“Even in a weak system without a quality improvement structure, it is possible to support district managers and facility providers to measure and improve quality care,” said Eliane Razafimandimby, Chief of Party of USAID’s flagship Maternal and Child Survival Program (MCSP) in Madagascar, at a recent Wilson Center event on improving the quality of reproductive, maternal, newborn, and child healthcare (RMNCH).

“One of the first victims of war is the health care system itself,” said Marco Baldan, the chief war surgeon for the International Committee of the Red Cross. Violence directed at health facilities and workers is common in conflict, despite international laws protecting medical personnel, facilities, and transport vehicles during war.

How much time passes between a laboring woman’s decision to seek care and her arrival at a health facility? Transportation for emergency obstetric care should be swift and timely, but for many refugees in the world’s conflict zones, it is not.

An analysis of refugee maternal mortality in 10 countries found that transportation problems contributed to more maternal deaths outside of refugee camps, which tend to have better access to emergency transportation services.

How much time passes before a woman—or her relatives—decide to seek care or emergency medical services during pregnancy? It often depends on how much they know about the services available.

This information may be hard to come by in conflict-affected areas, especially among internally displaced women. According to a retrospective study of health care during the 2006 war in Lebanon, 80 percent of Lebanese pregnant women before the war sought antenatal care, while the share of displaced women seeking care was only 34.5 percent.