Conflict and Health最新文献

{"title":"When the system fails, the community leads: field insights from the self-efficacy and knowledge (SEEK) trial during Lebanon's 2024 active conflict.","authors":"Shadi Saleh, Hady Naal, Zahraa Chamseddine, Dalia Sarieddine, Veloshnee Govender, Tania Bosqui, Gladys Honein-AbouHaidar, Hani Tamim, Fouad Fouad, Lale Say, Asmaa El Dakdouki","doi":"10.1186/s13031-026-00847-5","DOIUrl":"10.1186/s13031-026-00847-5","url":null,"abstract":"<p><strong>Background: </strong>Adolescent girls and young women affected by conflict experience persistent sexual and reproductive health challenges along with poorer mental health and wellbeing. Among Syrian adolescent girls and young women living in Lebanon, these challenges are exacerbated by displacement, economic challenges, and barriers to accessing needed health services. Community-based interventions are being increasingly adopted to address these gaps, however evidence remains limited on how these interventions can be effectively implemented while preserving fidelity and quality during periods of active conflict, especially when centralized delivery models are not feasible.</p><p><strong>Main body: </strong>This paper presents a comment on implementation insights from the Self-Efficacy and Knowledge (SEEK) trial, a community-based integrated intervention conducted in two primary healthcare centers in Lebanon to improve sexual and reproductive health service uptake and psychosocial wellbeing among Syrian adolescent girls and young women aged 15-24. Specifically, during implementation, escalating conflict severely restricted mobility and on-site supervision by the central team, threatening intervention continuity. As a result, the team shifted the implementation model from a centralized structure to a decentralized one, emphasizing co-leadership with local communities. To that end, local and affected community members were recruited, trained, and supervised to assume responsibility for field coordination, management of logistical procedures, and decision-making in real time, supported by remote supervision. Subsequent outcome evaluations identified positive effects on some outcomes, and limited effects on others, indicating that SEEK's effectiveness varied across outcomes. Beyond these findings, the experience highlighted how adaptive approaches that shift power to affected communities during implementation amid active conflict can transform contextual constraints into opportunities for culturally responsive and resilient implementation.</p><p><strong>Conclusion: </strong>The implementation of SEEK demonstrates that community-led models may not be merely emergency substitutes when traditional delivery systems fail, but foundational strategies for effective humanitarian programming during conflict. Shifting power to local and affected communities as co-implementers can strengthen ownership, adaptability, and sustainability during active conflict. Community leadership, supported by flexible planning and agile decision-making may be essential for building resilient health interventions.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"20 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066005","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":"Violence against health care workers in a post-conflict context: an exploratory qualitative study in the province of South Kivu, Eastern Democratic Republic of Congo.","authors":"Daniella Bugugu, Samuel Lwamushi Makali, Emmanuel Lurhangire, Pacifique Mwene-Batu, Armand Mulume Bisimwa, Giovanfrancesco Ferrari, Rosine Bigirinama, Jessica Ramirez Mendoza, Ghislain Bisimwa, Sonja Merten","doi":"10.1186/s13031-026-00821-1","DOIUrl":"10.1186/s13031-026-00821-1","url":null,"abstract":"<p><strong>Background: </strong>Violence against healthcare is a significant public health issue worldwide, yet it remains poorly documented in resource-limited countries, especially in sub-Saharan Africa. This study aims to explore the causes of such violence, types, perpetrators, consequences and mechanisms for its prevention within the post-conflict context of the South Kivu province in eastern Democratic Republic of the Congo (DRC).</p><p><strong>Methods: </strong>This exploratory qualitative study was conducted from April to May 2022 in the health zones (HZ) of Kamituga, Katana and Walungu. A diverse group of participants, including health system stakeholders, community members and policy makers were interviewed, through Focus Group Discussion (FGD) and key informant interviews (KII), guided by a pre-established interview guide. A deductive thematic analysis was carried out and the verbatim quotes were used to illustrate the respondents' comments.