1Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
2Division of Infectious Diseases and Geographic Medicine, Department of Anthropology, Stanford University, CA, USA
Nowhere are the barriers to a functional health infrastructure more clearly on display than in the Goma region of Democratic Republic of Congo. Kaboru et al. report poorly integrated services for HIV and TB in this war-torn region. Priorities in conflict zones include provision of security, shelter, food, clean water and prevention of sexual violence. In Goma, immediate health priorities include emergency treatment of cholera, malaria, respiratory illnesses, provision of maternal care, millions of measles vaccinations, and management of an ongoing rabies epidemic. It is a daunting task to determine an essential package of medical services in a setting where there are so many competing priorities, where opportunity costs are limited and epidemiologic information is scarce. Non-governmental agencies sometimes add to the challenge via an insidious reduction of state sovereignty and the creation of new levels of income inequality. Kaboru et al. have successfully highlighted many of the complexities of rebuilding and prioritizing healthcare in a conflict zone.
1. Kaboru BB, Ogwang BA, Namegabe EN, Mbasa N, Kabunga DK, Karafuli K. TB/HIV co-infection care in conflict-affected settings: a mapping of health facilities in the Goma area, Democratic Republic of Congo. International Journal of Health Policy and Management 2013 ; 1: 207–11. doi: 10.15171/ijhpm.2013.38
2. Refugees International [homepage on the Internet]. [cited 2013 Sep 5]. DR Congo field report. Available from: http://refugeesinternational.org/where-we-work/africa/dr-congo
3. United Nations [homepage on the Internet]. [updated 2013 March 28; cited 2013 Sep 5]. MONUSCO facts and figures. Available from: http://www.un.org/en/peacekeeping/missions/monusco/facts.shtml
4. Bredenkamp C. The puzzle of isolation bonuses for health workers. Democratic Republic of Congo. 2009 Sep. Report No.: 54275.
5. International Union Against Tuberculosis and Lung Disease [homepage on the Internet]. [cited 2013 Sep 5]. Health solutions for the poor. Available from: http://www.theunion.org
7. Bonane W, Zihalirwa G, Salmon M, Benfield N, Ruel T, Kamukehere JM, et al. Prevalence of HIV infection in conflict-affected areas of Eastern Democratic Republic of Congo. AIDS 2010- XVIII International AIDS Conference; 2009.
8. Spiegel PB, Bennedsen AR, Claas J, Bruns L, Patterson N, Yiweza D, et al. Prevalence of HIV infection in conflict-affected countries: a systematic review. Lancet 2007; 369: 2187–95. doi: 10.1016/s0140-6736(07)61015-0
9. Spiegel PB. HIV/AIDS among conflict-affected and displaced populations: Dispelling myths and taking action. Disasters 2004; 28: 322–39. doi: 10.1111/j.0361-3666.2004.00261.x