Conflict and Health最新文献

{"title":"Health system governance cooperation with unrecognised health authorities: a political economy analysis in Afghanistan and Northwest Syria.","authors":"Anna Paterson, Jennifer Palmer, Egbert Sondorp","doi":"10.1186/s13031-025-00669-x","DOIUrl":"10.1186/s13031-025-00669-x","url":null,"abstract":"<p><strong>Background: </strong>The government is normally the leading actor in health system governance, yet in some conflict-affected contexts, government or equivalent health authorities are not formally recognised by the international partners who co-finance the health system. This study considers what has inhibited or facilitated cooperation between two types of non-recognised health authorities and international partners in Afghanistan from 2021 to 24 and Northwest Syria from 2013 to 19.</p><p><strong>Methods: </strong>A literature review was combined with 14 semi-structured key informant interviews, mostly with representatives (often health advisers) of donors or UN agencies. A political economy analysis (PEA) analytical framework was used, focusing on the capacities, incentives, beliefs, institutional and structural factors that influenced the behaviour of the key health system actors.</p><p><strong>Results: </strong>Although widely cited as a critical barrier, the lack of formal recognition was not the main constraint on cooperation. The in/stability of the conflict context, the likelihood of survival of de facto health authorities, the extent to which there were clashing norms between actors, and the incentives and 'ways of doing things' of both unrecognised authorities and international actors also played key roles. For example, in Afghanistan, the Taliban's approach to women's rights and education was identified as the major barrier to cooperation. In Northwest Syria, on the other hand, establishing health governance bodies that were strongly technical in focus and claimed functional independence from sanctioned ruling militias significantly boosted cooperation and protected the health system. Most interviewees felt there was more room for international actors to work with unrecognised health authorities within the \"red lines\" of international law and organisational mandates, using promising entry points such as supporting Human Resources for Health. There was significant agreement between authorities and international partners on the core health system strategies and priorities in these contexts. But health authorities wanted - and aid cuts suggested they should take - more control over financing and management, and they were naturally more focused than international actors on the holistic needs of the health system, beyond 'emergency' assistance.</p><p><strong>Conclusions: </strong>International partners and de facto authorities can both take action to use more of the operational space for cooperation.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"30"},"PeriodicalIF":3.1,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144367","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":"Conflict exposure and mental health: a survey of adolescent girls and young women in Myanmar post the 2021 coup d'état.","authors":"Isabelle Pearson, Elaine Chase, Cing Van Kim, Nang Ma San, Hkawn Ja, Zin Mar Hlaing, Nandar Oo, Khin Lae, Ei Ei Soe, Brooke Zobrist, Cathy Zimmerman, Meghna Ranganathan","doi":"10.1186/s13031-025-00668-y","DOIUrl":"10.1186/s13031-025-00668-y","url":null,"abstract":"<p><strong>Background: </strong>Following the 2021 military coup in Myanmar, adolescent girls and young women have faced a multitude of threats to their health and wellbeing. Beyond direct exposure to armed combat, injuries and loss of life, they are also experiencing displacement, family separation, and restricted access to education and healthcare. These challenges are further compounded by military-imposed restrictions on humanitarian aid and access to the country. This study sought to address a critical gap in understanding how exposure to conflict in Myanmar is impacting adolescent girls' mental health.</p><p><strong>Methods: </strong>We conducted a survey, co-developed with peer-researchers, with 750 girls and young women aged 10 to 21 years from disproportionately disadvantaged communities across Myanmar. The survey included questions on participants' demographics, their exposure to conflict-related stressors and their self-reported depressive symptoms.</p><p><strong>Results: </strong>Participants reported widespread exposure to traumatic conflict-related stressors and high levels of depressive symptoms. There was a significant positive association between the number of different conflict-related stressors experienced by the study participants and the number of depressive symptoms reported. Additionally, participants who were living away from their parents reported significantly higher levels of depressive symptoms, emphasising the psychological implications of family separation during conflict.</p><p><strong>Conclusions: </strong>Our results highlight the urgent need for tailored interventions for adolescents, particularly girls and young women, who are exposed to armed conflict. In contexts of protracted instability and uncertainty, such as in Myanmar, interventions should explore ways to foster a sense of social safety, especially among adolescent girls who are displaced or living away from their families. Strengthening social safety systems may help to reduce the adverse mental health impacts of conflict-related stressors.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"29"},"PeriodicalIF":3.