• M C Van Hout and J S G Wells.
• Public Health Institute, Liverpool John Moores University, United Kingdom. Electronic address: m.c.vanhout@ljmu.ac.uk.
• Public Health. 2021 Mar 1; 192: 3-7.

ObjectivesThe catastrophic effects of armed conflict, particularly prolonged armed conflict, on individual and public health are well established. The 'right' to healthcare during armed conflict and its lack of enforcement despite a range of United Nations mandated requirements regarding health and healthcare provisions is likely to be a significant feature in future conflicts, as zoonotic-induced pandemics become a more common global public health challenge. The issue of enforcement of health rights assurance and its implications for the public health management of global pandemics such as coronavirus disease 2019 (COVID-19) in and between countries and regions in conflict is the objective of this Review.Study DesignA narrative review was conducted.MethodsReferenced to the framework of International humanitarian law (IHL) and International human rights law (IHRL) to explore and discuss the deficits in health rights assurances in conflict settings and illustrate how gaps in protection and lack of enforcement compounds the disease response. Both IHL, and IHRL can be leveraged to ensure human and health rights are assured in conflict settings. There is a distinct lack of international criteria with regard to standards of healthcare coverage, infrastructure and service preservation to the civilian population during times of armed conflict. This has far reaching consequences when confounded by a pandemic or even localised disease outbreak.ResultsWe illustrate how in a pandemic disease emergency, such as COVID-19, all life is threatened; and how leaving the citizen population exposed to this contagion is a human rights breach and an indirect method of warfare. The consequences of failure to effectively address such pandemic infections, (i.e. COVID-19), in a conflict setting are potentially catastrophic as prevention and containment responses are severely constrained by state insecurity, political instability, terrorism, repression, rights abuses, and displacement of citizens. Neglect by State actors potentially constitutes a breach of the universal right to life. States cannot justify their failures to mitigate disease based on claims of lack of resources, even when available resources are minimal. Where discrimination of people with a disease, such as COVID-19, or minority groups at the point of access to health facilities occurs, this further breaches the principle of medical neutrality.ConclusionsThe example of the COVID-19 response may offer a viable route to leverage greater access and coverage of healthcare in conflict and humanitarian settings. A radicalised partnership approach during these times of emergency is warranted, based on an ethical 'humanitarian intervention' approach to provide care to all affected by contagious disease in conflict settings.Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

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