Conflict and Health最新文献

{"title":"Community perceptions about factors influencing access to care after sexual violence in North Kivu, Democratic Republic of the Congo: a qualitative study.","authors":"Hanna Reinholdz, Jack Palmieri, Helena Frielingsdorf, Esther Katungu Kalere, Gérard Nteziryayo Heritier, Meggy Verputten, Anette Agardh","doi":"10.1186/s13031-025-00662-4","DOIUrl":"10.1186/s13031-025-00662-4","url":null,"abstract":"<p><strong>Background: </strong>Sexual violence is widespread in the eastern parts of the Democratic Republic of the Congo, including in the North Kivu province. Moreover, in this region survivors of sexual violence often have limited access to care and encounter a variety of barriers when seeking care and support. The aim of this study was to explore community perceptions about access to care, barriers, enablers and possible actions to improve access to care for survivors of sexual violence in North Kivu. A deeper understanding of community perceptions about access to care can guide ongoing efforts to overcome barriers and increase access to care for survivors of sexual violence.</p><p><strong>Methods: </strong>The study utilised a qualitative design, based on focus group discussions with male and female adult community members in the study area. Previous experience of sexual violence was not a requirement. The transcripts from the discussions were analysed using manifest and latent qualitative content analysis.</p><p><strong>Results: </strong>A total of 18 focus group discussions were carried out. The analysis resulted in three main themes; Knowledge and misconceptions around medical consequences crucial for care seeking, Community and family attitudes playing a dual role in care seeking behaviours and Care seeking dependent on optimised healthcare facilities and sensitive staff.</p><p><strong>Conclusions: </strong>Lack of correct knowledge, harmful attitudes from community and healthcare staff, and poorly adapted healthcare services constitute barriers to accessing care. Improved awareness raising around sexual violence is needed to address both lack of knowledge and misconceptions. Efforts should be made to build upon the community support models and actively work to improve community attitudes towards survivors of sexual violence. In addition, there is a need for better adapted healthcare services with improved proximity, access for different groups of survivors and respectful and well-trained healthcare staff.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"22"},"PeriodicalIF":3.1,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real ethics has dirty feet - data collector perspectives on risk exposure during data collection in conflict-affected Eastern DRC.","authors":"Stefan Jansen, Japhet Niyonsenga, Epaphrodite Nsabimana, Mediatrice Kagaba, Eugene Rutembesa, Henny Slegh, Bonaventure Mihigo, Jean Mutabaruka","doi":"10.1186/s13031-025-00658-0","DOIUrl":"10.1186/s13031-025-00658-0","url":null,"abstract":"<p><strong>Background: </strong>Conducting research in humanitarian crisis settings poses multiple logistical and ethical challenges. We studied a community-based intervention called 'Living Peace Initiative', collecting household-based data in conflict-affected Eastern DRC, inevitably exposing data collectors and trial participants to risk.</p><p><strong>Objective: </strong>This study explores the perceptions of local study implementers on the ethics of collecting data in a humanitarian crisis setting.</p><p><strong>Methods: </strong>We used a grounded theory qualitative research Approach. Structured individual interviews were conducted with data collectors (n = 19) and local data supervisors (n = 7). Interviews were audiotaped, transcribed and analyzed using thematic analysis, combining deductive and inductive coding. The analysis was structured around six predefined themes drawn from prior literature, field experiences, and discussions with research team members: motivation, personal safety, trial participant safety, accessibility and working conditions, emotional challenges, and field navigation.</p><p><strong>Results: </strong>Several subthemes emerged. Motivation was reflected in scientific curiosity, professional growth, financial benefits, among others. Personal safety concerns included exposure to armed groups, road inaccessibility, harassment, and illness. Trial participant safety risks included armed conflict, IPV, stigma among others. Accessibility and working conditions were affected by harsh weather, poor infrastructure, network issues, and others. Emotional challenges included exposure to distressing narratives and secondary trauma. Field navigation strategies involved teamwork, and adaptation to local norms. Despite these challenges, data collectors and local data supervisors expressed that the risks were justified and worth taking.