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Table 1 Possible health system support activities for international security forces by building block

From: A cross-case comparative analysis of international security forces’ impacts on health systems in conflict-affected and fragile states

Building block

Crisis acuity

Periods of quiescence

Acute crisis

Post-crisis

Governance

Develop baseline knowledge of health system leaders, providers, and financing mechanisms

Assess opportunities to save instruments of health governance such as medical and vaccination records, payroll systems, procurement data, health communication and information systems.

Consider how medical systems for indigenous security personnel and disaster preparedness systems relate to the civilian health sector. Work with health sector leadership to develop approaches to these health sub-systems that will avoid competition with the civilian health sector for health workers, public health emergency assets, and donor funding.

Consider offering communications and logistics support to health sector leadership if it is necessary to help them manage public health crises

If the ISF is engaged in anti-corruption initiatives, support or advocate for transparent health sector procurement and budgetary processes

Health information

Develop baseline knowledge of epidemiologic surveillance, census, and health performance systems

Assess if the ISF’s epidemiologic, environmental health surveillance, and public threat detection systems can feed into or strengthen civilian surveillance systems.

Assure robust protocols are in place regarding how public health threats will be monitored, who will be notified of their presence, and what collection of organizations and actors will act to mitigate them.

Contribute to or advocate for donors to fund baseline health data collection systems in fragile states

Assess if ISF situational awareness tools can yield information about the status of health sector assets, and if these tools can contribute to the overall international health system support effort.

Indigenous health service delivery

Consider opportunities to strengthen operational ties with leading health system institutions so these ties will be in place in case of acute civilian health crisis

Assess opportunities to protect health sector infrastructure. Be mindful that many instances the best protection strategy may be one of ‘passive support’ where maximum distance is kept between ISFs and indigenous health organizations and institutions. Likewise develop and implement plans for how ISFs can offer maximum protection to health sector workers

Consider if and how ISF logistics and engineering assets can bolster public health infrastructure or mitigate public health threats

If ISFs are going to provide direct health care to civilians, this care should be done in the context of supporting health system organizations regain pre-crisis operational levels.

  1. The potential health supporting activities listed in Table 1 are broken down by the health sector building blocks the cases revealed were most often affected by international security forces (ISFs). It is also organized by acuity of crises facing the health sector. In ‘periods of quiescence’ threats to the health system are minimal or insidious. Opportunities for strengthening health system functions exist. During acute crises, significant losses of health sector assets and degradation of health system functions are possible. Protection of assets and mitigating loss of health system functions is the priority. In post-crisis periods, efforts to restore health system assets and functions are made, or significant reforms to health system building blocks are undertaken.
  2. Throughout this project we have distinguished between ISF involvement in supporting health sectors in fragile settings and participating in humanitarian health aid delivery. The considerations presented in this table are not meant to replace careful analysis of how ISF actions will impact humanitarian organizations delivering health aid or on humanitarian space generally. The Interagency Standing Committee and Global Health Cluster guidelines provide an excellent tool for assessing the risks to humanitarian principles presented by ISF involvement in humanitarian health operations, for example [20]. In some instances, as when ISFs decide to provide health care directly to populations, both an analysis of how this will impact the indigenous health sector mentioned above, and an analysis of how it will impact humanitarian space needs to be undertaken.
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Conflict and Health

ISSN: 1752-1505