Armed Violence and the Breakdown of the Health System: Vulnerabilities of Health Personnel in the Conflict-Affected Borderland

The literature on health and conflict often highlights that health systems are devastated in conflicts as health professionals flee, infrastructure is destroyed and the supply of essential supplies is halted. But what happens when the conflicts are long-drawn or when they are repetitive? Or when the conflicts are not intensive but cause fragility as they persevere over time affecting individuals, households and institutions? What happens to health governance and health systems in such an atmosphere of political fragility? The chapter seeks to address these questions by examining the key state-run health institutions that are immediately adjacent to the study area. It traces out the history of a state-run public health centre closest to the border. The chapter outlines the process by which political unrest, armed movements and ethnic conflict interacted to impact health delivery systems and health personnel. The fleeing of health personnel and the subsequent absence of doctors due to the threat of violence lead to major consequences which are discussed in detail in the next two chapters: first, the high incidence of preventable deaths arising out of spread of diseases in the major ‘relief camps’ for the displaced populations; second, the emergence of informal healthcare provision as the primary choice for the conflict-affected communities. In addition, the inadequate provision of quality healthcare continued after the conflict. Political fragility in the area (which was a combination of conflict and the shifting power distribution between the state government and the local Bodoland Territorial Council) also impacted essential welfare services. It translated into poor implementation of government welfare schemes critical to the health and well-being of vulnerable populations like those related to food, guarantees of employment, supplementary nutrition of young children, school mid-day meals, housing and provision of safe drinking water and sanitation. Without these protective measures, those who have already suffered severe loss due to the conflict were left even more vulnerable to ill-health and ill-being. In the aftermath of violent conflicts, families and individuals in the Indo–Bhutan borderlands are thus left unassisted, with diminishing prospects of recovering over the long-term.