The International Federation of Medical Students’ Associations (IFMSA) extends its deep-felt concern and profound solidarity to the populations affected by the crises in Afghanistan, the Democratic Republic of Congo, Haiti, The Occupied Palestinian Territory, Somalia, Sudan, Syria, Ukraine, and Yemen. We are profoundly dismayed by these regions’ unfolding incidents and humanitarian emergencies.
A humanitarian crisis is an event or series of events that threaten a large group of people’s health, safety, and well-being, usually over a wide area. These crises mainly result from natural disasters, public health emergencies, armed conflicts or a combination of these. These issues trigger immediate and long-term adverse effects on communities’ well being referring here to the spread of infectious diseases, deepening of vulnerabilities that already existed, increasing the burden of non-communicable diseases and the risk of gender based violence, and exacerbated mental health problems.[1][2] While taking a significant toll on the societies, communities, and individuals they affect, they require a complex and multi-level response with the indispensable integration of a human rights-based approach.
Current Situations:
Afghanistan: The humanitarian emergency has persisted with ongoing conflict and instability affecting millions. Civilians, especially medical students and healthcare workers, face disruptions in essential services such as healthcare, food, water, electricity, internet, and shelter. Violations of International Humanitarian Law (IHL) and substantial damage to public health infrastructure have been reported. Furthermore, the United Nations Assistance Mission (UNAMA) reports [3] that in many provinces, as a form of oppression, women are not permitted to travel or access medical care without a mahram (male guardian) or his accord, and several instances of ill-treatment against women not wearing a hijab have been recorded. This also impacts women’s right to health as sometimes healthcare facilities are not available close to them. The ban on women accessing parks, gyms, and public baths infringes on their right to the highest attainable standard of physical and mental health. In some instances, public baths are the sole means for women to access hot water for bathing in the winter, affecting their right to water and sanitation. Women also remain prohibited from most employment opportunities, including positions with international organisations and the United Nations, except in healthcare, nutrition, and primary education. They must adhere to strict dress and behavioural codes even in these sectors. [4] IFMSA truly believes that gender equity closely contributes to people’s health and their quality of life, and it should be at the centre of any community as a fundamental value.
DR Congo: The Democratic Republic of Congo is grappling with ongoing armed violence and health crises. In 2023, 115 attacks on healthcare were recorded, and 41 healthcare workers were kidnapped, according to the Safeguarding Health in Conflict Coalition (SHCC) report. [5] Damaged or destroyed healthcare facilities lead to numerous preventable fatalities and long-term consequences for those who are deprived of necessary care. Attacks on medical facilities and staff during conflicts should be a priority when assessing the impact of the conflict. The disruption of essential services and reports of human rights violations have severely impacted civilians and healthcare infrastructure.
As it is noticeable, conflicts have a primary role in the spread of infectious diseases in the DRC. The DRC is one of the five countries that account for 86.5 % of cholera cases in the African region, according to the latest WHO AFRO Cholera Buletin [6]. Conflict situations have exacerbated already substandard infection control mechanisms due to disrupted health services compared to other resource-poor settings. These conditions often result in the employment of inadequately trained staff and a shortage of personal protective equipment.
Moreover, as the instability persists, the number of attacks on healthcare remains significant and disrupts an already severely affected healthcare system. Information is more challenging to collect compared to battle fatalities and civilian homicides and thus is often overlooked in overall war evaluations.
Conflict in DRC has been marked by the use of sexual violence as a weapon of war, with displaced populations at a heightened risk. The UN Secretary-General’s report highlighted that gang rape continues unabated in the DRC, with exceptionally high numbers of girls affected. [7] Armed conflicts, natural disasters, and public health emergencies exacerbate gender-based violence. In these settings, there is an increase in risks and vulnerabilities to families and communities, thus decreasing protection and reporting.
The humanitarian crisis in the DRC is dire, with the compounded effects of ongoing violence and health crises necessitating urgent international attention and intervention.
