Conflict and Health最新文献

{"title":"The political economy of expedience: examining perspectives on military support to Sierra Leone's Ebola response.","authors":"Samuel T Boland, Dina Balabanova, Susannah Mayhew","doi":"10.1186/s13031-023-00553-6","DOIUrl":"10.1186/s13031-023-00553-6","url":null,"abstract":"<p><p>The 2013-2016 West Africa Ebola Epidemic is the largest outbreak of Ebola in history. By September, 2014 the outbreak was worsening significantly, and the international president of Médecins Sans Frontières called for military assistance. In Sierra Leone, the British and Sierra Leonean militaries intervened. They quickly established a National Ebola Response Centre and a constituent network of District Ebola Response Centres. Thereafter, these inherently militarised centres are where almost all Ebola response activities were coordinated. In order to examine perspectives on the nature of the militaries' intervention, 110 semi-structured qualitative interviews were conducted and analysed. Military support to Sierra Leone's Ebola response was felt by most respondents to be a valuable contribution to the overall effort to contain the outbreak, especially in light of the perceived weakness of the Ministry of Health and Sanitation to effectively do so. However, a smaller number of respondents emphasised that the military deployments facilitated various structural harms, including for how the perceived exclusion of public institutions (as above) and other local actors from Ebola response decision making was felt to prevent capacity building, and in turn, to limit resilience to future crises. The concurrent provision of life-saving assistance and rendering of structural harm resulting from the militaries' intervention is ultimately found to be part of a vicious cycle, which this article conceptualises as the 'political economy of expedience', a paradox that should be considered inherent in any militarised intervention during humanitarian and public health crises.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"17 1","pages":"53"},"PeriodicalIF":3.6,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71488858","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":"Adolescent mental health in post-conflict communities: results from a cross-sectional survey in Northern Uganda.","authors":"Heather Wipfli, Kyra Guy, Abigail Kim, Peninah Tumuhimbise, Kenneth Odur","doi":"10.1186/s13031-023-00549-2","DOIUrl":"10.1186/s13031-023-00549-2","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated adolescents' mental health their knowledge, attitudes, and beliefs about mental health conditions, and their access to critical mental health services in Lira District, northern Uganda. The political history of the region, the epicenter of the decades-long conflict between the Lord's Resistance Army and the Ugandan government, makes for an interesting case study of the political and social determinants of mental health of those directly impacted by conflict, and on subsequent generations growing up in post-conflict communities.</p><p><strong>Methods: </strong>This paper presents the results of a community-based participatory research study carried out by youth public health ambassadors in Lira District, Uganda. The study consisted of a mixed methods cross-sectional survey of households, schools, and healthcare facilities.</p><p><strong>Results: </strong>The study found 66% of adolescents indicated poor well-being and possible symptoms of depression and 41% of adolescents reported at least 4 childhood trauma events. Over 35% reported feeling extremely sad and 60% reported feeling socially isolated during the COVID lockdowns that lasted from 2020 to 2021. Nearly half of the adolescents aged 14-17 surveyed (N = 306) believed that witchcraft caused mental health problems, while less than 20% believed that traumatic experiences could be a cause. Forty percent of respondents had no idea of where to seek mental health care, and few facilities had mental health services available.</p><p><strong>Discussion: </strong>These findings illustrate the need to study the political and social determinants of mental health, especially on those directly impacted by armed conflict and for the generations growing up in post-conflict communities as they seek to rebuild.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"17 1","pages":"52"},"PeriodicalIF":3.1,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10623748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429210","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":"\"There is a fear that you will be attacked just for the act of working in health\": a survey of experiences of violence against healthcare in Colombia.","authors":"Katerina Crawford, Tatiana Florez, Mario Rodriguez, Lendy Cirado, Róisín Read, Rohini Haar","doi":"10.1186/s13031-023-00548-3","DOIUrl":"10.1186/s13031-023-00548-3","url":null,"abstract":"<p><strong>Background: </strong>Colombia has experienced decades of conflict between the government and non-state actors. Attacks on healthcare have been a grave but regular facet of that violence. In response, the Misión Médica (MM) program was developed to support, protect, and defend healthcare. Sporadic violence continues, with many recent attacks perpetrated not by armed actors but by residents. Given the history of conflict and ongoing violence, we sought to capture the perspectives of both healthcare workers (HCWs) and community members (CMs) regarding the characteristics and impacts of attacks on health in Colombia to gain insight into how to better prevent violence and mitigate its impacts.