Table 8 Impact of conflict on Multiple Infectious Diseases outbreaks

Zhao et al., 2019 [56]

Iraq,

2003–2016

Incidence data collected from the Iraq Centre for Disease Control

• Deteriorating infrastructure during the conflict

• Deterioration of water quality and sanitation

• Lower vaccine coverage rate and higher vaccine failure rate

• Poor primary hygiene practices

• Interrupted water supplies

• Population displacement

Implemented:

The Ministry of Health:

• Reoriented the public health sector towards primary care

• Restored disease surveillance systems and screening programmes

• Individuals carry ‘smart cards’ with their registration and health records, and receive prompts for required immunisations and clinic visits

Suggested:

• Immediate water treatment and case management

• The prevention of active disease in latently infected individuals

• Federal government should manage public health security by expanding the disease surveillance system to include more types of facilities and the private sector

Haddison et al., 2020 [57]

Cameroon, Southwest Region,

2016–2018

Secondary analysis of routine surveillance data

• Reduced accessibility to health facilities due to the armed conflict

• Inability to deliver drugs and supplies to health facilities as a result of attacks on the highway, blocked roads or active fighting

• Abandoned health facilities due to attacks on health personnel or infrastructure

• Breakdown in communication networks hampering remote supervision and data collection in facilities operating in high-risk zones

• The armed conflict contributed to the internal displacement of the population and to the influx of refugees from Nigeria into Cameroon which placed an additional strain on the weakened health services in the area

• The disruption of normal life and health services due to the insurgency created an enabling environment for the spread of infectious diseases.

Implemented:

• Vaccine rollouts were made in a targeted fashion to displaced children

• Engagement of community health workers in providing a continuity of care

Suggested:

Local, national, regional, and global authorities must work together to develop risk-mitigating interventions in settings with armed conflicts to preserve the delivery and utilisation of health servicesservices.

Tarnas et al., 2021 [61]

Syria, Turkey, Lebanon, Jordan, and Iraq,

2003–2018

Population of Syria, Turkey, Lebanon, Jordan, and Iraq

• Disruption of WASH infrastructure

• Mass displacement

• Overcrowding in health systems that were not equipped to handle an influx of forcibly displaced people

• Interruption of standard health services including routine childhood vaccination

Implemented:

Not mentioned

Suggested:

Not mentioned

Malik et al., 2021 [59]

Jordan,

early October 2017 to January 2018

Children under-five living in Jordan

• A massive influx of Syrian refugees in Jordan placed immense pressure on the country’s over-stretched resources and affected the country’s health care system with exerted demand.

• People coming through conflict-driven displacement had no or low access to healthcare and lack basic healthcare facilities.

• Conflict-driven displacement has an immediate effect on child health because of access, availability and affordability issues with regard to health care services.

Implemented:

• Given the large number of refugees in urban areas, sanitation programmes and sewage networks have been implemented among refugee concentrated camps

Suggested:

• Concerted action is required to safeguard the health needs and avert public health emergencies due to conflict driven displacement.

• Coordinated and effective measures are needed to provide the best health care services among the displaced populations to prevent health risks.

• Collaborative efforts through global partners can help the countries facing the challenges of managing these health care emergencies

Haque et al., 2022 [58]

Ukraine,

24 February 2022–4 August 2022

Population of Ukraine

• Destruction of healthcare infrastructure

• Bombardment of hospitals, factories and dispensaries

• Destroyed roads

• Delayed or interrupted

vaccinations

• Disruption to clean sources of water

• Disruption to delivery of healthcare and health-related services

• Limited access to medical care and medications during the current conflict.

• In areas with active hostilities, critical supplies, including oxygen, insulin, and cancer treatments were in short supply.

• Displacement of people into shelters, and overcrowded spaces with limited or no access to water and sanitation facilities

Implemented:

Not mentioned

Suggested:

• Ukraine’s infrastructure, health, utility and other essential systems must be rebuilt to ensure appropriate recovery for the country and its people

• Continued surveillance and support are imperative to help mediate the long-term effects of the war and to rebuild Ukraine

Mobula et al., 2020 [60]

DRC,

2018

Ebola cases

• The conflict rendered certain health zones Inaccessible

• Population/contact mobility

• Insufficient aid for basic services impacted response activities.

• Community mistrust

• High population density

Implemented for Ebola:

• Testing

• Contact tracing

• Isolation

• Treatment

• Mitigation measures (including physical distancing)

Suggested for COVID-19:

• Application of similar infectious disease strategies and response measures as implemented for Ebola including the transfer of protocols and systems including:

• Response coordination - implementation of command and control of operation centres

• Surveillance systems - Creation of a monitoring framework including reporting, surveillance, contact tracing and the early detection and isolation of cases

• Use of innovative data sharing platforms developed for Ebola including epidemiological support.

• Risk communication and community engagement strategies

• Infection prevention and control strategies

• Public health emergency preparedness actions

• External donor coordination