Conflict and Health最新文献

{"title":"A review of the performance of the early warning alert and response system (EWARS) in conflict-affected Borno State, Nigeria: a five-year descriptive analysis.","authors":"Opeayo Ogundiran, Amaka Onyiah, Chima Thomas, Abiodun Oyefabi, Uzoma Ugochukwu, Collins Owili, Ifeanyi Okudo, Isabelle Devaux, George Sie Williams, Mary Stephen, Samuel Thliza, Wondimagegnehu Alemu","doi":"10.1186/s13031-025-00705-w","DOIUrl":"10.1186/s13031-025-00705-w","url":null,"abstract":"<p><strong>Background: </strong>The northeastern region of Nigeria has been experiencing a protracted humanitarian crisis, characterized by conflict, displacement, and a severely disrupted health system. The Early Warning Alert and Response System (EWARS) was implemented in 2016 to strengthen disease surveillance in this challenging context.</p><p><strong>Methods: </strong>This study employed a descriptive design to evaluate the performance of EWARS in Borno State, Nigeria, over a five-year period (2016-2021). The data sources included weekly health facility reports and the EWARS alert log. Key performance indicators, including timeliness and completeness of reporting, were analyzed.</p><p><strong>Results: </strong>EWARS coverage expanded significantly, reaching 341 health facilities across 25 local government areas. The timeliness of reporting ranged from 6 to 85%, with a median of 65.5% (95% CI: 59-73%). A statistically significant positive Pearson correlation was observed between timeliness and the duration of implementation (r = 0.45, p < 0.001). Completeness of reporting ranged from 42 to 96%, with a median of 68% (95% CI: 62.0-76.25%) and a weaker but significant positive correlation (r = 0.19, p < 0.001). A total of 13,737 alerts were generated, of which 89.6% were verified within 24 hours. However, only 0.1% required an immediate public health response. While systematically recorded data on response activities were limited, verified alerts-particularly for measles and cholera-reportedly triggered vaccination campaigns, case investigations, and WASH interventions.</p><p><strong>Conclusions: </strong>The EWARS system demonstrated significant operational value in strengthening disease surveillance and triggering early warning alerts in the conflict-affected Borno State. Despite not meeting all national performance targets, the system showed improvements over time and supported early detection and verification of potential outbreaks. Its utility as a first-line surveillance tool is evident, though future efforts should prioritize integrating response documentation and event-based surveillance components to strengthen public health impact assessment.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"66"},"PeriodicalIF":3.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193863","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":"Associations of psychological distress, alcohol and substance use, and HIV risk behaviour in forcibly displaced persons and migrants in Nigeria.","authors":"Gabriel Undelikwo, Tosin Olajide Oni, Leopold Achengui Zekeng, Francis Agbo, Fatimah Jajere, Seun Oshagbami, James Anenih, Samuel Emetu Anya, Takpa Koubagnine, Idayat Uthman, Ernest Ochang, Oluwaranmilowo Amusan, Veronica Akwenabuaye Undelikwo, Abel Ebe Banke, Babatunde Adelekan, Mohammed Abdullahi, Moréniké Oluwátóyìn Foláyan","doi":"10.1186/s13031-025-00706-9","DOIUrl":"10.1186/s13031-025-00706-9","url":null,"abstract":"<p><strong>Background: </strong>Forcibly displaced populations, refugees, and internally displaced persons (IDPs), and migrants face distinct challenges, increasing vulnerability to HIV infection and substance use disorders. This study assessed the associations between psychological distress, alcohol consumption, substance use, and HIV risk behaviour among these populations in Nigeria.</p><p><strong>Methods: </strong>This was a secondary analysis of the data of a cross-sectional study, collected in five states in Nigeria (Benue, Borno, Cross Rivers, Taraba, and Yobe), in December 2024. Data collected included the dependent variable (HIV risk behavior), independent variables (psychological distress level, substance use, and alcohol consumption), and confounding variables (age, sex at birth, sexual orientation, educational level, marital status, employment/occupational status, and religious status). A stepwise approach was used in the building of four models. Model 1 presented the unadjusted bivariate analysis. Model 2 was the adjusted multivariate logistic regression. Model 3 assessed the interaction effect of psychological distress level, alcohol consumption, substance use, and being IDP on HIV risk behaviour, and Model 4 assessed the same interaction for refugees.