Haiti: Haiti continues to face political instability, natural disasters, and health emergencies. The population endures a lack of access to essential services and violations of human rights, significantly affecting healthcare workers and facilities. The latest report of the UN Integrated Office in Haiti [8] highlights that the deterioration of security directly affects human rights. A wave of forced displacement followed, leading to the devitalization of neighbourhoods. There have been reported intentional attacks on social service providers. Hospitals and healthcare providers were not spared in this disaster, occasioning the closure of many health centres and reducing access to health services. At the same time, the necessity also increases the exodus of many healthcare providers. The constant trafficking of children is also alarming, accentuating the constant humanitarian crisis. The rise of gang violence also leads to a soaring rise in food insecurity in the country.
The displacement of the population leads to rape and other kinds of sexual violence, of the girls and women having to leave their homes.
Another major issue present in Haiti is the attacks of the armed gang groups that provoke public fear and the establishment of self-defence groups that conduct vigilante killings in some regions of the country. It is essential to emphasise the link between these issues and the disruption of public health systems. Also, this humanitarian crisis widely affects the mental health of the population, increasing the level of stress, anxiety and sometimes depression, mainly for those who had been directly or indirectly victims of trauma during gang attacks. [9][10] Social justice must be the base when addressing these issues and the social, economic and political inequalities.
The Occupied Palestinian Territory: With each passing minute, the number of innocent lives lost since October 2023 continues to rise, reaching 37396. Based on the 2022 population estimate of 2,375,259 for the Gaza Strip, this would represent 7.9% of the total population. [11] Civilians, including medical students and healthcare workers, face extensive disruptions of essential services. Reports indicate a significant increase in casualties and displacement, with attacks on healthcare facilities and personnel violating IHL, as nowhere is safe in Gaza. According to the latest reports, on Saturday, the 13th of July, there was a deadly airstrike on Gaza’s Al Mawasi area, which reportedly left at least 90 people dead and 300 injured. The attack again violates IHL, as the UN Spokesperson Stéphane Dujarric mentions that this area was densely populated and designated as a safe zone. [12] During the period from the 9th to the 16th of July, attacks by the Israeli Security Forces (ISF) on at least 8 schools, including 6 UNRWA schools, were reported; these schools were used by internally displaced people as shelters, significantly increasing the displacement and worsening the humanitarian crisis in Gaza. [13] Moreover, it is also essential to mention the grave violations against children’s health and rights that are happening in the absence of a ceasefire agreement. According to the Global Center for Responsibility and Protect, the UN verified 8,009 grave violations by all parties, and an additional 23,000 are pending verification. [7] More than 14,000 children have reportedly been killed, according to the latest estimate by the Palestinian Ministry of Health; thousands more have been injured. [14]
Disrupted health, water, waste and sanitation systems force people to live in dire conditions, thus determining the apparition of preventable communicable diseases and malnutrition. During the 77th World Health Assembly, the WHO reported that at least 30 patients died of malnutrition, and between 2.5-9% of children in Southern Gaza don’t have access to nutritious food. Approximately 850,000 cases of acute respiratory infections were recorded, and at least 450,000 cases of acute diarrhoea in children under five. [15]
The land crossing to Gaza, the one that is the most viable and effective when it comes to the delivery of humanitarian aid, has been fully functional since the start of the conflict in October 2023. On the 1st of April, seven aid workers from World Central Kitchen (WCK) were killed by Israeli army airstrikes. In early May 2024, the Israeli Defence Forces announced opening two crossings designated for delivering humanitarian aid. However, as of the 9th of May, the UN and other NGOs were no longer permitted to provide the help. When the assistance is being delivered, other issues are happening, such as vandalism and unnecessary extensions of the X-ray scans. All these issues further delay the help that the people in Gaza need. [16] On July 2, Sigird Kaag, the UN Senior Humanitarian and Reconstruction Coordinator for Gaza, called for an immediate and complete ceasefire in Gaza, the unconditional release of all hostages, and unhindered access to deliver large-scale aid. [17]
As the international medical students community, we are also mourning the loss of lives of 24 of our peers in the Gaza Strip whose lives were arbitrarily cut short by the Israeli airstrikes, as well as expressing our support and gratitude to the ones involved in the humanitarian and medical aid in the area.
