Conflict and Health最新文献

{"title":"Health systems resilience in fragile and conflict-affected settings: a systematic scoping review","authors":"Claudia Truppa, Sally Yaacoub, Martina Valente, Giulia Celentano, Luca Ragazzoni, Dell Saulnier","doi":"10.1186/s13031-023-00560-7","DOIUrl":"https://doi.org/10.1186/s13031-023-00560-7","url":null,"abstract":"Health systems resilience (HSR) research is a rapidly expanding field, in which key concepts are discussed and theoretical frameworks are emerging with vibrant debate. Fragile and conflict-affected settings (FCAS) are contexts exposed to compounding stressors, for which resilience is an important characteristic. However, only limited evidence has been generated in such settings. We conducted a scoping review to: (a) identify the conceptual frameworks of HSR used in the analysis of shocks and stressors in FCAS; (b) describe the representation of different actors involved in health care governance and service provision in these settings; and (c) identify health systems operations as they relate to absorption, adaptation, and transformation in FCAS. We used standard, extensive search methods. The search captured studies published between 2006 and January 2022. We included all peer reviewed and grey literature that adopted a HSR lens in the analysis of health responses to crises. Thematic analysis using both inductive and deductive approaches was conducted, adopting frameworks related to resilience characteristics identified by Kruk et al., and the resilience capacities described by Blanchet et al. Thirty-seven studies met our inclusion criteria. The governance-centred, capacity-oriented framework for HSR emerged as the most frequently used lens of analysis to describe the health responses to conflict and chronic violence specifically. Most studies focused on public health systems’ resilience analysis, while the private health sector is only examined in complementarity with the former. Communities are minimally represented, despite their widely acknowledged role in supporting HSR. The documentation of operations enacting HSR in FCAS is focused on absorption and adaptation, while transformation is seldom described. Absorptive, adaptive, and transformative interventions are described across seven different domains: safety and security, society, health system governance, stocks and supplies, built environment, health care workforce, and health care services. Our review findings suggest that the governance-centred framework can be useful to better understand HSR in FCAS. Future HSR research should document adaptive and transformative strategies that advance HSR, particularly in relation to actions intended to promote the safety and security of health systems, the built environment for health, and the adoption of a social justice lens.","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"126 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139082564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the armed conflict in Colombia: consequences in the health system, response and challenges","authors":"Oscar Bernal, Tatiana Garcia-Betancourt, Sebastián León-Giraldo, Lina Marcela Rodríguez, Catalina González-Uribe","doi":"10.1186/s13031-023-00561-6","DOIUrl":"https://doi.org/10.1186/s13031-023-00561-6","url":null,"abstract":"In Colombia, research on health and conflict has focused on mental health, psychosocial care, displacement, morbidity, and mortality. Few scientific studies have assessed health system functioning during armed conflicts. In a new period characterized by the implementation of the peace agreement with the Revolutionary Armed Forces of Colombia (FARC) armed group, understanding the effects of armed conflict on the health system, the functions, and institutions shaped by the conflict is an opportunity to understand the pathways and scope of post-conflict health policy reforms. Therefore, this study was conducted to assess the effects of armed conflict on the health system, response, and mechanisms developed to protect medical missions during armed conflict in Colombia. This research was conducted using a qualitative approach with semi-structured interviews and focus group discussions. The qualitative guide collected information in four sections: (1) conflict and health system, effects and barriers in health service provision, (2) actions and coordination to cope with those barriers, (3) health policies and armed conflict, and (4) post-accord and current situation. Twenty-two people participated in the interviews, including eight policymakers at the national level and seven at the local level, including two NGOs and five members of international organizations. An academic project event in December 2019 and four focus groups were developed (World Cafe technique) to discuss with national and local stakeholders the effects of armed conflict on the health system and an analytical framework to analyze its consequences. The conflict affected the health-seeking behavior of the population, limited access to healthcare