Earlier this week, I finally received the completed surveys from the NGO I’m working with in Armenia. On my preliminary read-through of the responses, I realized that I overlooked a fairly important factor when it comes to health seeking behavior in Artsakh. Artsakh is so small, especially following the loss of territory in the 2020 war, that I assumed it wouldn’t make too big of a difference whether the respondents were from Stepanakert (the capital city) or the surrounding villages—the region is roughly 1,220 square miles, around the same size as Rhode Island, and the majority of the population lived in Stepanakert pre-displacement (around 62.5%). However, I didn’t realize just how differently those living in the villages experienced the blockade compared to those in the city. Several respondents cited having to walk long distances in order to seek care, with the fuel shortage hindering access to transportation via car or bus. One respondent complained about pain in her feet and back as a result of having to walk so far to attend antenatal check-ups, and another clarified that those in the villages especially experienced difficulty reaching the city in order to receive medical support. However, I neglected to include a question about locality in my survey instrument, so for many of the respondents, it’s hard to tell whether they were from a village or the city unless they mention it specifically. I feel that this is a pretty major oversight in my data collection and partly attributable to my preconceptions about Artsakh as a diasporan, imagining the region to be more monolithic than it actually is.
This also came up in my lit review when I was reading through similar studies conducted in regions affected by conflict and blockade, particularly in occupied Palestine. In “Maternal and child access to care and intensity of conflict in the occupied Palestinian territory: a pseudo-longitudinal analysis (2000–2014),” the authors identify locality as the strongest factor determining the extent of the negative impact of conflict intensity on access to care. This was largely a result of checkpoints creating shortages or blockages in certain areas in the West Bank, leading to disparities in access. Meanwhile, the Gaza Strip is so small that distance to services tended to be shorter than in the West Bank, though during the period of study, the Gaza Strip was also under siege, jeopardizing care. Though the situation is not perfectly analogous to Artsakh, it only highlights the importance of locality in this kind of study.