Table 7 Impact of conflict on Malaria, Leishmaniasis, Measles, Dengue, Diphtheria and ABM outbreaks

Martins et al., 2009 [46]

Dili and four other districts: Aileu, Baucau, Ermera and Lautem, IDP camps and health facilities,

September –November 2006

Key informant interviews (N = 30), document reviews, focus group discussions (N = 3) and malaria morbidity data

Malaria

• Conflict led to the displacement of thousands of people and interrupted routine malaria service programmes

• Movement of people from low to high transmission areas, and environmental deterioration encouraging vector breeding, such as rainy seasons aid malaria transmissions

Implemented:

Collaboratively and rapidly organised interventions for IDPs covering:

• treatment,

• insecticide treated net distribution, with priority to pregnant women and children under five

• vector control,

• surveillance

Suggested:

Intervention response must be planned beyond the IDPs alone, and adequate resources and expertise should be made available to assure a whole-of-city approach

Sedda et al., 2015 [47]

Sub-Saharan African countries,

1997–2010

General population

Malaria

• The impact of conflicts on the prevalence of malaria is stronger in the presence of violent events (e.g., violence against civilians and riots/protests).

Implemented:

Not mentioned

Suggested:

Maintenance of intervention coverage and provision of healthcare in conflict situations to protect vulnerable populations

Alawieh et al., 2014 [49]

Lebanon,

January 2013 – March 2014

Lebanese, Syrian refugees, and Palestinian refugees

Leishmaniasis

• Massive and rapid increase in the arrival of Syrian refugees

• Infiltration of a high number of Syrian refugees in dense concentrates to different regions of Lebanon without restriction to designated camps.

• Limited access to treatment and the absence of well-trained healthcare professionals on this topic

Implemented:

The LMOPH to contain the spread of infection:

• sprayed pesticides to kill the vector

• provided free treatment and diagnosis for emerging cases,

• distributed medications free of charge to the different primary care centres,

• monitored of disease activity,

• trained physicians and health care workers on disease symptoms, raising their index of suspicion,

• educated the Lebanese public and Syrian refugees about the disease symptoms and how to seek medical advice and treatment.

• assigned new centres for Leishmania detection and treatment in all Lebanese hospitals, including those in rural areas and near refugee camps.

Suggested:

The coordinated efforts and cooperation among governmental departments, international agencies, local authorities, medical associations, and NGOs are critical for containing any outbreak.

Youssef et al., 2019 [50]

Latakia city, Syria,

2008–2016

Population of Latakia city

Leishmaniasis

The 2011 Syrian conflict:

• Displaced more than 6.5 million people

• Devastated the Syrian healthcare infrastructures, severely damaging 60% of the Syrian hospitals, and greatly reducing the pharmaceutical production capacity of the country.

• Crowding of the “safer Syrian cities” and their healthcare facilities, and displacement of a large population from leishmaniasis-endemic areas

• Potentially exposed younger males enrolled in the army who would transfer the parasite.

Implemented:

The LMOPH initiated a control campaign following the 2013 outbreak in the Lebanese refugee camps that included:

• Vector control

• Early detection

• Free treatment of leishmaniasis cases

A similar campaign was implemented in the Latakia governorate to counter the leishmaniasis outbreak after 2013 which consisted of:

• Vector control mainly indoor residual spraying

• Early detection and treatment

• Public education.

Suggested:

• Improving the living circumstances in sites with high population densities,

• Enforcing better healthcare services

• Activating surveillance, early diagnosis, vector control, and public education

CDC 2004 [51]

Sudan, Darfur,

2004

Children aged 9 months – 5 years

Measles

• Darfur experienced civil conflict during the previous year, resulting in the internal displacement of approximately one million residents and an exodus of an estimated 170,000 persons to neighbouring Chad.

• The conflict left a vulnerable population with limited access to food, health care, and other basic necessities.

• Measles vaccination coverage had been adversely affected

Implemented:

State ministries of health and various NGOs conducted:

• Vaccination campaigns in IDP camps and neighbouring communities, targeting children aged 9 months–5 years; these campaigns vaccinated approximately 80,000 children.

• Clinics were established in IDP camps to vaccinate current and incoming residents.

