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Kim HJ, Bruni E, Gorodetska G, Van den Bergh R, Bezer L, Artykutsa S, Andriamiseza N, Habicht J. Typology and implications of verified attacks on health care in Ukraine in the first 18 months of war. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003064. [PMID: 38781240 PMCID: PMC11115218 DOI: 10.1371/journal.pgph.0003064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/13/2024] [Indexed: 05/25/2024]
Abstract
Attacks on health care are part of the spectrum of threats that health care endures during conflict. Protecting health care services against attacks depends on understanding the nature and types of attacks that occur during conflict. The World Health Organisation has implemented the Surveillance System for Attacks on Health Care (SSA) in Ukraine since 2020, and the system has continued to monitor and report on attacks on health care during the war in Ukraine. This study aims to analyse the data reported through the SSA for the first 18 months of the war. This paper involves a retrospective, descriptive study based on the analysis of publicly available SSA data of all incidents of attacks on health care in Ukraine reported through the SSA between February 24th 2022 and August 24th 2023. Out of the 1503 verified attacks, 37% occurred in the initial six weeks of the war. Attacks involving violence with heavy weapons were among the most common incidents reported (83%). The reported attacks were associated with a total of 113 deaths and 211 injuries among health care workers and patients: 32 (2%) attacks were associated with a death of a health care worker or patient, and 63 (4%) were associated with an injury. Health transports facing attacks had a higher probability of experiencing casualties than other health resources (p<0.0001, RR 3.1, 95%CI 1.9-4.9). In conclusion, the burden of attacks on health care in Ukraine was high and sustained over the course of the first 18 months of the war. Reported casualties were not homogenously distributed among attack incidents, but occurred in a set of high-casualty incidents. Health transports were found to be particularly vulnerable. In addition to continued calls for a cessation of hostilities, prevention, protection, mitigation, and reconstruction strategies are urgently required.
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Affiliation(s)
- Hyo-Jeong Kim
- Attacks on Health Care Initiative, WHO, Geneva, Switzerland
| | | | | | | | - Lamia Bezer
- WHO Country Office for Ukraine, Kyiv, Ukraine
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Legesse AY, Teka Tseghay H, Abraha HE, Fisseha G, Ebrahim MM, Tsadik M, Berhe B, Gebrekurstos G, Ayele B, Gebremeskel T, Gebremariam T, Hadush MY, Hagos T, Gebreziabiher A, Muez K, Mulugeta A, Tesfay H, Godefay H. Maternal mortality during war time in Tigray, Ethiopia: A community-based study. BJOG 2024; 131:786-794. [PMID: 37752662 DOI: 10.1111/1471-0528.17677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE This study seeks to examine the impact of war on maternal mortality following an exacerbation in the dynamics of inequality in maternal health caused by the continuing conflict. DESIGN Community-based cross-sectional study. SETTING Tigray region of Northern Ethiopia, between November 2020 and May 2022. POPULATION This study surveyed a total of 189 087 households from six of the seven zones of Tigray in 121 tabiyas from 31 districts selected. A multistage cluster sampling technique was used to select the districts and tabiyas. METHODS The study was conducted in two phases. In the first phase, reproductive-age deaths that occurred during the study period were screened. In the second phase, verbal autopsies were conducted at the screened households. MAIN OUTCOME MEASURES Maternal mortality ratio level and cause-specific mortality. RESULTS The results of the study showed that the maternal mortality ratio was 840 (95% CI 739-914) per 100 000 live births. Haemorrhage, 107 (42.8%), pregnancy-induced hypertension, 21 (8.4%), and accidents, 14 (5.6%), were the main causes of mortality. Additionally, 203 (81.2%) of the mothers died outside of a health facility. CONCLUSIONS This study has shown a higher maternal mortality ratio following the dynamics of the Tigray war, as compared with the pre-war level of 186/100 000. Furthermore, potentially many of the pregnancy-related deaths could have been prevented with access to preventive and emergency services. Given the destruction and looting of many facilities, the restoration and improvement of the Tigray health system must take precedence.
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Affiliation(s)
- Awol Yemane Legesse
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Hale Teka Tseghay
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Hiluf Ebuy Abraha
- Hospital Quality, Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Girmatsion Fisseha
- Department of Reproductive Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Mache Tsadik
- Department of Reproductive Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Bereket Berhe
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Brhane Ayele
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | - Tsega Gebremariam
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Marta Yemane Hadush
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Tigist Hagos
- Department of Reproductive Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Abreha Gebreziabiher
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kibrom Muez
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Afework Mulugeta
- Department of Nutrition and Dietetics, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Haile Tesfay
- Maternal and Child Health Unit, Tigray Regional Health Bureau, Mekelle, Tigray, Ethiopia
| | - Hagos Godefay
- Maternal and Child Health Unit, Tigray Regional Health Bureau, Mekelle, Tigray, Ethiopia
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Flomin Y, Dubenko A, Dubenko O, Sokolova L, Slobodin T, Shepotinnyk Y, Guliaieva M, Pezzella FR. Neurological Practice in the Time of War: Perspectives and Experiences from Ukraine. Semin Neurol 2024; 44:225-232. [PMID: 38485123 DOI: 10.1055/s-0044-1782515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The full-scale Russian invasion of Ukraine has significantly impacted the country's healthcare system. Insufficient infrastructure, destruction of medical facilities, and barriers to prevention and treatment efforts hinder the provision of timely, high-quality care to our patients. We aim to describe the impact of the war on neurological care across Ukraine. In this article, leading national experts in stroke, epilepsy, multiple sclerosis, and movement disorders describe their personal experience and efforts in organizing and providing care since the war started in February 2022. A neurologist who cared for patients in Mariupol recounts the first weeks of the war when the city was under constant attacks. An international stroke expert describes the role of Task Force for Ukraine, a European Stroke Organization initiative to support the Ukrainian stroke community. We discuss a series of critical challenges facing Ukraine's neurologists, patients, and healthcare delivery system, including shortages of personnel and medical supplies, disrupted logistics, and lack of funding. In addition, we highlight various interventions and strategies aimed at counteracting these challenges, including international support, collaborations within Ukraine, and initiatives enhancing the resilience of the Ukrainian neurology community. As the war is ongoing, this article emphasizes the pressing need for continuous support and investment in the Ukrainian healthcare system to preserve guaranteed access to high-quality healthcare for the Ukrainian people during the war and in its aftermath. Insights from the essays can inform the development and implementation of effective strategies and interventions tailored to such extraordinary circumstances.
