Articles

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

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

Gender-based violence in conflict and displacement: qualitative findings from displaced women in Colombia

Gender-based violence (GBV) is prevalent among, though not specific to, conflict affected populations and related to multifarious levels of vulnerability of conflict and displacement. Colombia has been marked ...

Authors: Andrea L Wirtz, Kiemanh Pham, Nancy Glass, Saskia Loochkartt, Teemar Kidane, Decssy Cuspoca, Leonard S Rubenstein, Sonal Singh and Alexander Vu

Description of a large measles epidemic in Democratic Republic of Congo, 2010–2013

Although measles mortality has declined dramatically in Sub-Saharan Africa, measles remains a major public health problem in countries like the Democratic Republic of Congo (DRC). Here, we describe the large m...

Authors: Silvia Mancini, Matthew E Coldiron, Axelle Ronsse, Benoît Kebela Ilunga, Klaudia Porten and Rebecca F Grais

Neonatal survival in complex humanitarian emergencies: setting an evidence-based research agenda

Over 40% of all deaths among children under 5 are neonatal deaths (0–28 days), and this proportion is increasing. In 2012, 2.9 million newborns died, with 99% occurring in low- and middle-income countries. Man...

Authors: Diane F Morof, Kate Kerber, Barbara Tomczyk, Joy Lawn, Curtis Blanton, Samira Sami and Ribka Amsalu

Conflict and Health: seven years of advancing science in humanitarian crises

Authors: Ruwan Ratnayake, Olivier Degomme, Bayard Roberts and Paul Spiegel

Need for a gender-sensitive human security framework: results of a quantitative study of human security and sexual violence in Djohong District, Cameroon

Human security shifts traditional concepts of security from interstate conflict and the absence of war to the security of the individual. Broad definitions of human security include livelihoods and food securi...

Authors: Parveen Kaur Parmar, Pooja Agrawal, Ravi Goyal, Jennifer Scott and P Gregg Greenough

After abduction: exploring access to reintegration programs and mental health status among young female abductees in Northern Uganda

Reintegration programs are commonly offered to former combatants and abductees to acquire civilian status and support services to reintegrate into post-conflict society. Among a group of young female abductees...

Authors: Katherine A Muldoon, Godfrey Muzaaya, Theresa S Betancourt, Mirriam Ajok, Monica Akello, Zaira Petruf, Paul Nguyen, Erin K Baines and Kate Shannon

Spinal cord injury in the emergency context: review of program outcomes of a spinal cord injury rehabilitation program in Sri Lanka

The final months of the conflict in Sri Lanka in 2009 resulted in massive displacement of the civilian population and a high volume of orthopedic trauma including spinal cord injury. In response to this need, ...

Authors: Jo C Armstrong, Brooke E Nichols, Joan M Wilson, Roy A Cosico and Leslie Shanks

Implementing a successful tuberculosis programme within primary care services in a conflict area using the stop TB strategy: Afghanistan case study

Afghanistan has faced health consequences of war including those due to displacement of populations, breakdown of health and social services, and increased risks of disease transmission for over three decades....

Authors: Khaled Seddiq, Donald A Enarson, Karam Shah, Zaeem Haq and Wasiq M Khan

Acknowledgement of manuscript reviewers 2007–2013

The editors of Conflict and Health would like to thank all our reviewers who have contributed to the journal from Volume 1 (2007) to Volume 7 (2013).

Authors: Olivier Degomme, Ruwan Ratnayake and Bayard Roberts

A national population-based assessment of 2007–2008 election-related violence in Kenya

Following the contested national elections in 2007, violence occurred throughout Kenya. The objective of this study was to assess the prevalence, characteristics, and health consequences of the 2007–2008 elect...

Authors: Kirsten Johnson, Jennifer Scott, Treny Sasyniuk, David Ndetei, Michael Kisielewski, Shada Rouhani, Susan Bartels, Victoria Mutiso, Anne Mbwayo, David Rae and Lynn Lawry

Delivery of HIV care during the 2007 post-election crisis in Kenya: a case study analyzing the response of the Academic Model Providing Access to Healthcare (AMPATH) program

Widespread violence followed the 2007 presidential elections in Kenya resulting in the deaths of a reported 1,133 people and the displacement of approximately 660,000 others. At the time of the crisis the Unit...

