Choosing not to weaponize healthcare: politics and health service delivery during Nepal's civil war, 1996-2006

Healthcare has often been ‘weaponized’ during armed conflicts, with parties to the conflict interfering with or violently attacking health facilities and personnel for their own strategic ends - for example to deny access to services to supporters of their enemies. Such strategies have damaging consequences for the health system that continue long after the fighting has stopped. In this exploratory study of the civil war in Nepal (1996-2006), by contrast, we look at a case in which both sides (with a few limited exceptions) came to see it as in their interests to avoid targeting health facilities or deliberately disrupting healthcare delivery. As we seek to show, this does not seem to have been solely the result of a desire to comply with international humanitarian law, but rather the product of a strategic choice made by the parties for their own internal political reasons. Drawing on key informant interviews and documentary analysis, we identify four factors that appear to have contributed to the two sides making this choice: i) their interest in the continued functioning of the health systems (specifically, the need of the Maoists to access government-run facilities for treatment of their cadres, and the fact that Maoist healthcare provision ensured that at least some service delivery continued in areas under their control, contributing to the government’s efforts to ensure national health indicators continued to improve); ii) the fact that healthcare did not become an important ‘ideological battleground’ in the conflict; iii) the roles played by humanitarian and development organisations in shaping the behaviour of both the warring sides; and iv) the part played by health professionals in navigating the pressures on them and quickly mobilising to resist more sustained attempts at interference with healthcare.