Health and Post-Conflict Stability: Sierra Leone
19
Relatively cheap investments in civilian security through police, judicial and
rule-of-law
reform,
local
capacity-building
for
human
rights
and
reconciliation, and local capacity-building for public sector service delivery
can greatly benefit long term peacebuilding.
56
As noted above, the need to assist governments to practice ‘good governance’
is a regular part of the international development discourse. To relate this back to
understandings of why states fail it is clear that a requirement of any peacebuilding
process must be to rebuild the legitimacy of the post-war government. War is likely to
restart if opponents of the government reject its authority, and continue to insist upon
the legitimacy of ‘the rebels’. Lasting peace, therefore, requires a “reconstitution” of
the social contract.
57
Any post-war government which is seen as illegitimate by a
proportion of its population is likely to be reliant upon the use of force to maintain its
position, a tactic which is not a recipe for long-term stability. Given that the provision
of economic opportunity and public services (including health) is a vital part of this
social contract, assisting post-conflict governments to deliver in this area can have an
impact upon promoting peace and stability. Of course health-sector interventions will
not work alone, but they may have the ability to make a real contribution. There is
therefore a second way, less direct than HBP-type interventions, in which health can
contribute to peacebuilding.
In the case of Sierra Leone such an approach would appear to be particularly
apposite. As was highlighted above, the conflict in Sierra Leone was one which, to a
considerable degree, emerged as a result of the failure of successive governments to
deliver ‘good government’ and provide for their citizens, leading to the increasing
alienation of large sectors of society and ultimately to open conflict. This failure of
government was not the sole reason for the conflict – there were also real regional
issues, some ethnic tension and economic motives for the continuation of the war. But
it would certainly be true to say that the inability/unwillingness of the government to
provide vital services, including health services, played a major part. The lack of
adequate healthcare provision was certainly a symptom of the conflict through the
direct effects of the war, the resulting mass migration and breakdown of existing
56
Secretary-General’s High-Level Panel on Threats, Challenges and Change, A More Secure World:
Our Shared Responsibility (New York: United Nations, 2004).
57
Tony Addison & S. Mansoob Murshed, ‘From Conflict to Reconstruction: Reviving the Social
Contract’ (United Nations University/WIDER Discussion Paper No.2001/48). See also S. Mansoob
Murshed, ‘Conflict, Civil War and Underdevelopment: An Introduction’ Journal of Peace Research
vol.39(4) (2002), p.392.
Convention