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Affiliation(s)
- Yuriy Flomin
- Stroke Center, Medical Center 'Universal Clinic 'Oberig' and Bogomolets National Medical University, Kyiv, Ukraine
- Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Andriy Dubenko
- Department of Child Neurology and Paroxismal States, Institute of Neurology, Psychiatry and Narcology, National Academy of Medical Science of Ukraine, Kharkiv, Ukraine
| | - Olga Dubenko
- Department of Neurology and Child Neurology, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Larysa Sokolova
- Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Tatyana Slobodin
- Department of Neurology, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Yevhen Shepotinnyk
- Stroke Unit, Matsuk Mariupol Municipal Hospital No. 4, Mariupol, Ukraine
| | - Maryna Guliaieva
- Stroke Center, Medical Center 'Universal Clinic 'Oberig' and Bogomolets National Medical University, Kyiv, Ukraine
- Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine
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Legesse AY, Hadush Z, Teka H, Berhe E, Abera BT, Amdeselassie F, Abraha HE, Gebre D, Bazzano AN. Lived experience of healthcare providers amidst war and siege: a phenomenological study of Ayder Comprehensive Specialized Hospital of Tigray, Northern Ethiopia. BMC Health Serv Res 2024; 24:292. [PMID: 38448988 PMCID: PMC10916075 DOI: 10.1186/s12913-024-10655-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/29/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Most wars are fought in poor countries and result in significant proportions of disabilities and mortalities. The consequences of wars and political instability on health workers and access to healthcare remain under-studied. This study aimed to explore the lived experience of healthcare providers amidst war and siege, in a teaching hospital in northern Ethiopia. METHODS The study was conducted between February 2022 to March 2022. A qualitative phenomenological study was conducted between February to March 2022 with 20 healthcare providers working in Ayder Comprehensive and Specialized Hospital (ACSH), Tigray, Ethiopia, during the Tigray War. The study employed in-depth interviews. RESULTS The main themes identified included the consequences of the siege on health service delivery at ACSH, personal survival threats posed by the siege, immediate health consequences of the siege among care providers, and consequences of the siege on the motivation and energy of health professionals. CONCLUSIONS Health workers are exposed to a range of direct and indirect impacts of war, emphasizing the need to amend the conditions in which they live and work.
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Affiliation(s)
- Awol Yemane Legesse
- College of Health Sciences, Department of Obstetrics and Gynecology, Mekelle University, Tigray, Ethiopia.
| | - Znabu Hadush
- College of Health Sciences, School of Public Health, Mekelle University, Tigray, Ethiopia
| | - Hale Teka
- College of Health Sciences, Department of Obstetrics and Gynecology, Mekelle University, Tigray, Ethiopia
| | - Ephrem Berhe
- College of Health Sciences, Department of Internal Medicine, Mekelle University, Tigray, Ethiopia
| | - Bisrat Tesfay Abera
- College of Health Sciences, Department of Internal Medicine, Mekelle University, Tigray, Ethiopia
| | - Fasika Amdeselassie
- College of Health Sciences, Department of Surgery, Mekelle University, Tigray, Ethiopia
| | - Hiluf Ebuy Abraha
- Ayder Comprehensive Specialized Hospital, Mekelle University, Quality Office, Tigray, Ethiopia
- University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Daniel Gebre
- Ayder Comprehensive Specialized Hospital, Mekelle University, Labor ward, Tigray, Ethiopia
| | - Alessandra N Bazzano
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Truppa C, Yaacoub S, Valente M, Celentano G, Ragazzoni L, Saulnier D. Health systems resilience in fragile and conflict-affected settings: a systematic scoping review. Confl Health 2024; 18:2. [PMID: 38172918 PMCID: PMC10763433 DOI: 10.1186/s13031-023-00560-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS: 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. CONCLUSIONS 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.
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Affiliation(s)
- Claudia Truppa
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy.