</p><p><strong>Conclusion: </strong>Even when fully implementing international ethical guidelines, some risks in humanitarian crisis settings cannot be entirely foreseen or avoided. Local data supervisors and data collectors recognize these risks and take partial ownership in managing them as active agents and contributors to the research. In this sense, real ethics has dirty feet: Data collection in such settings cannot be entirely risk-free; but it still might be important to do the research. The decision to accept such risks however should not solely be made by external researchers who follow international ethical guidelines. It should also be informed by the local data collectors and supervisors who understand the risks within context and culture; and include their judgment on whether the research effort is worth doing.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"21"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menstrual hygiene management among girls and women refugees in Africa: a scoping review.","authors":"Alexis Harerimana, Gugu Mchunu, Julian David Pillay","doi":"10.1186/s13031-025-00657-1","DOIUrl":"10.1186/s13031-025-00657-1","url":null,"abstract":"<p><strong>Background: </strong>Menstrual Hygiene Management (MHM) presents a significant public health challenge for refugee women and girls in Africa. Displaced populations often lack access to menstrual products, adequate Water, Sanitation, and Hygiene (WASH) infrastructure, as well as comprehensive menstrual health education.</p><p><strong>Aim: </strong>This scoping review aimed to understand the state of MHM, identify key challenges, and evaluate existing interventions among refugee women and girls in Africa.</p><p><strong>Methods: </strong>Employing Levac et al.'s framework, the review analysed evidence from databases like CINAHL, Emcare, PubMed, Scopus, and Web of Science, focusing on studies published between 2014 and 2024. Sixteen articles met the inclusion criteria, and both numerical summaries and descriptive analyses were conducted.</p><p><strong>Results: </strong>Refugee women and girls often lack access to both disposable and reusable menstrual products, resorting to unhygienic alternatives such as clothing, leaves, and paper. Inadequate WASH facilities restrict safe and private spaces for menstrual management. Cultural stigma and taboos surrounding menstruation contribute to social exclusion and school absenteeism among girls. The interventions included distributing dignity kits, enhancing WASH infrastructure, and providing menstrual health education; however, they were inconsistently implemented due to resource limitations and cultural obstacles.</p><p><strong>Conclusion: </strong>This study highlights the urgent need for sustainable menstrual health solutions in refugee settings. Without access to necessary products, WASH facilities, and stigma-free education, women and girls risk exclusion, health issues, and interrupted education. Addressing these barriers requires consistent, well-resourced interventions that integrate cultural sensitivity to ensure dignity and long-term impact.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"20"},"PeriodicalIF":3.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preserving the scientific integrity of open science in conflict and health.","authors":"Karl Blanchet, Daniela Fuhr","doi":"10.1186/s13031-025-00659-z","DOIUrl":"10.1186/s13031-025-00659-z","url":null,"abstract":"","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"18"},"PeriodicalIF":3.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative assessment of disease and non-battle injuries in Ukraine since the Russian invasion.","authors":"Lynn Lieberman Lawry, Amandari Kanagaratnam, Ashleigh Roberds, Jessica Korona-Bailey, Luke Juman, Miranda Janvrin, Zoe Amowitz, Tiffany E Hamm, John Maddox, Oleh Berezyuk, Tracey Pérez Koehlmoos","doi":"10.1186/s13031-024-00632-2","DOIUrl":"10.1186/s13031-024-00632-2","url":null,"abstract":"<p><strong>Background: </strong>Disease and non-battle injuries (DNBI) often account for more military casualties than those from combat wounds. The February 2022 Russian invasion of Ukraine has severely limited access to care in areas with increasing patient care needs beyond combat injuries. The expansion of the draft resulted in an older military population susceptible to musculoskeletal injuries, while trench warfare and harsh winters create conditions conducive to cold weather injuries and infectious diseases. This study aims to assess the prevalence and scope of DNBI in Ukraine.</p><p><strong>Methods: </strong>We conducted qualitative key informant interviews with Ukrainian military and civilian health care workers from June 2023-February 2024 using an expanded version of the Global Trauma System Evaluation Tool which had components focusing on DNBI. Thematic content analysis was used to derive key themes related to DNBI from interviews.</p><p><strong>Results: </strong>We conducted 36 key informant interviews. Respondents described the wide range of DNBI that Ukrainian soldiers are experiencing. Infectious disease, cold weather injuries, musculoskeletal injuries, sexual assault, and mental health emerged as prevalent concerns. Respondents described the critical shortage of resources and the high burden on military hospitals as barriers to the delivery of adequate care for DNBI.