</p><p><strong>Results: </strong>The sample of 3,211 participants included 1237 (38.5%) migrants, 1497 (46.6%) IDPs, and 477 (14.9%) refugees. Among participants, moderate (AOR: 1.46; 95% CI: 1.38-1.56; p < 0.001) and high (AOR: 1.70; 95% CI: 1.57-1.85; p = 0.01) psychological distress significantly increased the odds of high-risk sexual behaviour. IDPs had the highest odds of engaging in risky behaviour compared to migrants (AOR: 1.59; 95% CI: 1.32-1.92; p = 0.02). Substance use further amplified risk, particularly for IDPs (OR: 3.17; 95% CI: 2.11-3.72; p < 0.001) and refugees (OR: 2.09; 95% CI: 2.02-2.37; p < 0.001) compared to migrants. No significant association was found between alcohol consumption and HIV risk behaviour.</p><p><strong>Conclusion: </strong>This study highlights the compounded vulnerability of IDPs and refugees, driven by psychological distress and substance use. Findings underscore the urgent need for integrated interventions addressing mental health, substance use, and HIV prevention tailored to forcibly displaced populations in Nigeria.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"65"},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180364","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":"Reproductive health risks of internally displaced persons (IDPs) in humanitarian settings of Ethiopia: a systematic review and meta-analysis.","authors":"Amare Simegn, Shegaw Zeleke, Worku Necho, Tigabu Munye, Demewoz Kefale, Solomon Demis, Yohannes Tesfahun, Diriba Teshome, Yitayal Ayalew, Amare Kassaw","doi":"10.1186/s13031-025-00678-w","DOIUrl":"10.1186/s13031-025-00678-w","url":null,"abstract":"<p><strong>Background: </strong>Over 70% of women and girls face heightened risks of sexual and reproductive health in conflict zones where reproductive health care is often neglected. This systematic review and meta-analysis aimed to estimate the epidemiological evidences of reproductive health risks of internal migrants in Ethiopia.</p><p><strong>Methods: </strong>Different data bases (CINHAL, Cochrane Library, EMBASE, Scopus, Google scholar and PubMed central) were accessed. Observational Studies conducted in English language were included as per the predetermined inclusion criteria. Meta-analysis of the prevalence of reproductive health risks was determined using a random effects model. PRISMA and Systematic Review Guidelines from the Center for Reviews and Dissemination recommendation were followed in the review. Random effect model with I² statistics and sensitivity testing was performed.</p><p><strong>Results: </strong>We found 324 studies on the databases searched and only eleven studies with 9976 individuals met the criteria of inclusion. The overall pooled magnitude of reproductive health risks in this study is 45.8% (95% CI: 35.6, 56.1). Nearly half of the studies were conducted in Amhara region. Gender based violence is the most frequently reported reproductive health risk. Premarital sex, early marriage and unmet need for contraceptives, abortion, sexually transmitted infections and unwanted pregnancy were reported.</p><p><strong>Conclusion and recommendation: </strong>Reproductive health risks among Internally Displaced Persons (IDPs) are frequent in all age groups of women, adolescent girls and boys. However, limited number of primary evidences is found to be the major bottleneck to summarize this review. Therefore, the government, non-governmental organizations and researchers with any responsible stockholders should give an appropriate attention to have precise and tangible data on the burden, extent of the problems and survivor population in need of sexual and reproductive health services.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"64"},"PeriodicalIF":3.4,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978729","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":"Uptake of COVID-19 vaccine among female healthcare workers in Syria: results from a 2022 cross-sectional survey.","authors":"Zlatko Nikoloski, Elnur Aliyev, Robert Bain, Leonardo Menchini, Sahar Hegazi, Mai Zalkha, Shaza Mouawad, Neha Kapil, Amaya Gillespie","doi":"10.1186/s13031-025-00700-1","DOIUrl":"10.1186/s13031-025-00700-1","url":null,"abstract":"<p><strong>Background: </strong>Healthcare workers play an important role in administering COVID-19 vaccines, particularly in conflict-affected settings. Syria has endured a protracted conflict for over a decade and while most of the healthcare workers in the country have been vaccinated with at least one COVID-19 vaccine dose, vaccinating all of them would reduce their risk of COVID-19 complications, given their daily interactions with patients.</p><p><strong>Methods: </strong>The goal of this study was to better understand the main barriers to uptake of COVID-19 vaccines among female healthcare workers in Syria. Using data from a wider national survey of 17,000 respondents conducted between October and November 2022, we analysed a sub-sample of 4136 responses from female healthcare workers, across 14 Governorates. The main outcome of interest was vaccination status, (vaccinated, willing (but not yet vaccinated), unsure about vaccination and finally, those unwilling to receive a COVID-19 vaccine). We present descriptive information about the sample and conduct a multivariate logistic regression analysis to shed light on some of the barriers preventing COVID-19 vaccination uptake.</p><p><strong>Results: </strong>We find that the vast majority (93.7%) of female healthcare workers have received at least one COVID-19 vaccination dose. We find that attitudes and beliefs around COVID-19 vaccines impact upon the decision to get a vaccination-positive attitudes around effectiveness and safety of the vaccines increase the likelihood of being vaccinated or willing to be vaccinated. More specifically, healthcare workers which believe in the safety of the vaccines are twice as likely to get vaccinated relative to those who don't. By contrast, we find that neutral attitudes regarding the vaccines are associated with vaccine indecision among female healthcare workers. In addition, we also find that female healthcare workers tend to trust COVID-19 vaccine information from their peers-close to 99% of vaccinated female healthcare workers tend to trust the vaccine information received from their peers.</p><p><strong>Implications: </strong>While the vaccination rates among healthcare workers are high, the results could further help in devising strategies for tackling the structural and individual barriers towards vaccine uptake among healthcare workers.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"63"},"PeriodicalIF":3.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12363114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876772","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":"Prehospital blood for the injured in conflict zones: what about civilians? - a scoping review.","authors":"Henrik Johansson, Johan von Schreeb","doi":"10.1186/s13031-025-00704-x","DOIUrl":"10.1186/s13031-025-00704-x","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhage is the leading cause of preventable death in trauma patients. Prehospital transfusion (PHT) has been proposed to reduce mortality; however, its effectiveness for civilians in a military conflict zone remains uncertain due to logistical and resource constraints. While PHT is endorsed in military contexts, its routine implementation for civilian trauma care during conflicts is still debated. This study aims to explore the challenges, benefits, and limitations of PHT in civilian conflict settings based on available literature.</p><p><strong>Methods: </strong>A scoping review was conducted using PubMed, Web of Science, and Google Scholar. Peer-reviewed searches were conducted from January to February 2023, with an update in May 2024. Gray literature was reviewed in June, September, and October 2023. Studies published in English with full-text access that addressed the research question were included. Data on study design, interventions, comparisons, and outcomes were narratively synthesized.</p><p><strong>Results: </strong>Six relevant studies were identified and analyzed. Findings revealed variability in PHT practices, shaped by injury severity, transfusion protocols, and evacuation logistics. While PHT may offer benefits in settings with prolonged evacuation times, current evidence is inconsistent, limiting its routine recommendation for civilian conflict settings. Key barriers include limited resources, deviations from clinical guidelines, and challenges in blood product access and storage.</p><p><strong>Conclusion: </strong>Optimizing trauma care in civilian conflict zones requires strengthening hemorrhage control, rapid evacuation, and adaptable, context-appropriate guidelines. PHT may offer benefits in select situations, current evidence does not support its routine use. Future research should identify feasible, scalable strategies tailored to the unique logistical, ethical, and resource challenges in these settings.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"62"},"PeriodicalIF":3.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12351817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849641","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":"Bridging the data divide: challenges and opportunities for trauma registries in conflict-affected MENA countries: a qualitative analysis of key informant interviews.","authors":"Tracy Daou, Fatima Mansour, Zahi Abdul Sater, Hady Naal, Lubna Jaber, Anika Gnaedinger, Ghassan Abu Sittah, Shadi Saleh","doi":"10.1186/s13031-025-00701-0","DOIUrl":"10.1186/s13031-025-00701-0","url":null,"abstract":"<p><strong>Background: </strong>Prolonged conflicts in the Middle East and North Africa (MENA) have led to widespread war-related injuries and strained healthcare systems. The absence of standardized trauma registries impedes effective injury assessment, quality of care evaluation, and optimal trauma response. This study explores the challenges associated with trauma data collection, management, and sharing in conflict settings.</p><p><strong>Methods: </strong>A qualitative study was conducted via semi structured interviews with 11 experts in trauma care and health data management. The data were collected in English or Arabic, transcribed, and analysed thematically to identify key barriers and potential solutions.</p><p><strong>Results: </strong>Four major themes emerged: (1) complexities in data collection (2), challenges in data management and sharing (3), resource and infrastructure limitations, and (4) recommendations for optimizing trauma data. The primary issues identified include the lack of standardized trauma definitions, fragmented data, geopolitical barriers, and inadequate funding. The participants highlighted the need for a minimum consensus-based trauma dataset, local ownership of data, increased financial support, and better integration of trauma data collection into medical education.</p><p><strong>Conclusion: </strong>Strengthening trauma data systems in the MENA region will require coordinated efforts focused on standardization, interoperability, and long-term investment in local capacity and infrastructure. Such improvements are critical to supporting evidence-based care and effective response in conflict-affected settings.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"60"},"PeriodicalIF":3.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823213","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":"Access and satisfaction with healthcare services among chronic disease patients during the Sudan armed conflict: a cross-sectional study.","authors":"Sohaib Mohammed Mokhtar Ahmed, Moram Elfadel Abdelrhaman Gasmalha, Ahmed Balla M Ahmed, Salma Alrawa, Khalid Abusofyan Eljezoli Mohammed, Muhannad Bushra Masaad Ahmed","doi":"10.1186/s13031-025-00703-y","DOIUrl":"10.1186/s13031-025-00703-y","url":null,"abstract":"<p><strong>Background: </strong>The ongoing conflict in Sudan has severely disrupted the healthcare system, leaving millions without access to essential services. Chronic disease patients are among the most affected due to their heightened reliance on consistent and specialized healthcare. This study aimed to assess the level of access to healthcare services and the satisfaction of chronic disease patients during the current war in Sudan.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among chronic disease patients residing in the safest states of Sudan during the ongoing conflict. Access to healthcare services and patient satisfaction were measured using a structured questionnaire that was specially designed and piloted for the purpose of this study. Descriptive statistics, including median, interquartile range, and percentages, were used to summarize the data. Inferential statistical methods, such as chi-square tests, were then applied to examine associations between socio-demographic factors and healthcare access. Statistical significance was defined as p < 0.05 for all analyses.</p><p><strong>Results: </strong>Among 1116 chronic disease patients, 13.3% never visited a health facility for regular check-ups during the current war, 20.1% reported facilities were over 5 km away by walking distance, 15.9% rarely or never accessed healthcare services during the war, and 22.0% reported a very large effect of the war on their healthcare access. Additionally, 22.3% noted excellent availability of healthcare personnel during the current war, while 18.1% were dissatisfied with the quality of care. Significant associations (p < 0.01) were found between the frequency of health facility visits and factors such as income level, ease of access, availability of personnel, satisfaction with care, confidence in providers, and the war's impact on access.</p><p><strong>Conclusion: </strong>Chronic disease patients experienced suboptimal follow-up for their conditions, limited access to healthcare services, and a significant proportion expressed dissatisfaction with the quality of care during the current Sudan war. To mitigate these challenges, coordinated efforts are urgently needed to strengthen Sudan's healthcare system, improve geographic access, and support healthcare providers.