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 |
---|---|---|---|---|
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 |