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted from January to March 2021 in seven departments in Colombia in regions that witnessed attacks on healthcare. Questionnaires were administered to HCWs and CMs via purposive sampling, probing their experiences with attacks on health with both closed and open-ended questions. The categorical responses were stratified by health worker vs. non-health worker and descriptively analyzed. Narrative responses were analyzed via a hybrid deductive/inductive thematic approach.</p><p><strong>Results: </strong>Seventy-three individuals participated in the study (36 HCWs and 37 cm). Approximately 77% of HCWs believed that attacks on healthcare impacted health outcomes while 68% of CMs did not see a direct connection between violence against healthcare and poor health outcomes. Awareness of the MM program was significantly different between HCWs (83.3%) and CMs (37.8%). The survey responses explored the characteristics of attacks on health, compounded impacts of violence on the health system, personal impacts, and perspectives on mitigation efforts.</p><p><strong>Conclusions: </strong>The study demonstrates that: (1) attacks on healthcare are context-dependent and require a local lens for mitigation and management; (2) both HCWs and CMs have critical perspectives that must be considered, (3) the impacts of violence against healthcare are complex and compounded and (4) that awareness of the legal protections of the Geneva Conventions must be combined with education on the health impacts for robust protection strategies. Critically, Both CMs and HCWs experience fear and psychosocial ramifications of these attacks, suggesting the need for stronger protections and resources to support the health workforce and the local community.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"17 1","pages":"51"},"PeriodicalIF":3.6,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10594855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159250","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":"Gender based violence (GBV) coordination in a complex, multi-crisis context: a qualitative case study of Lebanon's compounded crises (2019-2023).","authors":"Philomena Raftery, Jinan Usta, Ligia Kiss, Jennifer Palmer, Mazeda Hossain","doi":"10.1186/s13031-023-00543-8","DOIUrl":"10.1186/s13031-023-00543-8","url":null,"abstract":"<p><strong>Background: </strong>Since 2019 Lebanon has faced multiple compounded crises. Political and social instability, the COVID-19 pandemic, and the Beirut Port explosion, alongside the influx of refugees related to the ongoing Syrian conflict, have resulted in a nationwide economic emergency. In the context of the humanitarian response to the Syrian conflict, the UN and government-led gender-based violence (GBV) task force has coordinated the sub-sector since 2012. The compounded crisis, however, created new challenges for GBV coordination and service delivery, which we explore in this paper. We highlight lessons for strengthening GBV coordination in Lebanon and other complex emergencies.</p><p><strong>Methods: </strong>We conducted 29 remote in-depth interviews, reviewed key policy documents and observed seven GBV task force meetings. We analysed and presented our findings across three key themes: context-relevant and adaptable coordination mechanisms; coordination to support GBV service delivery; and stakeholders' roles, legitimacy and power.</p><p><strong>Results: </strong>Parallel response frameworks developed to address the multiple crises, created a complex humanitarian architecture within an increasingly challenging operating context, with some perceived inefficiencies. Positively, coordination was integrated under the established government-UN interagency system and the GBV task force maintained GBV sub-sector coordination. The task force was commended for effectively adapting to the evolving context, including working remotely, maintaining essential GBV services, assessing the compounded crises' impact on programming and adjusting accordingly, and harmonising guidance, tools and approaches. The importance of ensuring a government co-led response was highlighted by both UN and government informants, who pointed to examples where marginalising government leadership compromised coordination effectiveness and sustainability. The participation of local actors had become increasingly important but more difficult, with the impact of the various crises, and remote modalities, challenging service delivery and staff wellbeing.</p><p><strong>Conclusion: </strong>Experiences from Lebanon highlight the essential role of government leadership in coordination; the value of investing in local GBV capacity; the significance of effective national, subnational and intersectoral coordination to support service delivery and address cross-cutting GBV issues; the importance of targeted interventions to support marginalised populations; and the need to prioritize the well-being of front-line staff during crisis response. In Lebanon, and other complex crises, donors are encouraged to increase flexible, multiyear funding for GBV coordination and services, while women-led organizations should be at the forefront of recovery efforts, contributing to a more equitable society.