Conflict and Health最新文献

{"title":"Healthcare accessibility, utilization, and quality of life among internally displaced people during the Sudan war: a cross-sectional study.","authors":"Hind Elmukashfi ShamsEldin Elobied, Muhannad Bushra Masaad Ahmed, Ahmed Balla M Ahmed, Romaysa Abdelrahman Hassan Salih, Sohaib Mohammed Mokhtar Ahmed, Abdulhadi M A Mahgoub, Abdelmoula Hashim Abdelmagid Mohamed, Eman Hamid Abdallah Elamin, Al-Romaysa M Osman Khalafalla El-Haj, Mohamed Al-Hadi Hamed Abd-Allah, Arwa Yagoub Elmadani Ibrahim, Yousuf Alnoor Younis Mohamed, Arig Elias Shabo","doi":"10.1186/s13031-025-00655-3","DOIUrl":"10.1186/s13031-025-00655-3","url":null,"abstract":"<p><strong>Background: </strong>The ongoing war in Sudan has triggered a massive displacement crisis, leaving internally displaced people (IDP) struggling to access healthcare services. This study aimed to investigate healthcare access, utilization, and the quality of life among Sudanese IDP during the conflict.</p><p><strong>Methods: </strong>This cross-sectional study was carried out among Sudanese internally displaced people in six states. Quality of life was assessed using the WHOQOL-Bref questionnaire. Accessibility, utilization, and the consequences of not accessing healthcare were evaluated using an author-designed questionnaire, which was piloted prior to the study. Chi-square tests were used to analyze associations between categorical variables, while ANOVA was applied to assess differences in quality-of-life domains based on displacement duration and living conditions. Multinomial logistic regression identified predictors of healthcare affordability, with significance set at p < 0.05.</p><p><strong>Results: </strong>Among 612 participants, 40.3% reported facilities being very close, 13.0% faced waits over 2 h, and 54.3% found healthcare unaffordable. Only 33.6% always had access to qualified staff, and 22.8% of IDP visited public healthcare facilities supported by non-governmental organizations. The psychological domain had the highest quality-of-life mean score at 49.7 (18.1). Worsened symptoms (44%) were a common consequence of healthcare inaccessibility, while lack of transport (37.9%) was the most common barrier. Availability of qualified staff significantly increased the likelihood of seeking care (χ² = 11.30, p = 0.022). Quality-of-life domains varied significantly by displacement duration and living situation (p < 0.011).</p><p><strong>Conclusion: </strong>This study revealed significant variations in healthcare access and utilization among Sudanese IDP, with quality-of-life domains lower than those of IDP in other countries. Interventions should prioritize innovative solutions like telemedicine, targeted support for vulnerable groups, and expanding health insurance coverage to enhance access and long-term health outcomes.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"11"},"PeriodicalIF":3.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of the response and the emergency medical teams (EMTs) deployment in Armenia following an explosion at a fuel depot near Stepanakert (Nagorno-Karabakh)/ in Armenia.","authors":"Armen Melkonyan, Boniface Oyugi, Eugeniu Conovali, Oleg Storozhenko, Geert Gijs, Lusine Paronyan, Pryanka Relan, Flavio Salio","doi":"10.1186/s13031-025-00649-1","DOIUrl":"10.1186/s13031-025-00649-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;An explosion at a fuel depot in the region of Berkadzor, around 6 km near Stepanakert in Nagorno-Karabakh, happened on September 25, 2023 resulting in more than 220 lost lives and around 300 injuries. The Ministry of Health of the Republic of Armenia (MoH), collaborating with the WHO, requested assistance for burn specialised care teams and medical evacuation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study objectives: &lt;/strong&gt;To describe the emergency response learnings by reflecting on Armenia's experience managing the incident and the international EMTs' role in responding to it.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was an observational study whose data was compiled through a triangulation of data obtained from the EMT teams using information management tools, including an EMT Minimum Data Set (MDS) specifically designed for coordinating burns responses in a daily reporting format and others from the MoH and medical evacuation (Medevac) teams, together with the information and analysis from field coordination meetings and deliberation with MoH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Four international EMTs (I-EMTs) were deployed to Armenia in coordination with the MoH and WHO. They were well-prepared and self-sufficient, but the response highlighted the need for standardized protocols for Medevac and burns care. Nearly half of the patients were critical on the first day, with 58% in non-ICU centers and 42% in ICU, with 20 patients medically evacuated using draft Medevac guidelines. Severely burned patients in non-ICU units received 24-hour care from intensive care specialists. However, the