</p><p><strong>Conclusions: </strong>DNBI in Ukraine are directly related to the physical environment and the age and fitness of the military population. The troop shortage has resulted in soldiers with chronic illnesses returning to duty, while the physical environment limits prevention measures for weather-related injuries and infectious diseases. The complex healthcare challenges created by these factors highlight the importance of a military health system with the capacity to provide service members with the full spectrum of care beyond combat injuries.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"19"},"PeriodicalIF":3.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Health and well-being of older populations affected by humanitarian crises in low- and middle-income countries: a scoping review of peer-reviewed literature.","authors":"Sarah Al Omari, Stephen J McCall, Layal Hneiny, Abla Mehio Sibai","doi":"10.1186/s13031-025-00652-6","DOIUrl":"10.1186/s13031-025-00652-6","url":null,"abstract":"","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"17"},"PeriodicalIF":3.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"What other option did I have?\"- The effect of conflict and displacement on child marriage and early childbearing among displaced Rohingya adolescents.","authors":"Kate Mieth, Tahia Hasan, Adrija Chakrabarty, Kenna Lee, Adrita Kaiser, Tanvir Hasan, Shatha Elnakib, Caitlin Jackson, W Courtland Robinson, Linnea A Zimmerman","doi":"10.1186/s13031-025-00656-2","DOIUrl":"10.1186/s13031-025-00656-2","url":null,"abstract":"<p><strong>Background: </strong>Humanitarian emergencies are postulated to increase rates of early marriage and early childbearing, as drivers of both are heightened or exacerbated in crisis settings. There is a critical need for research that explores the causal mechanisms that motivate family formation, i.e. the process from marriage into childbearing, and how this process is affected by conflict and displacement.</p><p><strong>Objective: </strong>This paper aims to describe how displacement and living within a camp context has affected norms and drivers around family formation, focusing on the lived experience of female and male adolescents and young adults.</p><p><strong>Methods: </strong>We coded and analyzed qualitative data from forty-nine in-depth interviews and sixteen focus group discussions conducted with Forcibly Displaced Myanmar Nationals aged 15-24 who arrived in Cox's Bazar during or after October 2016.</p><p><strong>Results: </strong>Participants largely agreed that rates of child marriage have increased post-conflict and displacement. They attributed this increase to a variety of drivers, including fears around protection, socioeconomic need, lack of education and employment opportunities, and a perceived loosening of restrictions around legal age of marriage within camp. While some of these were pre-existing drivers exacerbated by conflict and displacement, others were new drivers that developed as a result. The ways that adolescents and young adults experienced each driver were highly gendered. Conversely, conflict and displacement had seemingly little effect on cultural expectations to demonstrate fecundity immediately after marriage. Finally, participants felt that adverse living conditions within camp have significantly lowered fertility intentions and have increased cultural acceptance and adoption of family planning.</p><p><strong>Conclusions: </strong>Our results demonstrate that many Rohingya families view child marriage as a practical tool to overcome challenges associated with being displaced, and early childbearing as an inevitable natural consequence of child marriage. The Government of Bangladesh must ease restrictions on income-generating opportunities as well as continue working with humanitarian organizations to provide and fund education and skills-building opportunities for both adolescent girls and boys, who otherwise have no alternatives to child marriage and few other opportunities to productively contribute to their communities.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"16"},"PeriodicalIF":3.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of resilience in general health and mental wellbeing among Syrian and Palestinian refugees in Lebanon: a mixed methods study.","authors":"Jinan Usta, Dana Janbek, Miya Abboud, Jumana Antoun, Rafika Al Ghrawi, Monica Adhiambo Onyango","doi":"10.1186/s13031-025-00653-5","DOIUrl":"10.1186/s13031-025-00653-5","url":null,"abstract":"<p><strong>Background: </strong>This pilot study explored the challenges experienced by Syrian and Palestinian refugees in Lebanon and the role of resilience in general health and mental wellbeing.