- International Committee of the Red Cross, Geneva, Switzerland.
| | - Sally Yaacoub
- Center for Research in Epidemiology and StatisticS (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
| | - Martina Valente
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, 13100, Vercelli, Italy
| | - Giulia Celentano
- ETH Zürich, Institut Für Bau- Und Infrastrukturmanagement, Chair of Sustainable Construction, Zurich, Schweiz
| | - Luca Ragazzoni
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, 13100, Vercelli, Italy
| | - Dell Saulnier
- Division of Social Medicine and Global Health/Department of Clinical Sciences, Lund University, Malmö, Sweden
- Geneva Centre of Humanitarian Studies, Université de Genève, Geneva, Switzerland
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Ghaleb Alrubaiee G, Alsabri M, Abdulrahman Al-Qadasi F, Ali Hussein Al-Qalah T, Cole J, Abdullah Ghaleb Alburiahy Y. Psychosocial Effects of COVID-19 pandemic on Yemeni healthcare workers: A Web-based, Cross-sectional Survey. Libyan J Med 2023; 18:2174291. [PMID: 36840952 PMCID: PMC9970220 DOI: 10.1080/19932820.2023.2174291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Yemeni healthcare workers (HCWs) experience high levels of psychosocial stress. The current study provides a psychosocial assessment of Yemeni HCWs during the COVID19 pandemic and the factors that influence this. Between 6 November 2020, and 3 April 2021, 1220 HCWs inside Yemen self-reported levels of stress, anxiety, insomnia, depression and quality of life using a web-based, cross-sectional survey. According to the findings, 73.0%, 57.3%, 49.8%, 53.2%, and 85.2% of all HCWs reported moderate or severe stress, insomnia, anxiety, depression, and a lower quality of life, respectively. Significant positive correlations were found between stress and anxiety, insomnia, and depression scores, as well as anxiety and insomnia and depression, and insomnia and depression (p < 0.001). There was also a significant inverse relationship between wellbeing scores and stress, anxiety, insomnia, and depression scores (p < 0.001). A high percentage of respondents (85.8%) were 40 years old or younger and 72.7% had fewer than 10 years' experience, suggesting that experienced medics leave Yemen for safer and more secure jobs elsewhere. Psychosocial support to assist in building resilience to the prevailing conditions may need to be embedded in medical school training and continuing professional development to help support HCWs within Yemen and prevent even more from leaving the country.
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Affiliation(s)
- Gamil Ghaleb Alrubaiee
- Department of Community Health, College of Nursing, Ha’il University, Hail, KSA,Department of Community Health, Faculty of Medical Sciences, Al-Razi University, Sana’a City, Yemen
| | - Mohammed Alsabri
- Emergency Department, Al-Thawra Modern General Teaching Hospital, Sana’a City, Yemen,CONTACT Mohammed Alsabri Department of Medical Surgical, College of Nursing, Ha’il University, Hail, KSA
| | | | | | - Jennifer Cole
- Department of Health Studies, Royal Holloway University of London, Egham, UK
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Chandini MA, Van den Bergh R, Agbor Junior AA, Willliam F, Obi AMM, Ngeha NC, Karimu I, Douba ECE, Kim HJ, Tendongfor N. "It is because of the love for the job that we are still here": Mental health and psychosocial support among health care workers affected by attacks in the Northwest and Southwest regions of Cameroon. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002422. [PMID: 37917598 PMCID: PMC10621865 DOI: 10.1371/journal.pgph.0002422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/06/2023] [Indexed: 11/04/2023]
Abstract
Attacks on health care have important consequences for the mental health (MH) and work availability of health care workers (HCW). In the conflict-affected Northwest and Southwest (NWSW) regions of Cameroon, health care attacks are common; however, little is known on the MH burden and/or (mental) health-seeking behavior among affected HCW. We therefore conducted a survey on mental conditions (relying on SRQ-20 and WASSS assessments) and access to MH services among 470 HCW from 12 districts in NWSW Cameroon in January-February 2022. In-depth interviews on personal experiences with attacks and on accessing MH services were conducted with a subset of 96 HCW. Among surveyed HCW, 153 (33%) had experienced an attack in the past 6 months, and a further 121 (26%) had experienced attacks more than 6 months ago. HCW facing attacks <6 months ago had significantly higher odds of exhibiting mental disorders (aOR 5.8, 95%CI 3.0-11.3, p<0.001) and of being unable to function (aOR 3.3, 95%CI 1.9-5.7, p<0.001). HCW who experienced an attack >6 months also had higher odds of being unable to function (aOR 2.9, 95%CI 1.7-5.2, p<0.001), and of missing time off work in the week preceding the survey (aOR 3.1, 95%CI 1.8-5.5, p<0.001). Previous access to MH services was also higher among HCW facing attacks. HCW showed a good understanding of the added values of accessing MH services, but faced multiple access barriers (including poor availability of services and their own prioritization of the care of others) and indicated a preference for self-care, peer-support and/or religious support. In conclusion, health care attacks in NWSW Cameroon contributed significantly to severe mental conditions and absenteeism rates among HCW. Strengthening access to MH support among attack-affected HCW is indicated; this should include strengthening of formal MH services and building the capacity of HCW and religious leaders to provide peer-support.