</p><p><strong>Results: </strong>A total of 143 participants were interviewed for this study. The types of violence reported included physical, verbal and psychological abuse, threats through communication channels and economic abuse (misappropriation of funds, unpaid discharge). The identified causes included interpersonal dynamics within the healthcare staff and between staff and patients, cultural influences and systemic organisational issues. Aggressors varied, spanning from patients and their companions, to the healthcare workers themselves, alongside political, administrative and customary authorities. The violence has far-reaching negative consequences, affecting the individual health care workers, their colleagues and the overall quality of healthcare delivery. Pre-existing warning and prevention mechanisms include recourse to the hierarchy, silence, the utilization of suggestion boxes, regular meetings at the Central Zone Office and supervisory measures.</p><p><strong>Conclusions: </strong>Violence against healthcare professionals is a well-known but poorly documented issue that affects both their wellbeing and professional performance. Integrated health system reforms addressing accountability, governance, and working conditions are needed to prevent violence against healthcare workers, with engagement of political authorities essential for developing and implementing effective prevention strategies.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392616","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":"Determinants of recovery time from cholera in a conflict-affected agro-pastoral region of ethiopia: evidence from survival models.","authors":"Tegenu Tento, Sebisibe Kumaso, Sitotaw Ahmed, Tilahun Asena, Nurhussen Ahmed","doi":"10.1186/s13031-026-00818-w","DOIUrl":"10.1186/s13031-026-00818-w","url":null,"abstract":"<p><strong>Background: </strong>Cholera remains a major public health concern in Ethiopia, particularly in conflict-affected agro-pastoral regions where access to healthcare, clean water and vaccination is limited. The main objective was to identify predictors of time to recovery from cholera among patients in a conflict-affected agro-pastoral area of Ethiopia using survival analysis models. Understanding the clinical and epidemiological factors influencing recovery time is critical for improving outcomes and guiding outbreak responses.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using data from cholera treatment centers in a conflict-affected agro-pastoral region. Time to recovery was analyzed using Kaplan-Meier recovery curves, Cox proportional hazards, and Accelerated Failure Time (AFT) models. Variables included clinical signs, demographic factors, vaccination status, and exposure history.</p><p><strong>Results: </strong>Severe dehydration (HR = 0.49, p < 0.0001; TR = 1.49), low pulse rate (HR = 0.69, p = 0.005), and lack of vaccination (HR = 0.56, p < 0.0001) were associated with significantly longer recovery times. Notably, patients with known contact with cholera cases showed slower improvement (HR = 0.63, p = 0.0003), suggesting higher exposure or delayed care-seeking. Vaccinated individuals and those with mild dehydration recovered significantly faster. The log-Normal AFT model confirmed these findings, showing prolonged recovery among high-risk groups.</p><p><strong>Conclusion: </strong>In conflict-affected agro-pastoral settings, clinical severity, vaccination status, and exposure history are key determinants of cholera recovery time. These findings underscore the importance of early case detection, aggressive rehydration, and targeted vaccination, especially among known contacts and high-risk individuals. Public health interventions should prioritize rapid response strategies and contact-based follow-up to reduce disease burden and improve recovery outcomes.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310420","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":"The health outcomes of shelter and settlements interventions in humanitarian crises: a systematic review.","authors":"Elizabeth Jarman, Lundi-Anne Omam, Jayshree Bagaria, Lizzie Babister, Jim Kennedy, Susannah Webb, Eba Pasha, Charles Kelly","doi":"10.1186/s13031-026-00811-3","DOIUrl":"10.1186/s13031-026-00811-3","url":null,"abstract":"<p><strong>Background: </strong>Shelter and settlement are critical determinants of health in humanitarian crises, yet their impacts on health outcomes remain underexplored. This review synthesizes published evidence on how shelter and settlement interventions impact health outcomes in humanitarian crises.</p><p><strong>Methods: </strong>A systematic review of peer-reviewed literature was conducted to identify studies examining the association between shelter and settlement interventions and health outcomes in humanitarian crises. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines a protocol was developed and three databases were searched for studies published between 2005 and 2025. Relevant data were extracted and thematically analysed.