Somalia: Ongoing conflict and drought have created a severe humanitarian crisis. Civilians suffer from a lack of access to essential services and significant violations of human rights, affecting the health sector profoundly. Cholera has been endemic to Somalia for years. Still, following historic flooding during the Deyr (October – December) 2023 rainy season, cholera and acute watery diarrhoea (AWD) have surged dramatically. Between January 1 and May 19, 2024, 12,327 cases of cholera/AWD have been reported, with 59% of those affected being children under five. The outbreaks have resulted in 114 deaths, with a case fatality rate (CFR) of 1.0%, across 28 districts in Somalia. [18] Moreover, malnutrition is a severe issue among Somali children. Malnourished children are more susceptible to hypothermia, hypoglycemia and communicable diseases.
The dire humanitarian crisis prolongs the violence in Somalia. According to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) [19], armed clashes between local clans were reported in Luuq town of Gedo region between the 5th and 7th of July due to a dispute over land ownership. At least four civilians were killed, and scores of civilians were displaced from Luuq town to nearby
localities. The complex political situation results in forced displacement that results in a unique set of health needs as people go through different displacement routes, inside and across borders, getting exposed to a variety of social, economic, legal, and environmental challenges. Approximately 42,000 people were forced out of their homes to seek safety in nearby settlements. The ongoing conflict made it very hard for humanitarian aid to be delivered, including WASH interventions, because the supplies could only be delivered by air interventions, and some of the populations moved to the areas controlled by the non-state armed groups.
Sudan: The situation in Sudan remains dire, with ongoing conflict and political instability continuing since April 2023. The healthcare system is overwhelmed, and civilians face significant disruptions in accessing essential services as a result of human rights violations. At the moment, according to UNHCR [20], Sudan has one of the highest numbers of forcibly displaced people in the world, accounting for more than 10 million people, from which approximately 8 million are classified as internally displaced persons (IDPs), and 2 million refugees in neighbouring countries. Urgent needs encompass water, food, shelter, healthcare, and essential relief items. Current priority activities include registering new arrivals, relocating individuals away from border areas, identifying particularly vulnerable families and individuals with specific needs, as well as implementing mechanisms to prevent and respond to gender-based violence. Additionally, ensuring alternative care services for unaccompanied refugee children is a critical focus. Moreover, according to the International Organization for Migration’s report, civilians have been subjected to secondary and tertiary displacement [21]. An estimated 70% of hospitals in conflict-affected states are out of service. [22]. Sudan hosts approximately 14 per cent of all IDPs worldwide, and approximately 1 in 7 IDPs worldwide is Sudanese, most of them fleeing to the Central African Republic (CAR), Chad, Egypt, Eritrea, Ethiopia, Libya, Rwanda, South Sudan and Uganda. [23]
In Sudan, the outbreak of armed conflict between the Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF) has had devastating effects on children, leading to a dramatic 480 per cent increase in grave violations compared to 2022. Children have borne the brunt of the escalating and widespread violence, as it is also reported that approximately 200 children have been forcibly drafted into armed groups. [24]. In West Darfur, the RSF Paramilitary Force conducted a genocide campaign against civilians, mainly targeting the Massalit African tribe. According to a new Human Rights Watch report, this resulted in 10,000 to 15,000 civilian casualties [25].
According to a FAO, UNICEF & WFP Report, 17.7 million people are facing acute hunger. 4.9 million are on the brink of famine. [26].
Syria: Syria’s prolonged conflict continues to devastate the country and affect its population. Ongoing economic decline and climate shocks that lead to unstable markets and worsening access to food and water strongly exacerbate the existing vulnerabilities of urban populations. These communities already contend with persistent insecurity, damaged infrastructure, and forced displacement. On the 30th of May, in his statement to the United Nations Security Council, Mr Martin Griffiths expressed concerns regarding the significant underfunding of the humanitarian response in Syria, noting that the funding gap was the largest since the crisis had begun. The humanitarian needs in Syria have surged, making everyday life unaffordable for its people. Now in its fourteenth year, Syria is continuously grappling with a grave crisis, causing immense hardship. Key challenges include economic decline, displacement, escalating military hostilities, global inflation, and the aftermath of the February 2023 earthquakes in southeastern Türkiye and northern Syria. [27] Displacement still remains one of the main factors that necessitate humanitarian aid, as there are approximately 7.2 million IDPs, from which approximately 2 million IDPs live in refugee camps.
