This is the second part of a two-part explainer on the assessment of healthcare costs and the impact of the ongoing conflict on Manipur’s population. Read the first part here. This piece is written by the Centre for New Economics Studies’ InfoSphere team, with the help of its field team. CNES notes that a paucity of localised data remains a challenge. The conflict situations exacerbate these challenges, making any data analytical exercise a difficult process. You can access the InfoSphere edition here.
The intricate relationship between conflict, healthcare and community-based intervention calls for a need to analyse the role of external and internal factors that shape or influence a state’s healthcare landscape. Conflict situations exacerbate healthcare security. And it takes decades for community-based interventions to normalise health outcomes and build trust among a community with respect to the state’s healthcare system.
In the current context of the ongoing ethnic crisis, Manipur serves as an ideal case study to examine the multifaceted impact of conflict situations on healthcare performance outcomes over time. By delving into economic, political, social, and environmental factors, as well as studying the role of local communities in peacebuilding processes, we can gain valuable insights into the complex interplay between conflict and healthcare.
CNES’s research team has spent the past three months closely studying the socio-political and socio-economic aspects of the conflict in Manipur. The lack of mobility and navigation options for external contingency response groups has made it difficult to provide relief-support.
Despite such challenges, many people from the local community and social groups have consistently made efforts in ensuring better contingency response, providing access to basic amenities, such as healthcare security to the affected communities.
External factors shaping healthcare
There are several factors which shape healthcare outcomes in a state.
Economic factors: Economic downturns can have detrimental effects on healthcare access. For instance, in an economy, where medical costs are high and even unaffordable for many, the slowdown can often lead families to delay or even forgo necessary healthcare. In Manipur, the existing economic challenges exacerbate healthcare access issues, disproportionately affecting the vulnerable populations who struggle to cope with both conflict-related displacement and financial strain.
Political factors: A stable political environment is conducive to a well-functioning healthcare sector. Conversely, political instability can have a detrimental impact on healthcare services and accessibility. In Manipur, the ongoing ethnic conflict disrupts healthcare services and impedes healthcare workers’ ability to reach patients, resulting in limited access to chronic disease treatments and general healthcare services.
Social factors: Sociocultural factors, including cultural beliefs, education levels, and openness to modern treatments, play a significant role in shaping healthcare utilisation patterns. Manipur’s diverse cultural landscape influences healthcare practices, as certain communities may hold strong beliefs in traditional medicine, leading them to prioritise these practices over modern healthcare services.
Environmental factors: Environmental factors such as air pollution and water contamination can significantly affect public health outcomes. In Manipur, the restricted mobility caused by the conflict presents challenges in coordinating effective healthcare responses, leaving communities vulnerable to various health risks, including exposure to pollution-related health problems.
Resource availability: Adequate resources, including skilled labour, sufficient funds, and proper medical equipment, are critical for ensuring quality healthcare. In Manipur, shortages of trained medical personnel lead to poor healthcare quality. This could be seen in the state’s public health centres. This scarcity of resources underscores the importance of addressing resource limitations in healthcare delivery.
The conflict’s impact on Manipur’s healthcare system
The ongoing ethnic conflict in Manipur has far-reaching implications for its healthcare system.
The conflict-driven displacement of over 50,000 people places immense strain on the state’s healthcare system. Many healthcare workers have been injured due to attacks on healthcare facilities, leading to disruptions in essential healthcare services. The conflict’s resultant disruption has particularly dire consequences for those in need of chronic disease management and general healthcare.
The conflict has also adversely affected access to mental healthcare. The restricted movement due to the crisis has significantly reduced people’s ability to seek and access mental health services. Given the psychological toll of any crisis, the reduced availability of mental health support is a concerning aspect of Manipur’s current healthcare landscape.
Additionally, the navigational challenges and restricted mobility have impeded effective healthcare responses. This situation not only hampers the state’s ability to coordinate healthcare efforts but also exacerbates the existing strain on Manipur’s healthcare infrastructure, leading to an overreliance on the already stretched medical facilities.