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"61"},"PeriodicalIF":3.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823212","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":"Psychological distress among healthcare workers in Kabul following the 2021 transition.","authors":"Shoaib Naeemi, Sayed Murtaza Sadat Hofiani, Ahmad Komail Frogh, Said Mohammad Rahim Niazy, Ali Mirzazadeh, Said Iftekhar Sadaat, Narges Neyazi","doi":"10.1186/s13031-025-00702-z","DOIUrl":"10.1186/s13031-025-00702-z","url":null,"abstract":"<p><strong>Background: </strong>Healthcare workers (HCWs) in conflict and post-conflict settings are particularly susceptible to psychological distress due to persistent occupational stress and limited systemic support. This study examined the prevalence of psychological distress among HCWs in Kabul, Afghanistan, in the wake of the political changes in August 2021.</p><p><strong>Methods: </strong>A cross-sectional survey study was conducted from September to October 2021 in 16 public tertiary hospitals in Kabul. The Afghan Symptoms Checklist (ASCL) was used to assess psychological distress and its related symptoms. Multivariable analysis using Generalized Linear Model (GLM) was performed to find the associated factors of psychological distress utilizing STATA 18.</p><p><strong>Results: </strong>A total of 277 HCWs participated in the study, with 48.4% identifying as female. Approximately 62% had considered leaving Afghanistan, and 64% had witnessed colleagues emigrate. The overall prevalence of psychological distress was 25% (CI 95%: 19.9-30.6), with stress-induced reactivity as the most prevalent symptom (35%, CI 95%: 29.8-41.4). Female HCWs were significantly more likely to report sadness with social withdrawal and somatic distress (POR = 2.32, CI 95%: 1.07-5.02, p = 0.03) and stress-induced reactivity (POR = 2.56, CI 95%: 1.22-5.44, p = 0.013). A lack of optimism about the future was associated with higher odds of stress-induced reactivity (POR = 3.14, CI 95%: 1.55-6.38, p = 0.001), ruminative sadness without withdrawal (POR = 3.05, CI 95%: 1.68-6.24, p = 0.002), and sadness with withdrawal and somatic distress (POR = 3.73, CI 95%: 1.71-8.13, p = 0.001).</p><p><strong>Conclusion: </strong>One in four HCWs reported psychological distress, with stress-induced reactivity being the most common symptom. Female gender and pessimism about the future were key associated factors of elevated distress. The findings highlight the critical need for long-term mental health support programs specifically designed for HCWs, broader support within the health system, and continued research into how HCWs cope and build resilience.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"59"},"PeriodicalIF":3.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12333094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800924","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 under fire: quantifying the impact of violence on medical services in facilities supported by International Medical Corps in three prefectures of Central African Republic, 2016-2020.","authors":"Natalya Kostandova, Jennifer OKeeffe, Audrey Mahieu, Blaise Bienvenu Ali, Christian Mulamba, Pierre Somsé, Odilon Guesset Bingou Iv, Sebastien Dackpa, Gerard Mbonimpa, Thierry Fikiri, Larissa Fast, Leonard Rubenstein","doi":"10.1186/s13031-025-00686-w","DOIUrl":"10.1186/s13031-025-00686-w","url":null,"abstract":"<p><strong>Background: </strong>Attacks on healthcare in the Central African Republic (CAR) are widespread, under-reported, and inadequately addressed. This study examined the impact of attacks on healthcare in three conflict-affected prefectures-Ouaka, Haute-Kotto, and Vakaga-between 2016 and 2020, assessing both immediate and longer-term disruptions.</p><p><strong>Methods: </strong>Disruptions at primary and referral facilities were evaluated using program data from International Medical Corps (IMC) and attack data from IMC, key informants, secondary datasets, and local media. Key indicators-outpatient consultations, first antenatal care visits (ANC1), facility deliveries, measles vaccination (MCV1), and hospitalizations-were analyzed using visual trend analysis, estimation of immediate change, and interrupted time series (ITS). Survival analysis assessed the association between attacks and time to the first reported measles case during a nationwide outbreak.