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"17 1","pages":"50"},"PeriodicalIF":3.1,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10591352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49693983","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":"Forms of sexual violence perpetrated in conflict and post-conflict settings against South Sudanese men resettled in two communities in Uganda: an exploratory qualitative study.","authors":"Tosin Olaluwoye, Elizabeth Hoban, Joanne Williams","doi":"10.1186/s13031-023-00544-7","DOIUrl":"10.1186/s13031-023-00544-7","url":null,"abstract":"<p><strong>Background: </strong>Consideration for men as survivors of sexual violence in conflict and post-conflict settings has gained some prominence in the last decade. There remains a paucity of empirical data on forms of sexual violence from the survivors' perspective, and no study has considered the context of the 2013 South Sudan conflict specifically.</p><p><strong>Methods: </strong>This paper reports the findings of an exploratory qualitative study on the forms of sexual violence perpetrated against men in conflict and post-conflict settings, with the survivors as the main participants. A purposive sampling technique was used to recruit 26 South Sudanese male sexual violence survivors who have resettled in two refugee resettlement communities in Uganda since the onset of the 2013 South Sudan conflict. In-depth semi-structured interviews were used to collect the data from the male survivors. Six humanitarian aid workers who support sexual violence survivors also participated as key informants. Thematic data analysis was performed on the qualitative data.</p><p><strong>Results: </strong>The 26 survivors reported experiencing eight direct and two indirect forms of sexual violence in conflict and post-conflict settings. The direct forms include (1) striping men naked; (2) male rape; (3) exchange of sex for favours; (4) forcing men to rape other people; (5) genital mutilation; (6) genital beating; (7) insertion of objects into men's anus, and (8) taking men as wives. The indirect forms were forcing men to witness the rape of a female relative and forcing men to cheer or assist during the rape of other people.</p><p><strong>Conclusion: </strong>To maximize positive health outcomes for survivors, stakeholders must consider both direct and indirect forms of male-directed conflict-related sexual violence in policy and practice.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"17 1","pages":"49"},"PeriodicalIF":3.6,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10585838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49685001","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":"\"Actually, the psychological wounds are more difficult than physical injuries:\" a qualitative analysis of the impacts of attacks on health on the personal and professional lives of health workers in the Syrian conflict.","authors":"Aula Abbara, Diana Rayes, Hannah Tappis, Mohamed Hamze, Reham Wais, Hesham Alahmad, Naser Almhawish, Leonard Rubenstein, Rohini Haar","doi":"10.1186/s13031-023-00546-5","DOIUrl":"10.1186/s13031-023-00546-5","url":null,"abstract":"<p><strong>Introduction: </strong>Attacks on healthcare in armed conflict have far-reaching impacts on the personal and professional lives of health workers, as well as the communities they serve. Despite this, even in protracted conflicts such as in Syria, health workers may choose to stay despite repeated attacks on health facilities, resulting in compounded traumas. This research explores the intermediate and long-term impacts of such attacks on healthcare on the local health professionals who have lived through them with the aim of strengthening the evidence base around such impacts and better supporting them.</p><p><strong>Methods: </strong>We undertook purposive sampling of health workers in northwest and northeast Syria; we actively sought to interview non-physician and female health workers as these groups are often neglected in similar research. In-depth interviews (IDIs) were conducted in Arabic and transcribed into English for framework analysis. We used an a priori codebook to explore the short- and long-term impacts of attacks on the health workers and incorporated emergent themes as analysis progressed.</p><p><strong>Results: </strong>A total of 40 health workers who had experienced attacks between 2013 and 2020 participated in IDIs. 13 were female (32.5%). Various health cadres including doctors, nurses, midwives, pharmacists, students in healthcare and technicians were represented. They were mainly based in Idlib (39.5%), and Aleppo (37.5%) governorates. Themes emerged related to personal and professional impacts as well as coping mechanisms. The key themes include firstly the psychological harms, second the impacts of the nature of the attacks e.g. anticipatory stress related to the 'double tap' nature of attacks as well as opportunities related to coping mechanisms among health workers.</p><p><strong>Conclusion: </strong>Violence against healthcare in Syria has had profound and lasting impacts on the health workforce due to the relentless and intentional targeting of healthcare facilities. They not only face the challenges of providing care for a conflict-affected population but are also part of the community themselves. They also face ethical dilemmas in their work leading to moral distress and moral injury. Donors must support funding for psychosocial support for health workers in Syria and similar contexts; the focus must be on supporting and enhancing existing context-specific coping strategies.