From: The impact of conflict on infectious disease: a systematic literature review
Author | Country, Setting, Timeframe | Population | Conflict to Disease Pathways | Prevention and Preparedness Strategies Suggested/Implemented |
---|---|---|---|---|
Betsi et al., 2006 [9] | Armed conflict in Cote d’Ivoire (Central, North and West areas), 2001- early 2004 | Key Informant survey (n = 165) among politicians, military leaders, health staff, members of organisations to address HIV, NGOs | • Population displacement (25-50%, depending on the part of the country) • Decrease in healthcare personnel (75–88% reduction), especially medical doctors (91–98%) • Reduction in functioning health facilities (72–80%) • Healthcare delivery structures had been plundered or destroyed, laboratory equipment had been stolen and patient records and epidemiological monitoring and surveillance data had disappeared • Lack of essential drugs and diagnostic kits for STIs • Low compliance to diagnostic algorithms • Lack of patient visitation • Lack of awareness campaigns • Interrupted condom distribution • Interruption of existing antiretroviral therapy programmes | Implemented: • An Increased number of active NGOs pursued education and sensitising programmes for the prevention and care of people living with HIV/AIDS. Suggested: • Awareness campaigns with emphasis on the age group 15–24 were suggested. • Health facilities to be structurally and functionally rehabilitated to provide people living with HIV/AIDS antiretroviral treatment and other STIs in the long term. |
Ali et al., 2012 [13] | Pakistan, conflict affected area in North Waziristan Pakistan, 2010–2011 | Population of the conflict-affected area | • The prolonged armed conflicts caused a reported increase in poverty, medical deprivation, uncertainty and the breakdown of social structures that facilitated the transmission of HBV. • Low socioeconomic status, and illiteracy were associated with HBV. • High HBV prevalence was observed in areas with high frequency of military activities • Transmission factors within this setting were the reuse of needles and syringes, sexual exposure, barbers’ shops, tattooing | Implemented: Not mentioned Suggested: • Vaccination and awareness programmes are necessary to prevent the HBV epidemic |
Vasylyeva et al., 2018 [11] | Ukraine, Earlier stages of the Ukraine conflict, 24 regional AIDS centres, 2012–2015 | Patients from Ukrainian AIDS centres | • The conflict internally displaced HIV-infected people • In conflict areas, healthcare provision and harm-reduction services were interrupted • The stress of the displacement might result in treatment failures for HIV-infected patients • Patients who had to relocate because of the conflict may be more likely to reduce treatment adherence or drop out of treatment for some time • Virus dissemination due to population movement was directed to the locations with the highest prevalence of people who inject drugs practising risky sexual behaviours | Implemented: Not mentioned Suggested: • Enabling sustainable prevention services and treatment provision in locations where services have been physically disrupted. • Proactive and routine integration of HIV testing for people who have relocated due to the war, or who frequently travel to the war zone. • Scale-up of harm reduction services for people who inject drugs will be an important factor in preventing new local HIV outbreaks in Ukraine. |
Katamba et al., 2020 [12] | Uganda, Post-conflict Northern Uganda, November 2011 - March 2015 | Conflict-affected population in three districts in Northern Uganda | • Conflict-affected participants who had experienced abduction and multiple traumas during the war were at greater risk of HIV infection. | Implemented: Not mentioned Suggested: • Trauma-informed HIV prevention and treatment services, and culturally safe mental health initiatives are needed |
Daw et al., 2022 [10] | Libya, Libyan armed conflict, 2011–2020 | People from four regions of Libya (East, West, North, and South) | • Healthcare services were continuously interrupted • Internal population displacement (25%) leading to geographic spread of HIV virus from the regions involved in the armed conflict to the rest of the country. • Population displacement may be reflected in the reduced treatment of HIV-infected individuals as patients who had to relocate because of the conflict may be more likely to reduce treatment adherence. | Implemented: Not mentioned Suggested: • National intervention policies during and at post-conflict periods should be implemented • Geographically tracing interventions should be introduced • Viral treatment therapy to those infected should be introduced all over the country • A national registry system for all infected patients to support access to care |