</p><p><strong>Results: </strong>A total of 138 articles were found. Thematic analysis identified six themes (living conditions, accommodation type, camp and site planning, displacement status, essential household items and cash-based interventions). Three cross cutting themes of gender, climate change and vulnerability were also identified. Two themes (living conditions and accommodation type) are presented here. Poor living conditions including damaged shelters, poor housing design and materials were associated with increased risks of communicable diseases such as malaria, diarrhoea, and soil-transmitted helminth infections while overcrowding heightened injury risk and psychological distress. Accommodation type influenced health outcomes with short-term shelters linked to acute mental health challenges and increased injuries; medium-term shelters with increased risk of non-communicable disease; and long-term housing with deteriorations in chronic disease management.</p><p><strong>Conclusions: </strong>This systematic review synthesises the evidence base showing how shelter and settlement interventions play a role in influencing health outcomes in humanitarian crises. It shows that shelter is a critical yet often under recognised determinant of health in these settings. Health outcomes are influenced by housing quality, accommodation type and duration, camp and settlement planning, displacement dynamics including frequency and length of displacement, and access to essential household items. Poor shelter conditions are likely to increase the risk of communicable diseases and mental health issues and have the potential to worsen chronic disease outcomes and risk. A key contribution of this review is the identification of shelter as a core entry point for public health action, highlighting the need for clearer operational guidance on shelter typologies, minimum standards, and their integration with health, protection and social services.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297382","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":"Cancer care in conflict-affected regions: a scoping review of service delivery challenges, healthcare system adaptations, and policy implications.","authors":"Omar Al-Qaisi, Shend Kryeziu, Lorent Sijarina, Patricia Tai, Melisa Stublla, Edward Yu, Maha Subih, Mohammed Dibas","doi":"10.1186/s13031-026-00816-y","DOIUrl":"10.1186/s13031-026-00816-y","url":null,"abstract":"<p><strong>Background: </strong>Armed conflicts severely disrupt cancer care delivery, destroying infrastructure and limiting access to essential diagnostics and treatments. Evidence on service challenges, adaptations, and policy implications remains fragmented.</p><p><strong>Methods: </strong>This scoping review of four databases (Scopus, PubMed, ScienceDirect, and CINAHL) was conducted for original peer-reviewed studies published between January 2020 and August 2025. The search focused on the effect of wars on cancer service delivery in conflict zones, and its impact on cancer care.</p><p><strong>Results: </strong>Wars in conflict-affected countries like Palestine, Sudan, Syria, Iraq, Ukraine, and Afghanistan caused widespread destruction of cancer infrastructure, unsafe hospitals, and interruptions in chemotherapy, radiotherapy, and surgery. Countries faced shortages of specialized centers, technicians/radiologists, and medical records, alongside high costs and supply chain disruptions. Despite these challenges, healthcare systems demonstrated resilience through adaptations including Ukraine's MedEvac program for EU treatment evacuation, cross-border referrals (Iraq→Lebanon, Afghanistan→Pakistan), telemedicine, mobile diagnostic units, and community-based care models. Policy responses emphasized international aid coordination, conflict-sensitive health planning, and supply chain restoration.</p><p><strong>Conclusion: </strong>Conflicts cause infrastructure destruction, workforce depletion/migration, treatment barriers/delays, drug supply disruptions, and psychosocial/economic impacts, which in turn create urgent policy/governance challenges. Although humanitarian aid may provide temporary relief, sustainable solutions require peace and global commitment, grounded in equity and the fundamental right to health.