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Conflict and Health

Wasim I M Sultan, José Crispim
Background: The structure, function, and capacity of the health care system in the Occupied Palestinian Territories (OPT) had been largely shaped by the complex political history of the country. Since the establishment of the Palestinian Authority in 1994, the reform efforts were subsidized much by the international aids to rebuild the country's institutional capacity. No previous studies have provided a realistic evaluation of Palestinian achievements in the conduct of public healthcare, we examine the relative productive efficiency of public hospitals (their managers' success in the usage of resources) during 2010-2015 within West Bank and Jordan...
2018: Conflict and Health
Waleed M Sweileh
Background: The Syrian conflict has created the worst humanitarian crisis of our time with approximately half of Syria's pre-war population killed or forced to flee their homes. The current study aimed to analyze peer-reviewed literature published on Syrian refugees and displaced people. Methods: A bibliometric methodology was implemented using Scopus database after retrieving documents relevant to Syrian refugees and displaced people. Findings: In total, 323 documents were retrieved...
2018: Conflict and Health
Ziad El-Khatib, Maya Shah, Samuel N Zallappa, Pierre Nabeth, José Guerra, Casimir T Manengu, Michel Yao, Aline Philibert, Lazare Massina, Claes-Philip Staiger, Raphael Mbailao, Jean-Pierre Kouli, Hippolyte Mboma, Geraldine Duc, Dago Inagbe, Alpha Boubaca Barry, Thierry Dumont, Philippe Cavailler, Michel Quere, Brian Willett, Souheil Reaiche, Hervé de Ribaucourt, Bruce Reeder
Background: It is a challenge in low-resource settings to ensure the availability of complete, timely disease surveillance information. Smartphone applications (apps) have the potential to enhance surveillance data transmission. Methods: The Central African Republic (CAR) Ministry of Health and Médecins Sans Frontières (MSF) conducted a 15-week pilot project to test a disease surveillance app, Argus, for 20 conditions in 21 health centers in Mambéré Kadéi district (MK 2016)...
2018: Conflict and Health
Rachel Burns, Kolitha Wickramage, Anwar Musah, Chesmal Siriwardhana, Francesco Checchi
Background: Although the adverse impacts of conflict-driven displacement on health are well-documented, less is known about how health status and associated risk factors differ according to displacement experience. This study quantifies health status and quality of life among returning refugees, internally displaced persons, and the host community in a post-conflict district in Northern Sri Lanka, and explores associated risk factors. Methods: We analysed data collected through a household survey ( n  = 570) in Vavuniya district, Sri Lanka...
2018: Conflict and Health
Catherine Lee, Amanda J Nguyen, Tara Russell, Yasmina Aules, Paul Bolton
Background: In Kachin State, Myanmar, collapse of a ceasefire in 2011 has resulted in widespread exposure to conflict and ongoing internal displacement. Such exposures are known risk factors for mental health and psychosocial (MHPS) problems, yet mental health services for children and youth are typically scarce in such circumstances. Following evaluation of a mental health treatment for adult trauma survivors on the Thailand-Myanmar border, our study team received requests to support the development of a similar intervention for displaced children in Kachin State...
2018: Conflict and Health
James A Elliott, Debashish Das, Philippe Cavailler, Fabien Schneider, Maya Shah, Annette Ravaud, Maria Lightowler, Philippa Boulle
Background: Patients with diabetes require knowledge and skills to self-manage their disease, a challenging aspect of treatment that is difficult to address in humanitarian settings. Due to the lack of literature and experience regarding diabetes self-management, education and support (DSMES) in refugee populations, Medecins Sans Frontieres (MSF) undertook a DSMES survey in a cohort of diabetes patients seen in their primary health care program in Lebanon. Methods: Structured interviews were conducted with diabetes patients in three primary care clinics between January and February 2015...
2018: Conflict and Health
Christos Eleftherakos, Wilma van den Boogaard, Declan Barry, Nathalie Severy, Ioanna Kotsioni, Louise Roland-Gosselin
Background: In 2015 and early 2016, close to 1 million migrants transited through Greece, on their way to Western Europe. In early 2016, the closure of the "Balkan-route" and the EU/Turkey-deal led to a drastic reduction in the flow of migrants arriving to the Greek islands. The islands became open detention centers, where people would spend months or years under the constant fear of being returned to Turkey.Syrians were generally granted refugee status in Greece and those arrived before the 20th of March 2016 had the option of being relocated to other European countries...