provision, and affected health professionals, and was associated with inadequate medical supplies in conflict areas. The health system implemented mechanisms to protect the medical mission, regulate healthcare provision in conflict areas, and commit to healthcare provision (mental and physical health services) for the population displaced by conflict. The state’s presence, trust, and legitimacy have significantly reduced in recent years. However, it is crucial to restore them by ensuring that state and health services are physically present in all territories, including remote and rural areas.","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"175 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139083153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-migration stressors, mental health and well-being in resettled refugees from Syria: Do individuals’ coping strategies matter?","authors":"Øivind Solberg, Alexander Nissen, Fredrik Saboonchi","doi":"10.1186/s13031-023-00556-3","DOIUrl":"https://doi.org/10.1186/s13031-023-00556-3","url":null,"abstract":"The evidence is mixed as to whether individuals’ coping strategies may mitigate the adverse mental health effects of post-displacement stressors in refugee populations, with some indications that the buffering effects of coping strategies are context dependent. The present study examined if problem-solving and acceptance coping strategies were effect modifiers between post-migration stressors and mental health in adult refugees from Syria resettled in Sweden. Study aims were investigated using cross-sectional survey data from a nationwide, randomly sampled group of adult refugees from Syria granted permanent residency in Sweden between 2011 and 2013 (Nsample = 4000, nrespondents = 1215, response rate 30.4%). Post-migration stressors examined included: financial strain, social strain, host-country competency strain and discrimination. Two mental health outcomes were used: anxiety/depression, measured with the Hopkins Symptom Checklist-25; and well-being, measured with the WHO-5 Well-being Index. Both outcomes were modelled continuously. Coping strategies were measured using the BRIEF Cope scale. Interactions between coping strategies and post-migration stressors were tested in fully adjusted linear regression models using Wald test for interaction, corrected for multiple testing using the Benjamini–Hochberg procedure. Both problem-solving and acceptance coping strategies buffered the adverse association between financial strain and symptoms of anxiety/depression, and problem-solving coping strategies buffered the adverse association between host-country competency strain and anxiety/depression. The study suggests that individuals’ coping strategies may to some degree buffer the adverse mental health effects of financial strain and host-country competency strain experienced by refugees in the resettlement phase. Although this pattern was only found in regard to anxiety/depression and not subjective well-being, the findings show that individual-level coping skills among refugees may contribute to adaptation in the face of post-settlement adversities. Notwithstanding the importance of attending to refugees’ psychosocial conditions, refugees residing in refugee camps and newly resettled refugees might benefit from interventions aiming at enhancing individual coping resources and skills. The potential effect of increased controllability and decreased conflict-proximity also warrants further exploration in future studies.","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"483 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138819279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal health outcomes in the context of fragility: a retrospective study from Lebanon","authors":"Hani Dimassi, Mohamad Alameddine, Nadine Sabra, Nour El Arnaout, Ranime Harb, Randa Hamadeh, Faysal El Kak, Abed Shanaa, Marta Orozco Mossi, Shadi Saleh, Natally AlArab","doi":"10.1186/s13031-023-00558-1","DOIUrl":"https://doi.org/10.1186/s13031-023-00558-1","url":null,"abstract":"The Lebanese healthcare system faces multiple challenges including limited capacities, shortage of skilled professionals, and inadequate supplies, in addition to hosting a significant number of refugees. While subsidized services are available for pregnant women, representing the majority of the refugee population in Lebanon, suboptimal access to antenatal care (ANC) and increased maternal mortality rates are still observed, especially among socioeconomically disadvantaged populations. This study aimed to review the maternal health outcomes of disadvantaged Lebanese and refugee pregnant women seeking ANC services at primary healthcare centers (PHCs) in Lebanon. A retrospective chart review was conducted at twenty PHCs in Lebanon, including Ministry of Public Health (MOPH) and United Nations Relief and Works Agency for Palestine refugees (UNRWA) facilities. Data was collected from medical charts of pregnant women who visited the centers between