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284771","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":"Availability of essential medicines in conflict-affected african regions: a systematic review and meta-analysis.","authors":"Sileshi Belew, Yesuneh Tefera Mekasha, Anne Kosgei, Anton De Spiegeleer, Evelien Wynendaele, Sultan Suleman","doi":"10.1186/s13031-026-00815-z","DOIUrl":"10.1186/s13031-026-00815-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Access to essential medicines is a fundamental human right and a critical pillar of effective healthcare. In Africa, armed conflicts severely weaken health systems, disrupting the availability of essential medicine, leading to gaps in patients' treatment and, in turn, posing a serious risk to overall public health. Therefore, this study aimed to identify the impact of armed conflicts on the availability of essential medicines as a cornerstone of healthcare across African regions, and quantify the extent of this disruption over time and by country.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this systematic review and meta-analysis, data were retrieved from published articles accessible in PubMed, Semantic Scholar, and grey literature covering the period from 1985 to 2025 and 2001 to 2024 for system impact and medicines availability studies, respectively. The literature search was conducted from January to May 2025. Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, studies were independently screened by two reviewers and included if they contained information on medicine availability or its relation to health systems in conflict zones and were published in English. The quality of studies was evaluated using the Joanna Briggs Institute criteria. Pooled estimates of medicine availability and their 95% CIs were obtained using a random-effects analysis. Heterogeneity was assessed using the I² statistic. The risk of bias and small study effects were assessed with funnel plots and Egger's test. Additionally, the leave-one-out sensitivity test and influence diagnostics test were considered to evaluate study-level impact.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The review included data from 1,581 health facilities and 989 essential medicines across eight conflict-affected African countries. The pooled availability of essential medicines calculated from the data obtained from 41 studies conducted in African countries shouldering frequent armed conflict was estimated at 55% (95% CI, 47-63), with substantial heterogeneity across studies (I² = 93%, p &lt; 0.001). Country-level analysis showed the highest availability in the Central African Republic (79%; 95% CI, 49-95) and the lowest in Nigeria (40%; 95% CI, 1-78). A temporal decline in medicine availability was observed, from 76% (2001-2010) to 46% post-2020. No significant publication bias was detected (funnel plot asymmetry p = 0.9560; Egger's test p = 0.494). Additionally, the influence diagnostic test and the leave-one-out sensitivity analysis indicated that observed heterogeneity likely reflects methodological differences and the sample size across the studies rather than bias or outliers. The systematic review revealed that armed conflicts have profoundly compromised health system functionality through the destruction of healthcare infrastructure, closure of medical facilities, displacement of the health workforce, pervasive insecurity and psycholo","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284759","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":"Effects of climate change-related hazards on food security and health within refugee settlements in Uganda.","authors":"Michael T Wagaba, Jean-Pierre Van Geertruyden, Justine Namakula, David Musoke, Alex Mulyowa, Calvin Murungi, Maiya G Block Ngaybe, Christopher Garimoi Orach, Hilde Bastiaens","doi":"10.1186/s13031-026-00817-x","DOIUrl":"10.1186/s13031-026-00817-x","url":null,"abstract":"<p><strong>Background: </strong>Climate change presents more dire impacts on food security and health in Africa than any other region worldwide. These impacts are expectedly more pronounced in predominantly agrarian refugee settings like Uganda, which is also the largest refugee host in Africa. However, there is limited contextual evidence regarding the effects of climate change-related hazards in Uganda to guide context-relevant interventions amidst the ongoing aid cuts. We assessed the impact of climate change-related hazards on food security and the health of refugees in three settlements in Uganda.</p><p><strong>Methods: </strong>We conducted a cross-sectional study using concurrent mixed methods in Kiryandongo, Nakivale, and Rhino Camp refugee settlements. We collected data from 600 heads of refugee households using a structured questionnaire, conducted 45 in-depth interviews with refugees, and held 14 key informant interviews with program implementers. Quantitative data were analysed using STATA v16, and a modified Poisson regression model was employed to determine significant associations. Qualitative data were analysed inductively using thematic analysis to complement the quantitative findings.