Conflict and Health最新文献

{"title":"Exploring relationships between conflict intensity, forced displacement, and healthcare attacks: a retrospective analysis from Syria, 2016-2022.","authors":"Maia C Tarnas, Mohamed Hamze, Bachir Tajaldin, Richard Sullivan, Daniel M Parker, Aula Abbara","doi":"10.1186/s13031-024-00630-4","DOIUrl":"https://doi.org/10.1186/s13031-024-00630-4","url":null,"abstract":"<p><strong>Introduction: </strong>Attacks on healthcare have been committed throughout the Syrian conflict in violation of International Humanitarian Law (IHL), contributing to the devastation of the country's healthcare system. The conflict has also forcibly displaced over half of Syria's pre-conflict population, 7.2 million of whom are internally displaced. In this retrospective analysis, we aim to assess the relationships between (1) healthcare attacks and general conflict and (2) healthcare attacks and forced displacement between 2016 and 2022.</p><p><strong>Methods: </strong>Data on healthcare attacks, conflict events, and displacement were extracted from the Syrian American Medical Society (SAMS), Uppsala Conflict Data Project, and OCHA Türkiye, respectively. The analysis addresses three research questions: the associations between (1) healthcare attacks and conflict events, (2) healthcare attacks and conflict events in the week after an attack on a healthcare facility, and (3) healthcare attacks and forced displacement. For each, we used generalized additive models with a negative binomial distribution that also accounted for spatial and temporal factors.</p><p><strong>Results: </strong>SAMS recorded a total of 541 attack events, comprising 650 attack rounds over 235 facilities between 2016 and 2022. Conflict events were significantly associated with healthcare attacks in the same week (IRR: 1.14, 95% CI 1.12-1.17), and healthcare attacks in one week were associated with a maximum of 1.44 greater risk (95% CI 1.08-1.91) of conflict events in the following week, even when accounting for general conflict levels in the previous weeks. Healthcare attacks were also significantly associated with increased displacement up to three months following the attacks.</p><p><strong>Discussion: </strong>We find that healthcare facilities are not avoided during conflict (as obliged under IHL), and that healthcare attacks significantly precede an escalation of general conflict in the same area. Healthcare attacks are also significantly associated with displacement for months following the attacks, even when accounting for conflict levels. Based on these findings, we present a framework outlining one pathway through which healthcare attacks may contribute to larger conflict tactics. Our findings highlight the critical role of healthcare infrastructure in conflict and reaffirm calls to hold perpetrators of these attacks accountable.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"70"},"PeriodicalIF":3.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and challenges in sustaining a community based surveillance system in post-Ebola Sierra Leone.","authors":"Christina Mergenthaler, Ankie van den Broek, Noor Tromp, Kimberly Nehal, Jip Janssen, Shiyong Wang, T T Samba, Mohammed Vandhi, Alpha Augustin Kombo, Osman Sankoh, M Koblo Kamara, Mirjam I Bakker","doi":"10.1186/s13031-024-00618-0","DOIUrl":"10.1186/s13031-024-00618-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In outbreak-prone settings, community-based surveillance (CBS) systems can alert health authorities to respond in a timely manner where suspected cases of disease are being reported. After the 2014-2016 Ebola outbreak, the WHO and other stakeholders supported the establishment of CBS in Sierra Leone, for which community health workers (CHW) were trained to collect and report symptoms data of 11 priority health conditions in their communities. Our study objective was to assess feasibility and challenges to sustain CBS in a low resource setting as part of a World Bank evaluation of Sierra Leone's Ministry of Health and Sanitation's (MoHS) CBS and electronic Integrated Disease Surveillance & Response (eIDSR) systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In 2019 we conducted a mixed methods assessment consisting of a household incidence survey, health facility survey, household case verification survey, a costing analysis, and in-depth interviews and focus group discussions with key stakeholders of the CBS system in eight chiefdoms of 4 purposefully selected districts in Sierra Leone. The study period for primary data collection was February through April 2019. We also conducted secondary data analysis of surveillance data in DHIS2 of all 32 chiefdoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In districts where CBS was 'fully functional', the number and type of CBS alerts corresponded to the number and type of diseases reported through facility based eIDSR system in the same period. However under-reporting of diarrhea and measles suspects from the community still appeared to occur, and reporting deteriorated when primary health care