Health care in conflict zones: a VaccinesWork guide

In the heart of a war zone, a functioning healthcare system may seem like a low priority. Yet throughout history, the main cause of death in conflict has always been what we call “the third army”: disease.

During the Napoleonic Wars, British soldiers died eight times more often from disease than from war wounds. During the American Civil War, two-thirds of deaths were due to pneumonia, typhoid, dysentery, or malaria.

Today, the World Health Organization estimates that a quarter of the world’s population lives in fragile, conflict-affected or vulnerable countries, but these countries account for more than 70% of cases of diseases with epidemic potential, such as cholera, measles and meningitis, as well as more than half of the deaths of children under five.

War and disease continue to go hand in hand.

When we talk about reaching the most vulnerable — zero-dose children and communities not covered by health systems — these are the populations we must target as a priority.

Nearly half of countries eligible for Gavi funding are now classified as fragile or conflict-affected, with a proportion of unvaccinated children three times higher than the rest of the world. Gavi aims to raise $9 billion for the period 2026-2030 to continue its work in these regions, working with new partners and adopting new approaches to reach the hardest to reach.

The consequences of inaction can be both local and global. It is not surprising that the mpox epidemic currently spreading in Africa has its origins in a region ravaged by decades of conflict, where outbreaks of Ebola, cholera and measles have also occurred in recent years.

But beyond the grim statistics, there are stories of courage, ingenuity and hope. In the Horn of Africa, humanitarian negotiators are partnering with vaccinators to ensure all children can access vaccines.

Between 1985 and 2018, 74 “vaccine ceasefires”, where the conflicting parties agree to suspend fighting in order to carry out a vaccination campaign, were recorded in war zones from Afghanistan to Sri Lanka. Lanka. The most recent example was last month, in Gaza.

This week, on VaccinesWorkwe will highlight the stories of those fighting disease in already hard-hit communities, while exploring the impact of conflict and fragility on population health.

Here is a selection of some of our favorite articles from our archives.

– The editorial staff