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Affiliation(s)
| | | | | | - Farnyu Willliam
- Department of Public Health and Hygiene, University of Buea, Buea, Cameroon
| | | | - Ngu Claudia Ngeha
- Department of Public Health and Hygiene, University of Buea, Buea, Cameroon
| | - Ismaila Karimu
- Department of Public Health and Hygiene, University of Buea, Buea, Cameroon
| | | | - Hyo-Jeong Kim
- Attacks on Health Care Initiative, WHO, Geneva, Switzerland
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Bou-Orm IR, Moussallem M, Karam J, deLara M, Varma V, Diaconu K, Apaydin MCB, Van den Bergh R, Ager A, Witter S. Provision of mental health and psychosocial support services to health workers and community members in conflict-affected Northwest Syria: a mixed-methods study. Confl Health 2023; 17:46. [PMID: 37794393 PMCID: PMC10548701 DOI: 10.1186/s13031-023-00547-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Northwest Syria (NWS) is a conflict area with challenging political, economic, demographic and social dynamics. The region has a high number of internally displaced persons with increasingly disrupted delivery of basic services, including healthcare. Mental health needs have been increasing in the region while the infrastructure and capacity of the health sector has been negatively affected by the conflict. This study aimed to explore the provision of mental health and psychosocial support (MHPSS) services to communities in NWS (including healthcare workers) and to assess the experiences of beneficiaries with MHPSS services. METHODS The study followed a mixed-methods research design that included qualitative and participatory methods (44 semi-structured interviews and a group model building workshop with 15 participants) as well as a survey with 462 beneficiaries. RESULTS Findings suggested an improvement of MHPSS services in the region over the last few years due to the creation of a specific Technical Working Group for MHPSS that contributed to assessment of community needs and support of the MHPSS response. The key elements of this response were: (1) training non-specialized health workers to address the shortage in specialized providers; (2) securing funding and coordination of services between different organizations; and (3) addressing gaps in the availability and geographical distribution of other needed resources, such as medicines. While those elements contributed to improving access to services and the quality of services-especially among health workers seeking MHPSS services-findings suggested gaps in the sustainability of services and a need to scale up those interventions in an integrated approach. CONCLUSION The study findings add to the evidence base on the challenges in scaling up MHPSS interventions and their long-term sustainability concerns. Priority actions should address the intermittent funding of the MHPSS response, incorporate MHPSS outputs and outcomes in the reimbursement of routine services, improve coordination between health partners and non-health actors in order to expand the scope of MHPSS response, and address the inequitable availability of resources in the region.
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Affiliation(s)
- Ibrahim R Bou-Orm
- ReBUILD for Resilience, Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK.
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon.
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK.
| | - Marianne Moussallem
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Joelle Karam
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | | | - Vinod Varma
- World Health Organization, Gaziantep, Turkey
| | - Karin Diaconu
- ReBUILD for Resilience, Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | | | - Rafael Van den Bergh
- Attacks On Health Care Initiative, World Health Organization, Geneva, Switzerland
| | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Sophie Witter
- ReBUILD for Resilience, Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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Kebede HK, Gesesew H, Ward P. Impact of armed conflicts on HIV treatment outcomes in sub-Saharan Africa: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e069308. [PMID: 37558447 PMCID: PMC10414123 DOI: 10.1136/bmjopen-2022-069308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 07/31/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Armed conflicts have significant negative impacts on the entire healthcare system in general and HIV care system in particular. Sub-Saharan Africa is suffering from a disproportionate double burden of armed conflict and HIV infection. Nevertheless, the impact of the armed conflict on the HIV treatment outcomes in conflict settings in sub-Saharan Africa has not been thoroughly and systematically synthesised. This protocol outlines a review that aims to summarise the available evidence on the impact of armed conflict on HIV treatment outcomes in sub-Saharan Africa. METHODS AND ANALYSIS A systematic review of all quantitative studies that assess the impact of armed conflicts on HIV treatment outcomes will be conducted. The systematic search will start with a preliminary search of Google Scholar, followed by implementation of the full search strategy across five databases (MEDLINE, PubMed, CINAHL, SCOPUS and Web of Science) and the screening of titles and abstracts then relevant full texts. Bibliographies will be reviewed to identify additional relevant studies. We will include studies conducted in sub-Saharan Africa that were published in English between 1 January 2002 and 31 December 2022. Methodological validity of the included studies will be assessed using standardised critical appraisal instruments from the Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument. Data will be extracted using standardised JBI instruments and analysed through narrative synthesis, and meta-analyses and regression. Heterogeneity will be assessed using I2 and Χ2 tests. ETHICS AND DISSEMINATION Since this study will not involve gathering primary data, formal ethical approval is not required. Journal publications, conference presentations and a media release will be used to share the study findings. PROSPERO REGISTRATION NUMBER CRD42022361924.