Challenges in Manipur’s healthcare system
Manipur’s healthcare system faces a multitude of challenges that impact its ability to effectively respond to conflicts and ensure healthcare security for its population.
Disparities in access: The disparities in access to healthcare are more pronounced in remote and hilly regions, where the challenging terrain and inadequate infrastructure hinder access to healthcare services. These challenges are exacerbated in tribal areas, where lower percentages of assisted births by medical professionals contribute to greater healthcare disparities.
Self-medication and traditional practices: The lack of access to qualified healthcare practitioners often leads to self-medication and reliance on traditional practices. This practice poses considerable risks to patients’ well-being, as incorrect diagnosis and treatment can lead to adverse health outcomes.
Dual practice of doctors: The dual practice of doctors, serving both in government and private hospitals, has implications for healthcare quality. This practice leads to shortages of doctors in government hospitals, impacting the level of care provided. This dual practice also raises questions about the motivations of doctors and the quality of care provided.
Limited OPD hours: Limited operational hours of outpatient departments (OPDs) in Manipur’s healthcare facilities hinder access to timely healthcare services. The shortage of doctors and resources contributes to these limitations, causing delays in treatment and affecting health outcomes.
Local initiatives and healthcare security
Despite these challenges, local communities in Manipur have played a crucial role in peacebuilding and healthcare support.
The White Flag Movement and community-based rallies exemplify how diverse communities are coming together to promote peace and unity. These initiatives underline the importance of grassroots efforts in building social cohesion and fostering dialogue.
The Forum for Naga Reconciliation (FNR) and the Interfaith Forum have highlighted the significance of dialogue, solidarity, and coexistence. These initiatives illustrate the power of collective action in promoting harmony among different communities.
The Pangal and Kuki communities have demonstrated solidarity through torch rallies and human chains, emphasising the importance of unity.
The Christian Forum Dimapur has embraced an inclusive approach by collaborating with various communities, showcasing the potential of community-driven initiatives in promoting peace and harmony.
Transitioning from classical to resilience humanitarianism
The paradigm shift from Classical Dunantist Humanitarianism to Resilience Humanitarianism is evident in Manipur’s context. This transition signifies the move from providing immediate relief to building long-term community resilience.
The integration of the Triple Nexus Approach, encompassing humanitarian development and peacebuilding efforts, emphasises a comprehensive approach to conflict mitigation and crisis response.
This shift is supported by local community involvement, as seen in the initiatives undertaken by different communities in Manipur. The emphasis on resilience acknowledges the interconnectedness of healthcare, peace, and development, promoting sustainable solutions that address the root causes of conflicts.
Understanding the external factors that shape healthcare outcomes during conflicts is crucial for crafting effective interventions.
Manipur’s case underscores the need to address economic challenges, ensure a stable political environment, consider sociocultural dynamics, and allocate resources effectively. The active participation of local communities in peacebuilding and healthcare initiatives signifies the transition towards resilience-based approaches, fostering unity, dialogue, and long-term stability. By recognising the interdependence of healthcare, peace, and development, Manipur is charting a path towards a more inclusive and sustainable future.
What one needs is more ground data for allowing local internal and external actors to provide immediate assistance and relief to the affected groups and displaced communities. Designing responses also requires data/evidence based on local insights and regular information flows. Peacebuilding efforts take time, and what takes even longer is a process of trust-building among those who have been at the forefront of the conflict. A lot more needs to be done in this regard and so far whatever little evidence we have – of the state doing so – is quite underwhelming.
Deepanshu Mohan is Professor of Economics and Director, Centre for New Economics Studies (CNES), Jindal School of Liberal Arts and Humanities, O.P. Jindal Global University. Amisha Singh, Aditi Desai, Shalaka Adhikari, Samragnee Chakraborty, Shilpa Santhosh and Vasudevan are Research Analysts with CNES and members of the InfoSphere Team. The authors thank Dr Samrat Sinha for his constant guidance, help and support. Previous field studies from the team’s work on Manipur can be accessed from here, here, here, and here.
Deepanshu Mohan, Amisha Singh, Aditi Desai, Shalaka Adhikari, Samragnee Chakraborty, Shilpa Santhosh, Vasudevan