In May, fires continued to consume large swaths of crops across various locations in Syria, causing significant losses to the country’s agriculture. These fires have primarily affected fields of wheat and barley, devastating local communities dependent on this industry. Despite efforts by authorities and communities to contain and extinguish the fires, extensive damage was reported. As of the 19th of May, the fire damaged large areas of wheat and barley, including the Sweida and a’Dar Governorates. Most farmers in the southern region of Syria have started harvesting their crops early to mitigate further losses. Water, soil and land contamination, air contamination, water scarcity, and wildlife harm may lead to environmental degradation and reduce individual and collective resilience and ability to adapt to the impact of climate change.
Ukraine: Ukraine continues to face severe challenges due to the ongoing Russian invasion. Since the full-scale invasion began, there have been 1,885 attacks on Ukraine’s healthcare system, leading to the deaths of 157 healthcare personnel and injuries to 435 more. [28] The conflict has caused approximately $1.4 billion in damage to the health sector, with 12.5% of health facilities partially or fully damaged. On the 8th of July 2024, the intensive care, surgical, and oncology wards of Kyiv’s largest paediatric hospital, Okhmatdyt, were severely damaged by a missile strike. [29][30] At the time of the missile strike, there were approximately 700 young patients in the hospital. The attack destroyed the operating rooms, the toxicology wing, and life-saving equipment, leading to the evacuation of the children to other hospitals. This tragic incident resulted in the deaths of 27 civilians, including four children, and injuries to 117 individuals, seven of whom were children.
[31] The war has also created significant barriers to accessing mental health care and high-quality sexual and reproductive health services. The impact extends beyond the health sector, with substantial damage to housing, electricity, gas, and heat supply infrastructure, resulting in Ukraine losing 50% of its electricity generation capacity as of June 2024.
The humanitarian crisis is exacerbated by reports from occupied territories indicating that healthcare facilities are being repurposed for military use, denial of care to civilians, and coercion of civilians into renouncing their nationality to access medical services. The enduring war and deliberate attacks on the healthcare system point to an urgent need for a robust international response to protect and restore essential health services and uphold human rights. Social justice and humanitarian principles must be at the forefront of addressing these ongoing crises. [32]
Yemen: Yemen’s ongoing conflict has resulted in a dire humanitarian situation. Yemen’s public health is confronted with substantial challenges exacerbated by ongoing conflict and various compounding factors. Nearly a decade of war has severely deteriorated the humanitarian situation, intensifying risks such as famine, severe acute malnutrition, and outbreaks of diseases including Polio, Diphtheria, Dengue, Malaria, and Measles. Additionally, the conflict has led to casualties, forced displacement, and setbacks in developmental efforts across the country. [33] According to the Humanitarian Needs Overview for 2024, an alarming 17.8 million people need health assistance, with a target set for 9 million to receive aid throughout the year. The cholera outbreak in Yemen persists, affecting most of the country. As of the 6th of July, the northern governorates have reported 92,918 suspected cases, while the southern governorates have reported 19,665 suspected cases as of the 10th of July. The Health Cluster, in coordination with relevant authorities and partners, is orchestrating a rapid response to the outbreak.
IHL recognises, by definition, “that the civilian population of a State affected by an armed conflict is entitled to receive humanitarian assistance. IHL regulates, in particular, the conditions for providing humanitarian assistance in the form of food, medicines, medical equipment, or other vital supplies to civilians in need.” The humanitarian principles of humanity, neutrality, impartiality and independence should be at the centre of aid delivery. They should be respected by all the parties engaged in the armed conflict and support the humanitarian actors in alleviating the suffering of the civilians affected by the conflict. Moreover, we believe that only through a ceasefire can the humanitarian crisis can be stopped.
Our Call to Action:
Guided by our dedication to humanitarian principles, we reiterate our call to all the armed parties involved to:
- Adhere strictly to IHL and respect all individuals’ rights, dignity, and lives.
- Ensure the safe passage of essential life-saving supplies and personnel to all impacted regions.
- Consistently respect human rights, particularly those of vulnerable populations such as women and children.
- Safeguard students, doctors in formation, healthcare workers and facilities, condemning violence against them.
- Establish safe and accessible channels for delivering essential supplies and create safe spaces for psychological first aid.
