Armed conflicts and other situations of fragility lead to high vulnerabilities [13, 14], particularly for communities in hard-to-reach areas and referred to as ‘last-mile’ populations. Beyond the immediate violent deaths and injuries caused by war and violence [15], the indirect health impact on these people is profound and enduring. The overall toll on human life is devastating [16, 17]. Moreover, when health workers, health facilities, or ambulances are not respected under International Humanitarian Law (IHL) and are targeted, the affected communities lose a last chance to access medical care [18].
The far-reaching political, economic, and humanitarian consequences of protracted armed conflicts raise serious concerns because livelihoods, infrastructures, provision of essential services, and economic activities are disrupted, and development is severely undermined.
The impact is higher when the resilience of these communities is overstretched by decades of hardships, such as in Yemen, Syria, Somalia, Afghanistan, Myanmar, or in the countries of the Great Lakes and the Sahel region.
When major public health emergencies occur, war-torn countries face growing challenges in addressing them. For the Democratic Republic of Congo (DRC), which has a long history of internal conflict, containing recurrent Ebola outbreaks has proven to be a critical undertaking. In areas controlled by non-state armed groups, access to essential healthcare services for civilians remains difficult, and widespread mistrust continues to exist towards aid coming from the central government or external sources.
An illustrative case is the Cholera outbreak occurred in Yemen in the period 2016-2022. This health crisis was primarily due to the disruption of the national health system caused by the long-standing internal conflict. The country was faced with the worst cholera epidemic of modern times, with more than 1 million suspected cases and 3000 deaths [19].
In Eastern DRC and Guinea, major obstacles in responding to Ebola outbreaks [20, 21] were observed when the local community showed resistance towards aid organizations and started to react with violence against community healthcare workers.
Amid the global emphasis on combating infectious diseases, a trend highlighted during the COVID-19 pandemic, particularly in fragile countries, was the persistent challenge to manage Non-Communicable Diseases (NCDs). In these contexts, local health systems rely on poor or inexistent NCD-related services. During the pandemic, the high prevalence of NCD in Low and Middle-Income Countries (LMICs) and in conflict settings [22, 23] resulted in severe discontinuity of care for diabetic, cancer, and cardio-vascular patients.
In the face of scarce life-saving assistance and protection, populations affected by armed conflicts not only face physical hardships, but also grapple with profound mental health and psycho-social consequences [24]. Pervasive uncertainty arising from forced and prolonged displacement has persistently posed challenges to these communities.
The separation from the loved ones, the absence of communication and connection with them, increase the profound psychological distress, trauma, and hardship [25], especially among children [26].
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