EHS-COVID (98) Lancet Global Health: War and COVID-19 in Nagorno-Karabakh and Armenia

28 November, 2020

As we explore questions about essential health services during COVID, some countries are facing the simultaneous challenge of war. This paper discusses the situation in Nagorno-Karabakh and Armenia. Citation, extracts and a comment from me below.

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CITATION: War in the time of COVID-19: humanitarian catastrophe in Nagorno-Karabakh and Armenia

Airazat M Kazaryan et al.

Lancet Global Health 2020

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30510-6/fulltext

As a small country with a population of 3 million, Armenia has been severely affected by the COVID-19 pandemic, and for several months was among the countries with the highest prevalence of COVID-19.1 On Oct 23, 2020, the number of confirmed cases was 70 836 and the number of new daily diagnosed cases reached 2484. As a result, Armenia is now the second country in the world with the highest number of new daily diagnosed cases per person (778 cases per million per day), overtaking only the Czech Republic (1321 cases per million per day).

The first case of COVID-19 in Armenia was registered at the beginning of March, 2020, and on March 16, the country declared a state of emergency and went into lockdown. During the next few months, the numbers rose substantially; but by the end of the summer, Armenia was able to flatten the curve. Although there was some increase in the number of cases because of the opening of schools, the number of new daily cases on Sept 26 was 328, and the country had started to overcome the threat from this global pandemic. Unfortunately, this success was short-lived, as another catastrophe began...

On Sept 27, 2020, Azerbaijan initiated a large-scale war against Nagorno-Karabakh... half of the entire Karabakh population, mainly women, children, and the elderly, have already been displaced to Armenia, further exacerbating the humanitarian catastrophe in this region.5 Several coauthors and signatories of this Comment have witnessed the bombardment of the capital, Stepanakert, when delivering medical care for those in need. Several of our colleagues were killed during this commitment.

As a result of these unrelenting attacks, large numbers of people have been wounded and require medical care, which has put the Armenian and Nagorno-Karabakh health-care systems under unprecedented pressure. This strain has forced many of the existing COVID-19 centres to shift their scope, and most non-emergency medical care has either been delayed or cancelled. Although a ceasefire was agreed on Nov 9, the situation remains volatile and previous ceasefires have proven short-lived...

With this Comment, we, as individuals and physicians from different countries and nationalities, call on our colleagues from all over the world and international medical community to pay attention to this crisis, and raise their voice against war in Nagorno-Karabakh with its ensuing humanitarian catastrophe...

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Comment: The WHO guideline 'Maintaining essential health services: operational guidance for the COVID-19 context interim guidance (June 2020)' does not specifically mention war or conflict, although it emphasises the need to protect the vulnerable. What is the role of evidence synthesis in supporting the maintenance of health services in conflict situations? I have not found WHO guidance on this. A quick google search identified a potentially useful publication from the International Peace Institute: 'Hard to Reach: Providing Healthcare in Armed Conflict' https://reliefweb.int/sites/reliefweb.int/files/resources/1812_Hard-to-R... Other organisations such as MSF and ICRC have long experience in providing health services during conflict, both in frontline care and in dealing with logistical and political challenges.

Best wishes, Neil

Coordinator, WHO-HIFA Collaboration: HIFA project on Essential Health Services and COVID-19

https://www.hifa.org/projects/essential-health-services-and-covid-19

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil AT hifa.org