</p><p><strong>Methods: </strong>This was a mixed methods cross-sectional study conducted in the cities of Beirut and Tripoli in Lebanon. Two hundred Syrian and Palestinian refugees were surveyed and 20 of them participated in in-depth interviews. Descriptive statistics summarized the demographic characteristics, depression, anxiety, resilience, somatic symptoms, and technological use. Associations between resilience and depression, anxiety, and somatic symptoms were measured by calculating Pearson correlation coefficients and Spearman's rank correlation coefficients. Inductive and deductive coding and analysis was used in qualitative data.</p><p><strong>Results: </strong>Refugees' migration journey was characterized by fear, lack of safety, and lack of food. In Lebanon, they experienced discrimination, racism, and challenges in meeting necessities. The three most important challenges experienced by refugees were securing electricity (40.8%), getting medicines (41.6%), and accessing medical care (37%). The mean resilience score was 68.20 ± 19.35. Palestinian refugees had higher mean resilience scores (77.01 ± 17.4) compared to Syrian (61.34 ± 19.45) and Syrian Palestinian (61.14 ± 14.69) refugees. Majority of participants had high levels of somatic complaints with a mean PHQ-15 score of 14.29 ± 6.77. The median GAD-7 score was 14.7 [11.0, 20.0], with the majority of participants (n = 161, 80.5%) reporting moderate or severe anxiety. The mean PHQ-9 score was 15.38 ± 7.33, with most of the participants (n = 121, 60.5%) reporting moderately severe or severe major depression symptoms. Higher resilience levels were associated with lower anxiety, depression, and somatic levels. Religion, friends, family, and good communication were reported as helping refugees cope with challenges.</p><p><strong>Conclusion: </strong>Resilience impacts physical and mental health. Participants with high resilience were found to have better mental and physical health outcomes. Those with higher resilience also reported stronger ties and use of these factors to overcome their challenges.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"15"},"PeriodicalIF":3.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between conflict intensity and health outcomes in contemporary conflicts, while accounting for the vulnerability and functioning of healthcare services.","authors":"Siddarth Daniels David, Anneli Eriksson","doi":"10.1186/s13031-025-00654-4","DOIUrl":"10.1186/s13031-025-00654-4","url":null,"abstract":"<p><strong>Background: </strong>Armed conflict can be described as human development in reverse. In addition to the direct consequences of violence, there are numerous ways in which armed conflict may have indirect effects on people's health and well-being. Studies give varying results, and health impacts seem to differ from context to context. We aimed to determine how conflict intensity is associated with health outcomes, accounting for existing vulnerabilities and the functioning of healthcare services in countries experiencing armed conflict.</p><p><strong>Method: </strong>This study is based on panel data on conflict intensity, vulnerability, healthcare service functioning, and health outcomes in 42 conflict-affected countries between 2000 and 2019 and uses fixed-effects panel regression analysis to determine the associations between conflict intensity and health outcomes.</p><p><strong>Results: </strong>Conflict intensity was positively associated with the health outcomes included in this study. As the conflict intensity increased, the mortality and prevalence of these outcomes also increased, although this increase was not statistically significant for half the outcomes (8/16). After adjusting for the vulnerabilities and functioning of healthcare services, this positive association became significant for all health outcomes. Vulnerability and functioning of healthcare services were strong predictors of outcomes. Subgroup analysis revealed that conflict intensity was more significantly associated with outcomes in countries with high and medium vulnerability scores.</p><p><strong>Conclusion: </strong>Existing vulnerabilities and healthcare system conditions are known to impact health outcomes. The association between conflict intensity and health outcomes strengthens when existing vulnerabilities and the state of healthcare services are considered. This underscores the importance of incorporating strategies to address socioeconomic inequities and strengthen healthcare system capacity in interventions for conflict-affected regions. This also raises additional concerns for long-term negative health effects related to the increasing trend of attacks on health care in contemporary conflicts.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"14"},"PeriodicalIF":3.1,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Health and well-being of older populations affected by humanitarian crises in low- and middle-income countries: a scoping review of peer-reviewed literature.","authors":"Sarah Al Omari, Stephen J McCall, Layal Hneiny, Abla Mehio Sibai","doi":"10.1186/s13031-025-00647-3","DOIUrl":"10.1186/s13031-025-00647-3","url":null,"abstract":"","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"13"},"PeriodicalIF":3.1,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}