Conflict and Health最新文献

{"title":"Tracking progress towards sustainable development goal 3.2 in Somalia using time series models: a comparative forecasting analysis.","authors":"Khadar Mowlid Abdi, Abdirisak Mohamed Moumin, Hibo Abdilahi Omer, Saralees Nadarajah, Abdisalam Hassan Muse","doi":"10.1186/s13031-026-00808-y","DOIUrl":"10.1186/s13031-026-00808-y","url":null,"abstract":"<p><strong>Background: </strong>High infant mortality rate (IMR) is a critical public health indicator. Understanding its trajectory is vital for policymaking, particularly in Somalia, where rates remain elevated. This study aimed to model and forecast Somalia's IMR to identify the most accurate method, providing data-driven insights for public health strategy.</p><p><strong>Objectives: </strong>The study aimed to formulate time series models, propose hybrid models, and rigorously compare their performance in forecasting IMR.</p><p><strong>Methods: </strong>This quantitative time-series analysis utilized annual World Bank data for Somalia from 1950 to 2022. Three models were developed: Autoregressive Integrated Moving Average (ARIMA), Artificial Neural Network (ANN), and a hybrid ARIMA-ANN model. Performance was evaluated using Root Mean Square Error (RMSE) and Symmetric Mean Absolute Percentage Error (sMAPE) on a test set spanning 2013 to 2022.</p><p><strong>Results: </strong>Upon achieving stationarity via first-order differencing, the ARIMA (1, 1, 3) model proved most effective. It demonstrated superior accuracy with an RMSE of 0.85, significantly outperforming the ANN (RMSE 1.04) and hybrid models (RMSE 3.01). Validated ARIMA forecasts project a continued, gradual decline in IMR from 59.02 deaths per 1,000 live births in 2023 to 40.37 in 2032.</p><p><strong>Conclusion: </strong>The ARIMA model offers the most reliable framework for forecasting Somalia's infant mortality rate based on historical data.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159068","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":"Survival under armed conflict: displacement, dialysis continuity, and financial burden among hemodialysis patients in Sudan.","authors":"Mazin M T Shigidi, Nazik M Abdulfatah","doi":"10.1186/s13031-026-00813-1","DOIUrl":"10.1186/s13031-026-00813-1","url":null,"abstract":"<p><strong>Background: </strong>Patients receiving maintenance hemodialysis are highly vulnerable during armed conflict, particularly when healthcare systems are disrupted. However, factors associated with survival under prolonged disruption remain poorly understood. This study examined survival and key associated factors among hemodialysis patients during the armed conflict in Sudan.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 158 adults receiving maintenance hemodialysis in Khartoum, Sudan, at the onset of the April 2023 conflict, with follow-up extending up to 18 months. Outcomes were confirmed for 122 patients, while 36 were untraceable and censored at their last verified contact. Participants were categorized according to displacement trajectory within the first three months. The primary outcome was survival. Key variables included displacement trajectory, dialysis frequency during follow-up, and out-of-pocket costs. Risk ratios and time-to-event approaches were used to examine associations, with sensitivity analyses conducted to assess the impact of loss to follow-up.</p><p><strong>Results: </strong>Of the 122 patients with confirmed outcomes, 53.3% remained alive at the end of follow-up. Survival rates differed across displacement trajectories: 81.8% among those who relocated internationally early, 53.3% among those who achieved internal settlement, 34.6% among those who experienced secondary displacement, and 13.8% among those who remained in the capital. Higher survival was observed among patients receiving at least two dialysis sessions per week compared with those receiving one or fewer sessions or emergency-only dialysis (68.8% vs. 43.2%; RR 1.59, 95% CI 1.15-2.20). Financial burden was substantial, with monthly dialysis-related costs ranging from USD 720-3,600 during early displacement and remaining high thereafter (USD 500-3,500).</p><p><strong>Conclusions: </strong>Survival differed across displacement patterns and dialysis continuity, and was influenced by financial burden. These findings underscore the need for conflict-adapted dialysis strategies and improved financial protection for patients reliant on life-sustaining therapies.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152168","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":"Between trauma and resilience - an ecological model of the determinants of mental health among Ukrainian war refugees in Europe: a cross-sectional study.","authors":"Małgorzata Szkup, Artur Kotwas, Karmen Erjavec, Sabina Krsnik, Olha Fedortsiv, Emilia Burbela, Sanja Stanisavljević, Elena Rousou, Agnieszka Kleszcz, Rita Fernandes, Marzena Mikła, Paraskevi Charitou, Beata Karakiewicz","doi":"10.1186/s13031-026-00812-2","DOIUrl":"10.1186/s13031-026-00812-2","url":null,"abstract":"<p><strong>Background: </strong>The full-scale invasion of Ukraine has generated the largest refugee crisis in Europe since the Second World War, exposing civilians to trauma, displacement, and prolonged uncertainty. Refugees face stressors across multiple ecological levels, making Bronfenbrenner's model a suitable framework for understanding mental health determinants. This study examined multilevel predictors of psychological distress among Ukrainian war refugees in Europe.