Civil unrest and the affects it has on the health of a nation’s children
Amelia Cutts writes on conflict and child health, with a particular focus on Haiti and Sudan.
The concept of power and politics affecting the health of a nation’s population is not a new one. Political instability is a common cause of poor health in a nation, leaving many civilians without access to clean water, adequate food supplies and medication. Young children are affected more than any other group in the population as they are more susceptible to malnutrition and are more likely to contract diseases such as cholera due to lower levels of immunity. (1)
During the American civil war in the 1860s, the health of the population suffered immensely. The primary reason being that there were few, if any, men left to work on the farms that sustained the towns and villages with food, as they were all at war. Estimates suggest that between 320,000 and 650,000 men died during this conflict, but many of these were from disease rather than as a result of direct conflict. Some sources say that this was as much as 3% of the population, having a profound affect on the lives of civilians at the time. (2)
The French revolution in the 1790s saw the poorer, hungry French civilians fight against the rich noblemen who ruled the country to try and overthrow them. This was an attempt to gain more control, but during this time they continued to suffer the hunger that they had endured for many years previously. At the time nobility were earning up to 250 times more than the peasants. (3) This vast inequality led to further exacerbations of the country’s instability, including rioting by women against the decisions of the government. (4)
Currently in Haiti, the lack of crops due to political instability has resulted in severe malnutrition and general poor health among children within the country. The conflict began due to the unpopularity of the elected president, and some of the population refusing to follow the country’s governmental law. (5) A major objective of the United Nations (UN) in Haiti has been to try and facilitate the return to governmental rule, maintain a secure and stable nation, and enforce the promotion of the rule of law. (6) The problem is noticeably severe in the capital, Port-au-Prince, where many people face extreme poverty and live in the surrounding shantytown.
The children of Haiti were already extremely vulnerable before the conflict began back in the mid-1990s. The low literacy rate has forced UNICEF to recommend that “schools should be treated as zones of peace so that they are a safe haven for children”. (7) Vaccinations are available for children to protect them against TB, Diphtheria, Tetanus, Measles and Polio. However, only 50 to 75% of Haitian children are actually vaccinated against these serious, life -threatening diseases. (8) Poor water quality leads to susceptibility to water-born diseases such as cholera. The provision of clean drinking water in urban areas is better than in rural areas, but only 70% of the urban population has access to safe water sources. The problem is so bad that 16% of children under five years of age die as a result of diarrhoeal disease due to poor sanitation. (8)
Approximately 29.7% and 18.9% of children under five years of age have stunted growth and are underweight, respectively. (8) The Haitian’s staple diet is currently one of clay and water moulded into mud cakes, which tends to quench their appetite, rather than provide the required nutrients. Food is available, but many people are unable to afford to buy it, as two-thirds of Haitian’s live on less than 50 pence per day. (9) The problem is further exacerbated by the poor quality soil, left as a result of burning forests for more cultivable land, which was previously essentially useless. Many of the knowledgeable farmers were left jobless after the importation of cheap food in the 1980s and now the skills that were once passed from generation to generation have been lost. The increasing cost of oil and food has compounded Haiti’s problems, contributing to their current status as the highest-ranking country in terms of suffering in the world. (9)
Political instability has also led to health problems in the Sudan, where there has been an ongoing conflict for 11 years between the ruling party and the Sudanese People’s Liberation Army, based on differences in religious and political beliefs. (10) There seems to be very little hope for a peaceful solution and the droughts are exacerbating the situation, increasing the number of people who are in need of emergency international relief.
Access to schooling in the refugee camps is very difficult. There are very few schools in the camps, together with a lack of teachers, funding and equipment to facilitate learning. The cost of educating a child is often too high for many families to afford, and so many do not fill the available places. (11) There are some organisations, such as Education Action, which are supporting the return of all Sudanese children to school, with the assistance of teachers from the UK.
Various vaccines are available for the protection of children against serious diseases, however, approximately 20% of children are still not immunised. (12) This figure is an improvement on previous years when approximately 40% of children did not receive vaccinations. With relatively low spending on health there are only three physicians to every 10,000 people, and only three times as many nurses. (12) Although 70% of the population has access to clean drinking water sources, the mortality rate of children under the age of five years due to diarrhoeal diseases remains 13% of all deaths. (12) Building wells and sourcing clean water sources is a long-term solution to providing safe drinking water to the entire Sudanese population. A UK gift website says that £8 will maintain a well and £9 will install a tap, a relatively small amount of money to those from richer countries, but which can be of potentially huge benefit to the Sudanese. (13)
Approximately 47.6% of children under 5 are stunted for their age and 38.4% are underweight. (12) This indicates that malnutrition is a severe problem in this region. Although the cultivation of crops in the Sudan is increasing, unequal distribution has left many of the most hungry and desperate civilians without access. Consequently, six million people are still dependant on food aid. (14) In South Sudan seeds, tools, fishing equipment and livestock medicines are distributed, together with the food aid, to families who are attempting to rebuild their lives. However, bandit attacks on food convoys in Darfur are preventing World Food Programme (WFP) deliveries, reducing availability by as much as 50%. (15) Furthermore using the food aid that is provided, the staple diet is that of flat breads, made with wheat, cooking oil and water. This does not provide the protein that is essential for childhood growth and so stunting occurs.
These two examples of the affect of political instability have very clear differences; the Haitian population is now concentrated into urban areas where disease and poverty ravages the communities, whereas in Sudan many people fled from their homes to refugee camps because of the political war, condensing problems within these rural tented villages. However, both Haiti and Sudan have a degree of dependence on food aid, neither country has an obvious view to improvement, and a solution seems almost overly optimistic. In both countries many children are malnourished, resulting not only in impairment of physical growth, but also mental development. Due to the large concentrations of people, the spread of disease is faster, which also causes health problems for the affected children. Worldwide many children are affected by malnutrition caused by food crisis and civil unrest. Food aid and emergency medical relief are only short-term solutions to a longer-term problem. Without proper education these situations are set to get worse. The situations in Haiti and Sudan illustrate how sometimes unaware the developed world can be about major crises. It is important that those in developed countries know the truth about places like Haiti and Sudan, so that a difference can be made.
Amelia Cutts, 2nd Year Medical Student at the University of Southampton, UK
References
(1) www.redcross.org/news/in/health/010312cholera2.html
(2) www.erols.com/mwhite28/wars19c.htm
(3) www.schoolhistory.co.uk/year8links/frenchrevolution_causes.shtml
(4) www.sparknotes.com/history/european/frenchrev
(5) www.haiti-info.com/spip.php?article1265
(6) www.un.org/Depts/dpko/missions/minustah
(7) www.unicef.org/media/media_19455
(8) www.who.int/countries/hti/en
(9) www.guardian.co.uk/world/2008/jul/29/food.internationalaidanddevelopment
(10) www.milnet.com/pentagon/centcom/chap5/unrest.htm
(11) www.education-action.org/default.asp?pageRef=27
(12) www.who.int/countries/sdn/en
(13) http://www.greatgifts.org/