shortage of ICU and specialized burns beds in Armenian hospitals was evident. The Emergency Medical Teams Coordination Cell (EMTCC) team effectively used information management tools to collect, process, analyze, and disseminate data to the MoH and response teams, facilitating rapid deployment and decision-making. The EMTs collaborated with local hospital staff, ensuring coordination with MoH and hospital management for follow-up and supply delivery. This integrated approach built local capacity, developed essential rehabilitation modules for burned patients, and delivered burn kits and surgical equipment. Early international assistance, coordinated by WHO and MoH, facilitated a rapid response, early EMT CC installation, and improved communication, ensuring the delivery of essential burn kits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;There is a need to set standards for elements such as Medevac and burns care through the WHO EMT Standards and recommendations. In addition, these settings should be integrated into the information management tools under development. The findings and lessons learnt on the specialised care teams have been essential and aligned with the 2030 EMT strategy. Major investments are needed to ensure that more specialised care teams are efficient and effective even in future responses, especially for healthcare facilities that are inadequately","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"10"},"PeriodicalIF":3.1,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451066","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 development of a caregiver intervention to address child mental health in settings of complex humanitarian emergency: a multi-phase, multi-method approach.","authors":"Sally Carter, Alison L Calear, Tambri Housen, Grace Joshy, Kamalini Lokuge","doi":"10.1186/s13031-025-00648-2","DOIUrl":"10.1186/s13031-025-00648-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Effective parenting can mediate the negative impact of complex humanitarian emergencies (CHEs) on child mental health, however many caregivers struggle to parent effectively in these settings. Parenting interventions have robust evidence in many settings, however research supporting their use in CHEs is limited. We describe the development of a caregiver group intervention delivered by non-specialist staff to support child mental health in CHEs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A multi-phase, multi-method approach was employed: Phase 1: semi-structured interviews, analysed inductively, with specialist mental health staff in CHEs on needs and challenges in providing mental healthcare to children and caregivers. Phase 2: initial intervention development informed by Phase 1 and evidence-based theoretical approaches and psychological therapies. Phase 3: expert review of draft intervention. Phase 4: semi-structured interviews, analysed inductively, with non-specialist staff in Papua New Guinea (PNG) to evaluate relevance, comprehensibility, and applicability of the intervention. Phase 5: cultural adaptation of the intervention prior to implementation in Northern Iraq. Different operational partners and research sites were employed at different phases of development to increase diversity of inputs and support the overall vision of an intervention that addressed common mental health difficulties and underlying factors to support children and caregivers across CHEs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mental health staff in CHEs identified a significant need for interventions to support parenting and address child mental health needs. A caregiver group intervention was developed consisting of six two-hour sessions, delivered weekly by non-specialist staff, and targeting parent knowledge and skills and parent stress. Expert consultation identified aspects of the intervention to emphasise or simplify, resulting in a refined intervention with ensured clinical quality. Non-specialist staff in PNG confirmed the intervention relevance to a vulnerable population in a humanitarian setting, and the manual was determined suitable for non-specialist facilitators. Mental health literacy, stigma and cultural views (masculinity, family privacy) were identified as challenges to address. A multi-stage method of cultural adaptation in Iraq ensured the clinical and cultural accuracy, relevance, and acceptability of the intervention. Initial adaptations to the language and metaphors used in the intervention resulted in high cultural appropriateness during pilot testing. Prioritising the recruitment and engagement of male caregivers is critical.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A caregiver intervention to support child mental health in CHEs is available. It's development using multi-method, co-design processes will ensure its relevance and acceptability to target populations. Further research to evaluate the effectiveness and long-term effectiv","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"9"},"PeriodicalIF":3.