In the past, war was one side fighting against another in 'clear cut' battles on a front line with a clear victor. Presently, what is considered 'war' is much different.
War now has a different sort of combatant, often terrorist groups or extremists fighting for political or economic goals.
The most devastating thing is that war now uses civilian casualties and destruction of innocents to prove their point further. For example, in the 20th century, 191 million people died of conflicts. ONE HALF of these people were civilians, or indirect casualties that aren't necessarily dying on the front line. In fact, by the 1990's the civilian death rate was 80% of all conflict casualties, whether due to malnutrition, removal from homes, removal of medical resources, etc. It is also found that typically, higher rates of these civilian casualties due to conflict are women, children, and elderly. I am still appalled that women and children have a higher death rate than soldiers.
It is a morbid thing to want to watch the rate of the innocents that die rise, but it is an extremely useful fact when considering how humanitarian efforts should be focused, where healthcare should be brought, and actually can help lessen the health effects of a conflict.
Humanitarian agencies are now taking on the caretaker role over the civilians in conflict areas, which are very successful in decreasing the number of indirect death. For example, the Sphere Project following the 1994 Rwandan Genocide conflict was built of humanitarian agencies that went in during an outbreak of Cholera. It created standards to be used in the event of conflict, such as nutrient intake for civilians, tent size, standard of access to water. A code of conduct was also included because not every agency works at the same level of conduct, so this provided a sort of accountability to the NGO's. BUT adhering to strict guideline can actually make matters worse. It is so important that you remember to focus on the needs of each country, because what works for one country may not work for another country.
To win the war on 'terror,' there are many blurry lines concerning what agencies can do, what they will do, and how they will do it. There are military agencies and humanitarian agencies that work with armed conflict, but unfortunately this had led to BOTH groups of agencies being targeted by terrorists. There are 'perceived links' that must be considered before entering a foreign area to provide aid. Military aid also brings up an issue of neutrality when giving care, which must also be considered.
It is difficult for agencies to remain neutral in conflict situations, and it is also difficult to decide whether the actions of the NGO are helping continue or helping end the war. To help this issue, an agency MUST be clear in who they are trying to help and how these people will be benefitting, so that they are not prolonging the war by unintentionally helping the wrong side of the conflict.
This does not seem like a direct health issue, but during and after conflict, health is an important factor. Health is often the cause of many preventable civilian deaths, such as in malnutrition, access to clean water, access to household or necessary sanitation. It is also an important factor in rebuilding. The health of the remaining will determine the health of the future population, especially concerning life expectancies, mortality rates, etc. It is also important to know the strengths and weaknesses of a country's health following conflict, so that it can be known where the issues will arise in the future, and where the healthcare system that was previously there failed. Healthcare does not protect completely; systems can fail especially in the face of conflict, and if this becomes the case there can be a significant growth of indirect, preventable civilian deaths.
As a student whose future goal is to establish an NGO that assists in developing countries, the idea of how to work in armed conflict is very important. In fact, whether armed or without arms, every place has conflict, and it is important to know how to approach this idea when entering a foreign place. When establishing, objectives must be strict and clear, and must be clearly understood by all involved. It must truly benefit the correct people, and must not add to the conflict nor create a sense of reliance. It is incredible to think about how much external and internal thought must go into creating an NGO for a developing country, especially to remain culturally relative and allowing the country's needs to be the focus of the organization. In all global health situations, you have to consider the unique needs of each country, because one size does NOT fit all.