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in 2025 across eight European countries. A total of 1,622 adult refugees completed standardized questionnaires. Psychological distress was assessed with the Refugee Health Screener-15 (RHS-15), and cultural trauma symptoms with the Cultural Symptoms of Trauma Scale (CSTS). Sociodemographic, relational, economic, institutional, cultural, and temporal variables were organised within Bronfenbrenner's ecological model. Group comparisons were conducted using non-parametric tests, and predictors of distress were identified through logistic regression.</p><p><strong>Results: </strong>Higher distress was associated with poorer self-rated health, weaker family and social relationships, unemployment, economic strain, and contact with family in war-affected areas. The strongest predictors were macrosystem factors, including emotional, cognitive, existential, and agency-related trauma symptoms (OR 1.40-2.78). Protective factors included better health, stronger family relationships, employment, and favourable economic conditions. Refugees who left Ukraine later in the conflict showed lower distress risk.</p><p><strong>Conclusions: </strong>Mental health outcomes among Ukrainian refugees reflect interactions across ecological levels. Interventions should integrate individual, relational, community, economic, and culturally informed components to address the multifaceted nature of refugee distress.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138973","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 impacts of peace and conflict resolution interventions on mental health and psychological well-being: a systematic review.","authors":"María Camila García Durán, Rakesh Singh, Mauricio Avendano, Crick Lund","doi":"10.1186/s13031-026-00804-2","DOIUrl":"10.1186/s13031-026-00804-2","url":null,"abstract":"<p><strong>Background: </strong>Prior studies have examined the impact of armed conflict on mental health. This systematic review synthesizes evidence on how peace and conflict resolution interventions influence the mental health and well-being of conflict-affected communities.</p><p><strong>Methods: </strong>We conducted a systematic review across multiple databases and identified studies evaluating the effects of peace and conflict resolution interventions on mental health and well-being from 1990 to 2026. Due to heterogeneity in study designs and outcomes, a narrative synthesis was conducted.</p><p><strong>Results: </strong>The search yielded 6,360 records, of which 15 were included. The majority of studies were cross-sectional (n = 6), and only two were randomised controlled trials (RCTs). Most studies were conducted in African countries, targeted the community level, and were implemented by government agencies or non-governmental organisations (NGOs). Overall, studies yield mixed mental health outcomes. On the one hand, rehabilitation programmes, reparations support, financial aid, and reconciliation media show positive effects on psychological well-being. However, truth and reconciliation interventions were associated with negative outcomes, as they exacerbate distress, posttraumatic stress disorder, and anxiety, particularly for survivors. Most studies were limited by a focus on short-term effects and lack of a comparison group.</p><p><strong>Conclusion: </strong>The findings present a mixed picture: while rehabilitation and economic interventions show mental health benefits, truth and reconciliation efforts were associated with psychological harms. More longitudinal studies with larger samples and rigorous designs are needed to assess long-term effects. Recognising both the mental health risks and benefits of peace and conflict interventions is essential to ensure they support not only political stability but also psychological recovery and resilience.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139746","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":"Household food insecurity status in Gulina District, zone 4 of conflict affected Afar Regional State, Northeast Ethiopia.","authors":"Fiseha Tsegaye, Goitom Sisay","doi":"10.1186/s13031-026-00809-x","DOIUrl":"10.1186/s13031-026-00809-x","url":null,"abstract":"<p><p>Investigating the Household Food insecurity situation of conflict affected communities has increasingly become a widespread issue around the world. Gulina District, situated within Zone 4 of the Afar region, faced significant challenges related to the impacts of conflict, which severely affect household food security. The study aimed to assess the household food security status in the conflict-affected Gulina District. The study used a cross-sectional study design using a combination of quantitative and qualitative data collection techniques. Data was collected from 366 randomly selected household heads. Food Consumption Score (FCS), Household Dietary Diversity Score (HDDS), and Household Food Insecurity Access Scale (HFIAS) were among the metrics utilized in the survey questionnaire to evaluate the level of household food security status. Employing HFIAS, 82.8% of households are food insecure; of these, 61.5% and 21.3% are classified as mildly and moderately food insecure, respectively. This demonstrated the problem of household food insecurity's seeming prevalence. Moreover, the HDDS and FCS survey result show that the study area is mainly characterized by the high consumption of milk and relatively moderate intake of staples and animal protein, but the low consumption of fruits and vegetables due to the pastoral nature of the community.