Most armed conflicts over the past decades have been characterised by prolonged civil strife, disproportionally affecting the civil population. Displacement, affected livelihoods, deteriorated health status and economic decline are only some of the consequences. Morbidity and mortality may increase substantially, due to the direct effects of warfare, but often predominantly due to indirect effects as a result of deteriorating determinants of health, including malnutrition, increased epidemic risks, and declines in preventive and curative health services. The government, usually party to the conflict, is often not able or willing to protect its citizens.
Prolonged conflict in often already weak states at the beginning of conflict tends to erode all institutions in the country and will even affect the very fabric of society. Poor institutional capacity typically affects all levels of government, including health authorities at national and subnational levels.