Conflict-affected Countries Research Articles

Education: War and Peace

Low-cost private schools are ubiquitous across the developing world. This book explores their nature and extent in some of the world’s most difficult places: Liberia, Sierra Leone, and South Sudan. The accepted wisdom of international agencies on education in conflict-affected states acknowledges that some kinds of low-cost private schools emerge during conflict. However, it also holds that private schools can only be tolerated as a temporary expedient, to be replaced by universal government education. Our research supports the accepted wisdom in terms of the existence of low-cost private schools. While this paper clearly supports the accepted wisdom about the emergence of low-cost private schooling, it challenges the assumption that such private education should only be a temporary expedient. In conflict-affected countries, low-cost private schools should be celebrated, and seen as major contributors to providing quality educational opportunities. Reducing the role of government in education has many potential advantages. The recent history of Liberia, Sierra Leone, and South Sudan shows how government education policies were major factors in provoking the conflicts. Reducing the temptation for governments to use education for their own ends would be very positive. Moving education outside government control could help reduce corruption and help bring about a better educated populace, which would act as a bulwark against states oppressing their people. Currently, international agencies tend to focus on creating, improving, and expanding the remit of ministries of education as their way of improving education. Our research suggests an alternative approach: a major underlying aim of any involvement should be to increasingly move educational provision away from government. Every effort should be taken to ensure that any initiative takes the potential for private delivery into account. Regulations can be adapted to allow for the flourishing of low-cost private education. Private-sector curriculum initiatives should be encouraged, to avoid government monopoly in areas that kindle conflict. Funding might only be required as targeted assistance for the most vulnerable groups who are not currently served well by private schools. Any such funding should go only to the families, to help supplement their income, not to schools. Provision of schooling by government is not required given the appetite and enthusiasm of educational entrepreneurs to provide schools where they are needed.

Promoting children's learning and development in conflict-affected countries: Testing change process in the Democratic Republic of the Congo.

Improving children's learning and development in conflict-affected countries is critically important for breaking the intergenerational transmission of violence and poverty. Yet there is currently a stunning lack of rigorous evidence as to whether and how programs to improve learning and development in conflict-affected countries actually work to bolster children's academic learning and socioemotional development. This study tests a theory of change derived from the fields of developmental psychopathology and social ecology about how a school-based universal socioemotional learning program, the International Rescue Committee's Learning to Read in a Healing Classroom (LRHC), impacts children's learning and development. The study was implemented in three conflict-affected provinces of the Democratic Republic of the Congo and employed a cluster-randomized waitlist control design to estimate impact. Using multilevel structural equation modeling techniques, we found support for the central pathways in the LRHC theory of change. Specifically, we found that LRHC differentially impacted dimensions of the quality of the school and classroom environment at the end of the first year of the intervention, and that in turn these dimensions of quality were differentially associated with child academic and socioemotional outcomes. Future implications and directions are discussed.

An assessment of the barriers to accessing the Basic Package of Health Services (BPHS) in Afghanistan: was the BPHS a success?

Afghanistan is one of the most fragile and conflict-affected countries in the world. It has experienced almost uninterrupted conflict for the last thirty years, with the present conflict now lasting over a decade. With no history of a functioning healthcare system, the creation of the Basic Package of Health Services (BPHS) in 2003 was a response to Afghanistan’s dire health needs following decades of war. Its objective was to provide a bare minimum of essential health services, which could be scaled up rapidly through contracting mechanisms with Non-Governmental Organisations (NGOs). The central thesis of this article is that, despite the good intentions of the BPHS, not enough has been done to overcome the barriers to accessing its services. This analysis, enabled through a review of the existing literature, identifies and categorises these barriers into the three access dimensions of: acceptability, affordability and availability. As each of these is explored individually, analysis will show the extent to which these barriers to access are a critical issue, consider the underlying reasons for their existence and evaluate the efforts to overcome these barriers. Understanding these barriers and the policies that have been implemented to address them is critical to the future of health system strengthening in Afghanistan.