August 2018 and August 2020. Statistical analysis was performed to explore outcomes such as the number of ANC visits, delivery type, and onset of delivery, using bivariate and multivariable logistic regression models. In the study, 3977 medical charts were analyzed. A multivariate logistic regression analysis, revealed that suboptimal ANC visits were more common in the Beqaa region and among women with current abortion or C-section. Syrians had reduced odds of C-sections, and Beqaa, Mount Lebanon, and South Lebanon regions had reduced odds of abortion. Suboptimal ANC visits and history of C-section increased the odds of C-section and abortion in the current pregnancy. As for preterm onset, the study showed an increased likelihood for it to occur when being Palestinian, having current C-section delivery, experiencing previous preterm onset, and enduring complications at the time of delivery. This study suggests the need for low-cost interventions aiming at enhancing access to ANC services, especially among pregnant women in fragile settings.","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"70 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138631977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attacks on Ukrainian healthcare facilities during the first year of the full-scale Russian invasion of Ukraine","authors":"Dennis G. Barten, Derrick Tin, Fredrik Granholm, Diana Rusnak, Frits van Osch, Gregory Ciottone","doi":"10.1186/s13031-023-00557-2","DOIUrl":"https://doi.org/10.1186/s13031-023-00557-2","url":null,"abstract":"Although the Geneva Conventions and Rome Statute demand protections for healthcare facilities during war, breaches of these protections are frequently reported. The ongoing war in Ukraine is no exception, with several healthcare attacks eliciting widespread condemnation. The Ukrainian Healthcare Center (UHC) has been collecting, verifying and documenting attacks on health infrastructure since the Russia–Ukraine War was launched. The aim of this study was to assess UHC documented healthcare facility attacks during the first year (24 February 2022 to 25 February 2023) of the full-scale Russian invasion of Ukraine. The Berkeley Protocol on Digital Open Source Investigations was used to document healthcare attacks. Data collection included temporal factors, location, facility type, attack and weapon type, number of killed and injured healthcare personnel and civilians, and whether facilities were damaged, destroyed or attacked more than once. There were 334 documented attacks on 267 Ukrainian healthcare facilities, with 230 facilities being damaged and 37 destroyed. General hospitals, primary care clinics, emergency departments and children’s hospitals were most frequently targeted. The majority of attacks took place during the first three months and in eastern Ukrainian oblasts. Heavy weaponry was employed in almost all attacks. The total number of casualties included 97 fatalities and 114 injuries. During the first year of the full-scale Russian invasion of Ukraine, there were 334 attacks on 267 Ukrainian healthcare facilities documented by the UHC. Heavy weaponry was commonly used, and the direct impact of attacks was considerable in terms of facility damage and casualty tolls.","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"49 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138555869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Participatory approaches and methods in gender equality and gender-based violence research with refugees and internally displaced populations: a scoping review","authors":"Michelle Lokot, Erin Hartman, Iram Hashmi","doi":"10.1186/s13031-023-00554-5","DOIUrl":"https://doi.org/10.1186/s13031-023-00554-5","url":null,"abstract":"Using participatory approaches or methods are often positioned as a strategy to tackle power hierarchies in research. Despite momentum on decolonising aid, humanitarian actors have struggled to describe what ‘participation’ of refugees and internally displaced persons (IDPs) means in practice. Efforts to promote refugee and IDP participation can be tokenistic. However, it is not clear if and how these critiques apply to gender-based violence (GBV) and gender equality—topics that often innately include power analysis and seek to tackle inequalities. This scoping review sought to explore how refugee and IDP participation is conceptualised within research on GBV and gender equality. We found that participatory methods and approaches are not always clearly described. We suggest that future research should articulate more clearly what constitutes participation, consider incorporating feminist research methods which have been used outside humanitarian settings, take more intentional steps to engage refugees and IDPs, ensure compensation for their participation, and include more explicit reflection and strategies to address power imbalances.","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"29 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138556126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Have