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"17 1","pages":"48"},"PeriodicalIF":3.6,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10561459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41141578","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":"Child health services and armed conflict in Tigray, North Ethiopia: a community-based study.","authors":"Mache Tsadik, Hailay Gebretnsae, Asefa Ayalew, Akeza Awealom Asgedom, Aregawi Gebreyesus, Tigist Hagos, Marta Abrha, Kiros Weldegerima, Birikti Abrha, Gelawdiwos Gebre, Mulubrhan Hagos, Rie Esayas, Mezgebe Gebregeorgis, Hailay Abrha Gesesew, Afework Mulugeta","doi":"10.1186/s13031-023-00545-6","DOIUrl":"10.1186/s13031-023-00545-6","url":null,"abstract":"<p><strong>Background: </strong>Access to basic health services, notably child health services, is severely hampered by the armed conflict in Tigray, North Ethiopia. Little is known regarding the impacts of the armed conflict during the war in Tigray on access to child health services. The current study investigates the impact of the armed conflict on the utilization of child health services in Tigray.</p><p><strong>Methods: </strong>4,381 caregivers from randomly recruited households (HHs) with at least one child younger than 1 year old participated in a community-based cross-sectional survey. We collected data on childhood immunizations and illness-related treatment seeking from August 4 to 20, 2021. We describe data using frequency and percentage and carry out an internal comparison among the study participants using chi-square tests.</p><p><strong>Results: </strong>4,381 children under the age of one included in the study. In total, 39% of infants received no basic vaccines, 61.3% of the children under the age of one received at least one vaccine, and 20% received all the vaccinations recommended for their age. About 61% of children were affected by at least one childhood ailments where majority of them were from rural areas. Mothers who did not seek postnatal care (PNC) were responsible for more than 75% of reported childhood illnesses.</p><p><strong>Conclusions: </strong>A sizable portion of children were unvaccinated and had at least one childhood sickness while the war was in progress. Particularly, people who live in rural areas reported a higher percentage of children's illnesses but a lower use of child health services. To lower childhood morbidity and mortality in the besieged area, such as Tigray, local to global actors need to get coordinated and warrying parties should stop weaponization of vaccination healthcare services.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"17 1","pages":"47"},"PeriodicalIF":3.6,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10557173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41140410","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":"Provision of mental health and psychosocial support services to health workers and community members in conflict-affected Northwest Syria: a mixed-methods study.","authors":"Ibrahim R Bou-Orm, Marianne Moussallem, Joelle Karam, Manuel deLara, Vinod Varma, Karin Diaconu, Murat Can Birand Apaydin, Rafael Van den Bergh, Alastair Ager, Sophie Witter","doi":"10.1186/s13031-023-00547-4","DOIUrl":"10.1186/s13031-023-00547-4","url":null,"abstract":"<p><strong>Background: </strong>Northwest Syria (NWS) is a conflict area with challenging political, economic, demographic and social dynamics. The region has a high number of internally displaced persons with increasingly disrupted delivery of basic services, including healthcare. Mental health needs have been increasing in the region while the infrastructure and capacity of the health sector has been negatively affected by the conflict. This study aimed to explore the provision of mental health and psychosocial support (MHPSS) services to communities in NWS (including healthcare workers) and to assess the experiences of beneficiaries with MHPSS services.</p><p><strong>Methods: </strong>The study followed a mixed-methods research design that included qualitative and participatory methods (44 semi-structured interviews and a group model building workshop with 15 participants) as well as a survey with 462 beneficiaries.</p><p><strong>Results: </strong>Findings suggested an improvement of MHPSS services in the region over the last few years due to the creation of a specific Technical Working Group for MHPSS that contributed to assessment of community needs and support of the MHPSS response. The key elements of this response were: (1) training non-specialized health workers to address the shortage in specialized providers; (2) securing funding and coordination of services between different organizations; and (3) addressing gaps in the availability and geographical distribution of other needed resources, such as medicines. While those elements contributed to improving access to services and the quality of services-especially among health workers seeking MHPSS services-findings suggested gaps in the sustainability of services and a need to scale up those interventions in an integrated approach.</p><p><strong>Conclusion: </strong>The study findings add to the evidence base on the challenges in scaling up MHPSS interventions and their long-term sustainability concerns. Priority actions should address the intermittent funding of the MHPSS response, incorporate MHPSS outputs and outcomes in the reimbursement of routine services, improve coordination between health partners and non-health actors in order to expand the scope of MHPSS response, and address the inequitable availability of resources in the region.