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148102362","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":"Client perceptions and satisfaction with HIV care clinic services in post-conflict Tigray, Ethiopia: a cross-sectional study.","authors":"Hafte Kahsay Kebede, Lillian Mwanri, Mengistu Welday Gebremichael, Fisseha Ashebir Gebregizabher, Gebremeskel Mamu Werid, Paul Ward, Hailay Abrha Gesesew","doi":"10.1186/s13031-026-00807-z","DOIUrl":"10.1186/s13031-026-00807-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The 2020-2022 Tigray conflict affected health infrastructure, antiretroviral therapy (ART) supply chains, and continuity of HIV care. Assessing patient satisfaction during the recovery period is important to monitor service quality and inform service improvement. This study aimed to (i) measure the level of patient satisfaction among people living with HIV (PLHIV) receiving ART in post-conflict Mekelle City, (ii) model the relationships between four service-quality dimensions and overall satisfaction, and (iii) identify determinants of overall satisfaction with HIV care clinic services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study was conducted from October to November 2024 in Mekelle City, Tigray (eight public facilities and three operated by non-governmental organizations (NGOs)). Eligible participants were adults (≥ 18 years) on ART for at least 12 months. Patient satisfaction was measured using a 21-item, 5-point Likert-scale questionnaire covering four domains: provider-client relationship (PCR), availability and accessibility of care (AAC), quality of care services (QCS), and facility and service environment (FSE). Confirmatory factor analysis (CFA) was used to validate the four-factor measurement model, a second-order structural equation model (SEM) examined associations between the four domains and overall satisfaction, and binomial logistic regression identified determinants of dichotomised overall satisfaction (mean composite score &gt; 3.69 = satisfied).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 631 eligible patients, 569 consented (90.17%); 521 were retained after exclusions. Mean age was 42.4 years and 60.7% female. Overall, 62.4% reported satisfaction with HIV care clinic services. Domain-level satisfaction was: 64.5% for PCR, 31.5% for AAC, 57.2% for QCS, and 57.4% for FSE. The second-order SEM showed strong, statistically significant standardised associations between overall satisfaction and each domain (PCR β = 0.920; AAC β = 0.963; QCS β = 0.925; FSE β = 0.985; all p &lt; 0.001). In multivariable logistic regression, clients at tertiary-level facilities (OR = 0.50, 95% CI 0.37-0.67) and at public facilities (OR = 0.64, 00195% CI 0.54-0.76) had significantly lower odds of satisfaction; sociodemographic and clinical variables were not independently associated with satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Overall satisfaction with HIV care clinic services in post-conflict Mekelle City was 62.4%, below Ethiopia's Health Sector Transformation Plan-II (HSTP-II) target of 80% and at the lower end of the Ethiopian pooled estimate of 69.7% (95% CI 63.8-75.5%). All four service-quality domains were strongly associated with overall satisfaction, and tertiary-level and public facilities had lower odds of satisfaction. Targeted quality improvement is warranted across access, environment and quality-of-care dimensions, particularly at tertiary and public facilities. Whether changes in satisfaction translate into ART i","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148102335","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":"Understanding Ukraine's immunization supply chain resilience in the face of war: a mixed-method study.","authors":"Stanislav Gaievskyi, Yevgenii Grechukha, Oleg Khomenko, Oleksandra Karkishechenko, Denys Deineha, Oleg Benes, Sharif Ismail, Jarno Habicht","doi":"10.1186/s13031-026-00806-0","DOIUrl":"10.1186/s13031-026-00806-0","url":null,"abstract":"<p><strong>Background: </strong>The full-scale invasion of Ukraine in 2022 created unprecedented pressures on the national immunization supply chain (ISC). Despite large-scale energy disruptions, population displacement, and insecurity, vaccine availability and storage conditions were largely maintained. This study aimed to examine how Ukraine's ISC has adapted to war-related disruptions and to identify key enablers, barriers, and priorities for strengthening its resilience.</p><p><strong>Methods: </strong>A mixed-methods approach combined 15 semi-structured interviews with stakeholders from national, oblast, and facility levels, a review of literature, regulatory documents, and programme data. Data were analyzed using thematic analysis and interpreted using the Blanchet et al. health system resilience framework.