 What is so intriguing about is the fact that during a ten year conflict within the country from 1996-2006, there  was  improvement in 16 of 19 Millennium Development Goals at the same time.  This goes against traditional thinking, that during conflict health indicators will regress.  Are there lessons that can be taken away for future conflict interventions?



	The international response to the genocide in Rwanda in the 1990s was, in the words of Dr. Paul Spiegel, “disastrous” .  The UN had very little presence in the country for the majority of the conflict, largely due to US reticence to intervene.  In 2000, the UN accepted responsibility for not doing enough to prevent the 1994 genocide.  In response, and to ensure an appropriate response in the future, the international community developed the Sphere minimum standards for healthcare in emergency situations.  Some of these standards, as found in the 2011 update of The Sphere Project's manual are:

Health Service Delivery – People have equal access to effective, safe and quality health services that are standardized and follow accepted protocols and guidelines.
Human Resources - Health services are provided by trained and competent health work- forces who have an adequate mix of knowledge and skills to meet the health needs of the population.
Prioritizing Health Services - People have access to health services that are prioritized to address the main causes of excess mortality and morbidity.
Communicable Disease Prevention - People have access to information and services that are designed to prevent the communicable diseases that contribute most significantly to excess morbidity and mortality. (Malaria and Dengue fever are of particular interest here)
Outbreak Detection and Response - Outbreaks are prepared for, detected, investigated and controlled in a timely and effective manner.

 	As of 2005, the number of IDPs in the world was estimated to be 25 million, with another 120 million adversely affected by conflict though not officially displaced.  In the last 15 years, access to healthcare has improved in conflict situations, but there is still a long way to go.  4 of the 5 countries with the highest under 5 mortality rate are conflict affected (Sierra Leone, Angola, Afghanistan, and Liberia).  Just as concerning are the apparent disparities between populations affected differently by the same conflict.  Healthcare services to internally displaced people has not improved to the same level as services for refugees.  There are a number of reasons for this.  IDPs generally don't have a “hub” similar to a refugee camp, for example, that would facilitate healthcare service provision.  In addition, Spiegel points to the “poor access to services and the absence of mandate and funding for one agency to assume decisive responsibility for non-refugee populations” as a complicating issue .  In other words, the lack of an international mandate to serve IDPs, like the one that exists for people deemed worthy of “refugee” status, complicates issues.  Complicating the situation even further, providing care often proves to be costly and difficult for many reasons, some of which are further  discussed below.
