The ongoing conflict between government forces and the local terrorist organizations Abu Sayyaf Group and Maute Group in Marawi City does not only have political and security implications.
The lives lost, injuries sustained and the exodus of residents from affected areas are among the public health impact of armed confrontations.
Wars or clashes in any part of the world often result in the displacement of large populations. These displaced groups are then housed in temporary shelters that are usually over-crowded, thereby making them very uncomfortable. This situation, often accompanied by inadequate clean water and sanitation, leads to increased exposure to diseases.
The paper “Conflict and Emerging Infectious Diseases” said that in protracted and post-conflict situations, populations have high rates of illness and mortality due to breakdown of health systems, flight of trained staff, failure of existing disease control programs, and destroyed infrastructure. As a consequence of conflicts, evacuees are more vulnerable to infection and disease due to undernutrition or malnutrition, low vaccine coverage, or long-term stress.
The World Health Organization (WHO) noted that high levels of mental health issues have also been reported in areas emerging from conflicts. It said that violent and traumatic events, forced displacement, impoverishment, uncertainty and isolation contribute to mental health concerns.
In preparation for the consequence of the clashes in Marawi City, the Department of Social Welfare and Development (DSWD) has raised its red alert status to ensure assistance for victims is on standby.
It reported that residents from at least 10 barangays have been forced to flee to safer grounds. They are taking refuge with families and friends outside of Marawi City while others have moved to newly opened evacuation centers in Iligan City and in nearby municipalities of Lanao Del Norte.
The Centers for Disease Control and Prevention (CDC) provided a list of special considerations for non-residential evacuation centers. These non-residential evacuation centers could be stadiums, churches or classrooms that may have limited capacity for providing sanitary and food preparation facilities.
Among others, the CDC recommended that open sleeping areas should be set up to prevent crowding, ideally with at least 3 feet separating each bed from the next. Frequent and supervised cleaning and maintenance of sanitary facilities are also important due to high ratio of residents to toilets in these non-residential facilities.
In general, it recommended that non-residential facilities must be used only for very short-term evacuation as much as possible. A similar observation was made by the WHO Western Pacific Region in a journal titled “Rapid health assessments of evacuation centers in areas affected by Typhoon Haiyan.”
It concluded that evacuation centers are needed in almost every disaster. However, they should be safely located and equipped with the required amenities. The assessment said that schools and community centers should not be designated as evacuation centers unless they are equipped with adequate sanitation services.
The managemement of persons with infectious diseases in evactuation centers is also crucial. The CDC said that the risk of spreading infection in evacuation centers is high with the arrival of evacuees who may have open wounds, symptomatic infections, and unrecognized or incubating infectious diseases, combined with potential for crowding and limited sanitary infrastructure.
It suggested that all residents entering an evacuation center should be screened if they have fever, cough, skin rash or sores, open wounds, vomiting and diarrhea. Persons with any of the said conditions should be admitted to the evacuation center only after appropriate medical evaluation and care.
In Marawi City, armed men were said to have forcibly entered the Amai Pakpak Medical Center, disrupting the delivery of needed healthcare services. Conflicts do make the healthcare system vulnerable. In 2016, the WHO called on a halt to attacks on health personnel and facilities. In a subsequent report released the same year, the WHO said that there were 594 reported attacks on health care that resulted in 959 deaths and 1561 injuries in 19 countries with emergencies over a two-year period.
In armed conflicts, no one wins. Certainly not the people’s health.
Disclaimer: The views in this blog are those of the blogger and do not necessarily reflect the views of ABS-CBN Corp.