Articles

Coincident polio and Ebola crises expose similar fault lines in the current global health regime

In 2014, the World Health Organization (WHO) declared two "public health emergencies of international concern", in response to the worldwide polio situation and the Ebola epidemic in West Africa respectively. ...

Authors: Philippe Calain and Caroline Abu Sa’Da

Conflict, displacement and sexual and reproductive health services in Mali: analysis of 2013 health resources availability mapping system (HeRAMS) survey

Little is known specifically about the effects of conflict and displacement on provision of sexual and reproductive health (SRH) services. We aimed to understand the association between levels of conflict and ...

Authors: Özge Tunçalp, Ibrahima Socé Fall, Sharon J. Phillips, Inga Williams, Massambou Sacko, Ousmane Boubacar Touré, Lisa J. Thomas and Lale Say

Effects of a community scorecard on improving the local health system in Eastern Democratic Republic of Congo: qualitative evidence using the most significant change technique

More than a decade of conflict has weakened the health system in the Democratic Republic of Congo and decreased its ability to respond to the needs of the population. Community scorecards have been conceived a...

Authors: Lara S. Ho, Guillaume Labrecque, Isatou Batonon, Viviana Salsi and Ruwan Ratnayake

A pilot study of a portable hand washing station for recently displaced refugees during an acute emergency in Benishangul-Gumuz Regional State, Ethiopia

Diarrheal disease is a common cause of morbidity and mortality. Displaced populations are especially vulnerable due to overcrowded camps and limited access to water and sanitation facilities, increasing the ri...

Authors: Farah Husain, Colleen Hardy, Lemlem Zekele, David Clatworthy, Curtis Blanton and Thomas Handzel

Impact of service provision platforms on maternal and newborn health in conflict areas and their acceptability in Pakistan: a systematic review

Various models and strategies have been implemented over the years in different parts of the world to improve maternal and newborn health (MNH) in conflict affected areas. These strategies are based on specifi...

Authors: Zohra S. Lassi, Wafa Aftab, Shabina Ariff, Rohail Kumar, Imtiaz Hussain, Nabiha B. Musavi, Zahid Memon, Sajid B. Soofi and Zulfiqar A. Bhutta

Perceptions, attitude and use of family planning services in post conflict Gulu district, northern Uganda

Northern Uganda was severely affected by two decades of civil war that led to the displacement and encampment of an estimated 1.6 million inhabitants. The objective of this study was to assess community perspe...

Authors: Christopher Garimoi Orach, George Otim, Juliet Faith Aporomon, Richard Amone, Stephen Acellam Okello, Beatrice Odongkara and Henry Komakech

Ebola in the context of conflict affected states and health systems: case studies of Northern Uganda and Sierra Leone

Ebola seems to be a particular risk in conflict affected contexts. All three of the countries most affected by the 2014-15 outbreak have a complex conflict-affected recent history. Other major outbreaks in the...

Authors: Barbara McPake, Sophie Witter, Sarah Ssali, Haja Wurie, Justine Namakula and Freddie Ssengooba

Mental health of displaced and returnee populations: Insight from the Sri Lankan post-conflict experience

The month of May 2015 marked the sixth year since the end of conflict in Sri Lanka. The cause of death, destruction and displacement, three decades of conflict has had a major impact on health, especially on m...

Authors: Chesmal Siriwardhana

Integrating staff well-being into the Primary Health Care system: a case study in post-conflict Kosovo

Staff well-being including stress awareness and stress management skills is usually not a priority in (mental) health policies. In Kosovo, the level of stress amongst primary health care (PHC) professionals is...

Authors: Albertien van der Veen, Tineke van Pietersom, Barbara Lopes Cardozo, Feride Rushiti, Genc Ymerhalili and Ferid Agani

Mechanisms underpinning interventions to reduce sexual violence in armed conflict: A realist-informed systematic review

Sexual violence is recognised as a widespread consequence of armed conflict and other humanitarian crises. The limited evidence in literature on interventions in this field suggests a need for alternatives to ...