2018: Conflict and Health
Stacey E Pizzino, Samuel Hundessa, Vinu Verghis, Mark Griffin, Jo Durham
Background: The presence of landmines and explosive remnants of war (ERW) including unexploded ordnance (UXO) poses a serious public health risk for populations living in conflict-affected and contaminated areas. Current analysis, however, provides only a partial view of the burden. In this study, we examined the multivariable relationship between year of injury, activity at the time of the incident, case fatalities and casualty rates in order to provide decision-makers with a more fine-grained understanding of landmines and ERW injuries in the Lao PDR...
2018: Conflict and Health
Jennifer J Mootz, Florence Kyoheirwe Muhanguzi, Pavel Panko, Patrick Onyango Mangen, Milton L Wainberg, Ilana Pinsky, Kaveh Khoshnood
Background: Relations among and interactions between exposure to armed conflict, alcohol misuse, low socioeconomic status, gender (in)equitable decision-making, and intimate partner violence (IPV) represent serious global health concerns. Our objective was to determine extent of exposure to these variables and test pathways between these indicators of interest. Methods: We surveyed 605 women aged 13 to 49 who were randomly selected via multistage sampling across three districts in Northeastern Uganda in 2016...
2018: Conflict and Health
Anna Myers, Samira Sami, Monica Adhiambo Onyango, Hari Karki, Rosilawati Anggraini, Sandra Krause
Background: Following the Nepal earthquake in April 2015, UNFPA estimated that 1.4 million women of reproductive age were affected, with approximately 93,000 pregnant and 28,000 at risk of sexual violence. A set of priority reproductive health (RH) actions, the Minimum Initial Services Package (MISP), was initiated by government, international and local actors. The purpose of this study was to identify the facilitators and barriers affecting the implementation of priority RH services in two districts...
2018: Conflict and Health
S Benjamin Doty, Emily E Haroz, Namrita S Singh, Sergiy Bogdanov, Judith K Bass, Laura K Murray, Karis L Callaway, Paul A Bolton
Background: In Ukraine, a large number of internally displaced persons (IDPs) and veterans experience social and psychological problems as a result of the ongoing conflict between Ukraine and Russia. Our purpose was to develop reliable and valid instruments to screen for common mental health and alcohol use problems in these populations. Methods: We used a three-step process of instrument adaptation and testing. The instrument-the Mental Health Assessment Inventory (MHAI)-combines adapted standard screeners with items derived locally in Ukraine...
2018: Conflict and Health
R Lafta, V Cetorelli, G Burnham
Background: In June 2014, an estimated 1500 fighters of the Islamic State of Iraq and Syria (ISIS) seized control of Mosul, Iraq's second city. Although many residents fled, others stayed behind, enduring the restrictive civil and social policies of ISIS. In December 2016, the military activity, known as the liberation campaign, began in east Mosul, concluding in west Mosul in June 2017. Methods: To assess life in Mosul under ISIS, and the consequences of the military campaign to retake Mosul we conducted a 40 cluster-30 household survey in Mosul, starting in March 2017...
2018: Conflict and Health
Jane Collier, Hanna Kienzler
Background: Non-communicable diseases (NCDs) - including cardiovascular disease (CVD), cancer and diabetes - have become a significant global burden on health. Particularly concerning are CVD rates, causing approximately 18 million deaths worldwide every year. The statistics show that the disease is no longer a predominantly high-income country phenomenon, but affects, increasingly, countries in both developing regions and conflict-affected areas. In the occupied Palestinian territory (oPt), the focus of this article, CVD ranks top of ten NCD killers, accounting for approximately 37...
2018: Conflict and Health
Edouard Hosten, Mandana Mehta, Emmanuel Andre, Khaled Abu Rumman, Dimitri Van der Linden
Background: In response to the influx of displaced Syrians since 2011, the Jordanian National Tuberculosis Program (NTP) implemented a specific Tuberculosis (TB) reduction strategy, including contact-tracing (CT). Contacts of all refugees diagnosed with pulmonary TB (PTB) were registered by the International Organization for Migration and screened for active & latent TB infection (LTBI) in 6 NTP centres.The objectives of this study were to assess prevalence of active TB and LTBI, risk factors for LTBI as well as program performance...
