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Kenya, Rwanda, Burundi and Uganda are _some_ of the east African countries that have reported cases of mpox – a viral infectious disease – in the latest outbreak which _started_ in the
Democratic Republic of Congo in January 2023. The outbreak was declared a _public health emergency of international concern_ by Africa Centres for Disease Control and the World Health
Organization in August 2024. There is a danger of the virus spreading further afield. The most vulnerable are countries in east Africa and the Horn that are at war or have recently faced
serious conflicts. Past – or ongoing – conflicts have devastated healthcare systems. Armed conflicts affect the entire spectrum of healthcare. This includes health promotion, prevention,
testing, diagnosis, linkage, treatment, and follow up. For example, in Sudan, where conflict has raged for more than a year, _70% of health facilities have been closed_. What’s left of the
health system is plagued by armed attacks, power outages and shortages of medical supplies and personnel. Another country in east Africa that’s endured conflict for decades is Somalia, with
devastating consequences for healthcare. It has one of the _lowest coverage rates for childhood immunisation_ in the world. Ethiopia is another country in the sub-region that has faced
recent conflict. This is the healthcare system we have studied. Our research focus is public health, including the negative impacts of conflict on health outcomes. We _mapped_ the
repercussions of the war in Tigray region of Ethiopia which started in 2020. Our main findings were that medical and humanitarian services were in a state of siege. There was also evidence
of a rise in illnesses. We concluded from our research that the war had left a catastrophic humanitarian crisis, including a collapse of the healthcare system. Insights from this as well
other research we have done in the region show clearly that armed conflict and the recent mpox outbreak make a deadly mix. And that particular steps need to be taken to manage the spread of
the disease in these environments. These include collaboration with local communities and humanitarian organisations to facilitate vaccination drives. They also include engaging with
military and security personnel for passage and access. Finally, it’s important to factor in vaccinations for people in transit and those crossing borders, as well as refugees and people
living in internally displaced camps. WHAT WE CAN LEARN FROM THE TIGRAY CRISIS The _civil war in Tigray_ that lasted from November 2020 to November 2022 involved the federal government of
Ethiopia imposing a _blockade_ on the entire region. This caused a collapse of the entire healthcare system – and a humanitarian crisis. Our research, published in 2021, found _evidence_ of
forced displacement of two million people, deliberate damage of 70%-80% of health facilities, targeted attacks on health workers, and rape of women and girls. A second study in which the
lead author of this article was involved _surveyed_ 4,381 children under the age of one to investigate the impact of the armed conflict on the use of child health services in Tigray. The
survey found that: