The Impact of Conflict on Healthcare Access in Pastoralist Communities: A Case Study of Bokos Local Government Area, Plateau State

Background: Pastoralist communities in conflict-affected regions face significant barriers to healthcare access due to persistent insecurity, infrastructure destruction, and displacement. This study examined the impact of conflict on healthcare accessibility, outcomes, and delivery systems among pastoralist communities in Bokos Local Government Area (LGA), Plateau State, Nigeria.  Objective: To assess the multifaceted impact of conflict on healthcare access in pastoralist communities, focusing on healthcare accessibility, health outcomes (maternal and child health, vaccination coverage, chronic disease management), healthcare delivery system disruptions, and community coping mechanisms.  Methods: A mixed-methods concurrent triangulation design was employed. The study included 94 participants: 50 pastoralist community members through Google Forms questionnaires, 24 through Focus Group Discussions (FGDs), and 20 healthcare workers through Key Informant Interviews (KIIs). Participants were selected through purposive sampling with snowball technique for communities and purposive sampling for healthcare workers. Data were analyzed using Microsoft Excel for quantitative data with descriptive statistics, and thematic analysis for qualitative data.  Results: All participants (100%) had experienced conflict, with religious conflicts (79.7%) and farmer-herder conflicts (70.3%) being most prevalent. Fear of traveling due to insecurity was the primary barrier to healthcare access (90.5%). Healthcare facility utilization shifted from government hospitals (70.3% before conflict vs. 50.0% during/after conflict) to increased reliance on traditional healers (29.7% vs. 70.3%) and self-medication (20.3% vs. 79.7%). Maternal health outcomes were severely affected, with only 28.8% of women completing recommended antenatal care visits and 42.3% experiencing delivery complications. Child vaccination coverage was critically low, with only 20.3% fully vaccinated and 62.7% partially vaccinated. Chronic disease management was severely disrupted, affecting 59.5% of households. Healthcare system disruptions included 90.0% healthcare worker displacement, facility closures, and severe medical supply shortages (rated 8.2/10). Communities adopted various coping strategies including increased traditional medicine use (79.7%), self-medication (70.3%), and mobile phone consultations (40.5%). Healthcare workers implemented adaptive strategies including mobile clinics, community partnerships, and "hit-and-run" vaccination campaigns.  Conclusion: Conflict has severely compromised healthcare access for pastoralist communities in Bokos LGA, resulting in poor health outcomes and increased reliance on informal healthcare sources. While communities and healthcare workers have developed adaptive strategies, these are insufficient to meet healthcare needs. The study validates the Frustration- Aggression Theory's application to understanding how systemic exclusion contributes to cycles of conflict that further undermine healthcare access. Urgent interventions are needed including conflict-sensitive health policies, mobile health services expansion, technology-enabled solutions, and addressing root causes of conflict.