staff including CHWs reported the stoppage of stipends. The annual budget impact for CBS was estimated at 4.4 million USD in 2018. The majority of costs were made at community level (73%) compared to regional (0.3%), primary health unit (21%), district (4%) and national (2%) level. The most important costs drivers were training of CHWs (59% of total costs) and salaries (including stipends of the CHWs) of human resources (15%). Barriers included sustainable financing of human resources, internet connectivity, as well as limited trainings and supportive supervision, and unsupported transportation costs for CHWs and peer supervisors (PS). CHWs and community members reported that communities are more willing to share information about health issues compared to the pre-CBS implementation period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The similarity between CBS and IDSR reports support the possibility that CBS increases the sensitivity of disease surveillance to the level of the community, which would enable local authorities to take early prevention measures when and where impact will be the greatest. Qualitative interviews suggest that CBS has improved the interface between the community and primary level of the health system. However if the barriers to sustainability are left unaddressed, opportunities for CBS","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"69"},"PeriodicalIF":3.1,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11550538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632471","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":"Integrating mental health and psychosocial support into economic inclusion programming for displaced families in Ecuador.","authors":"Arianna Moyano, Daniela Vergara, Amaleah Mirti, Annie G Bonz, Adriana Monar, Efrén Astudillo, Sara Vaca, Karen Cordova, Andrea Armijos, Adrian Barroso, Cesar Cherrez, Jennie Cottle, Aimée DuBois, Isabella Fernandez Capriles, Jean Pierre Grandes, Matias Irarrazaval, Belen Jaramillo, Jeremy C Kane, Carmen Martinez-Viciana, Franco Mascayano, Yescárleth Rodríguez, Matthew Schojan, Kathleen Sikkema, Ezra Susser, Peter Ventevogel, Mike Wessells, Aaron Zambrano López, Kathryn L Lovero, M Claire Greene","doi":"10.1186/s13031-024-00629-x","DOIUrl":"10.1186/s13031-024-00629-x","url":null,"abstract":"<p><strong>Background: </strong>Poverty is a key social determinant of mental health among forcibly displaced persons. This study aimed to design and pilot test a strategy to integrate existing mental health and economic inclusion interventions for displaced families in Ecuador.</p><p><strong>Methods: </strong>We conducted a series of qualitative interviews (n = 30), focus groups (n = 6), and workshops (n = 3) to develop a set of strategies for integrating cross-cutting and focused mental health and psychosocial support (MHPSS) strategies into an existing economic inclusion program for displaced families in Quito. We non-randomly assigned two field offices in Quito to (1) integrate cross-cutting strategies focused on improving economic outcomes or (2) integrate both those cross-cutting strategies plus focused MHPSS strategies into an economic inclusion program. We measured site-level implementation outcomes (adoption, appropriateness, acceptability, feasibility, fidelity, reach, retention, usability) and participant-level psychosocial (wellbeing, depressive symptoms, anxiety symptoms, functioning) and economic inclusion outcomes (financial resources, diet diversity, social capital/networks, self-reliance) over six months. We conducted a mixed-methods analysis to explore the acceptability and feasibility of the integration strategies and the ability to evaluate their effects in a future cluster randomized trial.</p><p><strong>Results: </strong>We developed a toolkit that included 10 strategies for integrating MHPSS into economic inclusion interventions. Fifty displaced persons participating in an existing economic inclusion program (25 per study condition) were enrolled and 88% remained in the study through the six-month follow-up. Participants and implementers reported that the integration strategy was appropriate, acceptable, feasible, and usable. Implementers, including people without prior experience in delivering mental health services, were able to deliver the intervention with high fidelity. Integration of focused MHPSS intervention components into an economic inclusion program appeared to improve MHPSS outcomes, the strength of social capital and networks, and engagement in economic and other programs.</p><p><strong>Conclusions: </strong>This study provides preliminary evidence of the acceptability and feasibility of integrating MHPSS into economic inclusion programs for displaced people. We found evidence supporting evaluation methods that can be employed in a future study to definitively test the added value of integrated approaches to mental health and economic wellbeing for displaced persons.