From: Civil conflict and sleeping sickness in Africa in general and Uganda in particular
Impacts and vulnerabilities associated with conflict | Impact on transmission determinants | Parameter impact |
---|---|---|
Economic and global effects | ||
• Reliance of governments on external funding for control resources and donor reluctance due to political insecurity | Reduction in provision of public health services | ↑ 1/r in people |
• Reduced reliability of economy for international investment and aid |  |  |
• Collapse of businesses and local economies. Loss of employment, income &provision of products & services | Decreased treatment and control of animal infection and transmission | ↑ 1/r in animal reservoirs |
• Abandonment or appropriation of land; changes in land ownership and land use. Possible increased vector habitat |  |  |
• Loss of educated and business elite in cases of emigration, exile, or purging; decreased overall response capacity and economic stability | Decreased vector control | ↑ 1/u, ↑m |
Decline of health systems and services | ||
• Absence of public health funding due to economic collapse, corruption, or re-allocation of funds to security or military expenses | Reduction in provision of public health services | ↑ 1/r in people |
• Collapse or decline in training programs for public health, veterinary, and vector control workers; decline in personnel and expertise; limited surge capacity for outbreak response | Decreased treatment and control of animal infection and transmission | ↑ 1/r in animal reservoirs |
• Total absence of case surveillance or reporting in some rebel-controlled areas or high-conflict zones; limited screening/treatment |  |  |
• Demotivation of health care, veterinary and vector control personnel caused by insecurity, inflation, or no pay | Decreased vector control | ↑ 1/u, ↑m |
• Collapse of vector control and veterinary health programs |  |  |
Forced migration and internal displacement of populations | ||
• Increased mortality and morbidity due to conflict violence | Increased exposure of people and cattle to tsetse habitat | ↑ a |
• Transport of people and animal hosts, vectors, and parasites into potentially naïve or uninfected populations |  |  |
• Loss of livelihoods – increased stress, reduced household resources, reduced health &nutritional status | Increased vector habitat | ↑m |
• Decreased access to health facilities; decreased population health | Increased mortality | - |
• Separation of household units |  |  |
• Abandonment of land; vegetation re-growth; increased vector habitat |  |  |
Regional insecurity and restricted access for external humanitarian support | ||
•Treatment facilities prone to looting and insurgent attacks | Reduction in provision of public health services | ↑ 1/r in people |
• Insecurity in affected regions constrains or prevents control and implementation logistics; access of mobile teams limited | Increased mortality | - |
• Lack of integration and continuity in primary care where a range of NGOs are the dominant providers of health and intervention services. |  |  |
• Patients delay seeking medical help due to travel insecurity or unavailable transport; higher proportion of late-stage or unreported and untreated cases. |  |  |