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086947","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":"Health care without medicine: the impact of war on Sudan's pharmaceutical manufacturing and supply.","authors":"Aly Verjee, Thouiba Hashim Galad, Ruoh-Yeng Chang","doi":"10.1186/s13031-025-00667-z","DOIUrl":"https://doi.org/10.1186/s13031-025-00667-z","url":null,"abstract":"<p><strong>Background: </strong>Armed conflict in Sudan since April 2023 has led to the widespread disruption of health care services, the destruction of public and private health care infrastructure nationwide, and the targeting of health care personnel. This study examines the impact of the conflict on a less publicized sector of Sudan's health system: the national pharmaceutical manufacturing and supply chain.</p><p><strong>Methods: </strong>Research interviews were conducted with representatives of 4 companies engaged in pharmaceutical manufacturing and/or supply in Sudan, in addition to a review of primary information from medical regulators and industry associations. Based on these interviews, 3 case studies are presented; insights from the fourth interview inform the study overall.</p><p><strong>Results: </strong>All 4 companies reported significant impacts on their operations, as well as on other companies in the pharmaceutical sector. Domestic pharmaceutical manufacturing has effectively come to a halt, leading to the non-availability of certain drugs in parts of the country. Manufacturers have shifted course to focus on imports, but heavy losses of domestically stored inventory and an inability to distribute medicines to large parts of the country have had a significant impact on pharmaceutical supply to retail pharmacies, public and private sector health facilities, and the National Medical Supplies Fund (NMSF).</p><p><strong>Conclusions: </strong>Sudan's pharmaceutical manufacturing industry has been devasted. Although less visible than hospitals and medical personnel, the effects on the pharmaceutical sector are consequential for Sudan's health sector, particularly for chronic conditions.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"28"},"PeriodicalIF":3.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Gender-based violence in the context of armed conflict in the Amhara Region, Northern Ethiopia.","authors":"Desalew Salew Tewabe, Muluken Azage, Gizachew Yismaw Wubetu, Sisay Awoke Fenta, Mulugeta Dile Worke, Amanu Mekonen Asres, Wallelign Alemnew Getnet, Genet Gedamu Kassie, Yonatan Menber, Alemtsehay Mekonnen Munea, Taye Zeru, Selamawit Alemayehu Bekele, Sadiya Osman Abdulahi, Tigist Biru Adamne, Hiwot Debebe Belete, Belay Bezabih Beyene, Melkamu Abte, Tesfaye B Mersha, Abel Fekadu Dadi, Daniel A Enquobahrie, Souci M Frissa, Yonas E Geda","doi":"10.1186/s13031-025-00665-1","DOIUrl":"https://doi.org/10.1186/s13031-025-00665-1","url":null,"abstract":"","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"27"},"PeriodicalIF":3.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005857","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":"Addressing dual deficiencies of SAM indicators; gaps and insights from inpatient admission to outpatient discharge, in conflict-affected Yemen; a retrospective study.","authors":"Mohammed Abdullah Al Amad, Yahia Ahmed Raja'a, Khaled Algendari","doi":"10.1186/s13031-025-00666-0","DOIUrl":"https://doi.org/10.1186/s13031-025-00666-0","url":null,"abstract":"<p><strong>Background: </strong>Severe acute malnutrition (SAM) remains a critical public health challenge in conflict-affected settings, where children face heightened vulnerability. Dual deficiencies in weight-for-height z-score (WHZ < -3) and mid-upper arm circumference (MUAC < 11.5 cm) indicate a more severe form of SAM, yet current admission protocols prioritize WHZ-based criteria for inpatient therapeutic feeding centers (TFCs). This approach may exclude children with MUAC deficiencies from optimal inpatient care, potentially impacting recovery outcomes in outpatient therapeutic programs (OTPs). In Yemen, prolonged conflict has exacerbated SAM burdens, leading to an expansion of TFC and OTP services since 2015. The aim is to determine whether existing WHO recovery criteria adequately support comprehensive recovery and prevent premature discharge.</p><p><strong>Method: </strong>A retrospective analysis was conducted using data from a prospective longitudinal study of children admitted with complicated SAM to TFCs in Sana'a City from September 2023 to November 2024. Children were categorized based on SAM diagnostic criteria (WHZ < -3, MUAC < 11.5 cm, or both) and analyzed under four discharge scenarios: (1) WHZ recovery, (2) MUAC recovery, (3) recovery by either WHZ or MUAC, and (4) recovery of both indicators. Chi-square and Kruskal-Wallis tests were used to assess differences between groups, and P < 0.05 was used to determine statistical significance.</p><p><strong>Results: </strong>Among 188 children admitted with complicated SAM, 56% (105) were female, 53% (100) were aged 6-<12 months, and 59% (111/188) presented with dual deficiencies. Admission based on WHZ criteria accounted for 82% (154/188) of admissions, of whom 72% also had MUAC < 11.5 cm. At OTP discharge, 96% met WHO recovery criteria, yet only 38% achieved full recovery (WHZ ≥ -2 and MUAC ≥ 12.5 cm). Full recovery was significantly lower among children with dual deficiencies at TFC admission than those with single deficiencies in MUAC or WHZ (31% vs. 47% and 51%, respectively, p = 0.032).