Authors: Suzanne Goodrich, Samson Ndege, Sylvester Kimaiyo, Hosea Some, Juddy Wachira, Paula Braitstein, John E Sidle, Jackline Sitienei, Regina Owino, Cleophas Chesoli, Catherine Gichunge, Fanice Komen, Claris Ojwang, Edwin Sang, Abraham Siika and Kara Wools-Kaloustian

An assessment of attitudes toward gender inequitable sexual and reproductive health norms in South Sudan: a community-based participatory research approach

Communities in South Sudan have endured decades of conflict. Protracted conflict exacerbated reproductive health disparities and gender inequities. This study, conducted prior to the country’s 2011 independenc...

Authors: Jennifer Scott, Sarah Averbach, Anna Merport Modest, Michele Hacker, Sarah Cornish, Danielle Spencer, Maureen Murphy and Parveen Parmar

Brief mental health interventions in conflict and emergency settings: an overview of four Médecins Sans Frontières – France programs

Mental health problems, particularly anxiety and mood disorders, are prevalent in the setting of humanitarian emergencies, both natural and man-made disasters. Evidence regarding best strategies for therapeuti...

Authors: Matthew E Coldiron, Augusto E Llosa, Thomas Roederer, German Casas and Marie-Rose Moro

The 2011 Famine in Somalia: lessons learnt from a failed response?

Famine early warning systems clearly identified the risk of famine in South Central Somalia in 2010–2011 but timely action to prevent the onset of famine was not taken. The result was large scale mortality, mo...

Authors: Andrew Seal and Rob Bailey

The association between post-traumatic stress-related symptoms, resilience, current stress and past exposure to violence: a cross sectional study of the survival of Quechua women in the aftermath of the Peruvian armed conflict

The long lasting resilience of individuals and communities affected by mass violence has not been given equal prominence as their suffering. This has often led to psychosocial interventions in post-conflict zo...

Authors: Eliana B Suarez

Measuring the incidence and reporting of violence against women and girls in liberia using the 'neighborhood method'

This paper reports on the use of a “neighborhood method” to measure the nature and incidence of violence against women and girls in post-conflict Liberia.

Authors: Lindsay Stark, Ann Warner, Heidi Lehmann, Neil Boothby and Alastair Ager

Counselling in humanitarian settings: a retrospective analysis of 18 individual-focused non-specialised counselling programmes

Médecins Sans Frontières (MSF) provides individual counselling interventions in medical humanitarian programmes in contexts affected by conflict and violence. Although mental health and psychosocial interventi...

Authors: Leslie Shanks, Cono Ariti, M Ruby Siddiqui, Giovanni Pintaldi, Sarah Venis, Kaz de Jong and Marise Denault

Syrian refugees, between rocky crisis in Syria and hard inaccessibility to healthcare services in Lebanon and Jordan

Around 3% of the world’s population (n = 214 million people) has crossed international borders for various reasons. Since March 2011, Syria has been going through state of political crisis and instability resu...

Authors: Ziad El-Khatib, David Scales, Jo Vearey and Birger C Forsberg

Comparison of HIV-related vulnerabilities between former child soldiers and children never abducted by the LRA in northern Uganda

Thousands of former child soldiers who were abducted during the prolonged conflict in northern Uganda have returned to their home communities. Programmes that facilitate their successful reintegration continue...

Authors: Sheetal Patel, Martin T Schechter, Nelson K Sewankambo, Stella Atim, Charles Oboya, Noah Kiwanuka and Patricia M Spittal

Sexual and gender-based violence in areas of armed conflict: a systematic review of mental health and psychosocial support interventions

Sexual and other forms of gender-based violence are common in conflict settings and are known risk factors for mental health and psychosocial wellbeing. We present findings from a systematic review of the acad...

Authors: Wietse A Tol, Vivi Stavrou, M Claire Greene, Christina Mergenthaler, Mark van Ommeren and Claudia García Moreno

Trauma and mental health of medics in eastern Myanmar’s conflict zones: a cross-sectional and mixed methods investigation

In conflict and disaster settings, medical personnel are exposed to psychological stressors that threaten their wellbeing and increase their risk of developing burnout, depression, anxiety, and PTSD. As lay me...

