by Allana Boateng – BA Politics & International Relations, University of Sussex

The World Health Organisation (WHO) estimates that Neglected Tropical Diseases (NTD’s) exist in 149 countries and affect over 1 billion people. The WHO has made significant progress in eliminating NTD’s such as Lymphatic filariasis in Egypt (as of the 12^th of March 2018) and Dracunculiasis in Kenya and South Sudan. Through their public health approaches, which are delivered both locally and through member states, implementation of resolutions is ensured. Efforts to carry out campaigns endorsed by the World Health Assembly NTD Resolution have become some of the largest public health initiatives in history; their legacy has been embedded in the United Nations Sustainable Development Goals (2015-2030).

Normative steps taken by the international community have contributed to much progress, especially in regard to the now subdued global burden of leprosy. Nevertheless, it does remain a prevalent issue; leprosy and Kala-azar (which, left untreated, has a fatality rate of 100% within two years) have been pinpointed as two particularly problematic NTDs.  In-depth, widespread research is crucial to initiatives aiming to lift the burden of disease and ensure no one is left behind.

However, such research is not always available.

In the tumultuous climate of current affairs, conflict is a common occurrence. Despite the existence of health programmes and their widespread effects, it is important to recognise that few programmes systemically reach displaced populations. Agencies such as International Organization for Migration (IOM) are interested in and capable of implementing NTD programmes, but they face many obstacles. Difficulty gaining access to drugs coupled with a lack of coordination with larger NTD control initiatives make their work particularly challenging. Partnership between those concerned with NTD programmes and those with displaced communities would be mutually beneficial, servicing both the goals of controlling NTD’s while allowing for measurement of drug efficacy.

Several factors complicate the challenge posed by NTD’s. Populations displaced and affected by continuous conflict are usually the most vulnerable. All too often placed at the bottom of the socio-economic barrel, they remain highly susceptible to NTD’s. These communities have little voice or representation and the victims are commonly children. Multiple layers of misfortune make this issue extremely difficult to tackle. The absence of literature linking human displacement and NTD epidemiology, alongside insufficient research into effective solutions, can only propel the issue into further turmoil. Human migration, an inevitable fallout of conflict, allows for the introduction and re-introduction of NTD’s into new communities. The climate in conflict zones is usually ripe for disease transmission, and a lack of sanitation, healthcare and health education further exacerbates this phenomenon.

Article 25 of the 1948 United Nations’ Universal Declaration of Human Rights (UDHR) states that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.” Positioning health as a human right reinforces responsibility for when this right is not protected; this responsibility needs to reside somewhere. The lens of Article 25 provides a useful legal framework to examine and address NTDs in conflict settings in particular: human rights conventions such as the UDHR open potential for treaties and subsequent legal obligations of member states to ensure accountability from those in power. Such a vehicle is particularly useful as it prevents these issues from being dismissed as the problems of ‘someone else’. Migration combined with ongoing climate change has allowed organisms to thrive, which ameliorates the issue of neglected tropical diseases in combat situations and gives them a greater target as opposed to just displaced communities.

The solution is far from simple. It is evidently difficult to implement programmes in volatile environments. Crucially, unforeseeable and unpredictable conflict hinders communication between vulnerable communities and informative bodies. However with increased conflict comes a higher likelihood of documentation and research, both key to the implementation of programmes necessary for change. Herein lies an irony, and one that calls for change: conflict should not be required to put this crucial issue in the global spotlight.

This blog post first appeared on the CORBIS Sussex Global Health Blog