</p><p><strong>Results: </strong>Of the 600 respondents, 60.6%, 95% CI = 56.5-64.6) were female, while most (76.2%) had lived in the settlement for 10-19 years. Climate change-related hazards associated with food insecurity included forest fires (aPR = 1.13; 95% CI = 1.08-1.23, p < 0.001), unreliable rainfall (aPR = 1.07; 95% CI = 1.01-1.15, p = 0.03), and landslides (aPR = 1.07; 95% CI = 1.01-1.14, p = 0.02). Qualitative findings highlighted that shifts in weather patterns, temperature fluctuations, and precipitation variations were perceived to have a profound impact on agricultural activities and to increase food insecurity and the incidence of vector-borne and waterborne diseases in the refugee settlements.</p><p><strong>Conclusions: </strong>Climate change-related hazards can exacerbate food insecurity and contribute to health challenges by increasing the incidence of vector-borne and waterborne diseases. To enhance the resilience of refugee settlements against climate-related hazards, it is crucial to implement community-based disaster preparedness systems, invest in climate-resilient agriculture, upgrade water and sanitation infrastructure, and integrate climate risk assessments into public health planning.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254505","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":"Normalization of abuse and barriers to reporting among adolescents and young people in settings of displacement in Nigeria.","authors":"Abuo James, Precious Chidozie Azubuike, Chimankpam Kingsley Ogbonna, Temidayo Akinreni, Uchenna Frank Imo, Prosper Ayenmo Kanu, Gina Marie Piane, Antor Ndep","doi":"10.1186/s13031-026-00814-0","DOIUrl":"10.1186/s13031-026-00814-0","url":null,"abstract":"<p><strong>Background: </strong>Adolescence is a critical developmental stage marked by physical, psychological, and cognitive growth, increasing autonomy, social exploration, and risk-taking behaviors. However, these natural transitions in displacement settings are overshadowed by heightened vulnerabilities such as gender-based violence. In many displacement settings, recurrent exposure to violence leads to its acceptance as an unavoidable part of daily life. Sometimes, violence is normalized, leading to further exacerbation of the crisis. Our study explored the in-depth experiences and normalization of abuse and existing barriers to reporting within the internally displaced persons settlement in Cross River State, Nigeria.</p><p><strong>Methods: </strong>Our qualitative study included adolescents and young people aged 15-24 years residing in the Bakassi Internally Displaced Persons camp within the Bakassi Local Government Area. Participants were selected via purposive sampling. Data were collected through 12 individual interviews and 3 focus group discussions. Data were transcribed verbatim, and thematic analysis was conducted using NVivo 14 to identify key themes.</p><p><strong>Results: </strong>Findings from the study reveal participants' experiences with sexual exploitation, abuse, harassment, and gender-based violence, as well as their perceptions of abuse and how it is normalized. Contextual factors such as self-blame, societal pressure to accept advances from men, and limited accountability contribute to heightened vulnerability within the camps, which result in emotional and psychological impacts. Barriers to reporting and seeking help included fear of repercussions, lack of trust in authorities or services, and stigma associated with victimhood.</p><p><strong>Conclusions: </strong>Our study demonstrates that normalization of abuse, alongside systemic barriers such as fear of repercussions, stigma, and limited trust in authorities, significantly constrains reporting and help-seeking behaviors. Furthermore, our study identifies weak and largely absent accountability mechanisms as a key structural factor enabling continued abuse. To enhance accountability and safeguard vulnerable populations, appropriate legal penalties and enforcement measures should be applied to all forms of abuse. Additionally, future interventions should also address the underlying vulnerabilities that predispose individuals to abuse, ensuring a more comprehensive approach to prevention and protection.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207008","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 review of practices and policies of international humanitarian organizations in conflict-affected settings: are we ensuring sustainability of surgical care?","authors":"Davy Lau, Irena Zivkovic, Apanuba Puhama, Agnes Zanotto Manoel, Naisan Garraway, Shahrzad Joharifard, Emilie Joos","doi":"10.1186/s13031-026-00805-1","DOIUrl":"10.1186/s13031-026-00805-1","url":null,"abstract":"<p><strong>Background: </strong>International humanitarian organizations providing surgical care in conflict-affected settings have an ethical obligation to adopt practices that promote sustainable surgical services. Our objective was to evaluate the prevalence of sustainable surgical practices and policies implemented by humanitarian organizations in conflict-afflicted settings, as well as to document instances where surgical services were disrupted or discontinued due to the outbreak of conflict.