</p><p><strong>Conclusions: </strong>These findings underscore the need to integrate WHZ and MUAC into discharge criteria to prevent premature discharge and ensure comprehensive recovery. Revising WHO protocols and enhancing SAM management in conflict-affected settings are critical to improving treatment outcomes.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"26"},"PeriodicalIF":3.1,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053537","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":"Assessing the health workforce in Afghanistan: a situational analysis into the country's capacity for Universal health coverage.","authors":"Narges Neyazi, Nima Yaghmaei, Mirwais Ahmadzai, Elisabeth Kleipool, Nadine Naumann, Myrte Wassenaar, Muhammad Haider Omar, Fethiye Gülin Gedik, Sandra Alba, Marjolein Dieleman, Abdul Ghani Ibrahimi, Alaa AbouZeid","doi":"10.1186/s13031-025-00663-3","DOIUrl":"10.1186/s13031-025-00663-3","url":null,"abstract":"<p><strong>Background: </strong>Universal health coverage (UHC) is a key component of Afghanistan's health plan, but the country faces challenges due to decades of conflict and instability. Concurrently, healthcare successes have been achieved despite significant shortages in the health workforce. A fit-for-purpose health workforce is crucial for achieving UHC, and requires decision-making by policy-makers driven by sufficient evidence. This study presents a comprehensive situational analysis of Afghanistan's health workforce in 2023, focusing on distribution by geography, gender, facility type, as well as trends in health worker production.</p><p><strong>Methods: </strong>A multi-stage assessment of the active health workforce was conducted through a national census-style count using active registries and facility-level verification through sampled facilities visits. Health worker production was estimated through an analysis of enrollment and graduation figures from public and private institutions from 2019 to 2023.</p><p><strong>Findings: </strong>We estimated 63,632 health workers in Afghanistan in 2023, with 73% in the public sector and 27% in the private sector. Key health workers (physicians, nurses and midwives) total 10.3 per 10,000 population, falling significantly short of the aspirational UHC threshold (44.5 key health workers per 10,000). Substantial geographic disparity exists between provinces, with remote provinces reporting far fewer key health workers compared to the national average and Kabul representing approximately 50% of the country's specialized physicians. Significant gender imbalances exist as only 18% of specialized physicians and 29% of nurses are female. Health workforce production is largely dependent on the private sector, and has declined for certain cadres due to restrictions on female education, which are increasing in severity. Majority female cadres, such as Obstetrics/Gynecology, are anticipating significant declines in active staff, jeopardizing aspirations of UHC.</p><p><strong>Interpretation: </strong>Afghanistan faces critical health workforce challenges, including shortages, gender imbalances and unequal geographic distribution. These findings provide essential insights for policymakers to guide human resources policies aimed at achieving UHC.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"25"},"PeriodicalIF":3.1,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026787","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":"Childhood exposure to intimate partner violence against women and its association with violence against children in refugee settlements in Uganda.","authors":"George Odwe, Francis Obare, Stella Muthuri, Peter Kisaakye, Dagim Habteyesus, Gloria Seruwagi, Yohannes Dibaba Wado, Yadeta Dessie, Bonnie Wandera, Caroline W Kabiru, Chi-Chi Undie","doi":"10.1186/s13031-025-00661-5","DOIUrl":"https://doi.org/10.1186/s13031-025-00661-5","url":null,"abstract":"<p><strong>Background: </strong>The association between witnessing intimate partner violence against women (IPVAW) and experiencing violence against children (VAC) has received limited attention in humanitarian settings. We examined the prevalence of witnessing IPVAW in childhood and its association with experiencing caregiver-perpetrated physical and emotional VAC and sexual VAC by any perpetrator in Uganda refugee settlements.</p><p><strong>Methods: </strong>Data were from the first-ever Ugandan Humanitarian Violence against Children and Youth Survey (HVACS), conducted from March to April 2022, involving 1,338 females and 927 males aged 13-24 years. Indicators of VAC included ever experiencing sexual (by any perpetrator), physical, or emotional (by a caregiver) violence among 13-17-year-olds and experiencing such violence prior to age 18 among 18-24-year-olds. The analysis entailed cross-tabulation with a chi-square (χ²) test and a multivariate logistic regression model.</p><p><strong>Results: </strong>The prevalence of witnessing IPVAW in childhood was significantly higher among males (31.2%) compared to females (16.5%). Witnessing IPVAW in childhood was associated with increased odds of experiencing physical VAC by a caregiver for both females (AOR = 2.53; 95% CI = 1.41-4.52) and males (AOR = 3.37; 95% CI = 1.72-6.59). It also significantly increased the odds of experiencing sexual VAC for females (AOR = 3.62; 95% CI = 1.65-7.92) and males (AOR = 5.52; 95% CI = 3.42-8.91). Additionally, witnessing IPVAW increased the odds of experiencing emotional VAC by a caregiver for both females (AOR = 2.61; 95% CI = 1.36-5.03) and males (AOR = 2.78; 95% CI = 1.53-5.07), compared to their peers who did not witness IPVAW.