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442537","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":"Self-managed abortion as a humanitarian revolution: accounts of a telehealth pilot in the Middle East.","authors":"Laureline Lasserre, Nelly Staderini, Maysa'a Hasan, Vanessa Rossi","doi":"10.1186/s13031-024-00641-1","DOIUrl":"10.1186/s13031-024-00641-1","url":null,"abstract":"<p><strong>Background: </strong>Access to safe abortion care (SAC) should be improved in fragile and humanitarian settings, and the implementation of interventions in that regard are currently limited. This is especially true for self-managed abortion (SMA), although it holds the potential of revolutionizing the prevention of maternal death and suffering.</p><p><strong>Case presentation: </strong>The medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) piloted a self-managed abortion model of care in the Middle East. 22 women were remotely supported in managing their safe abortions with a counsellor over the phone, using misoprostol doses that they took at home after having taken mifepristone in our health facility. We share our experience by describing the model of care and discussing the lessons learned through its implementation.</p><p><strong>Conclusions: </strong>The program delivered abortion services successfully and required few resources. This paper also reflects on the importance of facilitating SMA in humanitarian contexts. It increases access to care by providing increased confidentiality, close support, ample information, autonomy, and flexibility. It is simple to implement, effective, often preferred by women, and can be linked to information about contraception. The implementation of self-managed models should be expanded, notably in projects that do not have a sexual and reproductive health focus and in restrictive and challenging contexts. It represents a true revolution for access to safe abortion care.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"8"},"PeriodicalIF":3.1,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400824","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":"Realising health justice in Palestine: beyond humanitarian voices.","authors":"James Smith, Sara El-Solh, Layth Hanbali, Sawsan Abdulrahim, Sali Hafez, Samer Abuzerr, Bram Wispelwey, Mads Gilbert, Mohammed Seyam, Bassam Abu Hamad, Dorotea Gucciardo, Fahd Haddad, Rasha Khoury, Amira Nimerawi, David Mills, Ghassan Abu-Sittah","doi":"10.1186/s13031-024-00634-0","DOIUrl":"10.1186/s13031-024-00634-0","url":null,"abstract":"<p><p>In the shadow of Israel's ongoing genocide throughout occupied Palestine, this article examines the moral, political, and epistemic responsibilities of humanitarian, public health, global health, medical and related communities of practice amid profound violence and injustice. In this paper we offer a three-part critique of a May 2024 commentary by Karl Blanchet and colleagues, 'Rebuilding the health sector in Gaza: Alternative humanitarian voices' (Blanchet et al. in Confl Heal 18:42, 2024). We argue that in relation to the post-genocide reconstruction of the health system in Gaza, the authors have failed to adequately contextualise their analysis, or the health system reconstruction policy proposal as commissioned by the Gaza Health Initiative [Gaza Health Rebuilding Initiative (GHRI), Future of the Gaza health system: Needs assessment. https://static1.squarespace.com/static/656c4ff5b219116063f8099e/t/65c30c4d3e80fd21f1165b57/1707281499127/Final+first+draft+-+Gaza+health+system+report.pdf . Accessed 8 November 2024], and as such have failed to elucidate the root causes of what manifests most immediately as an entirely manufactured humanitarian crisis. This in turn undermines the substance and utility of the recovery proposal as it has been presented. We also argue that the authors have failed to afford due recognition to several key health actors in Palestine, in particular the Palestinian Ministry of Health in Gaza and UNRWA, and that this subtle but critical act of erasure further undermines the relevance and applicability of their recovery proposal as presented. In response we emphasise the centrality of Palestinian perspectives, and the need to uphold Palestinian leadership in all stages of the recovery process. Thirdly, we take issue with the suggested chronology and substance of the recovery proposal as presented, which overlooks response and recovery efforts already underway and led by Palestinians in Gaza, and which overstates ultimately harmful intervention strategies such as networks of internationally managed field hospitals. Against the backdrop of a very limited window for what we consider morally justifiable humanitarian engagement in Gaza, we join many others who have called for a paradigm shift away from the inertia of supposed objectivity and claimed neutrality that function to perpetuate injustice. Instead, we call for the collective practice of critical advocacy, solidarity with people affected by injustice and oppression, and an emancipatory politics in pursuit of justice in Palestine.