Fragility, Conflict and Violence’, and Health: New Questions for Policy Design

By Stephen Commins, Associate Director of Global Public Affairs @ UCLA Luskin,  Director of International Practice Pathway,  Faculty Cluster Leader of Global Environment and Resources, Lecturer in Urban Planning

Internally Displaced Persons on the Road, Sudan; Creative Commons: UN Photo/Tim McKulka

Over the past 15 years, donor agencies and researchers have sought to address the challenges of improving governance and services, as well as reducing levels of conflict in ‘fragile and conflict affected states’ (FCAS). One element of this effort has been different types of definitional and ratings systems on ‘state fragility’ and an accompanying area of research on the relationship between FCAS and health.

This year, two new approaches were presented at the World Bank’s Fragility Forum. The Bank has moved from FCAS to “Fragility, Conflict and Violence” (FCV). At the same time, the Organisation for Economic Co-operation and Development (OECD) has shifted its approach to a more nuanced framework involving five different elements:Violence (and Crime); Justice; Institutions; Economic Foundations; Resilience.

The shift in definitions and metrics points to several new elements beyond state ‘fragility’:

  1. Attention to the impact of inter-personal violence, which may be criminal or identity based (or a combination of both), on wellbeing and development
  2. Recognition of the impact of the levels of violent crime in general on well being
  3. Acknowledgement of the significant roles of criminal networks in particular situations

An additional point to consider is how and where these factors are changing due to the continual processes around urbanization. For example, in regards to urban areas, what matters in daily life may not be state fragility but everyday insecurity. Security and insecurity are sometimes understood as describing two, distinct contexts. Everyday insecurity points to the importance of assessing both different forms of insecurity/fragility as well as communities that can contain spaces that are relatively secure and those that are relatively insecure. Some individuals and neighborhoods have situations that can be relatively secure and those that are insecure depending on identity (ethnic, religious, political) or criminal activity.

Violence and crime may contribute to the lack of access to services, and to further weakening social cohesion and trust. Many urban poor people live at a physical and social distance from formal non-governmental organizations or government agencies. Thus, when they face pressures from crime and violence, which affects access to schools and livelihoods, they may not have any formal systems of support or help. In addition, gender-related violence includes not only household violence but threats that prevent access to sanitation and water services. For young people, the key elements of the transition to adulthood are often truncated by the experience of or exposure to violence and crime.

Just as there has been a shift in programmatic and policy thinking/approaches to include fragility and conflict in both assessment and practice, so greater attention to different types of violence and criminal activity is increasingly important. Traditionally, ‘development’ and ‘crime’ have been in different professional and academic domains. The new OECD framework and the FCV approach present an opportunity to establish more integrated and coherent approaches to development, including health services, especially in poor urban communities.

The new OECD framework and the new World Bank approach to FCV both provide an opportunity for understanding how health services are shaped, particularly in urban areas. New research could contribute to a better understanding of the implications for health, especially in urban areas:

  1. Access to health may be mediated by criminal networks, and in urban areas in particular, criminal networks
  2. Criminal networks and political parties may collaborate so that access to health, water and sanitation is controlled by a combination of political cronies and criminal groups
  3. Access to water and sanitation may be controlled by criminal organizations and women and girls may be deterred from using services due to fear of harassment and violence
  4. The relationship between Criminal Justice Systems and policing may impact security and access to services



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