Impacts After One Year of “Healing Classroom” on Children's Reading and Math Skills in DRC: Results From a Cluster Randomized Trial

ABSTRACTThis article examines the effects of one year of exposure to “Learning to Read in a Healing Classroom” (LRHC) on the reading and math skills of second- to fourth-grade children in the low-income and conflict-affected Democratic Republic of the Congo. LRHC consists of two primary components: teacher resource materials that infuse social-emotional learning principles into a reading curriculum and collaborative school-based teacher learning circles to exchange information about and solve problems in using the teacher resource materials. To test the impact of LRHC on children's reading and math skills, 40 school clusters containing 64 schools and 4,465 students were randomized to begin LRHC in 2011–2012 or to serve as wait-list controls. Hierarchical linear models (students nested in schools, nested in school clusters) were fitted. Results indicate marginally significant positive impacts on children's reading scores (dwt = .14) and geometry scores (dwt = .14) but not on their addition/subtraction scores. These results should be treated with caution given the reported significance level of p < .10. The intervention had the largest impacts on math scores for language minority children and in low-performing schools. Research, practice, and policy implications for education in low-income conflict-affected countries are discussed.

Priorities for International Co-operation with Libya: A Development Perspective

This article provides a development co-operation perspective on the challenges facing Libya during its post-Qadhafi transition. Four key areas for international co-operation are outlined: peace, reconciliation and justice; governance and public administration; economic diversification; and migration. While concrete initiatives in all of these areas depend on Libya’s domestic security situation, they need to be part of a long-term, holistic strategy for one of the most fragile and conflict-affected countries in North Africa. Assuming that Libya’s domestic power-brokers decide that a modern, prosperous country is what they want, patient and committed international support can help turn Libya into a success story.

Youth Interrupted: The Consequences of Urban Displacement for Young Men and Women in Afghanistan

In conflict-affected countries there is a trend of rapid urbanisation driven by internal migration and displacement. These countries are also increasingly young. Despite constituting a demographic majority in urban conflict and displacement-affected situations, youth are often invisible. Afghanistan fits this dynamic well with two-thirds of the population below the age of 25 and one in four living in cities in so-called ‘informal settlements’ on the fringes of cities, a vast majority with displacement backgrounds. Furthermore, Afghan youth have had very little agency in conceiving their future and that of their country. They are viewed as either vulnerable or risk factors for conflict, with action limited to ‘exit’ or ‘violence’. This article gives urban displaced Afghan youth a voice by telling their story of being caught between the desire for agency and the real and perceived obstacles that prevent this from happening.

Korea's ODA Policy for Fragile States in Asia

Since the Sustainable Development Goals (SDGs) were adopted in New York in September 2015, increased attention has been placed on fragile states, where most people live under the poverty line. Because the SDGs focus more on marginalized people, it will become necessary to address issues concerning fragile and conflict-affected countries. Eight out of fifty fragile states are located in Asia and 30% of the overall fragile state population is expected to reside in Asia. Thus, there is an urgent need for policy efforts to address problems regarding fragile states such as severe poverty and underdevelopment. Furthermore, five out of eight Asian fragile states are categorized as priority partner countries of Korea for 2016-2020. However, Korea's support to the fragile states has concentrated on emergency relief and humanitarian aid for recovery and reconstruction after conflicts or disasters. This is not enough to resolve fragilities and thus it is necessary to establish cooperation strategies to support fragile states.This paper provides policy implications on why and how Korea should prepare a cooperation strategy for supporting fragile states in Asia by analyzing and reviewing the definition and scope and current development situation, as well as Korea's policy and support for fragile states.

‘Why do they make us feel like we’re nothing? They are supposed to be teaching us to be something, to even surpass them!’: Student (dis)engagement and public schooling in conflict-affected Lebanon

In conflict-affected societies, education is seen as a vital vehicle in promoting students’ well-being and social cohesion. Little is known about students’ learning experiences in conflict-affected countries in the Arab world where young people are facing violence, fragmentation and poverty. This paper draws on the perspectives of public school students in Lebanon in order to explore their experiences of student engagement. The findings yielded a disconnection between education policy initiatives for an active and democratic citizenry, and the actual schooling experiences of students who desire to make schooling a more meaningful endeavour. In particular, students’ descriptions reflect the contradictions of the ideals of educational reforms that ostensibly aimed to promote social cohesion and democracy in Lebanon and yet have failed to address inequities in schooling. This disconnection necessitates developing a contextualised and critical understanding of how students experience schooling in Lebanon in order to better inform policy-making and practice.

