Journal of Climate Change and Pollution

ABSTRACT

Background

Environmental disruption is increasingly recognized as an important determinant of human, animal, and ecosystem health, particularly in fragile and conflict-affected settings. However, environmental governance and environmental infrastructure remain underrepresented within operational One Health recovery strategies. Following the 2020–2022 armed conflict in Tigray, Ethiopia, widespread disruption of healthcare, sanitation, waste management, and environmental regulatory systems created conditions potentially conducive to environmental contamination and increased health vulnerability.

Methods

A mixed-methods implementation science assessment was conducted in Tigray Regional State, Ethiopia. Quantitative components included healthcare waste assessments in nine hospitals, environmental assessments in eight urban centers, wastewater infrastructure evaluations, industrial effluent reviews, and legal compliance analysis of fifteen environmental policy instruments. Qualitative data were collected through key informant interviews (n = 48) and stakeholder validation workshops. Pre-conflict baseline information (2017–2018) was compared with post-conflict assessments conducted between 2024 and 2026. Findings were integrated to identify operational gaps and inform framework development.

Results

Substantial deterioration in environmental health systems was documented following the conflict. Functional controlled incineration capacity declined from five hospitals pre-conflict to two post-conflict. Open waste burning increased markedly across assessed facilities and municipalities, while municipal composting systems ceased operation. Wastewater treatment infrastructure operated at reduced capacity, and untreated wastewater discharge was observed across assessed urban centers. Stakeholders reported concerns regarding unmanaged animal carcasses, healthcare waste disposal, informal slaughtering practices, and environmental contamination. Environmental regulatory implementation was constrained by fragmented institutional mandates, limited financing, and reduced technical capacity. These findings informed development of a phased Environmental One Health recovery framework integrating healthcare waste management, environmental governance strengthening, community engagement, and wastewater-based epidemiology preparedness.

Conclusion

Environmental system disruption represents an important but often overlooked pathway linking armed conflict to One Health vulnerability. Strengthening environmental governance, healthcare waste management, wastewater systems, and community-based environmental engagement should be considered integral components of post-conflict One Health recovery planning. The proposed framework may provide a practical model for fragile and conflict-affected settings.

Keywords: One Health; Environmental Governance; Post-Conflict Recovery; Healthcare Waste Management; Wastewater-Based Epidemiology; Implementation Science; Fragile Settings