</p><p><strong>Results: </strong>Analysis found that the digitalization of the vaccine stock management system and the wide availability of training strengthened the knowledge capacity of the ISC. Large-scale investments by international partners in WHO-prequalified cold chain equipment during the COVID-19, complemented by the deployment of backup power solutions, significantly improved the system's ability to manage uncertainty related to electricity outages. The centralization of ISC function enhanced governance and coordination, contributing to legitimacy capacity. Strong collaboration across government institutions and with international partners also helped sustain ISC in the face of the war disruptions, demonstrating the importance of interdependence capacity. However, several barriers persist, including gaps in population data for forecasting vaccine needs and coverage monitoring, unequal distribution of new cold chain equipment, and continued reliance on donor support.</p><p><strong>Conclusions: </strong>Despite repeated attacks, Ukraine's ISC has continued to function. The findings highlight key enablers of resilience and remaining bottlenecks and provide actionable recommendations. Ukraine's experience offers transferable lessons for strengthening ISC resilience in other conflict settings.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018689","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":"Postoperative care in conflict-affected northwest Syria: a mixed-methods study assessing the perspectives of patients, health workers, and non-governmental organizations.","authors":"Camila Polinori, Maia C Tarnas, Kelli Wagner, Mohammad Darwish, Stefany M Lazieh, Ahmad Alnasser, Ahmad Ghandour, Ismail Alkhatib, Saverio Bellizzi, Bara Zuhaili, Gilbert Burnham","doi":"10.1186/s13031-026-00802-4","DOIUrl":"10.1186/s13031-026-00802-4","url":null,"abstract":"<p><strong>Introduction: </strong>Thirteen years of conflict have profoundly disrupted Syria's health system. In northwest Syria, constraints such as deliberate attacks on healthcare, chronic underfunding, and a fragmented health system have created a fragile surgical ecosystem in which health workers operate under extreme resource constraints, patients struggle to access care, and postoperative complications are increasingly likely. In this study, we aim to assess the burden of postoperative complications by examining patient-reported outcomes and barriers to care while integrating this data with insights from health workers and non-governmental organization (NGO) stakeholders.</p><p><strong>Methods: </strong>This mixed-methods study uses secondary data from a cross-sectional survey of 261 adult patients who underwent surgery in hospitals in northwest Syria. Firth's logistic regression was used to estimate adjusted odds of complications by surgery type. To contextualize these findings, a workshop engaged 31 surgeons, hospital administrators, and surgeons to identify perceived drivers of complications and prioritize interventions across the WHO health system building blocks.</p><p><strong>Results: </strong>Barriers to seeking postoperative follow-up care were reported by 57.5% of participants, with transportation, cost, appointment availability, and proximity among the most prevalent barriers. Trauma and orthopedic surgeries demonstrated notably higher odds of adverse outcomes. Workshop participants identified workforce shortages, surgeon rotation across hospitals, fragmented health information systems, and underfunded systems as factors perceived to be associated with these challenges. Workshop participants proposed interventions focused on expanding clinical training, strengthening infection prevention and control, improving provider-patient communication, and establishing governance mechanisms that incentivize quality care.</p><p><strong>Conclusions: </strong>Our findings illustrate how systemic vulnerabilities shaped outcomes for surgical patients and the surgical ecosystem in northwest Syria. Although data collection occurred during the Assad regime, the findings provide relevant insights for Syria's health system reconstruction, as addressing the identified challenges will be critical not only for strengthening the surgical ecosystem but also for supporting long-term recovery and resilience efforts.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13383526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007644","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":"From HIV testing to ART initiation under fire: joinpoint regression analysis of regional disparities during the full-scale war against Ukraine.","authors":"Oleksandr Neduzhko, Oksana Kovtun, Oksana Pashchuk, Nadiia Semchuk, Kostyantyn Dumchev","doi":"10.1186/s13031-026-00796-z","DOIUrl":"10.1186/s13031-026-00796-z","url":null,"abstract":"<p><strong>Background: </strong>The full-scale Russian invasion of Ukraine in February 2022 caused large-scale displacement and major disruption of health services. We assessed national and subnational trends in HIV testing, test positivity, number of newly registered HIV cases, and antiretroviral therapy (ART) initiation during 2020-2023, and examined whether trajectories differed by regional exposure to hostilities.</p><p><strong>Methods: </strong>This ecological time-series study analyzed routine national surveillance and program data from January 2020 through December 2023. Joinpoint regression was used to identify trend breakpoints and estimate quarterly percent change (QPC), average quarterly percent change (AQPC), monthly percent change (MPC), and average monthly percent change (AMPC), with 95% confidence intervals. Subnational analyses were stratified into three categories of exposure to hostilities: active hostilities in 2023, history of active hostilities in 2022 but not in 2023, and no active hostilities or occupation during 2022-2023.