Innovation in Graduate Education for Health Professionals in Humanitarian Emergencies.

The objective of this report was to show how the Center for Humanitarian Emergencies (the Center) at Emory University (Atlanta, Georgia USA) has trained graduate students to respond to complex humanitarian emergencies (CHEs) through innovative educational programs, with the goal of increasing the number of trained humanitarian workers. Natural disasters are on the rise with more than twice as many occurring from 2000-2009 as there were from 1980-1989. In 2012 alone, 144 million people were affected by a natural disaster or displaced by conflict worldwide. This has created an immense need for trained humanitarian workers to respond effectively to such disasters. The Center has developed a model for educational programming that targets learners along an educational continuum ranging from the undergraduate level through continuing professional education. These programs, based in the Rollins School of Public Health (RSPH) of Emory University, include: a competency-based graduate certificate program (the Certificate) in humanitarian emergencies; a fellowship program for mid-career professionals; and funded field practica. The competency-based Certificate program began in 2010 with a cohort of 14 students. Since then, 101 students have received the Certificate with 50 more due for completion in 2016 and 2017 combined. The fellowship program for mid-career professionals has hosted four fellows from conflict-affected or resource-poor countries, who have then gone on to assume leadership positions with humanitarian organizations. From 2009-2015, the field practicum program supported 34 students in international summer practicum experiences related to emergency response or preparedness. Students have participated in summer field experiences on every continent but Australia. Together the Certificate, funded field practicum opportunities, and the fellowship comprise current efforts in providing innovative education and training for graduate and post-graduate students of public health in humanitarian response. These modest efforts are just the beginning in terms of addressing the global shortage of skilled public health professionals that can coordinate humanitarian response. Evaluating existing programs will allow for refinement of current programs. Ultimately, these programs may influence the development of new programs and inform others interested in this area. Evans DP , Anderson M , Shahpar C , del Rio C , Curran JW . Innovation in graduate education for health professionals in humanitarian emergencies. Prehosp Disaster Med. 2016;31(5):532-538.

Community midwifery initiatives in fragile and conflict-affected countries: a scoping review of approaches from recruitment to retention.

Birth assisted by skilled health workers is one of the most effective interventions for reducing maternal and neonatal mortality. Fragile and conflict-affected states and situations (FCAS), with one-third of global maternal deaths, face significant challenges in achieving skilled care at birth, particularly in health workforce development. The importance of community-level midwifery services to improve skilled care is internationally recognized, but the literature on FCAS is limited. This review aimed to examine community midwifery (CMW) approaches, from recruitment to retention, in FCAS. This scoping review design adapted Arksey and O'Malley's six-stage framework. Data collection included systematic searching of seven databases, purposive hand-searching of reference lists and web sites, and stakeholder engagement for additional information. Potential sources were screened against inclusion and exclusion criteria. Included sources were appraised for methodological quality using the McGill University Mixed Methods Appraisal Tool. Data were analysed thematically, using deductive (i.e. cadre definition, recruitment, education, deployment and retention) and inductive coding (i.e. capacity, gender and insecurity). Twenty-three sources were included, of 2729 identified, discussing community midwifery programmes in six FCAS (i.e. eight for Sudan, six for Afghanistan, three each for Mali and Yemen, two for South Sudan and one for Somalia). Source quality was relatively poor, and cadre definitions were context dependent. Major enablers for effective CMW programmes were community linkages and acceptance, while barriers included inappropriate recruitment, non-standardized education, weak supportive environment, political insecurity and violence. While community engagement and acceptance were crucial, CMW programmes were weakened by inappropriate recruitment and training, lack of support and general insecurity. Further research and implementation evidence is needed to aid policy-makers, donors and implementing agencies in developing and implementing effective CMW programmes in FCAS.