- Appeal to international agencies, governments, and involved parties to pursue mechanisms for an immediate cessation of hostilities and a sustainable, peaceful resolution.
Call to UN Bodies, NGOs, Civil Society Organizations:
Acting according to humanitarian mandates and the principles of humanity, neutrality, impartiality, and independence, it is essential to strengthen the rule of law and impartial accountability systems. This approach ensures the protection of human rights principles, thereby promoting peace and health.
Call to the Medical Community:
We call upon our National Member Organizations (NMOs) and the future healthcare professional community to seek factual and unbiased information, advocate for the thorough implementation of IHL, and support initiatives that safeguard and uplift human lives amidst crises. Moreover, in these times of conflict, we emphasise the importance of collecting data and sharing only verified sources of information, as it is our responsibility to share the truth about health emergencies happening worldwide.
Our thoughts, prayers, and efforts remain with the affected communities. We mourn the tragic loss of lives especially of our peers and their families and stand firm in our advocacy for an end to the ongoing atrocities. We stand in unwavering solidarity with each individual enduring this hardship, advocating unceasingly for peace, justice, and humanity to prevail in these trying times.
Let our collective stand for peace, unity, and humanity be the beacon that guides our actions and influences in the global arena. There is no peace without health, and no health without peace!
Credible Sources of Information:
– Doctors Without Borders: https://www.msf.org/latest-portal r
– UNRWA: https://www.unrwa.org/
– ReliefWeb: https://reliefweb.int/
– ICRC: https://www.icrc.org/en/news
– Safeguarding Healthcare in Conflict Report: https://insecurityinsight.org/wp-content/uploads/2024/05/2023-SHCC-Critical-Conditions.pdf
-Insecurity Insight: https://insecurityinsight.org/wp-content/uploads/2024/04/The-impact-of-violence-against-health-care-on-the-health-of-children-and-mothers-IRC.pdf
– Resources from the UNRWA – IFMSA – The Lancet Side Event During WHA77: https://drive.google.com/file/d/1gSYYKqh4VhPYHkJ7EHM2X-9xzBTup928/view?usp=sharing
– International Rescue Committee: https://www.rescue.org/eu
Hotlines:
– Protection against sexual abuse and exploitation (PSEA): reachable at 121 and through WhatsApp at +972 59-4040121 (East Jerusalem at 1-800-500-121): [Sawa](https://childhelplineinternational.org/palestine-sawa-121/)
– Sudan: https://help.unhcr.org/sudan/refugees-and-asylum-seekers-in-sudan/reaching-out-to-unhcr-in-sudan/
– Ukraine: https://www.unicef.org/eca/resources-and-helplines-families-fleeing-ukraine
Donations:
– ICRC: https://www.icrc.org/en/donate
– International Rescue Committee: https://www.rescue.org/
– UNRWA: https://donate.unrwa.org/
– Doctors Without Borders: https://donate.doctorswithoutborders.org/
– Save The Children: https://www.savethechildren.org/us/ways-to-help/ways-to-give
IFMSA Policy Documents:
- Peace and Health: https://ifmsa.org/wp-content/uploads/2024/04/Peace-and-Health.pdf
- Gender Equity: https://ifmsa.org/wp-content/uploads/2024/04/MM24-Gender-Equity.pdf
- Control of Emerging Infectious Diseases: https://ifmsa.org/wp-content/uploads/2021/09/GS_AM2021_POLICY_CONTROL-OF-EMERGING-INFECTIOUS-DISEASES-3-1.pdf
- Protection of Healthcare: https://ifmsa.org/wp-content/uploads/2023/05/IFMSA-Policy-Document-on-Protection-of-Healthcare.pdf
- Eliminating Gender-Based Violence: https://ifmsa.org/wp-content/uploads/2023/05/IFMSA-Policy-Document-on-Eliminating-Gender-Based-Violence.pdf
- Ensuring Access to Medical and Humanitarian Aid: https://ifmsa.org/wp-content/uploads/2023/05/IFMSA-Policy-Document-on-Ensuring-Access-to-Medical-and-Humanitarian-Aid.pdf
- Climate Change: https://ifmsa.org/wp-content/uploads/2023/05/IFMSA-Policy-Document-on-Climate-Change.docx.pdf
