Table 3 Impact of conflict on COVID-19 outbreaks

Daw et al., 2020 [26]

Libya,

25 March 2020–25 June 2020

Population of Libya

The armed conflict:

• hindered access to populations and thus masked the actual status of the pandemic, particularly in cities such as Tarhona, Tawerga and Sert, which have been devastated by the ongoing conflict and in which no official health authority could work and no cases of COVID-19 have been reported

• caused population movement that spread the virus to counties located over 100 km away from the fighting such as Sebha

Implemented:

• Lockdown measures and isolation procedures within main cities

Suggested:

• Mapping the disease to enable the national authorities to ensure effective implementation of protective infectious disease interventions

• Applying internationally accepted standards, guidelines and tools adapted to conflict situations

• Specific training of health planners and health facility staff, and rapid mobilisation of international experts to provide technical field support

• Effective public education programmes

Elhadi and Msherghi, 2020 [28]

Libya,

Civil war in Libya,

24 March 2020–12 May 2020

Population of Libya

• Healthcare infrastructure deteriorated

• Inadequate human and financial support,

• Inadequate health facilities with limited bed capacity and lack of readiness of health emergency services

• Population mobility due to displacement

• Limited public knowledge and awareness of COVID-19

Implemented:

Not mentioned

Suggested:

• Encourage the support of healthcare workers by providing adequate training and personal protective equipment,

• Increasing the capacity of diagnostic tools and supplies, establishing isolation sites

• Increasing local awareness among the Libyan population

Chumachenko and Chumachenko, 2022 [27]

Ukraine,

War in Ukraine,

From 24 February 2022

Population of Ukraine

• Destruction of medical facilities and shortages of medical personnel

• Reduced beds due to emergency medical care to the wounded

• Limited testing and recording of cases in active conflict areas

• Reduced access to oxygen and hospital beds which are prioritised for the wounded

• No medicine delivery due to active hostilities

• Non-application of social distancing measures due to high population density during the evacuation, both in trains and at stations and within shelters

• Limited application of personal protective measures or self-isolation policies in shelters

• Lack of vaccination plans in active conflict areas

• Population displacement

Implemented:

• Vaccination campaign

Suggested:

Not mentioned

Njoh et al., 2022 [29]

Cameroon (Northwest

Region),

January 1st, 2020 to September 4th, 2021

COVID-19 cases

• Massive internal displacement of the population

• Looting and destruction of health facilities

• Killing of healthcare workers, disruption of the healthcare system in the region

• Challenges related to delivering vaccines in security compromised areas

Implemented:

Not mentioned

Suggested:

• Scale- up COVID-19 vaccination

• Innovative approaches adapted to the local context including community participation at every level of the vaccine rollout

• Carrying out vaccination at transit points such as bus stations and refuge sites

Uwishema et al., 2022 [31]

Ukraine,

From 24 February 2022

Population of Ukraine

• Shattered healthcare infrastructure, wreaked primary healthcare facilities

• Patients who managed to make it to hospitals encountered severe constraints such as power outages and oxygen shortages

• Mass migrations

• People sought refuge in closed subway systems or migrated to more shielded places

Implemented:

Not mentioned

Suggested:

• Rebuilding of the broken healthcare System

• NGOs, doctors and front-line workers should extend their support and supply vaccines and medicine

• Preparation of standard medical facilities, i.e. medications, equipment, medical military personnel and a combat support hospital with intensive care capacity.

• Education of military personnel and civilians on infectious diseases, personal protective measures, immunisations, chemoprophylaxis and surveillance

Quinn et al.,

2021 [30]

Ukraine,

2020 - publication date, April 2021

Population of Ukraine

• Lack of health-related infrastructure and health-care staff that were forced to migrate to safe locations

• Disaster response was further hindered as resources were allocated to warfighting efforts against an invading and occupying force

• Primary health-care services were destroyed during the Russian invasion

• Reduced access to basic primary prevention for the paediatric population

• In occupied territories health-care system was poorly equipped

• Many regional medical centres lacked COVID-19 testing in the beginning of the outbreak

• Insufficient logistical equipment of hospitals;

• Lack of qualified specialists on infectious diseases, virology, epidemiology

• Lack of surveillance and appropriate testing labs

• Lack of adequate personal protective equipment

• During the winter period from 2020 to 2021, climate problems were identified and complicated COVID-19 detection and diagnosis

Implemented:

• Social distancing

• Face masks

• Handwashing

• Isolation

• Quarantine

• Limited movement

• Limited traveling abroad especially to countries where COVID-19 cases are confirmed

• Diagnostic test kits at checkpoints across state borders/ increased testing services at ports of entry

• Financing of the production of RT-PCR tests by the Ukrainian Institute of Molecular Biology and Genetics of the National Academy of Sciences

• Self-isolation of troops

• Military medical clinical centres and deployed mobile hospitals were supported for COVID-19 prevention and treatment

Suggested:

• The medical readiness system in Ukraine will need to create reserves of medical equipment, medicines, medical devices, personal protective equipment, disinfectants, and capacity building and training

• Surveillance and testing policies not only for severe cases but should include milder cases and asymptomatic infections

• Broad access to accurate testing

• International coordination, knowledge and information sharing between states/ international partners for rapid implementation of containment, mitigation, treatment, and rapid vaccine rollout options

• Step up capacity building efforts to train and supply Ukrainian epidemiologists and laboratories to handle the diagnostic and biostatistics requirements for responding to any infectious disease outbreak and integration biosurveillance, antimicrobial resistance

• Strict prioritisation in allocation of resources, beds, and medical staff

• Interoperability with international partners must be increased and expanded upon across all domains of battle and disaster response