Authors: Jo Spangaro, Chinelo Adogu, Anthony B. Zwi, Geetha Ranmuthugala and Gawaine Powell Davies

Assessments of health services availability in humanitarian emergencies: a review of assessments in Haiti and Sudan using a health systems approach

Assessing the availability of health services during humanitarian emergencies is essential for understanding the capacities and weaknesses of disrupted health systems. To improve the consistency of health faci...

Authors: Jason W. Nickerson, Janet Hatcher-Roberts, Orvill Adams, Amir Attaran and Peter Tugwell

Analyzing Katana referral hospital as a complex adaptive system: agents, interactions and adaptation to a changing environment

This study deals with the adaptation of Katana referral hospital in Eastern Democratic Republic of Congo in a changing environment that is affected for more than a decade by intermittent armed conflicts. His o...

Authors: Hermès Karemere, Nathalie Ribesse, Bruno Marchal and Jean Macq

“Impact of and response to increased tuberculosis prevalence among Syrian refugees compared with Jordanian tuberculosis prevalence: case study of a tuberculosis public health strategy”

By the summer of 2014, the Syrian crisis resulted in a regional humanitarian emergency with 2.9 million refugees, including 608,000 in Jordan. These refugees access United Nations High Commissioner for Refugee...

Authors: Susan T. Cookson, Hiba Abaza, Kevin R. Clarke, Ann Burton, Nadia A. Sabrah, Khaled A. Rumman, Nedal Odeh and Marwan Naoum

Access to healthcare for the most vulnerable migrants: a humanitarian crisis

A series of Médecins Sans Frontières projects for irregular migrants over the past decade have consistently documented high rates of 14 physical and sexual trauma, extortion and mental illness amidst severe he...

Authors: Kevin Pottie, Jorge Pedro Martin, Stephen Cornish, Linn Maria Biorklund, Ivan Gayton, Frank Doerner and Fabien Schneider

Diabetes in an emergency context: the Malian case study

The World Health Organization proposes 6 building blocks for health systems. These are vulnerable to challenges in many contexts. Findings from a 2004 assessment of the health system in Mali for diabetes care ...

Authors: Stéphane Besançon, Ibrahima-Soce Fall, Mathieu Doré, Assa Sidibé, Olivier Hagon, François Chappuis and David Beran

A cross-case comparative analysis of international security forces’ impacts on health systems in conflict-affected and fragile states

Destruction of health systems in fragile and conflict-affected states increases civilian mortality. Despite the size, scope, scale and political influence of international security forces intervening in fragil...

Authors: Margaret Bourdeaux, Vanessa Kerry, Christian Haggenmiller and Karlheinz Nickel

A tool to improve competence in the management of emergency patients by rural clinic health workers: a pilot assessment on the Thai-Myanmar border

Shoklo Malaria Research Unit has been providing health care in remote clinics on the Thai-Myanmar border to refugee and migrant populations since 1986 and 1995, respectively. Clinics are staffed by local healt...

Authors: Lilian Stanley, Thaw Htwe Min, Hla Hla Than, Marie Stolbrink, Kathryn McGregor, Cindy Chu, François H Nosten and Rose McGready

Health status and health needs of older refugees from Syria in Lebanon

The flight of Syrian and Palestinian families into Lebanon from Syria included a number of older refugees. This study sought to characterize the physical and emotional conditions, dietary habits, coping practi...

Authors: Jonathan Strong, Christopher Varady, Najla Chahda, Shannon Doocy and Gilbert Burnham

Health in the service of state-building in fragile and conflict affected contexts: an additional challenge in the medical-humanitarian environment

Global health policy and development aid trends also affect humanitarian health work. Reconstruction, rehabilitation and development initiatives start increasingly earlier after crisis, unleashing tensions bet...

