Health Inequities in Conflict Settings: The Case of Gaza, Ukraine, and Sudan

January 18, 2025

Health equity—the fair and just opportunity for all individuals to attain their highest level of health—is critically undermined in conflict settings. The interplay of violence, displacement, and the collapse of healthcare systems creates a landscape where health inequities thrive. Regions like Gaza, Ukraine, and Sudan illustrate how armed conflict exacerbates health disparities, particularly affecting vulnerable populations such as women, children, and the elderly. This blog explores the impact of these conflicts on the most vulnerable groups, highlighting alarming statistics and calling for urgent action.

The Impact on Women

In conflict zones, women often bear the brunt of health inequities. Their health needs are compounded by violence, displacement, and a lack of resources. In Gaza, the ongoing blockade and recurrent military conflicts that have taken place since October 2023 have led to severe shortages of medical supplies and reproductive health services. According to the WHO, maternal mortality rates in Gaza have risen from 20 to 38 per 100,000 live births in 2020. WHO is now estimating a significant increase in maternal mortality from these pre-conflict levels. This deterioration can be traced back to inadequate prenatal and postnatal care, with over 90% of women in Gaza lacking access to necessary maternal healthcare services.

Moreover, gender-based violence becomes rampant during conflicts, as societal structures break down. In Ukraine, the war, initiated by Russia in 2022, has seen a 30% increase in reported domestic violence cases, as the chaos of conflict often leaves women isolated and vulnerable. The UN reports that more than 40% of women have experienced some form of violence since the onset of the war, and access to essential services, such as counseling and shelters, has drastically diminished. The psychological toll of such experiences is immense; many women report feelings of hopelessness and despair.

Since clashes broke out in Sudan between rival military factions in April 2023, more than 1.1 million pregnant Sudanese women are in need of healthcare as access to maternal health services has become increasingly challenging due to the scarcity and inaccessibility of healthcare facilities across the country. As the conflict continues, Sudan has now become the largest internal displacement crisis globally, with women and girls accounting for half of those affected. 

The Impact on Children

Children are particularly vulnerable in conflict zones, facing immediate health risks and long-term developmental challenges. In Gaza, UNICEF estimates that over 1.4 million children require urgent humanitarian assistance. Malnutrition is a critical issue, with approximately 1 in 4 children under five suffering from stunting, or impaired growth and development, due to inadequate access to nutritious food. The impact of this malnutrition extends beyond physical health, affecting cognitive development and educational attainment.

The psychological effects on children in conflict zones are equally alarming. A survey conducted by the Palestinian Center for Policy and Survey Research found that nearly 70% of children in Gaza exhibit symptoms of trauma, including anxiety and depression. This psychological distress can hinder their ability to learn and develop normally, creating a cycle of disadvantage that can persist into adulthood.

In Ukraine, the conflict has displaced over 5 million children, disrupting their education and access to healthcare. A staggering 1.5 million children are estimated to require mental health support, with many suffering from the effects of shelling, loss of family members, and the disruption of their daily lives. Schools and healthcare facilities have been destroyed, leaving children without safe spaces for learning or treatment for preventable diseases. The lack of vaccinations due to disrupted healthcare services has raised concerns about outbreaks of diseases like measles and polio, which were previously under control.

The recent analysis published by the Integrated Food Security Phase Classification highlights that the stark and rapid deterioration of food security in Sudan leaves over half of the population at high levels of acute food insecurity, with 14 areas at risk of famine. Between June and September 2024, 25.6 million people (54% of the population) are expected to face crisis or worse levels of acute food insecurity, increased from 17.7 million in the previous update (between October 2023 and February 2024). Almost half of all children are acutely malnourished. 

The Impact on the Elderly

The elderly population in conflict settings faces unique challenges, often exacerbated by physical ailments and social isolation. In Sudan, the protracted conflict has resulted in a fragmented healthcare system, making it increasingly difficult for older adults to access necessary medical care. The Sudanese Ministry of Health reports that chronic illnesses, such as diabetes and hypertension, remain poorly managed due to a lack of medications and healthcare facilities. As a result, the mortality rate among elderly individuals has surged, with estimates indicating that over 50% of older adults have limited access to basic healthcare services.

