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Conflict and Health

Andrew T Boyd, Kristin Becknell, Steven Russell, Curtis Blanton, Susan T Cookson, Oleg O Bilukha, Mark Anderson
Background: Following decades of armed conflict, Colombia remains highly affected by explosive device (ED) contamination, especially in rural areas. Many victims are injured by EDs despite knowing their dangers. Determining risk factors for unsafe behaviors toward EDs, including grenades, is critical for preventing injuries. Methods: In 2012, CDC assisted Colombian partners in conducting a multi-stage knowledge, attitudes, and practices survey in rural ED-affected areas...
2018: Conflict and Health
Julia Brooks, Timothy B Erickson, Stephanie Kayden, Raul Ruiz, Stephen Wilkinson, Frederick M Burkle
Background: The repeated use of prohibited chemical weapons in the Syrian conflict poses serious health, humanitarian, and security threats to civilians, healthcare personnel, and first responders. Moreover, the use of chemical weapons constitutes a clear and egregious violation of international law-likely amounting to a war crime-for which continued impunity is setting a dangerous precedent in relation to current and future conflicts. This debate article calls upon concerned states, organizations, and individuals to respond urgently and unequivocally to this serious breach of international legal and humanitarian norms...
2018: Conflict and Health
S M Murray, J Augustinavicius, D Kaysen, D Rao, L K Murray, K Wachter, J Annan, K Falb, P Bolton, J K Bass
Background: Sexual violence is associated with a multitude of poor physical, emotional, and social outcomes. Despite reports of stigma by sexual violence survivors, limited evidence exists on effective strategies to reduce stigma, particularly in conflict-affected settings. We sought to assess the effect of group Cognitive Processing Therapy (CPT) on stigma and the extent to which stigma might moderate the effectiveness of CPT in treating mental health problems among survivors of sexual violence in the Democratic Republic of Congo...
2018: Conflict and Health
Alastair Ager, Carolyn Bancroft, Elizabeth Berger, Lindsay Stark
Background: Gender-based violence (GBV) is a significant problem in conflict-affected settings. Understanding local constructions of such violence is crucial to developing preventive and responsive interventions to address this issue. Methods: This study reports on a secondary analysis of archived data collected as part of formative qualitative work - using a group participatory ranking methodology (PRM) - informing research on the prevalence of GBV amongst IDPs in northern Uganda in 2006...
2018: Conflict and Health
N Glass, N Perrin, A Clough, A Desgroppes, F N Kaburu, J Melton, A Rink, S Read-Hamilton, M Marsh
Background: Gender-based violence (GBV) is a significant issue for women and girls in humanitarian settings. Innovative primary prevention programs are being developed and implemented with existing response programs to change harmful social norms that sustain GBV in humanitarian settings. Social norms are expectations of how women, men, girls and boys should behave, who should have power and control over behavior, and how families and communities value women and girls and support their rights and opportunities...
2018: Conflict and Health
Fabian Kahl, Thomas Kühlein
The number of refugees arriving in Europe increased dramatically in 2015, challenging the German health system. Amongst others, the treatment of infectious diseases is an important topic in refugee healthcare. A high prevalence of multi-drug-resistant organisms has been identified among the refugee population. Still, little is known about the prescription of antibiotic medication for refugees. We conducted a descriptive analysis of all antibiotics prescribed to newly arrived refugees who were treated as outpatients between 10/01/2014 and 09/30/2015 in Erlangen, an average sized German town...
2018: Conflict and Health
Gillian Dunn
Background: This research examines the relationship between violent conflict and childhood wasting in Northeast Nigeria, where residents have been subjected to fighting between the Nigerian government and Boko Haram - an extremist Islamist movement - since 2009. Methods: Using two Demographic and Health Surveys from before and after the Boko Haram insurgency started, a double-difference (difference-in-difference) approach is used to assess the impact of the conflict on mean weight-for-height z-scores and the likelihood of wasting...