</p><p><strong>Results: </strong>National HIV testing declined through 2021 and dropped sharply at invasion onset, followed by sustained increases after Q2 2022 (QPC + 9.14% [95% CI: 3.89; 22.47]), exceeding pre-war levels by late 2023. However, the number of positive tests decreased steadily from 5,458 in Q1 2020 to 3,590 in Q4 2023 (AQPC -3.25% [-4.86; -1.56]) and test positivity dropped from approximately 1% to 0.5% after Q2 2022 (QPC -10.48% [-22.04; -5.99]). Newly registered HIV cases were stable through 2021, declined sharply at invasion onset, briefly rebounded, and then decreased through December 2023 (MPC -1.12% [-2.39 to -0.31]). ART initiation decreased steadily from 1,495 in January 2020 to 797 in December 2023 (AMPC -1.11% [-1.40; -0.81]), without breakpoints. Post-invasion trajectories diverged regionally: regions exposed to prolonged hostilities experienced the deepest and most persistent disruptions, whereas less affected regions demonstrated gradual increases in registrations and ART initiation.</p><p><strong>Conclusions: </strong>The full-scale war caused substantial disruption in key HIV services. Although testing increased after the initial shock, it did not translate into higher case detection, reflecting a shift from testing high-risk populations toward war-related expanded screening of blood donors, military personnel, and displaced individuals. Regional divergence in trends was consistent with population displacement and redistribution of HIV service delivery. Interpretation of wartime HIV indicators requires attention to changes in the tested population and regional service capacity. Sustaining epidemic control under prolonged war will require combining targeted case-finding with broader screening, and strengthening cross-region linkage from diagnosis to ART initiation.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984377","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":"Increased utilization of health care services for non-communicable diseases during the COVID-19 pandemic among refugees in Jordan: a mixed-methods study.","authors":"Chiara Altare, Yousef Kakish, Gabrielle Prager, Ahmad Mobaideen, Waseem Rihani, Jennifer OKeeffe, Muhammad Fawad, Heba Hayek, Paul Spiegel, Adam Musa Khalifa","doi":"10.1186/s13031-026-00800-6","DOIUrl":"10.1186/s13031-026-00800-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Maintaining routine health services during epidemics and humanitarian crises is instrumental to reduce preventable mortality and morbidity. Given the health service disruptions observed during the COVID-19 pandemic worldwide, we aimed to investigate the evolution of health care service utilization for acute and routine chronic care among refugees in Jordan during distinct phases of the COVID-19 pandemic and discuss the interventions that may have contributed to the observed changes in utilization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a mixed-methods study with three components: (1) interrupted time-series analysis of routine health data in Azraq and Zaatari camps; (2) a household survey among refugees in and out-of-camps (descriptive statistics and comparisons across pandemic periods using Poisson models with household-correlated robust variance estimation); 3) focus group discussions among refugees in and out-of-camps (inductive and deductive thematic content analysis). The analyses compared outcomes across four study periods: (1) Pre-COVID-19 (January 2018-March 2020); (2) Lockdown (April 2020-June 2021); (3) Post-lockdown (July 2021-April 2022); (4) Normalization (May 2022-March 2023), and three refugee groups (Syrian in-camps, Syrian out-of-camps, non-Syrian out-of-camps). Study outcomes included health care utilization for acute and chronic conditions (average number of outpatient consultations per person per year) and self reported health care seeking behaviour.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Acute care utilization declined sharply during the lockdown and recovered gradually to pre-pandemic level during the post-lockdown period. Diabetes care utilization was low before the pandemic across groups. After a reduction during lockdown, it increased significantly during the normalization phase to above pre-pandemic rates. A package of service adaptations was introduced to facilitate access to services and medicines: multi-months drug prescription; new distribution system for medication home delivery; home visits; telephonic follow-up; hotline for questions. Study participants reported different experiences in accessing care, from spontaneous support to perceived barriers and limited access. While challenges were highlighted (waiting time, transportation, cost), most participants appreciated the intervention package and praised the comprehensiveness of the provided services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This paper investigates changes in health care services utilization of acute and routine chronic care among refugees in Jordan during the COVID-19 pandemic. We learned that acute care will likely rebound back to pre-shock levels and that the utilization of chronic care benefitted from introduced changes in the approach of service delivery, namely a package of complementary interventions that proved helpful in facilitating access to care and medicines for NCD patients while reducing COVID-19 exposure. ","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943742","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}