Before and after urban warfare: Conflict prevention and transitions in cities

AbstractThe rising pressures of urbanization in fragile and conflict-affected countries have increased concerns about the vulnerability of cities to armed threats. Changes in the character of armed conflict during the twenty-first century and its effects on cities in the developing world have exposed gaps in the planning and practice of peace and security, which retain a “nation-State bias” that circumvents local perspectives and agencies. Whereas full-scale use of military power in cities remains as destructive today as it has ever been, international organizations such as the United Nations have called for changed approaches to State tactics in urban areas. Mechanisms designed to prevent conflict or to help countries transition back to peace are particularly key if massive human and economic damages are to be avoided in a world of increasingly dense cities. Another key concern is the vulnerability of developing-world cities to low-intensity, if protracted, forms of violence by non-State actors, particularly in post-conflict contexts. Conflict prevention and peace transitions in cities (including mainstream international tools such as peacekeeping, stability and reconstruction aid) are affected by specifically urban pressures linked to rising populations, migration, ethnic tensions, institutional deterioration and the weakening of urban services. Therefore, the physical and social characteristics of cities interact with military and developmental policies in unique ways. An understanding of key local actors, services and institutions affecting urban drivers of armed conflict – an urban strategic environment – can help practitioners and strategists to craft comprehensive policies.

Official Development Assistance for reproductive health has increased but may not be going to those who need it the most.

Objective To provide information on trends on official development assistance (ODA) disbursement patterns for reproductive health activities in 18 conflict-affected countries. Design Secondary data analysis. Sample 18 conflict-affected countries and 36 non-conflict-affected countries. Methods The Creditor Reporting System (CRS) database was analyzed for ODA disbursement for direct and indirect reproductive health activities to 18 conflict-affected countries (2002–2011). A comparative analysis was also made with 36 non-conflict-affected counties in the same ‘least-developed’ income category. Multivariate regression analyses examined associations between conflict status and reproductive health ODA and between reproductive needs and ODA disbursements. Main outcome measures Patterns of ODA disbursements (constant U.S. dollars) for reproductive health activities. Results The average annual ODA disbursed for reproductive health to 18 conflict-affected countries from 2002 to 2011 was US$ 1.93 per person per year. There was an increase of 298% in ODA for reproductive health activities to the conflict-affected countries between 2002 and 2011; 56% of this increase was due to increases in HIV/AIDS funding. The average annual per capita reproductive health ODA disbursed to least-developed non-conflict-affected countries was 57% higher than to least-developed conflict-affected countries. Regression analyses confirmed disparities in ODA to and between conflict-affected countries. Conclusions Despite increases in ODA for reproductive health for conflict-affected countries (albeit largely for HIV/AIDS activities), considerable disparities remains.

Road traffic fatalities in selected governorates of Iraq from 2010 to 2013: prospective surveillance.

BackgroundThe insurgency tactics that characterize modern warfare, such as suicide car bombs and roadside bombs, have the potential to significantly impact road traffic injuries in conflict affected-countries. As road traffic incidents are one of the top ten causes of death in Iraq, changes in incidence have important implications for the health system. We aimed to describe patterns of road traffic fatalities for all demographic groups and types of road users in Iraq during a period characterized by a resurgence in insurgency activity.MethodsIraqi Ministry of Health routine prospective injury surveillance collects information on all fatal injuries in eight governorates of Iraq: Baghdad, Al-Anbar, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya. From all injury fatalities documented at the coroner office, we analyzed only those attributed to road traffic that occurred between 1 January 2010 and 31 December 2013. Coroners ascertain information from physical examinations, police reports and family members.ResultsAnalysis included 7,976 road traffic fatalities. Overall, 6,238 (78.2 %) fatalities were male and 2,272 (28.5 %) were children under 18 years of age. The highest numbers of road traffic fatalities were among males 15 to 34 years of age and children of both sexes under 5 years of age. 49.2 % of fatalities occurred among pedestrians. Among children and females, the majority of road traffic fatalities were pedestrians, 69.0 % and 56.6 %, respectively. Fatalities among motorcyclists (3.7 %) and bicyclists (0.4 %) were least common. Rates of road traffic fatalities ranged from 8.6 to 10.7 per 100,000 population.ConclusionsThe injury surveillance system provides the first data from a conflict-affected country on road traffic fatalities disaggregated by type of road user. The highest numbers of fatalities were among children and young men. Nearly half of fatalities were pedestrians, a proportion nearly double that of any neighboring country. As insurgency activity increased in 2013, the number of road traffic fatalities declined.

Injury-related fatalities in selected governorates of Iraq from 2010 to 2013: Prospective surveillance.

