Post-conflict health system recovery: the case of Kosovo.

The Environment Short of War The world now can claim that there are fewer declared wars for the first time in almost two decades. Is it a time for celebration or for further reflection on what might come next? I recently dusted off a never-shown slide presentation on post-conflict responsibilities written in 1992. It was put aside then because of a sudden eruption of internal wars in Africa, Asia, the Balkans, and the Middle East, which preoccupied the humanitarian community with life-saving emergency aid and remained far away from thoughts of meaningful post-conflict recovery. The recovery tasks, I suggested, would be difficult, old mindsets on bureaucratically heavy healthcare delivery would have to change and be refocused on primary health care and building, from scratch in many situations , the protective public health infrastructure and systems that keep com-municable and non-communicable diseases at bay. I believed it might take several decades to see health recovery, especially considering on how long it would take to rehabilitate the long decimated medical and nursing education systems. But having no evidence that this was fact, I quickly changed this timeline to a " decade or less before results would be realized " believing my anticipated target audience of humanitarian workers might become discouraged by such a dismal timeline. I expressed concern that the humanitarian community alone might not be up to the challenge and, even in health recovery , jobs and trade would be pivotal to success. My only working model was post-WWII Germany and Japan, which recovered fairly quickly. I never gave security more than a passing thought. How right, and how so very wrong, I was. We now can reopen old studies and reflect on new ones that unexpectedly reveal a highly complex environment that may fail more often than succeed. Studies suggest that 47% of these countries would return to fighting within a decade; in Africa this would be 60%. 1 To call these countries " post-conflict " is problematic. Having a complex lingering level of violence is commonplace in these " environments short of war " that is poorly understood. Too often, small arm weapons remain rampant, economic gains become stagnated, and health indices, like infant mortality rates, worsen. The once rural Africa is now a continent where 67% of its population resides in urban settings that claim over 75% of the population as squatters. 2 Dense and migrating populations lead …