Abstract
Background:There is ongoing scientific evidence pointing out the adverse effects of conflict on population health and development. Union of Comoros has experienced nearly two decades of political instability and military rule. This comprehensive review was carried out to ask whether the health crisis in Comoros is attributable to the consequences of the chronic political instability.Methods:This study involved a series of semi-structured interviews with key informants complemented by a comprehensive literature search of electronic databases and grey literature. A literature search was performed using all identified keywords associated with health indicators in Comoros to identify potential eligible publications in both English and French from 1975 to July 2020.Results:The analysis demonstrated that political instability and lack of proper leadership from the Government undermine the establishment of health policies which contributed dramatically to the decline in health performance. Additionally, the resurgence and emergence of old and new diseases such as cholera, chikungunya, malaria, HIV/AIDS as indicators of inadequate health services were most likely during political turmoil. Data also showed an out-migration of the health workforce and an increased overseas medical treatment demand, which indicate less attractive working conditions and weak health systems in the country. Meanwhile, an increasing performance of health status indicators was observed after the comprehensive peace process of the 2000-Fomboni Declaration.Conclusions:The chronic political instability in Comoros has contributed to the health crisis facing the Union of Comoros. It has hampered the implementation of proper institutions, which might guarantee the socio-economic development and prosperity of the population. Further studies were needed to evaluate the health burden associated with the two decades of political instability and military rule.
Highlights
Annals of Global HealthGood health is the bedrock on which social progress is built
The war in Syria [16, 17], Lebanon [8, 18], Bosnia Herzegovina [19], genocide in Rwanda [5, 7, 9, 20, 21], ethnic cleansing in Kosovo [22,23,24], and the invasion of Iraq led to the loss of lives [13, 25, 26], but deliberate destruction of health infrastructure, health workforce migration, reduction of financial resources, and decreased access to health service had a massive toll on the lives of survivors
Since its independence in 1975, Comoros, like many African countries, has inherited a health system characterized by massive disparities, with the more privileged urbanites having greater access to health care [46,47,48,49,50]
Summary
Other studies investigating the effects of political instability on the health system have shown that in the crisis-affected region, for example, Goma in DRC, the HIV and TB control appeared not to be the focus of the health intervention despite the high risks of infection [14]. This could significantly increase the incidence of HIV infections and other sexually transmitted infections (STI) and jeopardize the country’s ability to cope with HIV/AIDS, likewise in Kenya during the 2007 post-election crisis [2]. This comprehensive review was carried out to ask whether the health crisis in Comoros is attributable to the consequences of the chronic political instability
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