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"68"},"PeriodicalIF":3.1,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592059","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":"Maternal and newborn health prioritization in Yobe State, Nigeria: analysis of stakeholders' perspective.","authors":"Emilia Ngozi Iwu, Charity Pring'ar Maina, Rifkatu Sunday Aimu, Rejoice Helma Abimiku, Sussan Israel-Isah, Kazeem Olalekan Ayodeji, George Odonye, Hadiza Sabo, Naoko Kozuki, Mamothena Mothupi","doi":"10.1186/s13031-024-00628-y","DOIUrl":"10.1186/s13031-024-00628-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Maternal and newborn mortality and morbidity in conflict-affected northeastern areas of Nigeria, such as Yobe State, are disproportionately higher than those in the rest of the country. There is limited evidence on the factors that influence maternal and newborn health (MNH) policymaking and implementation in this region, particularly with respect to the impact of conflict and context-specific issues. This study explores the political, economic and health system factors that drive the prioritization of MNH policies in Yobe State. The aim of this study was to elucidate the conflict-related factors influencing MNH outcomes, which could inform targeted interventions to improve MNH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study is a descriptive case study that relies on multiple data sources and is guided by the Health Policy Analysis Triangle. We reviewed national and subnational research, technical reports and policies related to reproductive health and the MNH in Nigeria since 2010. Following stakeholder mapping, we identified and invited prospective participants in the MNH policymaking space. Nineteen stakeholders from the government, civil society and nongovernmental organizations, donor agencies, and public and private sector health providers in Yobe State participated in the semistructured in-depth interviews. Data were collected from November 2022 through January 2023 and were thematically analysed via Dedoose software.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;MNH services in Yobe State have received considerable attention through initiatives such as the National Midwifery Service Scheme, free MNH services, training of midwives with deployment to rural areas, and health facility renovations. The effective implementation of MNH services and policies faces challenges due to insufficient funding, and sustainability is hampered by changes in governance and political transitions. The Boko Haram insurgency exacerbated the humanitarian crisis in Yobe State and disrupted MNH services due to the displacement of populations and the decline in the number of health workers. Additionally, sociocultural and religious beliefs hinder timely access to and utilization of MNH services. Although policies and guidelines for MNH services exist in the state, they are inadequately disseminated to health providers, which affects their effective implementation across facilities. Collaboration and intersectoral coordination platforms exist, but competition and rivalries among unions, political entities, and implementing agencies sometimes impede progress.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Enhancing MNH services in Yobe state requires increased commitment for funding through the Northeast Development Commission rehabilitation fund; strengthening the health workforce, safety and retention plan; promoting gender inclusivity within the health sector; and addressing sociocultural barriers to women's health-seeking behaviors. Concrete, time-bound plans f","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"67"},"PeriodicalIF":3.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585370","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":"War-related trauma and posttraumatic stress disorder in refugees, displaced, and nondisplaced people during armed conflict in Sudan: a cross-sectional study.","authors":"Khadija A Khalil, Galia Tajelsir Fadulelmula Mohammed, Ahmed Balla M Ahmed, Salma S Alrawa, Hager Elawad, Amna A Almahal, Radia F Mohamed, Eithar M Ali","doi":"10.1186/s13031-024-00627-z","DOIUrl":"10.1186/s13031-024-00627-z","url":null,"abstract":"<p><strong>Background: </strong>The ongoing armed conflict in Sudan has caused mass displacement, affecting mental health. This study aimed to assess the prevalence of posttraumatic stress disorder (PTSD) and trauma among refugees, internally displaced, and nondisplaced people, while also examining the link between displacement type, PTSD severity, and associated factors.</p><p><strong>Methods: </strong>This cross-sectional study used the Posttraumatic Stress Disorder Checklist for DSM-5 to assess PTSD symptoms and the General Health Questionnaire-28 to evaluate depression. Data were collected from 642 participants, targeting general social media groups for those within Sudan and specific groups for refugees outside the country. Sociodemographic and trauma event data were also gathered. Data analysis was conducted using SPSS, applying one-way ANOVA and independent t-tests to compare PTSD and depression. Binary logistic regression identified associations between sociodemographic factors and PTSD symptoms.