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Affiliation(s)
- Hafte Kahsay Kebede
- Pharmacy school, Mekelle University, Mekelle, Ethiopia
- Research center for Public Health, Equity, and Human Flourshing, Torrens University Australia, Adelaide, South Australia, Australia
| | - Hailay Gesesew
- Epidemiology, Mekelle University, Mekelle, Ethiopia
- Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Paul Ward
- Research center for Public Health, Equity, and Human Flourshing, Torrens University Australia, Adelaide, South Australia, Australia
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Attal B, Dureab F, Abbara A. Yemen: current peace talks must also prioritise health. BMJ 2023; 381:p1242. [PMID: 37277135 DOI: 10.1136/bmj.p1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Bothaina Attal
- The Healthcare Improvement Studies (THIS) Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fekri Dureab
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Aula Abbara
- Imperial College, Department of Infection, London, UK
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11
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Lerosier T, Touré L, Diabaté S, Diarra Y, Ridde V. Minimal resilience and insurgent conflict: qualitative analysis of the resilience process in six primary health centres in central Mali. BMJ Glob Health 2023; 7:e010683. [PMID: 37185362 PMCID: PMC10580275 DOI: 10.1136/bmjgh-2022-010683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND In the context of universal health coverage in the Sahel, the study focuses on primary health centres and the difficulties of their implementation in the context of insurgency conflicts in central Mali. METHODS This is qualitative research through a multiple case study. We selected six health centres according to a reasoned choice to bring together contrasting situations. We conducted 96 semistructured interviews and consulted secondary quantitative data on attendance. By focusing on community health centres, the conceptual approach focuses on the process of resilience that unfolds in a dual context of chronic health system dysfunctions and armed conflict. RESULTS The resilience strategies deployed by health professionals were relatively basic and uncoordinated. In the end, it was the individuals who showed absorption. However, their room for manoeuvre was limited. In the most isolated health centres, resilience was based on subordinate, poorly trained staff, often from the locality. Degraded working conditions and fear caused a form of resignation among health workers. CONCLUSION The strategies and resources used showed a form of minimal resilience. This form is unfolding in a context marked by two structuring features. On the one hand, the Malian health system was relatively dysfunctional before the crisis, and on the other hand, the type of conflict was relatively low intensity that allowed health centres to remain open.
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Affiliation(s)
| | | | | | | | - Valery Ridde
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
- Institut de Santé et Développement, Université Cheikh Anta Diop, Dakar, Senegal
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12
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Tazinya RMA, El-Mowafi IM, Hajjar JM, Yaya S. Sexual and reproductive health and rights in humanitarian settings: a matter of life and death. Reprod Health 2023; 20:42. [PMID: 36899344 PMCID: PMC9999057 DOI: 10.1186/s12978-023-01594-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
It is estimated that approximately 4.3 million sexually active persons worldwide will receive poor and/or limited access to Sexual and Reproductive Health (SRH) services in their lifetime. Globally, approximately 200 million women and girls still endure female genital cutting, 33,000 child marriages occur daily, and a myriad of Sexual and Reproductive Health and Rights (SRHR) agenda gaps continue to remain unaddressed. These gaps are particularly pertinent for women and girls in humanitarian settings where SRH conditions including gender-based violence, unsafe abortions, and poor obstetric care are among the leading causes of female morbidity and mortality. Notably, the past decade has featured a record high number of forcibly displaced persons globally since World War II and has led to over 160 million persons requiring humanitarian aid globally, 32 million of whom are women and girls of reproductive age. Inadequate SRH service delivery continues to persist in humanitarian settings, with basic services insufficient or inaccessible, putting women and girls at higher risk for increased morbidity and mortality. This record number of displaced persons and the continued gaps that remain unaddressed pertaining to SRH in humanitarian settings require renewed urgency to create upstream solutions to this complex issue. This commentary discusses the gaps in the holistic management of SRH in humanitarian settings, explores why these gaps persist, and addresses the unique cultural, environmental, and political conditions which contribute to continued SRH service delivery inadequacies and increased morbidity and mortality for women and girls.
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Affiliation(s)
| | | | - Julia Marie Hajjar
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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13
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Parada V, Fast L, Briody C, Wille C, Coninx R. Underestimating attacks: comparing two sources of publicly-available data about attacks on health care in 2017. Confl Health 2023; 17:3. [PMID: 36717946 PMCID: PMC9885616 DOI: 10.1186/s13031-023-00498-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 01/04/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Attacks on health care represent an area of growing international concern. Publicly available data are important in documenting attacks, and are often the only easily accessible data source. Data collection processes about attacks on health and their implications have received little attention, despite the fact that datasets and their collection processes may result in differing numbers. Comparing two separate datasets compiled using publicly-available data revealed minimal overlap. This article aims to explain the reasons for the lack of overlap, to better understand the gaps and their implications. METHODS We compared the data collection processes for datasets comprised of publicly-reported attacks on health care from the World Health Organization (WHO) and Insecurity Insight's Security in Numbers Database (SiND). We compared each individual event to compile a comparable dataset and identify unique and matched events in order to determine the overlap between them. We report descriptive statistics for this comparison. RESULTS We identified a common dataset of 287 events from 2017, of which only 33 appeared in both datasets, resulting in a mere 12.9% (n = 254) overlap. Events affecting personnel and facilities appeared most often in both, and 22 of 31 countries lacked any overlap between datasets. CONCLUSIONS We conclude that the minimal overlap suggests significant underreporting of attacks on health care, and furthermore, that dataset definitions and parameters affect data collection. Source variation appears to best explain the discrepancies and closer comparison of the collection processes reveal weaknesses of both automated and manual data collection that rely on hidden curation processes. To generate more accurate datasets compiled from public sources requires systematic work to translate definitions into effective online search mechanisms to better capture the full range of events, and to increase the diversity of languages and local sources to better capture events across geographies.