Authors: Mit Philips and Katharine Derderian

Neuropsychiatric disorders among Syrian and Iraqi refugees in Jordan: a retrospective cohort study 2012–2013

The burden of neuropsychiatric disorders in refugees is likely high, but little has been reported on the neuropsychiatric disorders that affect Syrian and Iraqi refugees in a country of first asylum. This anal...

Authors: Erica D McKenzie, Paul Spiegel, Adam Khalifa and Farrah J Mateen

Advancing reproductive health on the humanitarian agenda: the 2012-2014 global review

Authors: Sarah K Chynoweth

Availability and distribution of human resources for provision of comprehensive emergency obstetric and newborn care in Afghanistan: a cross-sectional study

For over a decade, Afghanistan’s Ministry of Public Health and its international development partners have invested in strengthening the national health workforce and establishing a system of primary health ca...

Authors: Manizha Faqir, Partamin Zainullah, Hannah Tappis, Jaime Mungia, Sheena Currie and Young Mi Kim

An assessment of antenatal care among Syrian refugees in Lebanon

After more than three years of violence in Syria, Lebanon hosts over one million Syrian refugees creating significant public health concerns. Antenatal care delivery to tens of thousands of pregnant Syrian ref...

Authors: Matthew Benage, P Gregg Greenough, Patrick Vinck, Nada Omeira and Phuong Pham

Assessing the experiences of intra-uterine device users in a long-term conflict setting: a qualitative study on the Thailand-Burma border

In Burma, severe human rights violations, civil conflict, and the persecution of ethnic and linguistic minority populations has resulted in the displacement of millions of people, many of whom now reside as in...

Authors: Jillian Gedeon, Saw Nanda Hsue, Meredith Walsh, Cari Sietstra, Hay MarSan and Angel M Foster

Comparison of impact and cost-effectiveness of rotavirus supplementary and routine immunization in a complex humanitarian emergency, Somali case study

A humanitarian emergency involves a complete breakdown of authority that often disrupts routine health care delivery, including immunization. Diarrheal diseases are a principal cause of morbidity and mortality...

Authors: Lisa M Gargano, Jacqueline E Tate, Umesh D Parashar, Saad B Omer and Susan T Cookson

Acknowledgement of manuscript reviewers 2014

The editors of Conflict and Health would like to thank all our reviewers who have contributed to the journal in Volume 8 (2014).

Authors: Olivier Degomme, Ruwan Ratnayake, Bayard Roberts, Ines Keygnaert, Adrianna Murphy and An-Sofie Van Parys

Mental health care in Nepal: current situation and challenges for development of a district mental health care plan

Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There...

Authors: Nagendra P Luitel, Mark JD Jordans, Anup Adhikari, Nawaraj Upadhaya, Charlotte Hanlon, Crick Lund and Ivan H Komproe

Exploring the influence of the Global Fund and the GAVI Alliance on health systems in conflict-affected countries

Global Health Initiatives (GHIs) respond to high-impact communicable diseases in resource-poor countries, including health systems support, and are major actors in global health. GHIs could play an important r...

Authors: Preeti Patel, Rachael Cummings and Bayard Roberts

Reproductive health services for Syrian refugees in Zaatri Camp and Irbid City, Hashemite Kingdom of Jordan: an evaluation of the Minimum Initial Services Package

The Minimum Initial Services Package (MISP) for reproductive health, a standard of care in humanitarian emergencies, is a coordinated set of priority activities developed to prevent excess morbidity and mortal...

Authors: Sandra Krause, Holly Williams, Monica A Onyango, Samira Sami, Wilma Doedens, Noreen Giga, Erin Stone and Barbara Tomczyk

Progress and gaps in reproductive health services in three humanitarian settings: mixed-methods case studies

Reproductive health (RH) care is an essential component of humanitarian response. Women and girls living in humanitarian settings often face high maternal mortality and are vulnerable to unwanted pregnancy, un...

