Health worker flight, “brain drain”, often occurs during civil war — triggered by threats to personal safety. Attacks on the health system often take the form of targeting health workers. RENAMO frequently attacked health professionals in the Mozambique, both mutilating (Hanlon 1992) and killing them outright (Summerfield 1988). In Nicaragua, Contra rebels used a similar strategy, attacking and kidnapping doctors, health technicians, nurses, medical students, health educators and volunteers — often in rural areas (Garfield 1985, Garfield et al. 1987). Similar attacks were seen during Nepal’s civil war where health workers were harassed, threatened, and assaulted by both the Maoist rebels and government security forces (Devkota And van Teijlingen 2009).
Fear for their personnel safety often causes health workers — especially those working close active fighting — to abandon their posts (Brentlinger 1996). During the Ivorian civil war, many regions experienced a pronounced drop in health workers of all types. In country’s north, central, and west there was a decrease of 66 percent, 88 percent, and 88 percent of health workers during the conflict respectively (Betsi et al. 2006). This brain drain was most significant in doctors. One region saw a 98 percent reduction in the number of physicians, who fled to government held areas in the south or to other countries (Betsi et al. 2006). During the 1992 war in Bosnia and Herzegovina, two-thirds of health workers left their posts (Bagaric 2000). Areas with a Croat majority were particularly hard hit, the number of doctors before the war compared to after in Jajce, Fojnica, and Travnik dropped from 79 to 4, 37 to 1, and 137 to 18, respectively (Bagaric 2000). In Uganda, 50 percent of doctors and 80 percent of pharmacists left the country between 1972 and 1985, during a period when the country had experienced both an interstate and civil war (Dodge and Wiebie 1985). The result of this health worker brain drain is an inability to staff health positions to provide adequate care. Worse still, the training of a single health worker takes years — even decades. Replacing a lost generation of health professionals is a slow and difficult process.
Hanlon, Joseph. 1991. Mozambique: Who Calls the Shots? Indiana University Press.
Summerfield, D. 1988. “MOZAMBIQUE: HEALTH AND WAR.” The Lancet 331(8581): 360.
Devkota, Bhimsen, and Edwin R van Teijlingen. 2009. “Politicians in apron: case study of rebel health services in Nepal.” Asia-Pacific Journal of Public Health / Asia-Pacific Academic Consortium for Public Health 21(4): 377-384.
Brentlinger, Paula E. 1996. “Health sector response to security threats during the civil war in El Salvador.” BMJ 313(7070): 1470-1474.
Dodge, Cole P., and P. D. Wiebie. 1985. Crisis in Uganda: The Breakdown in Health Services. Pergamon.
Bagaric, I. 2000. “Medical services of Croat people in Bosnia and Herzegovina during 1992-1995 war: losses, adaptation, organization, and transformation.” Croatian Medical Journal 41(2): 124-40.
Christopher R. Albon is a political science Ph.D. specializing in armed conflict, public health, human security, and health diplomacy.