• Vaccination using a combination of fixed posts and outreach immunisation teams,

• Use of checklists to monitor vaccination sessions,

• Social mobilisation activities, and

• Surveillance for adverse events after vaccination

• Rapid convenience surveys were used to monitor coverage in hard-to-reach areas.

• At the state level, meetings were held at the end of each working day to review progress and address problems.

• Tally sheets were used to monitor campaign coverage, and data were sent to the federal level for compilation and analysis.

• Vaccination sites included fixed centres, temporary posts, and mobile teams.

Suggested:

Not mentioned

Babakura et al., 2021 [52]

Nigeria, Borno State,

2017–2018

Measles surveillance data among children, Nigeria

Measles

• The majority of the LGAs were not fully accessible for optimal conduct of the measles immunisation campaign

• Children in inaccessible areas were denied access to immunisation services.

• Inability to implement RES strategy to deliver measles vaccine to partially accessible areas because of escalation in insurgency during the time frame and the prioritisation of the military and joint task forces on addressing the security risk over delivering health commodities

• Aggravation of factors related to disease transmission like the mass movement of people between IDP camps and host communities which may introduce transmission of measles

Implemented:

Organised vaccination campaigns based on the accessibility mapping of each area developed by the government and partners. The immunisation strategies included:

• Fixed posts (where the team was based at the health facilities) and temporary posts (located at strategic areas of the communities such as schools, markets, places of worship etc.).

• The RES strategy which was implemented in some partially accessible parts of the State involved the deployment of vaccination teams with security cover by the Military or armed local vigilante referred to as the Civilian Joint Taskforce

• Combined Human and Animal Vaccinations teams were organised targeting nomadic populations.

Suggested:

• The strategy of Reaching Inaccessible Children was adopted to reach eligible children in security-compromised areas by leveraging the military personnel to conduct vaccination, but the plan was suspended and, thus, not implemented.

• The engagement with the military must continue and be strengthened to ensure increased collaboration with security forces

• The re-establishment of holding camps and vaccination posts at all entry points into IDP camps and host communities to ensure all new entrants are screened and vaccinated with Measles vaccines

Alghazali et al., 2019 [53]

Taiz, Yemen, Hospital and medical centres in Taiz,

2016

Patients with clinical suspected dengue in hospitals and medical centres in Taiz, Yemen

Dengue

• The civil war:

• caused widespread destruction to public health infrastructure

• displaced > 2.2 million persons into living in cramped shelters with poor hygiene and inadequate healthcare support

• created numerous potential mosquito-breeding sites, such as open water storage containers, areas with inadequate drainage, discarded plastic containers in which water accumulates, and puddles of water

Implemented:

Not mentioned

Suggested:

Not mentioned

Weil et al., 2021 [54]

Bangladesh,

MSF diphtheria treatment centres located in Balukhali and Jamtoli camps,

2017–2019

Patients with symptoms of diphtheria

Diphtheria

• A massive influx of approximately 630 000 FDMNs

• Makeshift settlements in and around established refugee camps in Bangladesh where the first suspected diphtheria case was reported

• Over 800 suspected cases reported in the area by mid-December 2017

Implemented:

Not mentioned

Suggested:

Not mentioned

Al-Samhari et al., 2023 [55]

Yemen

2014–2020 all children aged < 5 years admitted to all the nine sentinel

hospitals in Yemen 2014–2020

All children aged < 5 years admitted to all the nine sentinel

hospitals in Yemen 2014–2020

Acute Bacterial Meningitis (ABM)

• Ddisplacement of 4.3 million people,

• 20.1 million people unable to access healthcare and > 20.7 million people in need of humanitarian aid

• With the continuation of the conflict, the vaccination coverage rate dropped

• The major government maternal and children’s hospital was repeatedly attacked and subject to armed incursions that resulted in damage not only to the medical infrastructure but also resulting in many patients leaving against medical advice

Implemented:

Not mentioned

Suggested:

• Immunisation Program on Immunization through sustainable investments in war-damaged infrastructure and providing decentralised finances are prerequisites

• More serotype/group

data for ABM patients are needed to better understand the prevalence of specific pathogen strains across Yemen