After several years of relative stability in Iraq, the emergence of the Islamic State militant group has spurred a resurgence of violence. This study explores the impact of the conflict on the overall injury profile to estimate the proportion of injury fatalities related to conflict and better understand how violence has affected nonconflict-related injuries. Routine prospective injury surveillance operated by the Iraqi Ministry of Health. Surveillance data were collected from coroner offices in eight pilot governorates: Al-Anbar, Baghdad, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya. We analyzed all fatalities from external injury causes recorded between January 1, 2010 and December 31, 2013. Analysis included 32,664 fatal injuries. Of all injury fatalities reported, 27.1 percent were conflict-related fatalities, approximately the same proportion as road traffic-related fatalities (24.4 percent) and other unintentional injuries (27.5 percent). The proportion of fatalities from conflict was approximately three times higher among males than females (33.0 percent and 10.3 percent, respectively) and four times higher among adults than children (29.8 percent and 7.3 percent, respectively). The total number of injury fatalities remained stable between 2010 and 2012; an increase in injury fatalities in 2013 was driven primarily by increases in fatalities from both interpersonal violence and conflict. From 2010 to 2013, nearly one in four injury fatalities in Iraq was attributable to conflict, a notably higher proportion than other conflict-affected countries in the region. The overall profile of nonconflict injuries in Iraq is also distinct from other countries of similar socioeconomic level that have not experienced violence.

Prioritization in Somali health system strengthening: a qualitative study.

After years of decline and disintegration, the Somalia Federal Government alongside international and domestic partners is beginning the process of rebuilding its national health system. In this study, we aim to shed light on the current approaches to health system strengthening, as viewed by stakeholders closely involved in its development. Key informant interviews were undertaken with health and development professionals working within all three administrative regions of Somalia, as well as with Somali ministry of health officials, global health and policy specialists with interests in health system reconstruction in fragile states. A review of published and grey literature on Somalia, health systems, fragile and conflict-affected countries using PubMed and Reliefweb was also conducted. Technical documents designed for Somali health system building by external development partners were also reviewed. Key priorities identified by participants were, strengthening of local governance and management capacity, scaling-up efforts to structure a robust health financing mechanism, engagement with the burgeoning and dynamic private sector, as well as investing in the appropriate human resources for health. The study found that there was widespread agreement among participants that health system strengthening through a coordinated system would improve long-term capacity in Somalia's health sector. Future research should focus on the evaluation of the modalities by which health system strengthening interventions are implemented, on neglected topics such as mental health within the Somali health system, as well as on population-level barriers to accessing health systems.

Understanding the International Rule of Law Community, its History, and its Practice

This Practitioner’s Guide provides an overview of the range of organizations and individuals engaged in rule of law assistance in conflict-affected countries, the history of rule of law promotion and an overview of contemporary practice. Section I outlines the categories of these organizations, giving specific examples in each category. Section II provides a history of rule of law assistance. It is especially important for national actors and international actors to examine the mistakes of the past, so that they are not repeated in the country they are working in. Section III outlines a number of critiques of the international rule of law assistance. These critiques have been acknowledged by the international community, and in an effort to do better, it has created principles to guide rule of law assistance. These principles are explained in Section IV. Finally, Section V ends the guide on a more optimistic note by exploring more novel approaches to rule of law assistance that are currently being pioneered.

The Comparative Economics of Knowledge Economy in Africa: Policy Benchmarks, Syndromes and Implications

The paper complements the scarce literature on knowledge economy (KE) in Africa by comparing KE dynamics within Africa in order to assess best and worst performers based on fundamental characteristics of the continent’s development. The five dimensions of the World Bank’s knowledge economy index (KEI) are employed, notably: education, information and communication technology, innovation and, economic incentives and institutional regime. The empirical evidence is based on a five-step novel approach with data from 53 African countries for the period 1996-2010. Limitations of the beta catch-up approach are complemented with the sigma convergence strategy. Based on the determined fundamental characteristics, computed dynamic benchmarks, policy syndromes and syndrome free scenarios we establish that: Landlocked, Low-income, Conflict-affected, sub-Saharan African, Non-oil-exporting and French civil law countries are generally more predisposed to lower levels of KE whereas; English common-law, Notlandlocked, Conflict-free, North African and middle-income countries are characteristics that predispose certain nations to higher KE. Broad and specific policy implications are discussed in detail.