In Gaza, the elderly population is similarly affected by the ongoing health crisis. Many older adults suffer from age-related diseases, yet access to specialized care is severely limited. A study conducted by the Gaza-based Al Mezan Center for Human Rights found that approximately 60% of elderly individuals in Gaza are unable to access healthcare services. This lack of access has profound implications for their quality of life, as untreated chronic conditions can lead to significant morbidity and mortality.

The Impact on People Living with Disabilities and Chronic Illness

In conflict settings individuals living with disabilities and chronic illnesses face compounded health challenges. These populations are already vulnerable due to their ongoing medical needs, but war exacerbates their situation by disrupting access to essential healthcare, medications, and specialized treatments. In Gaza, where the healthcare system is overwhelmed by repeated airstrikes and blockades, people with disabilities face severe barriers in accessing rehabilitation services, mobility aids, and consistent medical care for conditions like diabetes or heart disease. Chronic illness patients often experience interrupted treatment regimens, leading to worsening health outcomes. The damage to healthcare facilities means that many people with disabilities or chronic conditions are unable to receive the routine care that is crucial to managing their health, increasing their risk of complications, disabilities, and even death.

In addition to disrupted healthcare, individuals with disabilities and chronic illnesses in conflict zones are more likely to experience physical danger, social isolation, and psychological trauma. In Ukraine, as the war continues, many people with disabilities find themselves unable to evacuate from dangerous areas or access emergency medical services, leaving them at higher risk during bombings or sieges. The destruction of infrastructure, including the loss of accessible transportation and healthcare facilities, makes it even harder for people with limited mobility to receive help. In these environments, the psychological stress of living with a chronic condition or disability during conflict is immense, as people experience increased anxiety, depression, and fear for their safety. The combination of these physical, social, and psychological burdens leads to a deterioration of quality of life for individuals living with disabilities and chronic illnesses, contributing to long-term health impacts that extend well beyond the immediate crisis.

Health and Care Workers Under Siege

Health and care workers play an essential role in maintaining public health, particularly during times of crisis. However, in conflict zones like Gaza, Sudan, and Ukraine, these workers face increasing threats, jeopardizing not only their lives but also the health and well-being of entire populations. The loss of skilled medical personnel, the destruction of medical infrastructure, and the psychological trauma faced by healthcare workers can set back public health efforts for years, if not decades. 

In Gaza, the situation has been particularly severe due to ongoing conflict and political instability. Health workers in Gaza, already working under immense pressure, face direct attacks on medical facilities, as well as the threat of violence during their daily tasks. Israel’s military strikes on hospitals and clinics have intensified the risk for health professionals, many of whom are forced to work in unsafe conditions with limited resources. The psychological toll on these workers is significant, as they witness death, trauma, and devastation on an unprecedented scale. The impact on health outcomes is dire: with health systems overstretched and essential medical supplies scarce, preventable deaths increase, and the quality of care suffers. The threat of violence against medical professionals further deters individuals from pursuing healthcare careers in conflict zones, exacerbating existing shortages of skilled personnel.

In Sudan, attacks on healthcare facilities have become a common occurrence, with health workers caught in the crossfire. Clinics and hospitals are often looted or damaged, making it nearly impossible to provide care for civilians. The humanitarian crisis has led to a breakdown in basic healthcare services, including vaccinations, maternal care, and the treatment of chronic conditions. The constant threat of violence has forced many health workers to abandon their posts, leaving vulnerable populations without adequate medical assistance. Additionally, many healthcare workers are targeted specifically because of their profession, with medical staff facing abduction or death in some cases. This erodes public trust in the healthcare system, leading to widespread fear and reluctance to seek medical care, even for non-violent conditions.