Authors: Andrew George Lim, Lawrence Stock, Eh Kalu Shwe Oo and Douglas P Jutte

Clinical care for sexual assault survivors multimedia training: a mixed-methods study of effect on healthcare providers’ attitudes, knowledge, confidence, and practice in humanitarian settings

Sexual assault is a threat to public health in refugee and conflict affected settings, placing survivors at risk for unintended pregnancy, unsafe abortion, STIs, HIV, psychological trauma, and social stigma. I...

Authors: Janel R Smith, Lara S Ho, Anne Langston, Neha Mankani, Anjuli Shivshanker and Dhammika Perera

Development of a screening tool to identify female survivors of gender-based violence in a humanitarian setting: qualitative evidence from research among refugees in Ethiopia

High levels of gender-based violence (GBV) persist among conflict-affected populations and within humanitarian settings and are paralleled by under-reporting and low service utilization. Novel and evidence-bas...

Authors: Andrea L Wirtz, Nancy Glass, Kiemanh Pham, Amsale Aberra, Leonard S Rubenstein, Sonal Singh and Alexander Vu

Piloting community-based medical care for survivors of sexual assault in conflict-affected Karen State of eastern Burma

Given the challenges to ensuring facility-based care in conflict settings, the Women’s Refugee Commission and partners have been pursuing a community-based approach to providing medical care to survivors of se...

Authors: Mihoko Tanabe, Keely Robinson, Catherine I Lee, Jen A Leigh, Eh May Htoo, Naw Integer and Sandra K Krause

Analyzing the microfoundations of human violence in the DRC - intrinsic and extrinsic rewards and the prediction of appetitive aggression

Civil wars are characterized by intense forms of violence, such as torture, maiming and rape. Political scientists suggest that this form of political violence is fostered through the provision of particular i...

Authors: Roos Haer, Lilli Banholzer, Thomas Elbert and Roland Weierstall

Nuclear war between Israel and Iran: lethality beyond the pale

The proliferation of nuclear technology in the politically volatile Middle East greatly increases the likelihood of a catastrophic nuclear war. It is widely accepted, while not openly declared, that Israel has...

Authors: Cham E Dallas, William C Bell, David J Stewart, Antonio Caruso and Frederick M Burkle Jr

Relations among appetitive aggression, post-traumatic stress and motives for demobilization: a study in former Colombian combatants

Former combatants have frequently reported that aggressive behaviour can be appetitive and appealing. This appetitive aggression (AA) may be adaptive for survival in a violent environment, as it is associated ...

Authors: Roland Weierstall, Claudia Patricia Bueno Castellanos, Frank Neuner and Thomas Elbert

Growth and development of children aged 1–5 years in low-intensity armed conflict areas in Southern Thailand: a community-based survey

A low-intensity armed conflict has been occurring for nearly a decade in southernmost region of Thailand. However, its impact on child health has not yet been investigated. This study aimed to estimate the pre...

Authors: Rohani Jeharsae, Rassamee Sangthong, Wit Wichaidit and Virasakdi Chongsuvivatwong

Family therapy sessions with refugee families; a qualitative study

Due to the armed conflicts in the Balkans in the 1990s many families escaped to other countries. The main goal of this study was to explore in more detail the complexity of various family members’ experiences ...

Authors: Gunilla Jarkman Björn, Per A Gustafsson, Gunilla Sydsjö and Carina Berterö

Rwanda – lasting imprints of a genocide: trauma, mental health and psychosocial conditions in survivors, former prisoners and their children

The 1994 genocide of the Tutsi in Rwanda left about one million people dead in a period of only three months. The present study aimed to examine the level of trauma exposure, psychopathology, and risk factors ...

Authors: Heide Rieder and Thomas Elbert

Fatal and non-fatal injuries due to intentional explosions in Nepal, 2008-2011: analysis of surveillance data

Nepal is one of the post-conflict countries affected by violence from explosive devices. We undertook this study to assess the magnitude of injuries due to intentional explosions in Nepal during 2008-2011 and ...

Authors: Oleg O Bilukha, Kristin Becknell, Hugues Laurenge, Luhar Danee and Krishna P Subedi