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Affiliation(s)
| | | | - Carolyn Briody
- grid.3575.40000000121633745Intelligence Innovation and Integration Unit, Health Emergency Intelligence and Surveillance Systems Division, WHO, Geneva, Switzerland
| | | | - Rudi Coninx
- grid.3575.40000000121633745Health Emergencies Programme, Interagency Policy for Emergencies Unit, WHO, Geneva, Switzerland
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14
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Alhaffar M, Basaleem H, Othman F, Alsakkaf K, Naji SMM, Kolaise H, Babattah AK, Salem YAM, Brindle H, Yahya N, Pepe P, Checchi F. Adult mortality before and during the first wave of COVID-19 pandemic in nine communities of Yemen: a key informant study. Confl Health 2022; 16:63. [PMID: 36510241 PMCID: PMC9743127 DOI: 10.1186/s13031-022-00497-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Widespread armed conflict has affected Yemen since 2014. To date, the mortality toll of seven years of crisis, and any excess due to the COVID-19 pandemic, are not well quantified. We attempted to estimate population mortality during the pre-pandemic and pandemic periods in nine purposively selected urban and rural communities of southern and central Yemen (Aden and Ta'iz governorates), totalling > 100,000 people. METHODS Within each study site, we collected lists of decedents between January 2014-March 2021 by interviewing different categories of key community informants, including community leaders, imams, healthcare workers, senior citizens and others. After linking records across lists based on key variables, we applied two-, three- or four-list capture-recapture analysis to estimate total death tolls. We also computed death rates by combining these estimates with population denominators, themselves subject to estimation. RESULTS After interviewing 138 disproportionately (74.6%) male informants, we identified 2445 unique decedents. While informants recalled deaths throughout the study period, reported deaths among children were sparse: we thus restricted analysis to persons aged ≥ 15 years old. We noted a peak in reported deaths during May-July 2020, plausibly coinciding with the first COVID-19 wave. Death rate estimates featured uninformatively large confidence intervals, but appeared elevated compared to the non-crisis baseline, particularly in two sites where a large proportion of deaths were attributed to war injuries. There was no clear-cut evidence of excess mortality during the pandemic period. CONCLUSIONS We found some evidence of a peak in mortality during the early phase of the pandemic, but death rate estimates were otherwise too imprecise to enable strong inference on trends. Estimates suggested substantial mortality elevations from baseline during the crisis period, but are subject to serious potential biases. The study highlighted challenges of data collection in this insecure, politically contested environment.
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Affiliation(s)
- Mervat Alhaffar
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Huda Basaleem
- Department of Community Medicine and Public Health, Faculty of Medicine and Health Science, University of Aden, Aden, Yemen
| | - Fouad Othman
- Faculty of Medicine and Health Science, Ta'iz University, Ta'iz, Yemen
| | - Khaled Alsakkaf
- Department of Community Medicine and Public Health, Faculty of Medicine and Health Science, University of Aden, Aden, Yemen
| | | | - Hussein Kolaise
- Department of Internal Medicine, Faculty of Medicine and Health Science, University of Aden, Aden, Yemen
| | - Abdullah K Babattah
- Primary Health Care Program, Health Sector, HUMAN ACCESS for Partnership and Development, Aden, Yemen
| | | | - Hannah Brindle
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Pasquale Pepe
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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15
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Rija A, Islam Z, Bilal W, Qamar K, Gangat SA, Abbas S, Mirha HT, Mohanan P, Rahmat ZS, Shaeen SK, Djedid SNK, Essar MY, Kashyap R. The impact of violence on healthcare workers' mental health in conflict based settings amidst COVID‐19 pandemic, and potential interventions: A narrative review. Health Sci Rep 2022; 5:e920. [PMCID: PMC9638051 DOI: 10.1002/hsr2.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Aiman Rija
- Faculty of Medicine, Dow Medical College Dow University of Health Sciences Karachi Pakistan
| | - Zarmina Islam
- Faculty of Medicine, Dow Medical College Dow University of Health Sciences Karachi Pakistan
| | - Wajeeha Bilal
- Faculty of Medicine, Dow Medical College Dow University of Health Sciences Karachi Pakistan
| | - Khulud Qamar
- Faculty of Medicine, Dow Medical College Dow University of Health Sciences Karachi Pakistan
| | - Shazil Ahmed Gangat
- Faculty of Medicine, Dow Medical College Dow University of Health Sciences Karachi Pakistan
| | - Samina Abbas
- Faculty of Medicine, Dow Medical College Dow University of Health Sciences Karachi Pakistan
| | - Hania Tul Mirha
- Department of Medicine CMH Lahore Medical College Lahore Pakistan
| | | | - Zainab Syyeda Rahmat
- Faculty of Medicine, Dow Medical College Dow University of Health Sciences Karachi Pakistan
| | - Sean Kaisser Shaeen
- Faculty of Medicine, Dow Medical College Dow University of Health Sciences Karachi Pakistan
| | | | | | - Rahul Kashyap
- Critical Care Medicine Mayo Clinic Rochester Minnesota USA
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16
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Vuorio A, Bor R. Safety of Health Care Workers in a War Zone-A European Issue. Front Public Health 2022; 10:886394. [PMID: 35433616 PMCID: PMC9005878 DOI: 10.3389/fpubh.2022.886394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alpo Vuorio
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.,Mehiläinen Airport Health Centre, Vantaa, Finland
| | - Robert Bor
- Centre for Aviation Psychology, London, United Kingdom.,Royal Free Hospital, London, United Kingdom
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17
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Gillespie SL, Christian LM, Mackos AR, Nolan TS, Gondwe KW, Anderson CM, Hall MW, Williams KP, Slavich GM. Lifetime stressor exposure, systemic inflammation during pregnancy, and preterm birth among Black American women. Brain Behav Immun 2022; 101:266-274. [PMID: 35031400 PMCID: PMC8885874 DOI: 10.1016/j.bbi.2022.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 01/07/2023] Open
Abstract