attacks on healthcare become the new normal? a public health call to action for armed conflicts before it is too late.","authors":"Karl Blanchet, Leonard Rubenstein, Bertrand Taithe, Larissa Fast","doi":"10.1186/s13031-023-00555-4","DOIUrl":"10.1186/s13031-023-00555-4","url":null,"abstract":"<p><p>The scale of attacks on healthcare has become more visible and its impact greater in recent armed conflicts in Ukraine, Sudan and Myanmar. In these conflicts, combatants systematically target health facilities and ambulances. We need to ensure that attacks on healthcare do not become the new norm amongst governmental troops and non-State armed groups. There is limited evidence about why and how attacks on healthcare have become \"normal\" practice amongst many combatants, despite the likely tactical and strategic costs to themselves. We are convinced that the problem now needs to be tackled like any other public health issue by assessing: the scale of the problem; who is the most at risk; identifying risk factors; developing new interventions to prevent the risks or address the issue; and evaluating the effectiveness of these interventions.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"17 1","pages":"56"},"PeriodicalIF":3.6,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10701961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500166","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 hidden toll of war: a comprehensive study of orthopedic injuries in Yemen.","authors":"Mohammad Hutaif, Abdullah Al Moaish, Mosleh Soliman, Anwar Al-Fadliy","doi":"10.1186/s13031-023-00551-8","DOIUrl":"10.1186/s13031-023-00551-8","url":null,"abstract":"<p><strong>Background: </strong>Yemen has been experiencing a protracted civil war and humanitarian crisis since 2015, which has resulted in many war-related injuries. However, there is a lack of data on the epidemiology, characteristics, and outcomes of these injuries, especially the orthopedic ones. This study aimed to describe the war-related orthopedic injuries in Yemen and their impact on the patients' health and function.</p><p><strong>Methods: </strong>This was a retrospective study based on medical records and trauma registries of 3930 patients who were admitted to three major trauma centers in Sana'a city with war-related orthopedic injuries from January 2015 to December 2020. We collected data on demographics, injury mechanisms, injury types and locations, surgical procedures, complications, mortality, and functional outcomes using the Musculoskeletal Function Assessment questionnaire. We used descriptive and inferential statistics to analyze the data and performed a logistic regression analysis to identify the factors associated with mortality.</p><p><strong>Results: </strong>Most of the patients were young males and civilians who suffered from complex and severe injuries involving multiple body regions, especially the lower extremities. The main mechanisms of injury were gunshot wounds, blast injuries, and landmine explosions. The patients required multiple surgical procedures and implants, and had high rates of complications and mortality. The most common complications were infection, nonunion, malunion, and amputation. The most common cause of death was sepsis. The functional outcomes were poor, as indicated by the high mean MFA score. The logistic regression analysis showed that older age, blast injuries, spine injuries, vascular injuries, and infection were significant predictors of mortality.</p><p><strong>Conclusion: </strong>This study provides valuable information on the war-related orthopedic injuries in Yemen and their impact on the patients' health and function. It also identifies some areas for future research, such as exploring the risk factors for infection and nonunion/malunion, evaluating the effectiveness and cost-effectiveness of different surgical procedures and implants, assessing the long-term outcomes and quality of life of the patients, and developing novel strategies to enhance bone and soft-tissue healing.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"17 1","pages":"55"},"PeriodicalIF":3.6,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10691014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464375","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":"Factors associated with health-seeking patterns among internally displaced persons in complex humanitarian emergency, Northeast Nigeria: a cross-sectional study.","authors":"Saheed Gidado, Melton Musa, Ahmed Ibrahim Ba'aba, Lilian Akudo Okeke, Patrick M Nguku, Idris Suleman Hadejia, Isa Ali Hassan, Ibrahim Muhammad Bande, Martins Onuoha, Gideon Ugbenyo, Ntadom Godwin, Rabi Usman, Jibrin Idris Manu, Abede Momoh Mohammed, Muhammad Maijawa Abdullahi, Mohammed Isa Bammami, Pekka Nuorti, Salla Atkins","doi":"10.1186/s13031-023-00552-7","DOIUrl":"10.1186/s13031-023-00552-7","url":null,"abstract":"<p><strong>Background: </strong>Currently, over two million persons are internally displaced because of the complex humanitarian emergency in Nigeria's northeast region. Due to crowded and unsanitary living conditions, the risk of communicable disease transmission, morbidity, and mortality among this population is high. This study explored patterns and factors associated with health-seeking among internally displaced persons (IDPs) in northeast Nigeria to inform and strengthen disease surveillance and response activities.