of health care services, preventive efforts such as immunization programmes and mother and child care, as well as other services (e.g. sanitation, water and power supply) that are essential for healthy living. Through displacement and trauma, conflict increases the need for health services. At the same time, the services are being disrupted by the conflict (Ressler, Tortorici and Marcelino, 1993).
During conflicts, the health environment suffers in three fundamental ways (Figure 3).
Insufficient Health Services & Unhealthy Environment
A major impact of conflict on the health structures is through the loss of health staff because they flee as refugees to other countries or become displaced within the country. Health workers may be drafted into the military who often have priority over skilled medical personnel, or they may be targeted and killed by the military as part of the war strategy (Ibid). During a conflict, there is a lack of training courses eventually leading to staff shortages.
In addition, work overload due to high demand as well as the frequent loss and looting of buildings and infrastructure will have a serious impact on both the quality and quantity of health care. Also, contamination of water supplies is a common outcome of conflict, which seriously endangers health conditions in an area. For the staff remaining active, the loss of experience through non-practice of skills due to lack of supplies and equipment, lack of incentives, and low morale resulting from the conflict, will have a negative impact on the quality of services provided. This is frequently linked with a collapse of government management structures and the civil service leading to insufficient coverage of many areas by the health services. The negative impact of all of the factors above is exacerbated by the lack of access to drugs, vaccines and cold chains.
The destruction of the health service and water supply is worsened by population movements. When populations are displaced, they frequently lose most of their possessions. Apart from leaving their homes and communities and losing health provisions, the loss of basic household equipment such as water containers and cooking equipment means that food hygiene deteriorates. Food preparation and water storage become major problems for the family. Inadequate access to firewood and water reduces the time that people can spend caring for children as more time is spent searching for basic necessities. During displacement, the loss of mosquito nets, clothing and shoes increases the risks of disease, especially malaria and hookworm, at a time when the population is already weakened.
The physical environment of the area where a displaced population finds shelter often influences the health and consequently, the nutritional status of people. In order to reach a camp or shelter, people may have to pass through an area where disease is endemic. In southern Sudan, a rapid spread in kalazar, an infectious disease transmitted by sandflies, occurred following a series of food distributions which required people to pass through an endemic area to get to the distribution point. People may be displaced to less healthy environments, for instance, swamps, or face transmission of diseases from other areas. In addition, populations are frequently moved to safe areas where overcrowding leads to a rapid spread of disease, there is increased competition for limited safe water supplies, and a deterioration in sanitation occurs. On top of this, conflict, displacement and generally poor living conditions lead to an increase in stress and trauma within the population which cause an increased need for health services.