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War and violence have an impact on the health of the populations that have to endure them, even years after they have finished. C\u00f4te d\u2019Ivoire<\/ins> is an example of this reality.<\/p>\n\n\n\n\n\n Armed conflicts are a danger to public health<\/strong> and one of the most important causes of mortality and diseases throughout history. Their impact is divided between the direct causes of the war, i.e. deaths in combat, and those that are indirect, that may be defined as following on from war and deriving from it, i.e. after subtracting the habitual number of deaths in a prior period. The latter far outweigh the former, in a ratio of 9:1<\/a> compared to those killed in war, but they are more difficult to quantify. To the disabilities caused during the conflict we must add the lack of healthcare services<\/strong>, which makes the spread of avoidable diseases easier, the poor primary care<\/strong>, and the lack of immunization<\/strong>.<\/p>\n\n\n\n On 19 September 2002 the first civil war in C\u00f4te d\u2019Ivoire<\/ins> began<\/strong>, lasting until 2007. Despite the few deaths in relative numbers (around 3,000 people), attacks against health made healthcare more difficult both during and after the conflict. Primary care was reduced<\/strong> because of the attacks and looting of hospitals, and this led to outbreaks of diseases<\/strong> such as cholera, measles, meningitis, and polio, as well as an increase in child malnutrition, which increased from affecting 20% of children to one in three, in just two years.<\/p>\n\n\n\n Money received from international institutions post-conflict was characterized by short-term measures, but even so it was ineffective given the high expenditure on salaries, 40% of the total, as well as the l<\/strong>ack of state <\/strong>capaci<\/strong>ty for the delivery of <\/strong>medic<\/strong>ines and <\/strong>immunization<\/strong> programmes<\/strong>. Four years later, the second civil war was much more bloody, and in just a few months had seen almost the same number of direct deaths as the first in five years. Meanwhile the healthcare system was still recovering and was unable to finish the programme implemented in 2009. In April 2011, when former president Laurent Gagbo was arrested, the majority <\/strong>of <\/strong>h<\/strong>ospitals<\/strong> ha<\/strong>d closed<\/strong> and 70% of the population, especially in the west of the country, as well as in the capital Abidjan, had no access to healthcare.<\/p>\n\n\n\n The incoming (and current) president Alassane Ouattara attempted to guarantee free public healthcare, but less than one year later the plan failed because of its high cost and the corruption in the handling of funds. Poor management and the lack of state <\/strong>capaci<\/strong>ty<\/strong> have reduced the effectiveness of policies to improve public health.<\/p>\n\n\n\n The effects of violence can be felt even today. If we compare with the democratic stability of neighbouring country Ghana, C\u00f4te d\u2019Ivoire<\/ins> is still paying a high price in health for the two civil wars<\/strong> it has endured in the past twenty years.<\/p>\n\n\n\n Ghana has the eleventh best healthcare system in Africa, while C\u00f4te d\u2019Ivoire<\/ins> is still ranked 31 out of 55 countries on the continent<\/strong>. Likewise, while life expectancy in Ghana equals the continental average of 64, The internal conflict in C\u00f4te d\u2019Ivoire<\/ins> <\/strong><\/h2>\n\n\n\n
Comparison between Ghana and C\u00f4te d\u2019Ivoire<\/ins><\/strong><\/h2>\n\n\n\n
C<\/del>\u00f4te d\u2019Ivoire<\/ins> is one of ten countries with a lower average, of 58.<\/p>\n\n\n\n