</p><p><strong>Methods: </strong>In a cross-sectional study conducted during June-October 2022, we employed stratified sampling technique to select 2,373 IDPs from 12 IDPs camps. A semi-structured tool was used to collect data on health-seeking patterns, socio-demographics, households, and IDPs camps characteristics. We classified health-seeking patterns into three outcome categories: 'facility care' (reference category), 'non-facility care' (patent medicine vendors, chemists, traditional healers, religious centers), and 'home care/no care'. We performed complex survey data analysis and obtained weighted statistical estimates. Univariate analysis was conducted to describe respondents' characteristics and health-seeking patterns. We fitted weighted multivariable multinomial logistic regression models to identify factors associated with health-seeking patterns.</p><p><strong>Results: </strong>Of 2,373 respondents, 71.8% were 18 to 39 years old, 78.1% were females, and 81.0% had no formal education. Among the respondents, 75.7% (95% CI: 72.9-78.6) sought 'facility care', 11.1% (95% CI: 9.1-13.1) sought 'non-facility care', while 13.2% (95% CI: 10.9-15.4) practiced 'home care/no care'. Respondents who perceived illness was severe (Adjusted Odds Ratio (AOR) = 0.15, [95% CI: 0.08-0.30]) and resided in officially-recognized camps (AOR = 0.26, [95% CI: 0.17-0.39]) were less likely to seek 'non-facility care' compared to 'facility care'. Similarly, respondents who resided in officially-recognized camps (AOR = 0.58, [95% CI: 0.36-0.92]), and received disease surveillance information (AOR = 0.42, [95% CI: 0.26-0.67) were less likely to practice 'home care/no care' rather than seek 'facility care'.</p><p><strong>Conclusions: </strong>This population exhibited heterogeneous patterns of health-seeking at facility and non-facility centers. Perception of illness severity and camps' status were major factors associated with health-seeking. To enhance surveillance, non-facility care providers should be systematically integrated into the surveillance network while ramping up risk communication to shape perception of illness severity, prioritizing unofficial camps.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"17 1","pages":"54"},"PeriodicalIF":3.6,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10630990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523378","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 political economy of expedience: examining perspectives on military support to Sierra Leone's Ebola response.","authors":"Samuel T Boland, Dina Balabanova, Susannah Mayhew","doi":"10.1186/s13031-023-00553-6","DOIUrl":"10.1186/s13031-023-00553-6","url":null,"abstract":"<p><p>The 2013-2016 West Africa Ebola Epidemic is the largest outbreak of Ebola in history. By September, 2014 the outbreak was worsening significantly, and the international president of Médecins Sans Frontières called for military assistance. In Sierra Leone, the British and Sierra Leonean militaries intervened. They quickly established a National Ebola Response Centre and a constituent network of District Ebola Response Centres. Thereafter, these inherently militarised centres are where almost all Ebola response activities were coordinated. In order to examine perspectives on the nature of the militaries' intervention, 110 semi-structured qualitative interviews were conducted and analysed. Military support to Sierra Leone's Ebola response was felt by most respondents to be a valuable contribution to the overall effort to contain the outbreak, especially in light of the perceived weakness of the Ministry of Health and Sanitation to effectively do so. However, a smaller number of respondents emphasised that the military deployments facilitated various structural harms, including for how the perceived exclusion of public institutions (as above) and other local actors from Ebola response decision making was felt to prevent capacity building, and in turn, to limit resilience to future crises. The concurrent provision of life-saving assistance and rendering of structural harm resulting from the militaries' intervention is ultimately found to be part of a vicious cycle, which this article conceptualises as the 'political economy of expedience', a paradox that should be considered inherent in any militarised intervention during humanitarian and public health crises.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"17 1","pages":"53"},"PeriodicalIF":3.6,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71488858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}