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"7"},"PeriodicalIF":3.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A descriptive analysis of a medical humanitarian aid initiative for quality perinatal management in war-torn Ukraine.","authors":"Iryna Mogilevkina, Dmytro Dobryanskyy, Rhona MacDonald, Diane Watson, David Southall","doi":"10.1186/s13031-025-00644-6","DOIUrl":"10.1186/s13031-025-00644-6","url":null,"abstract":"<p><strong>Background: </strong>Russian's invasion of Ukraine has seriously disrupted perinatal care. In a humanitarian initiative, emergency obstetric and neonatal equipment and drugs were provided by Maternal and Childhealth Advocacy International and distributed by Ukrainian partners to a selected 61 maternity hospitals throughout Ukraine. The programme included engaging mothers in labour to undertake fetal heart rate monitoring using a battery operated, portable, doppler ultrasound probe. This paper describes some characteristics of participants and analyses differences in fetal distress management and maternal / neonatal outcomes following different approaches to fetal health surveillance.</p><p><strong>Methods: </strong>Data from 28,808 births were collected in specially developed database which contained information on maternal characteristics, course of pregnancy and childbirth, maternal and neonatal outcomes and donated drugs and equipment used. After informed consent, mothers (n = 13735) who agreed to use in labour fetal self-monitoring in addition to standard intrapartum fetal health surveillance, monitored and recorded fetal heart rate changes on a \"contraction-by-contraction\" basis into a special form. Data on maternal experience with self-monitoring were collected. Cases where fetal heart rate changes were identified (n = 1434) were extracted and analysed for differences in case management and maternal and neonatal outcomes in different approaches: joint monitoring (mother plus staff, n = 901) vs. staff only monitoring (n = 533) and different actors in case of joint monitoring (mothers, n = 512, vs. staff, n = 389).</p><p><strong>Results: </strong>Vacuum assisted delivery was utilised in only < 2% cases. Caesarean section rate was 27%. Mothers reported their experience with self-monitoring as great or good in 79%. Preterm deliveries were less frequent where fetal monitoring was provided by both staff and mothers jointly. In the staff plus mother group, more often lateral tilt, intravenous fluid, spontaneous vaginal and vacuum assisted delivery and less often caesarean sections were undertaken even when fetal distress alone was an indication for operative delivery at term pregnancy.</p><p><strong>Conclusion: </strong>Involvement of women may help to make delivery safer for mothers as complications may be recognized earlier and appropriately treated. Overall, the data shows that despite the full-scale war in Ukraine, it remained possible for high quality perinatal health care to continue.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"6"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076527","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":"Evaluation of a peer support group programme for vulnerable host population and refugees living with diabetes and/or hypertension in Lebanon: a before-after study.","authors":"Leah Anku Sanga, Carla Njeim, Éimhín Ansbro, Rima Kighsro Naimi, Ali Ibrahim, Benjamin Schmid, Jasmin Lilian Diab, Jytte Roswall, Tim Clayton, Lars Bruun Larsen, Pablo Perel","doi":"10.1186/s13031-025-00646-4","DOIUrl":"10.1186/s13031-025-00646-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Non-communicable diseases (NCDs) are the leading cause of death globally, and many humanitarian crises occur in countries with high NCD burdens. Peer support is a promising approach to improve NCD care in these settings. However, evidence on peer support for people living with NCDs in humanitarian settings is limited. We evaluated the implementation of peer support groups (PSGs) for people with diabetes and/or hypertension as part of an integrated NCD care model in four primary care centers in Lebanon.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Our objectives were to: (1) evaluate the reach of the PSGs; (2) evaluate the association of PSGs with patient-reported outcomes; and (3) evaluate the association of PSGs with clinical outcomes (blood pressure, HbA1c, and BMI). We used a before-after study design and included a control group for clinical outcomes. The PSG intervention began in December 2022 and was carried out in two waves. The first wave was implemented from December 2022 to July 2023, and the second wave from July 2023 to January 2024. For the control group on clinical outcomes, we used data collected from January 2023 to January 2024. We used routinely collected programmatic and administrative data. The patient reported outcomes (PROMs) were collected at baseline and at six months by trained volunteers for all PSG participants. We performed a before-after analysis