</p><p><strong>Results: </strong>Among the 642 participants, 46.3% were internally displaced people (IDP), 42.1% were refugees, and 11.7% were non-displaced individuals. Clinically significant PTSD symptoms were identified in 36.6% of the participants. Refugees had a significantly greater percentage of traumatic events (M = 4.31, SD = 2.605, p < .01). Depression symptoms were found to be strongly associated with clinically significant PTSD (p < .001). Factors significantly linked to depression symptoms included female gender (p = 0.015), being single (p = 0.048), younger age (p = 0.036), dissatisfaction with living conditions (p < 0.001), and unemployment (p = 0.021). Dissatisfaction with living conditions also significantly influenced the likelihood of developing PTSD (p < .001).</p><p><strong>Conclusion: </strong>The study found that 36.6% of participants experienced PTSD, with refugees having a 1.4 times greater risk of developing PTSD compared to IDP and non-displaced individuals. Traumatic events were moderately correlated with PTSD symptoms, though non-displaced individuals had higher exposure to such events. These findings highlight the need for targeted mental health interventions, particularly for refugees and those affected by traumatic events. Further research using probability sampling is necessary to confirm these results and inform more effective mental health policies and programs for displaced populations.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"66"},"PeriodicalIF":3.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559447","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":"Close relationships with caregivers as protective factor for the mental health and functioning of war-affected Congolese youth.","authors":"Florian Scharpf, Roos Haer, Tobias Hecker","doi":"10.1186/s13031-024-00624-2","DOIUrl":"10.1186/s13031-024-00624-2","url":null,"abstract":"<p><strong>Background: </strong>Supportive social connections are a crucial determinant of the mental health and adjustment of youth in conflict-torn regions. Conflict-affected youth face particular risks to their well-being due to high levels of trauma exposure and perpetration of violent acts as members of armed groups and post-conflict discrimination. However, little is known about the possible protective role of close relationships with caregivers in the aftermath of trauma. This study examined whether a higher perceived quality of relationships with caregivers would attenuate the associations between exposure to traumatic experiences and four indicators of adjustment (posttraumatic stress symptoms [PTSS], emotional problems, behavioural problems, criminal behaviour) in a sample of 268 war-affected youth (61.2% male, Mage = 16.31 years) living in Bukavu, Democratic Republic of Congo. More than half of the present sample (56.7%) were former members of armed groups.</p><p><strong>Methods: </strong>Data were collected using quantitative structured interviews and analyzed through regression models using the PROCESS macro.</p><p><strong>Results: </strong>Higher cumulative trauma exposure was significantly related to higher levels of PTSS and emotional problems, while more frequent perpetration of war-related violence was significantly related to higher levels of PTSS, behavioural problems, and criminal behavior. The perceived quality of relationships with caregivers significantly moderated the associations between youth's cumulative trauma exposure and all four outcomes. At higher perceived quality of relationships with caregivers, the associations between trauma exposure and emotional problems, behavioural problems, and criminal behaviour were no longer significant and the association with PTSS was significantly weakened. Higher perceived quality of relationships with caregivers was also directly significantly related to lower levels of mental health problems and criminal behaviour.</p><p><strong>Conclusions: </strong>The findings suggest that interventions that focus on strengthening relationships with caregivers are crucial for supporting the mental health and functioning of youth who experienced and perpetrated war-related violence.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"65"},"PeriodicalIF":3.1,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512961","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":"Changes in healthcare seeking behaviors among caretakers of children in the previously occupied ISIS territory: Hadeetha, Anbar, Iraq: a cross-sectional survey of 415 households.","authors":"Sara Al-Dahir, Tahseen Abdulateef Hasan, Alaa Khalil, William J Moss, Kawsar R Talaat, Maria Deloria Knoll, Gilbert Burnham","doi":"10.1186/s13031-024-00622-4","DOIUrl":"10.1186/s13031-024-00622-4","url":null,"abstract":"<p><strong>Background: </strong>The western province of Anbar, and the district of Hadeetha, have suffered direct impacts from the second United States led invasion (2003) through the ISIS invasion (2014-2017). With the primary health care centers being closed or inaccessible, the remaining population experienced changes in health seeking. The area of Anbar, Iraq remains largely remote from the discourse of health system recovery post-conflict. The objective of this study was to describe changes in health seeking behaviors of caregivers of children ages 12-72 months of age in Hadeetha, Anbar, Iraq from the conflict period of ISIS (Islamic State of Syria and Iraq), 2014-2017, to the post-conflict period, 2021.