Although Black American mothers and infants are at higher risk for morbidity and mortality than their White counterparts, the biological mechanisms underlying these phenomena remain largely unknown. To investigate the role that lifetime stressor exposure, perceived stressor severity, and systemic inflammatory markers might play, we studied how these factors were interrelated in 92 pregnant Black American women. We also compared inflammatory marker levels for women who did versus did not go on to give birth preterm. During the early third trimester, women completed the Stress and Adversity Inventory for Adults to assess the stressors they experienced over their lifetime. Women also provided blood samples for plasma interleukin (IL)-6, IL-8, IL-1β, and tumor necrosis factor (TNF)-α quantification. Preterm births were identified by medical record review. Controlling for relevant covariates, there were significant positive associations between average levels of both overall and acute perceived stressor severity and plasma IL-1β levels. Controlling for perceived stress at assessment and exposure to racial discrimination did not affect these results. Mediation models revealed that exposure to more chronic stressors was related to higher plasma IL-1β levels, as mediated by higher average levels of overall perceived stressor severity. Exposure to fewer acute stressors was related to higher plasma IL-1β levels, as mediated by higher average levels of acute perceived stressor severity. Finally, women who went on to give birth preterm had higher levels of plasma IL-6. These data thus highlight the potential importance of assessing and addressing lifetime stressor exposure among mothers before and during maternal-infant care.
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Affiliation(s)
- Shannon L. Gillespie
- College of Nursing, The Ohio State University, Columbus, OH, USA,Please address correspondence to Shannon L. Gillespie, 358 Newton Hall, 1585 Neil Avenue, Columbus, OH, USA; 1-614-292-4589 Office;
| | - Lisa M. Christian
- Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus, OH, USA,Institute for Behavioral Medicine Research, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Amy R. Mackos
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Timiya S. Nolan
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Kaboni W. Gondwe
- College of Nursing, University of Wisconsin, Milwaukee, WI, USA,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA,Department of Nursing Research & Evidence-based Practice, Children’s Hospital of Wisconsin, Milwaukee, WI, USA
| | | | - Mark W. Hall
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA,Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - George M. Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, CA, USA
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18
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Kallström A, Al-Abdulla O, Parkki J, Häkkinen M, Juusola H, Kauhanen J. I don't leave my people; They need me: Qualitative research of local health care professionals' working motivations in Syria. Confl Health 2022; 16:1. [PMID: 34980205 PMCID: PMC8721480 DOI: 10.1186/s13031-021-00432-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background The Syrian conflict has endured for a decade, causing one of the most significant humanitarian crises since World War II. The conflict has inflicted massive damage to civil infrastructure, and not even the health care sector has been spared. On the contrary, health care has been targeted, and as a result, many health professionals have left the country. Despite the life-threatening condition, many health professionals continued to work inside Syria even in the middle of the acute crisis. This qualitative study aims to determine the factors that have motivated Syrian health professionals to work in a conflict-affected country. Methods The research is based on 20 semi-structured interviews of Syrian health care workers. Interviews were conducted in 2016–2017 in Gaziantep, Turkey. A thematic inductive content analysis examined the motivational factors Syrian health care workers expressed for their work in the conflict area. Results Motivating factors for health care workers were intrinsic and extrinsic. Intrinsic reasons included humanitarian principles and medical ethics. Also, different ideological reasons, patriotic, political and religious, were mentioned. Economic and professional reasons were named as extrinsic reasons for continuing work in the war-torn country. Conclusions The study adds information on the effects of the Syrian crisis on health care—from healthcare workers' perspective. It provides a unique insight on motivations why health care workers are continuing their work in Syria. This research underlines that the health care system would collapse totally without local professionals and leave the population without adequate health care.
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Affiliation(s)
- Agneta Kallström
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, The University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Orwa Al-Abdulla
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, The University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Jan Parkki
- Independent Researcher, Helsinki, Finland
| | | | - Hannu Juusola
- Department of Cultures, The University of Helsinki, Helsinki, Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, The University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
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Niba JO, Ngasa SN, Chang N, Sanji E, Awa AM, Dingana TN, Sama CB, Tchouda L, Julius ME. Conflict, healthcare and professional perseverance: A qualitative study in a remote hospital in an Anglophone Region of Cameroon. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001145. [PMID: 36962876 PMCID: PMC10021219 DOI: 10.1371/journal.pgph.0001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/20/2022] [Indexed: 12/03/2022]
Abstract
Armed conflicts are a major contributor to global disease burden owing to their deleterious effects on health and healthcare delivery. The Anglophone crisis in Cameroon is one of the ongoing conflicts in Sub-Saharan Africa and has led to massive displacement of healthcare workers (HCWs). However, some HCWs have stayed back and continued working. An understanding of their experiences, perspectives and professional perseverance is lacking. We designed a phenomenological study using Focused Group Discussions (FGDs) and in-depth interviews to: understand the experiences of 12 HCWs in a remote hospital in the North West region of Cameroon with armed groups; evaluate how it affects healthcare delivery from HCWs perspective and examine HCWs coping mechanisms during the conflict with a view of informing HCW protection policies in conflict zones. Results revealed that HCWs go through all forms of violence including threats, assaults and murders. Overall insecurity and shortage of health personnel were major barriers to healthcare delivery which contributed to underutilization of healthcare services. Participants observed an increase in complications due to malaria, malnutrition and a rise in maternal and infant mortality. The hospital management and Non-Governmental Organizations (NGOs) played an essential role in HCWs adaptation to the crisis. Nevertheless they unanimously advocated for a cease fire to end the conflict. In the meantime, passion for their job was the main motivating factor to stay at work.