2018: Conflict and Health
Manuela Rehr, Muhammad Shoaib, Sara Ellithy, Suhib Okour, Cono Ariti, Idriss Ait-Bouziad, Paul van den Bosch, Anais Deprade, Mohammad Altarawneh, Abdel Shafei, Sadeq Gabashneh, Annick Lenglet
Background: Tackling the high non-communicable disease (NCD) burden among Syrian refugees poses a challenge to humanitarian actors and host countries. Current response priorities are the identification and integration of key interventions for NCD care into humanitarian programs as well as sustainable financing. To provide evidence for effective NCD intervention planning, we conducted a cross-sectional survey among non-camp Syrian refugees in northern Jordan to investigate the burden and determinants for high NCDs prevalence and NCD multi-morbidities and assess the access to NCD care...
2018: Conflict and Health
Gemma Bowsher, Patrick Bogue, Preeti Patel, Peter Boyle, Richard Sullivan
The conflict environment in Libya is characterized by continued pervasive insecurity amidst the widespread availability of small arms and light weapons (SALW). After the First Civil War, armed brigades took the law into their own hands and the resulting violence terminated a short-lived post-conflict period that has relapsed into a Second Civil War. The Libyan government has struggled to assert authority over armed groups and these brigades, refusing to disarm have contributed directly the initiation of a second conflict; some are motivated by self-defense, status, criminality, vindication or political aims...
2018: Conflict and Health
Cecilia Ferreyra, Daniel O'Brien, Beatriz Alonso, Abdulbasset Al-Zomour, Nathan Ford
Background: Unstable settings present challenges for the effective provision of antiretroviral treatment (ART). In this paper, we summarize the experience and results of providing ART and implementing contingency plans during acute instability in the Central African Republic (CAR) and Yemen. Case presentation: In CAR, MSF has provided HIV care in three conflict-affected rural regions; these were put on hold throughout the acute phase of violence. "Run-away bags" containing 3 or 4 months of ART were distributed to patients at MSF facilities...
2018: Conflict and Health
Maria Paola Bertone, Eelco Jacobs, Jurrien Toonen, Ngozi Akwataghibe, Sophie Witter
Background: Performance based financing (PBF) has been increasingly implemented across low and middle-income countries, including in fragile and humanitarian settings, which present specific features likely to require adaptation and to influence implementation of any health financing programme. However, the literature has been surprisingly thin in the discussion of how PBF has been adapted to different contexts, and in turn how different contexts may influence PBF. With case studies from three humanitarian settings (northern Nigeria, Central African Republic and South Kivu in the Democratic Republic of Congo), we examine why and how PBF has emerged and has been adapted to those unsettled and dynamic contexts, what the opportunities and challenges have been, and what lessons can be drawn...
2018: Conflict and Health
Rebecca Hémono, Bridget Relyea, Jennifer Scott, Sinan Khaddaj, Angeliki Douka, Alison Wringe
Background: By 2017, more than 500,000 Syrian refugees had passed through Greece seeking safety and asylum. Understanding how their health needs evolved over the refugee crisis in Greece and in relation to changing migration policy, and exploring the challenges involved in delivering their healthcare is timely as non-governmental organizations (NGOs) transition health service provision to the Greek health authorities. Methods: We conducted a qualitative study to explore stakeholders' perspectives on delivering health services to Syrian refugees over the course of the humanitarian response in Greece from 2015 to 2017...
2018: Conflict and Health
Erica Koegler, Caitlin E Kennedy
The association between poor mental health and factors related to HIV acquisition and disease progression (also referred to as HIV-related factors) may be stronger among conflict-affected populations given elevated rates of mental health disorders. We conducted a scoping review of the literature to identify evidence-based associations between mental health (depression, anxiety, and post-traumatic stress disorder [PTSD]) and factors related to HIV acquisition and progression in conflict-affected populations...
2018: Conflict and Health
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