2018: Conflict and Health
Daphne Lagrou, Rony Zachariah, Karen Bissell, Catherine Van Overloop, Masood Nasim, Hamsaya Nikyar Wagma, Shafiqa Kakar, Séverine Caluwaerts, Eva De Plecker, Renzo Fricke, Rafael Van den Bergh
Background: Provision of Emergency Obstetric and Neonatal Care (EmONC) reduces maternal mortality and should include three components: Basic Emergency Obstetric and Neonatal Care (BEmONC) offered at primary care level, Comprehensive EmONC (CEmONC) at secondary level and a good referral system in-between. In a conflict-affected province of Afghanistan (Khost), we assessed the performance of an Médecins Sans Frontières (MSF) run CEmONC hospital without a primary care and referral system...
2018: Conflict and Health
Emma Diggle, Wilhelmina Welsch, Richard Sullivan, Gerbrand Alkema, Abdihamid Warsame, Mais Wafai, Mohammed Jasem, Abdulkarim Ekzayez, Rachael Cummings, Preeti Patel
Background: The Syrian armed conflict is the worst humanitarian tragedy this century. With approximately 470,000 deaths and more than 13 million people displaced, the conflict continues to have a devastating impact on the health system and health outcomes within the country. Hundreds of international and national non-governmental organisations, as well as United Nations agencies have responded to the humanitarian crisis in Syria. While there has been significant attention on the challenges of meeting health needs of Syrian refugees in neighbouring countries such as Jordan, Lebanon and Turkey, very little has been documented about the humanitarian challenges within Syria, between 2013 and 2014 when non-governmental organisations operated in Syria with very little United Nations support or leadership, particularly around obtaining information to guide health responses in Syria...
2017: Conflict and Health
Emma Massey, James Smith, Bayard Roberts
Background: The combination of global demographic changes and a growing number of humanitarian crises in middle-income countries that have a higher life expectancy has led to an increase in the number of older populations affected by humanitarian crises. The aim of this review was to systematically examine evidence on the health needs of older populations in humanitarian crises, including both armed conflicts and natural disasters, in low- and middle-income countries (LMICs). Methods: A systematic review methodology was used...
2017: Conflict and Health
Alyssa Ferguson, Kate Shannon, Jennifer Butler, Shira M Goldenberg
Background: While the conditions in emergency humanitarian and conflict-affected settings often result in significant sex work economies, there is limited information on the social and structural conditions of sex work in these settings, and the impacts on HIV/STI prevention and access to sexual and reproductive health (SRH) services for sex workers. Our objective was to comprehensively review existing evidence on HIV/STI prevention and access to SRH services for sex workers in conflict-affected settings globally...
2017: Conflict and Health
Jennifer J Palmer, Okello Robert, Freddie Kansiime
Background: Ensuring equity between forcibly-displaced and host area populations is a key challenge for global elimination programmes. We studied Uganda's response to the recent refugee influx from South Sudan to identify key governance and operational lessons for national sleeping sickness programmes working with displaced populations today. A refugee policy which favours integration of primary healthcare services for refugee and host populations and the availability of rapid diagnostic tests (RDTs) to detect sleeping sickness at this health system level makes Uganda well-placed to include refugees in sleeping sickness surveillance...
2017: Conflict and Health
Amanda Culver, Roger Rochat, Susan T Cookson
Background: During the last decade, conflict or natural disasters have displaced unprecedented numbers of persons. This leads to conditions prone to outbreaks that imperil the health of displaced persons and threaten global health security. Past literature has minimally examined the association of communicable disease outbreaks with complex emergencies (CEs) and natural disasters (NDs). Methods: To examine this association, we identified CEs and NDs using publicly available datasets from the Center for Research on the Epidemiology of Disasters and United Nations Flash and Consolidated Appeals archive for 2005-2014...
2017: Conflict and Health
Prasansa Subba, Nagendra P Luitel, Brandon A Kohrt, Mark J D Jordans
Background: Despite increasing efforts to expand availability of mental health services throughout the world, there continues to be limited utilization of these services by persons with mental illness and their families. Community-based detection that facilitates identification and referral of people with mental health problems has been advocated as an effective strategy to increase help-seeking and service utilization. The Community Informant Detection Tool (CIDT) was developed for the community informants to identify people with depression, psychosis, alcohol use problems, epilepsy, and child behavioral problems in community settings...
