Immunization and conflict
Children everywhere, in any situation or circumstance, have the right to survive and thrive.
Around forty per cent of un- and under-vaccinated children live in countries that are either partially or entirely affected by conflict. These children are often the most vulnerable to disease outbreaks like measles and polio, which can cause death or profound disability.
Children in conflict-affected areas miss out on basic immunizations because of the breakdown – and sometimes the deliberate destruction – of vital health services. Areas in conflict also see the killing of health workers and the destruction of medical facilities, supplies and equipment.
In many countries, refugees and those internally displaced by conflict live in crowded conditions – in informal urban settlements, reception centres, camps, or immigration detention – where infectious diseases can spread easily. Yet those displaced by conflict often face barriers in accessing routine healthcare services, including vaccinations, because of a lack of civil documentation and registration.
The resultant population displacement, malnutrition and over-crowding create an ideal environment for disease outbreaks and means children are far more likely to die or suffer complications from conditions that could be easily and inexpensively treated in a peaceful setting.
Meanwhile, the COVID-19 pandemic has exacerbated the threat to children’s health, with lockdowns and increasingly overstretched basic services constraining efforts to reach the most vulnerable populations. Routine immunization services were disrupted in more than 60 countries, including in conflict-affected countries, in 2020, increasing the potential for outbreaks of vaccine-preventable diseases.
Children affected by conflict are pushed into a downward spiral of deprivation that robs them of their health. Vaccines can help to break this vicious cycle but getting vaccination supplies to those in need is often a matter of life and death.
Vaccinators brave rough terrain, cross hostile conflict lines and put their lives at risk to immunize children. In Yemen, polio vaccinators have crisscrossed valleys and mountains to reach children; in some conflict-affected areas of Mali, UNICEF has supported health workers forced to swap motorcycles for donkeys to deliver life-saving vaccines; and in Afghanistan, UNICEF and partners have supported a team of tens of thousands of women who travel throughout their communities to educate families about polio and encourage routine vaccination.
Yet many health workers and vaccinators are intentionally targeted and have lost their lives in recent years. Part of UNICEF’s work is to advocate for safe passage and security for health workers as they carry out their responsibilities in conflict affected communities.
Vaccine supplies must be kept safe and at the right temperature to be effective – the so-called cold chain. UNICEF therefore works with partners to establish, maintain or improve the cold chain for vaccines and other essential medical supplies. We also train health workers to provide immunization, nutrition screening, vitamin A supplements and medical treatment for women and children.
What’s more, UNICEF’s support for immunization services in conflict helps revive other badly needed social services. For example, in conflict-affected areas of Iraq, Syria and Yemen, immunization campaigns also reach communities with services for health and nutrition.
In 2019, UNICEF delivered health care to millions of children in fragile, vulnerable and conflict settings in 61 countries
UNICEF helps vaccinations in conflict-affected regions through:
- Negotiating corridors of peace and days of tranquility with armed groups that allow vaccinators to access conflict-affected areas and deliver essential health interventions including immunization.
- Supporting initiatives for setting up resilient systems including solarization of health facilities, as seen in Syria and Yemen, to be able to deliver immunization and other essential interventions even where there are some disruptions in logistics resulting from conflict.
- Human resources training to ensure capacity is available to provide services based on the do-no-harm principle for the health workers and community.
- Ensuring continuous supply of vaccines and other essential commodities to sustain immunization and other essential services.
- Supporting risk communication and community engagement including active engagement of community gatekeepers to address mistrust, suspicions and rumours that can negatively impact vaccine confidence in conflict settings.
- Supporting integrated outreach strategies to ensure that the multiple deprivations faced by children and women is addressed during windows of access with well-organized and monitored services that integrate multiple interventions, including immunization, reproductive health and nutrition.