</p><p><strong>Methods: </strong>A review of primary literature was conducted using Medline. Articles were included if they described sustainable surgical practices or policies in conflict-affected settings. Sustainability was defined according to a previously published modified Delphi consensus framework, which outlined key pillars of sustainability in global surgery partnerships. A grey literature review was also performed to identify sustainable policies published by international humanitarian organizations on their online platforms.</p><p><strong>Results: </strong>Of 1,057 articles screened, 29 articles met inclusion criteria, describing 54 surgical programs implemented by 17 international humanitarian organizations -most commonly Médecins Sans Frontières (n = 27) and International Committee of the Red Cross (n = 5). These programs were implemented in 36 conflicts between 1946 and 2023, most commonly in Sub-Saharan Africa (n = 20), the Middle East (n = 11), and Southeast Asia (n = 9). The following six sustainability pillars were explicitly described: context-relevant education (94.4%), multidisciplinary involvement (74.1%), outcome measurement (72.2%), stakeholder engagement (66.7%), handover to local stakeholders (18.5%), and multisource funding (13.0%). Escalating violence led to permanent closure of 13.0% of programs and led to service interruptions in 9.3%. The mean duration of programs was 9.5 ± 9.7 years. Publicly available policies were identified for six organizations (35.3%), and all but one organization captured every aforementioned pillar of sustainability.</p><p><strong>Conclusions: </strong>International humanitarian organizations have increasingly adopted sustainable practices and policies when delivering surgical care in conflict-affected settings-most notably in the area of context-relevant training. We encourage global actors to continue prioritizing this domain, especially in fragile states where service cessation or interruptions can occur at any time, necessitating sustainable surgical care delivered by trained local physicians. This review highlights exemplary practices documented in the literature and offers insights into how global surgery partners can build on existing efforts.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195148","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":"Anemia among children (6 To 59 months) in Qoloji internally displaced people camp, Somali Region, eastern Ethiopia.","authors":"Umar Sead Hussein, Barwako Ibrahim Aden, Zerihun Ataro, Eydrus Mohammed Sherif, Habtamu Mitiku","doi":"10.1186/s13031-026-00810-4","DOIUrl":"10.1186/s13031-026-00810-4","url":null,"abstract":"<p><strong>Background: </strong>Anemia remains a significant public health issue, especially in emergency areas and refugee camps. This study was conducted to determine the prevalence of anemia and its associated factors among children aged 6 to 59 months in Qoloji internally displaced people camp site, Somali Region, eastern Ethiopia.</p><p><strong>Methods: </strong>A community-based cross-sectional study was conducted among 401 children aged 6 to 59 months. Capillary blood was collected and hemoglobin level was determined using HemoCue Hb 301. Data was analyzed using SPSS version 26. Bivariable and multivariable logistic regression were used to identify determinants of anemia.</p><p><strong>Results: </strong>The overall prevalence of anemia was found to be 51.4% (95% CI: 46.6%, 56.4%). Of the anemic children 29.4% (95% CI: 25.2%, 33.9%), 16.7% (95% CI: 13.2%, 20.7%) and 5.2% (95%CI: 3.2%, 7.5%) had mild, moderate, and severe anemia respectively. Initiation of complementary feeding below 6 months (AOR = 2.6;95% CI:1.5,4.6), household food insecurity (AOR = 5.4;95% CI:2.8,10.2), mothers of child having no formal education (AOR = 2.8; 95% CI: 1.3, 5.7), inadequate dietary diversity (AOR = 7.9; 95%CI:4.4, 13.9) and lack of antenatal care follow up during pregnancy (AOR = 3.5;95% CI:1.8, 6.7) were found associated with of anemia.</p><p><strong>Conclusion: </strong>The prevalence of anemia was high among children. Household food insecurity, dietary diversity, initiation of complementary feeding, maternal educational status and antenatal care during pregnancy were factors found associated with anemia. Therefore, adequate interventions should be designed and implemented considering improvement of household food security, access to maternal education and dissemination of nutrition and health related information.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195140","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}