</p><p><strong>Methods: </strong>This was a mixed-methods study composed of a cross-sectional 415 household survey and focus groups in Hadeetha, Anbar, Iraq. Caretakers of children were interviewed from February to April 2021. Children were sampled from a list of children who missed at least one vaccination appointment without a return for follow-up from the birth cohorts of 2014 to 2020. Healthcare workers focus groups and key informant interviews occurred from 2019 to 2021 centered around experiences from the 2014 to 2021 period.</p><p><strong>Results: </strong>In the post-conflict period, there were no differences in health seeking based upon provider type between respondents. Physicians were primary healthcare providers in the post-conflict period for 79% of respondents versus only 47% in the conflict period. Healthcare workers described major barriers to delivering services in Hadeetha during the ISIS occupation due to infrastructure damage, threats of violence, decreased medical personnel, lack of compensation and disruptions in medical supplies from 2014 to 2017.</p><p><strong>Conclusion: </strong>This study provides insight into health seeking challenges among the many individuals who remained in Hadeetha during the ISIS occupation. Health use patterns by provider type mirror the concerns the healthcare providers shared: limited availability, efflux of professional workers, limited resources and security challenges to providing care. Positive trends toward increased access to physicians during periods of peace are an encouraging marker for continued population resilience during the post-conflict period. Recovery efforts continue to be hampered by internal sectarian discord within Iraq as well as insufficient resources to maintain health services as well as provide catch-up health services, such as immunizations.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"64"},"PeriodicalIF":3.1,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480749","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 the response and the emergency medical team (EMT) deployment following a tanker explosion in Freetown, Sierra Leone.","authors":"Boniface Oyugi, Ibrahim Franklyn Kamara, Innocent Nuwagira, Robert Musoke, Sulaiman Lakoh, Abdulai Jalloh, Rashidatu Fouad Kamara, Pryanka Relan, Camila Lajolo, René André Macodou Ndiaye, Babacar Niang, Mouhamadou Mansour Fall, Thierno Balde, Flavio Salio, Mustapha Kabba","doi":"10.1186/s13031-024-00619-z","DOIUrl":"10.1186/s13031-024-00619-z","url":null,"abstract":"<p><strong>Background: </strong>On 5 November 2021, a fire incident following a tanker explosion occurred in the Wellington PMB Junction east of Freetown, Sierra Leone, injuring and killing people. WHO facilitated the deployment of international emergency medical teams (EMTs) to support the Ministry of Health (MoH) in providing care to the wounded in four hospitals.</p><p><strong>Objective: </strong>In this study, we document Sierra Leone's experience managing the fire incident and the role of EMTs in responding to it.</p><p><strong>Method: </strong>This is a cross-sectional After-Action Review (AAR) debrief of the response and deployment, including focus group discussion with WHO and MoH staff (n = 14) in a virtual workshop and document reviews on the response. The results thematically cover the event and the different agencies' responses and a review of EMTs' responses.</p><p><strong>Results: </strong>At the onset of the emergency, the National Disaster Management Agency (NDMA) instituted a well-coordinated response mechanism in collaboration with the MoH and managed all response actions, such as medical services, informing partners and the public and coordinating all other agencies. WHO facilitated EMT deployments and mobilised medical supplies and equipment, while the MoH provided accommodation, logistics and coordination. The EMTs dispensed their functions with professionalism, adapted to the environment and available resources, and augmented the care the national health workers provided. They offered additional care: reconstructive surgery, pain management, palliative care, wound care, rehabilitation, physiotherapy and psychosocial counselling, which were initially inadequate at the onset of the disaster. 94 out of 157 patients were discharged home at the end. National clinicians acquired additional skills through the capacity-building activities of EMTs. The community appreciated the teams.