of PROMs for all patients who completed the PSG sessions. T-tests were used to analyze the differences in PROMs from baseline. Change in PROMs, together with 95% confidence intervals (CIs), and p-values for the changes were reported. To assess the association between the implementation of the PSG strategy and changes in clinical outcomes, including systolic blood pressure (SBP), glycated hemoglobin A1c (HbA1c), and body mass index (BMI), analysis of covariance (ANCOVA) models were used, adjusting for age, sex, and the baseline values of the outcome being analyzed (baseline SBP and baseline HbA1c, respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 445 patients were approached for enrolment in wave 1, 259 (58%) consented, of whom 81 were enrolled. In wave 2, 169 patients were approached, 92 (54%) consented of whom 91 were enrolled. We found some statistical evidence that PSG improved certain PROMs, including potentially clinical meaningful improvements in overall quality of life (wave 1), physical quality of life (wave 1), social quality of life (wave 2), environmental quality of life (wave 1), adherence (wave 2), patient centeredness (wave 1), and exercise (wave 1). However, we did not find strong statistical evidence of an improvement in clinical outcomes (SBP, HbA1c, or BMI) in participants of the PSGs compared to the control group. We found differences in the association of PSGs and outcomes between the two waves.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our study showed mixed results. In terms of reach, over 50% of those approached consented to particip","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"5"},"PeriodicalIF":3.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069728","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":"Social determinants of student mental health before and after the Beirut port explosion: two cross-sectional studies.","authors":"Julia Scheuring, Tania Bosqui","doi":"10.1186/s13031-025-00645-5","DOIUrl":"10.1186/s13031-025-00645-5","url":null,"abstract":"<p><strong>Background: </strong>Students in Lebanon are facing the devastating impact of multiple national crises, including an unprecedented economic collapse and the Beirut port explosion that killed hundreds, injured thousands, and displaced hundreds of thousands of people. The aim of this study was to identify key social determinants of common mental health symptoms before and after the Beirut port explosion for students at the American University of Beirut, a university based around 4 km from the port.</p><p><strong>Methods: </strong>Two cross-sectional studies were conducted using a representative sample of undergraduate and graduate students at the American University of Beirut. The study was conducted just before (Study 1) and repeated after the Beirut port explosion (Study 2).</p><p><strong>Results: </strong>A total of 217 students participated (n = 143 in Study 1 and n = 74 in Study 2). In Study 1 before the explosion, poorer family functioning and social support were correlated with higher levels of depressive symptoms, but not with anxiety or trauma symptoms. Financial stress was correlated with depressive and trauma symptoms. In the partially adjusted regression model (adjusting for demographics), only financial stress was significantly associated with depressive symptoms. In the fully adjusted model (adjusting for adversity), financial stress was associated with depressive and anxiety symptoms. In Study 2 after the explosion, poorer family functioning and poorer social support were correlated with higher levels of depressive symptoms, while only poorer social support was correlated with higher levels of anxiety symptoms-trauma symptoms were not correlated with either. Financial stress was correlated with all symptoms. In the partially adjusted regression model, only financial stress was significantly associated with all symptom clusters. In the fully adjusted model, no variables were significant.</p><p><strong>Conclusion: </strong>Findings indicate a detrimental impact of financial stress on the mental health of students in Lebanon, beyond the otherwise protective effects of family and social support, in the context of an unprecedented economic crisis and extremely high levels of distress after the explosion. Findings indicate that mental health interventions for college students in Lebanon should include addressing financial stress, and that further research is needed to identify protective factors during acute emergencies.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"4"},"PeriodicalIF":3.