Authors: Sara E Casey, Sarah K Chynoweth, Nadine Cornier, Meghan C Gallagher and Erin E Wheeler

Tracking humanitarian funding for reproductive health: a systematic analysis of health and protection proposals from 2002-2013

The Inter-agency Working Group on Reproductive Health in Crises conducted a ten-year global evaluation of reproductive health in humanitarian settings. This paper examines proposals for reproductive health act...

Authors: Mihoko Tanabe, Kristen Schaus, Sonia Rastogi, Sandra K Krause and Preeti Patel

Evaluations of reproductive health programs in humanitarian settings: a systematic review

Provision of reproductive health (RH) services is a minimum standard of health care in humanitarian settings; however access to these services is often limited. This systematic review, one component of a globa...

Authors: Sara E Casey

Implementing people-centred health systems governance in 3 provinces and 11 districts of Afghanistan: a case study

Previous studies show that health systems governance influences health system performance and health outcomes. However, there are few examples of how to implement and monitor good governing practices in fragil...

Authors: Zelaikha Anwari, Mahesh Shukla, Basir Ahmad Maseed, Ghulam Farooq Mukhlis Wardak, Sakhi Sardar, Javid Matin, Ghulam Sayed Rashed, Sayed Amin Hamedi, Hedayatullah Sahak, Abdul Hakim Aziz, Mariah Boyd-Boffa and Reshma Trasi

Lessons learnt from coordinating emergency health response during humanitarian crises: a case study of implementation of the health cluster in northern Uganda

Between the late 1980s and 2000s, Northern Uganda experienced over twenty years of armed conflict between the Government of Uganda and Lord’s Resistance Army. The resulting humanitarian crisis led to displacem...

Authors: Olushayo Olu, Abdulmumini Usman, Solomon Woldetsadik, Dick Chamla and Oladapo Walker

Community health workers of Afghanistan: a qualitative study of a national program

Afghanistan is a country that has been in conflict for decades, resulting in the destruction of much of its social infrastructure including the health system. In 2003, after the intervention of US-led NATO for...

Authors: Said Ahmad Maisam Najafizada, Ronald Labonté and Ivy Lynn Bourgeault

Treating drug-resistant tuberculosis in a low-intensity chronic conflict setting in India

The eastern part of India has been affected by an ongoing low-intensity conflict between government forces and armed Maoist groups, known as Naxalites. Since 2006, Médecins Sans Frontières (MSF) has been provi...

Authors: Edward Armstrong, Mrinalini Das, Homa Mansoor, Ramesh B Babu and Petros Isaakidis

Evaluating the use of locally-based health facility assessments in Afghanistan: a pilot study of a novel research method

Through the Balanced Scorecard program there have been independent, annual and nationwide assessments of the Afghan health system from 2004 to 2013. During this period, Afghanistan remained in a dynamic state ...

Authors: Jack S Rowe, Kayhan Natiq, Olakunle Alonge, Shivam Gupta, Anubhav Agarwal and David H Peters

Measurement of attacks and interferences with health care in conflict: validation of an incident reporting tool for attacks on and interferences with health care in eastern Burma

Attacks on health care in armed conflict and other civil disturbances, including those on health workers, health facilities, patients and health transports, represent a critical yet often overlooked violation ...

Authors: Rohini J Haar, Katherine HA Footer, Sonal Singh, Susan G Sherman, Casey Branchini, Joshua Sclar, Emily Clouse and Leonard S Rubenstein

Conflict, forced displacement and health in Sri Lanka: a review of the research landscape

Sri Lanka has recently emerged from nearly three decades of protracted conflict, which came to an end five years ago in 2009. A number of researchers have explored the devastating effect the conflict has had o...

