Conceptual Issues of Conflict as a Social Determinant of Health: Explorations from Manipur

Abstract

One-sixth of India’s population lives in areas of conflict (including the insurgency-riddled states of the North-East, the secessionist violence in Kashmir, and the struggle to capture power by Maoist groups in several regions of the country). Most armed conflicts generate major public health consequences, both in terms of the population’s health status and the structure, policies, and financing of the health system (Watts et al. in Social determinants of health in countries in conflict and crises: the eastern mediterranean perspective, [1]; WHO in Regional Office for the Eastern Mediterranean, [2]). Conflict not only has implications for health status, but also has serious consequences for the broad social and economic determinants and conditions that affect people’s health crisis settings (Watts et al. in Social determinants of health in countries in conflict and crises: the eastern mediterranean perspective, [1]). The WHO Regional Office for the Eastern Mediterranean [2] identifies conflict as a social determinant of health that bears on health through the loss of human rights, breaches in medical neutrality, and progression from stress to distress and disease that results in constant exposure to life-threatening circumstances. Moreover, conflict reinforces existing SDH: in conflict settings, the marginalized and poverty stricken face a widening of pre-existing inequalities and differentials in health status and consequences. This paper will explore these relationships and their impacts in the Indian context, with a particular emphasis on the state of Manipur, which has been rife with conflict for over four decades.