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061498","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":"Examining the integration of refugees into the national health system in Uganda: an analysis using the policy triangle framework.","authors":"Henry Komakech, Shatha Elnakib, Lama Bou Karroum, Evelyn Nyachwo, Winnie Adoch, Sarah Sali, Godfrey Goddie Okeny, Christopher Garimoi Orach","doi":"10.1186/s13031-024-00640-2","DOIUrl":"10.1186/s13031-024-00640-2","url":null,"abstract":"<p><strong>Background: </strong>Uganda has been confronted with a sustained influx of refugees for decades. This prompted the government to explore opportunities to integrate refugees into local service structures including its national health system. This paper chronicles the history of policies and strategies that have influenced the integration of refugees into the national health system in Uganda and investigates factors that impacted policy evolution and progression.</p><p><strong>Methods: </strong>We used a case study approach that drew on a document review and key informant interviews with 28 respondents at national and subnational levels. Interviews were analyzed using thematic qualitative analysis and findings were organized using Walt and Gilson's Policy Triangle Framework. Data from the literature review, media review, and key informant interviews were triangulated.</p><p><strong>Results: </strong>Uganda's experience with the integration of refugee's dates to 1999 when the country first implemented the Self-reliance strategy. Since then, policy learning and evolution have taken place, with policies around integration evolving and improving over time, moving the country towards more effective implementation of integrated health services. A conducive policy environment was key as a set of legislations at national and district-levels and sector-specific plans and budgets that included refugees have provided the foundation for implementation. The integration received support and buy-in from the highest levels of government including the President and the Office of The Prime Minister. This was coupled with deliberate efforts by the government to mainstream refugee response in local plans and budgets, allowing implementation at district and sub-district levels. These factors were pivotal to the implementation of the integration agenda.</p><p><strong>Conclusion: </strong>Our study highlights the complex, dynamic, evolving, and multifaceted nature of the multisectoral health policy process in the integration of health services in refugee settings. The findings shed light on the importance of collaboration between stakeholders, mobilization of legal and political frameworks to shape the integration of refugee health services into the national health system, and the importance of ensuring that high-level commitments translate to action and development plans at local levels.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 Suppl 1","pages":"78"},"PeriodicalIF":3.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016304","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":"Navigating challenges, solutions and requirements in the provision of trauma care in conflict settings by humanitarian actors: a scoping literature review.","authors":"Nikolaos Markou-Pappas, Luca Ragazzoni, Claudia Truppa, Flavio Salio, Francesco Barone-Adesi, Hamdi Lamine","doi":"10.1186/s13031-025-00643-7","DOIUrl":"10.1186/s13031-025-00643-7","url":null,"abstract":"<p><strong>Background: </strong>The evolving nature of irregular warfare and the increasingly frequent violations of human rights law and international humanitarian law pose unique challenges for humanitarian actors delivering trauma care in conflict settings.</p><p><strong>Methods: </strong>A scoping review was conducted on PubMed, Scopus, and Web of Science and a web search (on Google, Google scholar and Bing) to analyze and review past humanitarian interventions offering trauma care in conflict settings. Relevant records were identified from scientific and grey literature. The thematic areas identified by the framework for a Public Health Emergency Operations Centre were used to facilitate the synthesis and analysis.</p><p><strong>Results: </strong>Eleven records examining all phases of conflict identifying gaps throughout the continuum of care in the trauma systems were included. Challenges, solutions and requirements in transportation capacity, data collection methodologies, field coordination mechanisms, and rehabilitative care services were highlighted. Addressing the shortages in skilled healthcare workers, implementing quality improvement measures, and developing standardized training curricula were some of the requirements reported.</p><p><strong>Conclusions: </strong>Our findings suggest that a multidimensional approach emphasizing strong coordination, with inclusive partnerships, is fundamental for effective trauma care systems in conflict zones. Key recommendations include robust medical transport, comprehensive healthcare training, preemptive mass casualty planning, standardized educational materials, continuous context reassessment, data protection, and improved transparency. These strategies could enhance trauma care interventions, ensuring they are effective, equitable, accountable, and sustainable.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"3"},"PeriodicalIF":3.1,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016287","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}