Authors: Chesmal Siriwardhana and Kolitha Wickramage

Engaging frontline health providers in improving the quality of health care using facility-based improvement collaboratives in Afghanistan: case study

Access to health services in Afghanistan has expanded in the last decade; however, gaps in care quality and outcomes of care remain a challenge. Recognizing these gaps, in 2009 the USAID Health Care Improvemen...

Authors: Mirwais Rahimzai, Ahmad Jan Naeem, Silvia Holschneider and Ahmad Kamran Hekmati

The “empty void” is a crowded space: health service provision at the margins of fragile and conflict affected states

Definitions of fragile states focus on state willingness and capacity to ensure security and provide essential services, including health. Conventional analyses and subsequent policies that focus on state-deli...

Authors: Peter S Hill, Enrico Pavignani, Markus Michael, Maurizio Murru and Mark E Beesley

Health systems and gender in post-conflict contexts: building back better?

The post-conflict or post-crisis period provides the opportunity for wide-ranging public sector reforms: donors fund rebuilding and reform efforts, social norms are in a state of flux, and the political climat...

Authors: Valerie Percival, Esther Richards, Tammy MacLean and Sally Theobald

Human resource management in post-conflict health systems: review of research and knowledge gaps

In post-conflict settings, severe disruption to health systems invariably leaves populations at high risk of disease and in greater need of health provision than more stable resource-poor countries. The health...

Authors: Edward Roome, Joanna Raven and Tim Martineau

Development of a scale to measure individuals’ ratings of peace

The evolving concept of peace-building and the interplay between peace and health is examined in many venues, including at the World Health Assembly. However, without a metric to determine effectiveness of int...

Authors: Howard Zucker, Roy Ahn, Samuel Justin Sinclair, Mark Blais, Brett D Nelson and Thomas F Burke

Expansion of health facilities in Iraq a decade after the US-led invasion, 2003–2012

In the last few decades, Iraq’s health care capacity has been severely undermined by the effects of different wars, international sanctions, sectarian violence and political instability. In the aftermath of th...

Authors: Valeria Cetorelli and Nazar P Shabila

Fragile and conflict affected states: report from the Consultation on Collaboration for Applied Health Research and Delivery

Fragile and Conflict Affected States present difficult contexts to achieve health system outcomes and are neglected in health systems research. This report presents key debates from the Consultation of the Col...

Authors: Joanna Raven, Tim Martineau, Eleanor MacPherson, Amuda Baba Dieu-Merci, Sarah Ssali, Steve Torr and Sally Theobald

Interpersonal psychotherapy versus treatment as usual for PTSD and depression among Sichuan earthquake survivors: a randomized clinical trial

Without effective treatment, PTSD and depression can cause persistent disability in disaster-affected populations.

Authors: Rui Fang Jiang, Hui Qi Tong, Kevin L Delucchi, Thomas C Neylan, Qijia Shi and Susan M Meffert

A systematic review of resilience and mental health outcomes of conflict-driven adult forced migrants

The rising global burden of forced migration due to armed conflict is increasingly recognised as an important issue in global health. Forced migrants are at a greater risk of developing mental disorders. Howev...

Authors: Chesmal Siriwardhana, Shirwa Sheik Ali, Bayard Roberts and Robert Stewart

Women’s perceptions of effects of war on intimate partner violence and gender roles in two post-conflict West African Countries: consequences and unexpected opportunities

The aim of this paper is to explore women’s perceptions of the causes of intimate partner violence (IPV) in West Africa, and the ways in which they understand these causes to interact with the experiences of war.

Authors: Rebecca Horn, Eve S Puffer, Elisabeth Roesch and Heidi Lehmann

A window of opportunity for reform in post-conflict settings? The case of Human Resources for Health policies in Sierra Leone, 2002–2012

It is recognized that decisions taken in the early recovery period may affect the development of health systems. Additionally, some suggest that the immediate post-conflict period may allow for the opening of ...

Authors: Maria Paola Bertone, Mohamed Samai, Joseph Edem-Hotah and Sophie Witter