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"17 1","pages":"46"},"PeriodicalIF":3.6,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10548701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41156534","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 crisis context: a mixed cross-sectional study in Eastern Democratic Republic of Congo.","authors":"Samuel Lwamushi Makali, Jean Corneille Lembebu, Raïssa Boroto, Christian Chiribagula Zalinga, Daniella Bugugu, Emmanuel Lurhangire, Bigirinama Rosine, Christine Chimanuka, Pacifique Mwene-Batu, Christian Molima, Jessica Ramirez Mendoza, Giovanfrancesco Ferrari, Sonja Merten, Ghislain Bisimwa","doi":"10.1186/s13031-023-00541-w","DOIUrl":"10.1186/s13031-023-00541-w","url":null,"abstract":"<p><strong>Background: </strong>Health Care Workers (HCWs) in conflict zones face high levels of violence while also playing a crucial role in assisting the population in distress. For more than two decades, the eastern provinces of the Democratic Republic of the Congo (DRC), have been wracked by conflict. This study aims to describe the state of violence against HCWs and the potential prevention mechanisms in eastern DRC.</p><p><strong>Methods: </strong>In North and South Kivu, between February 5 and 21, 2021, we conducted a mixed cross-sectional convergent study in health facilities (health centers and hospitals). An anonymized self-administered questionnaire was sent to HCWs about their experience of violence in the 12 months prior to the study. In-depth individual interviews with HCWs, present on the day of the investigation, were also done to explore their experience of violence. A descriptive analysis of the quantitative data and a thematic analysis of the qualitative data was carried out.</p><p><strong>Results: </strong>Of a total of 590 participants, 276 (45.9%) reported having experienced violence in the 12 months before the study. In North Kivu, aggressors were more frequently the patients (43.7% vs. 26.5%) and armed group members (14.3% vs. 7.9%) than in South Kivu. Most respondents (93.5%) reported verbal aggression (insults, intimidation, death threats). Other forms of physical aggression including with bare hands (11.2%), firearm (1.81%), and stabbing (4.7%). Only nearly one-tenth of the attacks were officially reported, and among those reported a higher proportion of sanctions was observed in South Kivu (8.5%) than in North Kivu (2.4%). The mechanisms proposed to prevent violence against HCWs were community initiatives and actions to strength the health system.</p><p><strong>Conclusions: </strong>In Eastern DRC, HCWs face multiple and severe forms of aggression from a variety of individuals. The effects of such levels violence on HCWs and the communities they served could be devastating on the already pressured health system. Policy framework that defines the roles and responsibilities for the protection of HCWs and for the development and implementation of preparedness measures such as training on management of violence are possible solutions to this problem.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"17 1","pages":"44"},"PeriodicalIF":3.6,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41156646","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":"Healthcare workers' experiences of workplace violence: a qualitative study in Lebanon.","authors":"Linda Abou-Abbas, Rana Nasrallah, Sally Yaacoub, Jessica Yohana Ramirez Mendoza, Mahmoud Al Wais","doi":"10.1186/s13031-023-00540-x","DOIUrl":"10.1186/s13031-023-00540-x","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has brought unprecedented challenges to healthcare workers (HCWs) around the world. The healthcare system in Lebanon was already under pressure due to economic instability and political unrest before the pandemic. This study aims to explore the impact of COVID-19 and the economic crisis on HCWs' experiences of workplace violence in Lebanon.</p><p><strong>Methods: </strong>A qualitative research design with an inductive approach was employed to gather data on workplace violence through Focus Group Discussions (FGDs) from HCWs in Tripoli Governmental Hospital (TGH), a governmental hospital in North Lebanon. Participants were recruited through purposive sampling. The interviews were conducted in Arabic, recorded, transcribed, and translated into English. Thematic analysis was used to analyze the data.</p><p><strong>Results: </strong>A total of 27 employees at the hospital participated in the six FGDs, of which 15 females and 12 males. The analysis identified four main themes: (1) Types of violence, (2) Events witnessed, (3) Staff reactions to violence, and (4) Causes of violence. According to the interviews conducted, all the staff members, whether they had experienced or witnessed violent behavior, reported that such incidents occurred frequently, ranging from verbal abuse to physical assault, and sometimes even involving the use of weapons. The study findings suggest that several factors contribute to the prevalence of violence in TGH, including patients' financial status, cultural beliefs, and lack of medical knowledge. The hospital's location in an area with a culture of nepotism and favoritism further exacerbates the issue. The staff's collective response to dealing with violence is either to submit to the aggressor's demands or to remove themselves from the situation by running away. Participants reported an increase in workplace violence during the COVID-19 pandemic and the exacerbated economic crisis in Lebanon and the pandemic.</p><p><strong>Conclusion: </strong>Interventions at different levels, such as logistical, policy, and education interventions, can help prevent and address workplace violence. Community-level interventions, such as raising awareness and engaging with non-state armed groups, are also essential to promoting a culture of respect and zero tolerance for violence.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"17 1","pages":"45"},"PeriodicalIF":3.6,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10548579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41165448","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}