2017: Conflict and Health
Rima Mourtada, Jennifer Schlecht, Jocelyn DeJong
Background: Recent reports have suggested that child marriage among Syrians may be increasing as a result of displacement and conflict. This study sought to gather qualitative data about the factors that promote child marriage practices among Syrian refugees in Al Marj area in the Bekaa valley, Lebanon, where the majority of Syrian refugees have settled in Lebanon. The second aim of this study was to generate recommendations on how to mitigate the drivers and consequences of child marriage practices based on the findings...
2017: Conflict and Health
Anna E Kågesten, Linnea Zimmerman, Courtland Robinson, Catherine Lee, Tenaw Bawoke, Shahd Osman, Jennifer Schlecht
Background: Very young adolescents (VYA) in humanitarian settings are largely neglected in terms of sexual and reproductive health (SRH). This study describes the characteristics of VYA aged 10-14 years in two humanitarian settings, focusing on transitions into puberty and access to SRH information. Methods: Data were collected through a cross-sectional survey with Somali VYA residing in the Kobe refugee camp in Ethiopia ( N  = 406) and VYA from Myanmar residing in the Mae Sot and Phop Phra migrant communities in Thailand ( N  = 399)...
2017: Conflict and Health
Jocelyn DeJong, Farah Sbeity, Jennifer Schlecht, Manale Harfouche, Rouham Yamout, Fouad M Fouad, Seema Manohar, Courtland Robinson
Background: The conflict in Syria that began in 2011 has resulted in the exodus of over 5 million Syrian refugees to neighbouring countries, with more than one million refugees currently registered by UNHCR in Lebanon. While some are living in tented settlements, the majority are living in strained conditions in rented accommodation or collective shelters in the Bekaa Valley next to Syria. Adolescents are particularly vulnerable in any crisis. In 2013-4, the American University in Beirut in collaboration with the Women's Refugee Commission, Johns Hopkins and Save the Children, sought to understand the specific experiences of very young adolescents, those 10-14 years of age, in this protracted crisis context...
2017: Conflict and Health
Catherine Lee, Yasmina Aules, Samira Sami, Paw Kree Lar, Jennifer Schlect, Courtland Robinson
Background: The very young adolescent (VYA) population age 10-14 years is often neglected in the field of sexual and reproductive health (SRH) research due to the combined sensitivity of the topic and the young age group, resulting in little data about the SRH needs and concerns of VYA. In 2013, the Women's Refugee Commission (WRC), Johns Hopkins University (JHU), Adolescent and Reproductive Health Network (ARHN) and Karen Youth Organization (KYO) implemented qualitative participatory research to explore the SRH needs and risks of VYA...
2017: Conflict and Health
Luis Ortiz-Echevarria, Meghan Greeley, Tenaw Bawoke, Linnea Zimmerman, Courtland Robinson, Jennifer Schlecht
Background: Kobe Refugee camp hosts roughly 39,000 refugees displaced from Somalia during the 2011-2012 Horn of Africa Crisis. Sexual and reproductive health, as with the greater issues of health and well-being for adolescents displaced from this crisis remain largely unknown and neglected. In 2013, the Women's Refugee Commission, Johns Hopkins University, and International Medical Corps in Ethiopia, implemented qualitative and quantitative research to explore the factors and risks that impact the health of very young adolescents (VYAs), those 10-14 years of age, in this setting...
2017: Conflict and Health
M Claire Greene, Mark J D Jordans, Brandon A Kohrt, Peter Ventevogel, Laurence J Kirmayer, Ghayda Hassan, Anna Chiumento, Mark van Ommeren, Wietse A Tol
Delivery of effective mental health and psychosocial support programs requires knowledge of existing health systems and socio-cultural context. To respond rapidly to humanitarian emergencies, international organizations often seek to design programs according to international guidelines and mobilize external human resources to manage and deliver programs. Familiarizing international humanitarian practitioners with local culture and contextualizing programs is essential to minimize risk of harm, maximize benefit, and optimize efficient use of resources...
2017: Conflict and Health
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