Public Health in Non-state Spaces

Since 2001, the number of civil wars across the globe has increased 30 percent, leading to a proliferation of ungoverned and semi-governed spaces — territory under the control of militias, insurgent groups, or other autonomous local actors. This poses an acute challenge to public health; one scholar noted that "75 percent of epidemics during the last three decades have occurred in countries where war, conflict, and prolonged political violence have crippled their capacity to respond, leaving their neighbors and the world vulnerable.” In particular, these areas are potential sources of pandemics and “superbugs.” But successful public health programs require strong state actors, international coordination, and systemic solutions. This study explores the issue of public health in non-state spaces, focusing attention particularly on the way in which basic health services become privatized during times of war, and the inherent weaknesses of relying on third-party actors (such as international NGOs) to implement public health programs. It offers a new framework to approach public health provision in non-state spaces, one that does not primarily depend on third-party actors and seeks to avoid the pitfalls of operating solely through the mechanisms of the international state system.

Abandoned Intravenous Drip, Mosul, 2018, Nick McDonell.