</p><p><strong>Conclusion: </strong>Witnessing IPVAW in childhood is common in refugee settlements in Uganda and is strongly associated with experiencing VAC perpetrated by a caregiver. Violence prevention and response programs should pay attention to IPVAW as a risk factor for VAC, emphasizing integrated approaches that target both forms of violence within households.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"24"},"PeriodicalIF":3.1,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060379","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":"Growing up amidst violence: mapping mental health ecologies with young people on Colombia's Pacific Coast.","authors":"Sanne Weber, Francy Carranza, Ana María Arango, Juan Roberto Rengifo, Mónica Pinilla-Roncancio, Sarah-Jane Fenton, Germán Casas, Paul Jackson, Juan Pablo Aranguren","doi":"10.1186/s13031-025-00664-2","DOIUrl":"10.1186/s13031-025-00664-2","url":null,"abstract":"<p><strong>Background: </strong>Experiencing violence and conflict during childhood and adolescence can significantly impact mental health, including affecting young people's social and economic development. We lack research in conflict-affected contexts that directly analyses the perceptions and experiences of young people themselves. We do not understand enough how conflict-affected environments damage the social tissue and connectedness of young people. We need a better understanding of the resources and agency that young people have to access support for their mental health and emotional wellbeing.</p><p><strong>Methods: </strong>Based on participatory creative research methods, this article describes which resources young Afro-Colombian people living in the city of Quibdó make use of to improve and support their emotional wellbeing. Drawing on Bronfenbrenner's ecological systems theory, we explore the social tissue of youth mental health.</p><p><strong>Results: </strong>Participants mostly drew on sources of support in their immediate microsystem: family and friends; arts and sports in the neighbourhood; culture and nature; and individual coping strategies in the home. These microsystems bore signs of significant disruption as a result of conflict and violence, increasing individual and collective vulnerability. We identify a disconnect between these young people, their immediate environment (family, school, neighbourhood) and existing support mechanisms offered by the state and community organisations.</p><p><strong>Conclusions: </strong>To promote mental wellbeing, we identify the significance of safe spaces where young people are able to talk and connect to others and where trusted persons can connect young people to the wider exosystem of mental health care provision and to social, economic, peacebuilding and wider political processes.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"23"},"PeriodicalIF":3.1,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052164","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":"Community perceptions about factors influencing access to care after sexual violence in North Kivu, Democratic Republic of the Congo: a qualitative study.","authors":"Hanna Reinholdz, Jack Palmieri, Helena Frielingsdorf, Esther Katungu Kalere, Gérard Nteziryayo Heritier, Meggy Verputten, Anette Agardh","doi":"10.1186/s13031-025-00662-4","DOIUrl":"10.1186/s13031-025-00662-4","url":null,"abstract":"<p><strong>Background: </strong>Sexual violence is widespread in the eastern parts of the Democratic Republic of the Congo, including in the North Kivu province. Moreover, in this region survivors of sexual violence often have limited access to care and encounter a variety of barriers when seeking care and support. The aim of this study was to explore community perceptions about access to care, barriers, enablers and possible actions to improve access to care for survivors of sexual violence in North Kivu. A deeper understanding of community perceptions about access to care can guide ongoing efforts to overcome barriers and increase access to care for survivors of sexual violence.</p><p><strong>Methods: </strong>The study utilised a qualitative design, based on focus group discussions with male and female adult community members in the study area. Previous experience of sexual violence was not a requirement. The transcripts from the discussions were analysed using manifest and latent qualitative content analysis.</p><p><strong>Results: </strong>A total of 18 focus group discussions were carried out. The analysis resulted in three main themes; Knowledge and misconceptions around medical consequences crucial for care seeking, Community and family attitudes playing a dual role in care seeking behaviours and Care seeking dependent on optimised healthcare facilities and sensitive staff.</p><p><strong>Conclusions: </strong>Lack of correct knowledge, harmful attitudes from community and healthcare staff, and poorly adapted healthcare services constitute barriers to accessing care. Improved awareness raising around sexual violence is needed to address both lack of knowledge and misconceptions. Efforts should be made to build upon the community support models and actively work to improve community attitudes towards survivors of sexual violence. In addition, there is a need for better adapted healthcare services with improved proximity, access for different groups of survivors and respectful and well-trained healthcare staff.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"22"},"PeriodicalIF":3.1,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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