Abstract
Background: Enjoyment of physical and mental health is not only recognized as a human right but also as an integral part of development, as reflected in Sustainable Development Goal (SDG) 3 – to ensure healthy lives and promote well-being for all at all ages. The rapid physical, psychosocial and behavioural changes that take place during adolescence have a strong influence on the rest of a person’s life course, so investments in adolescent health services constitute a unique opportunity to reap lifelong and inter-generational dividends. Yet the evidence base on adolescents’ access to health services, particularly in conflict-affected contexts, remains thin. This article explores adolescents’ access to health services in the Gaza Strip, and their experiences and perceptions of those services. Methods: The article draws on mixed-methods research in the Gaza Strip in 2016 and 2017 involving 240 adolescents and 65 service providers, combining a QuickTapSurvey,™ key informant interviews, peer-to-peer research and individual in-depth interviews. Results: The findings underscore that gender norms—especially those pertaining to adolescent girls’ sexual purity––shape adolescent health in multiple ways. Girls face increasing restrictions on their mobility and social interactions, leaving them with limited opportunities for leisure or exercise, socializing with peers or seeking health (including mental health) services. Adolescent boys in Gaza do not face the same restrictions, but given the multiple political, economic and familial stressors, they are at high risk of substance abuse and involvement in peer violence. Moreover, our findings suggest that a range of socioeconomic, cultural and structural barriers prevent adolescents in Gaza from accessing quality and appropriate health care. Study participants cited the main challenges as an absence of preventive adolescent health initiatives and limited information on sexual and reproductive health, as well as drug shortages, high treatment costs, and negative interactions with service providers. Conclusions: The article highlights the importance of (1) designing and implementing conflict-sensitive and age- and gender-appropriate adolescent services and information; (2) promoting preventive services targeted at adolescents; and (3) improving service provider awareness of adolescents’ specific health needs in all contexts.
Adolescent access to health services in fragile and conflict-affected contexts: the case of the Gaza Strip