In Ukraine, the ongoing war with Russia has resulted in widespread destruction of medical infrastructure and has put healthcare workers in life-threatening situations. Hospitals and clinics have been hit by artillery strikes, and medical professionals have faced direct attacks or been forced to work in dangerous, makeshift conditions. In many cases, healthcare workers have been forced to treat the wounded in underground shelters or bombed-out facilities. The war has not only created an overwhelming number of casualties but has also disrupted the distribution of medical supplies, further compounding the challenge. Health professionals have become targets of violence, with some kidnapped or killed by occupying forces. This creates a profound loss in skilled labor, further reducing the country’s ability to care for its citizens. The morale of healthcare workers has been severely affected, with many experiencing burnout from working in high-pressure, life-or-death conditions for extended periods.

In addition to the immediate loss of life and suffering, there are long-term consequences for the health systems in these regions. The loss of trust in healthcare, the disruption of essential services, and the absence of a stable workforce create cycles of vulnerability that can undermine recovery and development efforts long after the conflicts have ended.

Calls To Action

The conflicts in Gaza, Ukraine, and Sudan, although only illustrative examples of the many conflicts occuring around the globe, underscore the urgent need for health equity in crisis settings. Women, children, and the elderly are disproportionately affected, and face increased health risks and barriers to accessing necessary care. The statistics illustrate the severity of the situation, highlighting the critical need for immediate response and long-term strategies to rebuild health systems and ensure equitable access to healthcare for all.

We call on governments and the international community to:

1. Protect Vulnerable Populations in Crisis Settings

  • Ensure Health Equity: Deliver tailored health interventions for women, children, elderly individuals, and people living with disabilities, addressing their unique needs in emergencies.
  • Expand Access to Critical Services: Guarantee availability of reproductive health care, pediatric and elder care, mental health services, and disability support in humanitarian responses.
  • Combat Health Disparities: Strengthen community-level healthcare and ensure that marginalized groups are prioritized in crisis responses.

2. Address Intentional Attacks on Health Systems and Health Workers

  • Enforce International Humanitarian Law (IHL): Advocate for accountability for deliberate attacks on health systems and health workers, which are war crimes under IHL.
  • Strengthen Monitoring Mechanisms: Support initiatives like the WHO’s Surveillance System for Attacks on Healthcare to document and respond to these violations.
  • Protect Health Workers: Provide security training, protective equipment, and legal protections to frontline health professionals.
  • Prosecute Violators: Push for international sanctions and criminal prosecutions of those responsible for targeting health infrastructure.

3. Guarantee Access to Life-Saving Medicines and Supplies

  • Secure Supply Chains: Ensure uninterrupted delivery of essential medicines, vaccines, and medical supplies to crisis-affected areas.
  • Remove Barriers: Facilitate the distribution of health resources in conflict zones and disaster-stricken regions.

4. Build Resilient and Inclusive Health Systems

  • Invest in Preparedness: Strengthen health systems to withstand shocks and deliver care during emergencies.
  • Engage Diverse Voices: Include women, survivors, people with disabilities, and community leaders in planning and implementing crisis response strategies.

5. Mobilize Multilateral Support

  • Integrate Health Priorities in Peacebuilding: Urge the United Nations, regional organizations, and global actors to position the protection of health workers, health systems, and equitable health access as central components of peace and security agendas.
  • Enhance Coordination Mechanisms: Strengthen partnerships between international agencies, national governments, and local organizations to deliver cohesive, timely, and effective health responses in conflict zones.

6. Support Emergency Health Funding Mechanisms

  • Enhance Global Funding Streams: Reinforce funding streams such as the WHO Contingency Fund for Emergencies and establish innovative financing tools to respond swiftly to health crises.

Ultimately, fostering health equity in conflict settings not only saves lives but also lays the groundwork for sustainable recovery and resilience, ensuring that all individuals have the opportunity to thrive, regardless of their circumstances.

This article was co-authored by the Global Health Council Health Equity Working Group Members:

Action Girls Foundation

Africa Health Budget Network

GRAVIS

Help Age

Royal Health Awareness Society

Speak Trust Pakistan

Youth Centre for Global Health and Research

Youth Network for Positive Change- YOUNETPO