</p><p><strong>Results: </strong>A total of 127 individual attacks were identified over five years, primarily from IMC security reports. The most common incidents were asset removal or attempted removal (27%), threat (18%), and pillage (17%). At least one form of physical or sexual violence was documented in 23.2% of attacks, with 13 instances of murder. Visual analysis showed three impact patterns: facility closure, disruption of specific services, and minimal or short-term changes. Immediate changes also varied, with service changes ranging from - 100 to 655%. In ITS analysis four of eight facilities showed > 25% deficit in outpatient consultations while three showed > 25% surplus. Survival analysis demonstrated significant difference in time to first measles case between attacked and facilities without attacks (p < 0.001), though findings are limited by small sample size. Overall, maternal health services had fewer fluctuations while vaccination services ceased altogether in some facilities.</p><p><strong>Conclusions: </strong>This study shows improved identification and profiling of attacks is possible in low-resource settings and presents several approaches to quantify their impact. It also highlights challenges conducting analysis with significant limitations in data quality and availability. Findings reinforce the urgent need for systematic data collection, real-time monitoring, tailored, context-specific mitigation strategies, and support to local actors who maintain services when external support is limited. Future research should build on these findings to provide more effective protection, mitigation, and recovery strategies for healthcare systems in conflict zones.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"57"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12323227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790709","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":"'This caused our journey': the relationship between sexual and gender-based violence and cross-border Sudan to South Sudan migration.","authors":"Josephine Chandiru Drama, Badradin Elizeo Abdalla, Pamela Imma Lindrio, Richard Stephen Oneka, Lilian Sule Mazira, Onyango Galdine Loyda, C Ashton Drew, Heather Tasker, Sabine Lee, Susan A Bartels","doi":"10.1186/s13031-025-00699-5","DOIUrl":"10.1186/s13031-025-00699-5","url":null,"abstract":"<p><strong>Background: </strong>Sexual and gender-based violence (SGBV) is a significant issue in the context of armed conflict and migration. The ongoing conflict in Sudan has led to catastrophic levels of SGBV, with widespread documentation of a range of severe and systematic abuses. This study examines the relationship between SGBV and migration in this region, with a particular focus on how it affects women and girls.</p><p><strong>Methods: </strong>A cross-sectional, mixed-methods study was conducted in July 2024 using a 'sensemaking' approach among migrants crossing from Sudan to South Sudan at the Aweil North border crossing. Participants, both women and men aged 13 and older, shared brief narratives about migration experiences and interpreted them through quantitative questions. Data were analysed using descriptive statistics, geometric means and confidence intervals for triad data, and violin plots for slider questions. Qualitative data were used to complement and illustrate quantitative findings.</p><p><strong>Results: </strong>A total of 695 self-interpreted micronarratives were collected from 671 unique participants. Findings revealed that SGBV is a significant driver of migration from Sudan to South Sudan, with 53.1% of participants indicating it as a major factor in their decision to migrate. Adolescent girls were statistically more likely to cite SGBV as the primary reason for migration compared to older women. Participants perceived reception centers in South Sudan as relatively safer compared to Sudan but reported significant challenges in accessing basic needs such as food, shelter, and medical care with approximately 82% struggling to make ends meet all or most of the time.</p><p><strong>Conclusions: </strong>SGBV is an important driver of migration from Sudan to South Sudan, especially among adolescent girls. These findings highlight the urgent need for comprehensive SGBV prevention and response services in Sudan, particularly for adolescents. In South Sudan, economic empowerment programs and basic needs assistance for returnees are crucial to mitigate the risks of further sexual exploitation and abuse. Future research should focus on evaluating SGBV prevention and response interventions and exploring intersectional factors affecting SGBV experiences.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"58"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790710","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}