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Affiliation(s)
- Juste Ongeh Niba
- Clinical Research Education Networking and Consultancy (CRENC), Douala, Cameroon
- Medical Research and Career Organization, Oxford, United Kingdom
| | - Stewart Ndutard Ngasa
- Medical Research and Career Organization, Oxford, United Kingdom
- Health Education for England, North West School of Psychiatry, Liverpool, United Kingdom
| | - Neh Chang
- Medical Research and Career Organization, Oxford, United Kingdom
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Eric Sanji
- Medical Research and Career Organization, Oxford, United Kingdom
| | - Anne-Marie Awa
- Saint Joseph Catholic Hospital (SJCHC), Widikum, Cameroon
| | | | | | - Leticia Tchouda
- Medical Research and Career Organization, Oxford, United Kingdom
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20
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Parvin T, Rosenbaum S, Ozen S, Ewagata L, Ventevogel P. Mental Health and Perceived Social Support of Humanitarian Workers in Bangladesh During the COVID-19 Pandemic. INTERVENTION 2022. [DOI: 10.4103/intv.intv_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Huynh BQ, Kwong LH, Kiang MV, Chin ET, Mohareb AM, Jumaan AO, Basu S, Geldsetzer P, Karaki FM, Rehkopf DH. Public health impacts of an imminent Red Sea oil spill. NATURE SUSTAINABILITY 2021; 4:1084-1091. [PMID: 34926834 PMCID: PMC8682806 DOI: 10.1038/s41893-021-00774-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/20/2021] [Indexed: 06/14/2023]
Abstract
The possibility of a massive oil spill in the Red Sea is increasingly likely. The Safer, a deteriorating oil tanker containing 1.1 million barrels of oil, has been deserted near the coast of Yemen since 2015 and threatens environmental catastrophe to a country presently in a humanitarian crisis. Here, we model the immediate public health impacts of a simulated spill. We estimate that all of Yemen's imported fuel through its key Red Sea ports would be disrupted and that the anticipated spill could disrupt clean-water supply equivalent to the daily use of 9.0-9.9 million people, food supply for 5.7-8.4 million people and 93-100% of Yemen's Red Sea fisheries. We also estimate an increased risk of cardiovascular hospitalization from pollution ranging from 5.8 to 42.0% over the duration of the spill. The spill and its potentially disastrous impacts remain entirely preventable through offloading the oil. Our results stress the need for urgent action to avert this looming disaster.
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Affiliation(s)
- Benjamin Q. Huynh
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Laura H. Kwong
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Harvard FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA
| | - Elizabeth T. Chin
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Amir M. Mohareb
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Aisha O. Jumaan
- Yemen Relief and Reconstruction Foundation, Mercer Island, WA, USA
| | - Sanjay Basu
- Center for Primary Care, Harvard Medical School, Boston, MA, USA
- School of Public Health, Imperial College, London, UK
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Fatima M. Karaki
- Refugee and Asylum-seeker Health Initiative, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- These authors contributed equally: Fatima M. Karaki, David H. Rehkopf
| | - David H. Rehkopf
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- These authors contributed equally: Fatima M. Karaki, David H. Rehkopf
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22
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Yousuf MH, Jabbar A, Ullah I, Tahir MJ, Yousaf Z. Violence against health care system in areas of conflict: Unveiling the crisis globally. ACTA ACUST UNITED AC 2021; 19:100730. [PMID: 34729388 PMCID: PMC8554489 DOI: 10.1016/j.jemep.2021.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022]
Affiliation(s)
| | - Abdul Jabbar
- Department of Clinical Medicine, Faculty of Veterinary Science, University of Veterinary and Animal Sciences, 54600, Lahore Punjab, Pakistan
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
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23
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Islam Z, Rocha ICN, Mohanan P, Jain S, Goyal S, Dos Santos Costa AC, Ahmad S, Mehedi Hasan M, Essar MY. Mental health impacts of humanitarian crisis on healthcare workers in Yemen. Med Confl Surviv 2021; 37:112-117. [PMID: 34225504 DOI: 10.1080/13623699.2021.1950519] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Zarmina Islam
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Shubhika Jain
- Department of Medicine, Kasturba Medical College, Manipal, India
| | - Samarth Goyal
- Department of Medicine, Kasturba Medical College, Manipal, India
| | | | - Shoaib Ahmad
- Department of Surgery, District Head Quarters Teaching Hospital, Faisalabad, Pakistan
| | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
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