Prevalence and correlates of explosive anger among pregnant and post-partum women in post-conflict Timor-Leste.

BackgroundLittle is known about explosive anger as a response pattern among pregnant and post-partum women in conflict-affected societies.AimsTo investigate the prevalence and correlates of explosive anger among this population in Timor-Leste.MethodWe assessed traumatic events, intimate partner violence, an index of adversity, explosive anger, psychological distress and post-traumatic stress disorder among 427 women (257 in the second trimester of pregnancy, 170 who were 3–6 months post-partum) residing in two districts of Timor-Leste (response >99%).ResultsTwo-fifths (43.6%) had explosive anger. Levels of functional impairment were related to frequency of explosive anger episodes. Explosive anger was associated with age (>35 years), being married, low levels of education, being employed, traumatic event count, ongoing adversity and intimate partner violence.ConclusionsA combination of social programmes and novel psychological therapies may assist in reducing severe anger among pregnant and post-partum women in conflict-affected countries such as Timor-Leste.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Testing a cycle of family violence model in conflict-affected, low-income countries: A qualitative study from Timor-Leste

The present study examines key aspects of an emerging cycle of violence model as applied to conflict-affected countries. We focus specifically on the roles of intimate partner violence (IPV), consequent experiences of explosive anger amongst women, and associated patterns of harsh parenting. Between 2010 and 2011, we conducted a women-centred and culturally sensitive qualitative inquiry with 77 mothers drawn consecutively from a data-base of all adults residing in two villages in Timor-Leste. We over-sampled women who in the preceding whole of household survey met criteria for Intermittent Explosive Disorder (IED). Our methodology included in-depth qualitative interviews followed by a focus group with a comprehensive array of service providers. We used the NVivo software package to manage and analyse data. Our findings provide support for a link between IPV and experiences of explosive anger amongst Timorese mothers. Furthermore, women commonly reported that experiences of explosive anger were accompanied by harsh parenting directed at their children. Women identified the role of patriarchy in legitimizing and perpetuating IPV. Our findings suggest that empowering women to address IPV and poverty may allow them to overcome or manage feelings of anger in a manner that will reduce risk of associated harsh parenting. A fuller examination of the cycle of violence model will need to take into account wider contributing factors at the macro-level (historical, conflict-related, political), the meso-level (community-wide adherence to patriarchal norms affecting the rights and roles of women), and the micro-level (family interactions and gendered role expectations, individual psychological responses, and parenting). Longitudinal studies in post-conflict settings are needed to examine whether the sequence of male violence against women, mothers experience of explosive anger, and consequent harsh parenting contributes to risk of aggression and mental disorder in offspring, both in childhood and adulthood.

Exploring the influence of the Global Fund and the GAVI Alliance on health systems in conflict-affected countries.

BackgroundGlobal Health Initiatives (GHIs) respond to high-impact communicable diseases in resource-poor countries, including health systems support, and are major actors in global health. GHIs could play an important role in countries affected by armed conflict given these countries commonly have weak health systems and a high burden of communicable disease. The aim of this study is to explore the influence of two leading GHIs, the Global Fund and the GAVI Alliance, on the health systems of conflict-affected countries.MethodsThis study used an analytical review approach to identify evidence on the role of the Global Fund and the GAVI Alliance with regards to health systems support to 19 conflict-affected countries. Primary and secondary published and grey literature were used, including country evaluations from the Global Fund and the GAVI Alliance. The WHO heath systems building blocks framework was used for the analysis.ResultsThere is a limited evidence-base on the influence of GHIs on health systems of conflict-affected countries. The findings suggest that GHIs are increasingly investing in conflict-affected countries which has helped to rapidly scale up health services, strengthen human resources, improve procurement, and develop guidelines and protocols. Negative influences include distorting priorities within the health system, inequitable financing of disease-specific services over other health services, diverting staff away from more essential health care services, inadequate attention to capacity building, burdensome reporting requirements, and limited flexibility and responsiveness to the contextual challenges of conflict-affected countries.ConclusionsThere is some evidence of increasing engagement of the Global Fund and the GAVI Alliance with health systems in conflict-affected countries, but this engagement should be supported by more context-specific policies and approaches.