</p><p><strong>Conclusion: </strong>The government, partners and EMTs were important in the response and worked with speed and political acceptability using the context experience to provide surge support to the country. This experience brought to focus the idea of developing a national EMT in Sierra Leone, which would be useful to help respond even more swiftly. In collaboration with WHO, there is a need to institute further mechanisms to facilitate rapid response and quality-assured deployment of EMTs at regional and sub-regional levels and strengthen to support future responses.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"63"},"PeriodicalIF":3.1,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480747","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":"Low cost and real-time surveillance of enteric infection and diarrhoeal disease using rapid diagnostic tests in Cox's Bazar, Bangladesh.","authors":"Samuel I Watson, Mohammed Atique Ul Alam, Ryan T T Rego, Richard J Lilford, Ashok Kumar Barman, Baharul Alam, A S G Faruque, Md Sirajul Islam","doi":"10.1186/s13031-024-00617-1","DOIUrl":"https://doi.org/10.1186/s13031-024-00617-1","url":null,"abstract":"<p><strong>Background: </strong>Real-time disease surveillance is an important component of infection control in at-risk populations. However, data on cases or from lab testing is often not available in many low-resource settings. Rapid diagnostic tests (RDT), including immunochromatographic assays, may provide a low cost, expedited source of infection data.</p><p><strong>Methods: </strong>We conducted a pilot survey-based prevalence mapping study of enteric infection in Camp 24 of the camps for the forcibly displaced Rohingya population from Myanmar in Cox's Bazar, Bangladesh. We randomly sampled the population and collected and tested stool from under-fives for eight pathogens using RDTs in January-March 2021 and September-October 2021. A Bayesian geospatial statistical model allowing for imperfect sensitivity and specificity of the tests was adapted.</p><p><strong>Results: </strong>We collected and tested 396 and 181 stools in the two data collection rounds. Corrected prevalence estimates ranged from 0.5% (Norovirus) to 27.4% (Giardia). Prevalence of Escherichia coli O157, Campylobacter, and Cryptosporidium were predicted to be higher in the high density area of the camp with relatively high probability (70-95%), while Adenovirus, Norovirus, and Rotavirus were lower in the areas with high water chlorination. Clustering of cases of Giardia and Shigella was also observed, although associated with relatively high uncertainty.</p><p><strong>Conclusions: </strong>With an appropriate correction for diagnostic performance RDTs can be used to generate reliable prevalence estimates, maps, and well-calibrated uncertainty estimates at a significantly lower cost than lab-based studies, providing a useful approach for disease surveillance in these settings.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"62"},"PeriodicalIF":3.1,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480751","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":"Challenges faced by internally displaced diabetes patients in managing their health during a conflict: a qualitative study.","authors":"Shiri Shinan-Altman","doi":"10.1186/s13031-024-00625-1","DOIUrl":"https://doi.org/10.1186/s13031-024-00625-1","url":null,"abstract":"<p><strong>Background: </strong>This study examines the experiences of diabetic patients who were displaced during the Israel-Hamas conflict, highlighting the substantial challenges they face in managing their health under these circumstances.</p><p><strong>Methods: </strong>A qualitative-phenomenological approach was employed, focusing on the experiences of 14 individuals with diabetes who were displaced during the conflict. Data were collected through semi-structured interviews and subsequently subjected to content analysis.</p><p><strong>Results: </strong>Three central themes emerged: (1) \"I left without clothes and medications\": Participants described the chaotic evacuation process and the difficulty in maintaining diabetes care without their supplies. (2) \"Dual coping\": Participants struggled with managing their diabetes while adapting to new, temporary living conditions that disrupted their care routines. (3) Seeking inner resilience while drawing strength from external support: This theme reflected the importance of internal resilience and support from family, friends, and healthcare professionals in coping with health management and displacement challenges.</p><p><strong>Conclusions: </strong>The study underscores the significant challenges diabetes patients face during conflict evacuation, including disruptions in their routine care, heightened psychological stress, and the essential role of support systems. These findings underscore the need for emergency preparedness plans to ensure continuity of care for patients with chronic conditions during crises.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"60"},"PeriodicalIF":3.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480748","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}