BackgroundViolent attacks on and interferences with hospitals, ambulances, health workers, and patients during conflict destroy vital health services during a time when they are most needed and undermine the long-term capacity of the health system. In Syria, such attacks have been frequent and intense and represent grave violations of the Geneva Conventions, but the number reported has varied considerably. A systematic mechanism to document these attacks could assist in designing more protection strategies and play a critical role in influencing policy, promoting justice, and addressing the health needs of the population.Methods and findingsWe developed a mobile data collection questionnaire to collect data on incidents of attacks on healthcare directly from the field. Data collectors from the Syrian American Medical Society (SAMS), using the tool or a text messaging system, recorded information on incidents across four of Syria’s northern governorates (Aleppo, Idleb, Hama, and Homs) from January 1, 2016, to December 31, 2016. SAMS recorded a total of 200 attacks on healthcare in 2016, 102 of them using the mobile data collection tool. Direct attacks on health facilities comprised the majority of attacks recorded (88.0%; n = 176). One hundred and twelve healthcare staff and 185 patients were killed in these incidents. Thirty-five percent of the facilities were attacked more than once over the data collection period; hospitals were significantly more likely to be attacked more than once compared to clinics and other types of healthcare facilities. Aerial bombs were used in the overwhelming majority of cases (91.5%). We also compared the SAMS data to a separate database developed by Physicians for Human Rights (PHR) based on media reports and matched the incidents to compare the results from the two methods (this analysis was limited to incidents at health facilities). Among 90 relevant incidents verified by PHR and 177 by SAMS, there were 60 that could be matched to each other, highlighting the differences in results from the two methods. This study is limited by the complexities of data collection in a conflict setting, only partial use of the standardized reporting tool, and the fact that limited accessibility of some health facilities and workers and may be biased towards the reporting of attacks on larger or more visible health facilities.ConclusionsThe use of field data collectors and use of consistent definitions can play an important role in the tracking incidents of attacks on health services. A mobile systematic data collection tool can complement other methods for tracking incidents of attacks on healthcare and ensure the collection of detailed information about each attack that may assist in better advocacy, programs, and accountability but can be practically challenging. Comparing attacks between SAMS and PHR suggests that there may have been significantly more attacks than previously captured by any one methodology. This scale of attacks suggests that targeting of healthcare in Syria is systematic and...

This study shows that, in general, drinking and driving remains a problem in Cambodia. A multi-pronged, coordinated approach is needed to effectively address this issue. Such an approach ought to include social marketing and public education campaigns, enhanced enforcement, and programs that either limit the number of drinks to drivers or those that provide alternatives to drinking and driving.

This study describes sex trafficking and associations with violence and health among female migrants in the sex industry in Mae Sot, Thailand. The mixed-methods study included a qualitative interview phase ( n = 10), followed by a cross-sectional survey phase ( n = 128). Entry via trafficking (force, fraud, or coercion [FFC], or as minors) was prevalent (76.6%), primarily FFC (73.4%). FFC was associated with inconsistent condom use, inability to refuse clients, poor health, and anxiety. Past-year violence was normative including client sexual violence (66.4%), client coercion for condom nonuse (> 95%), and police extortion (56%). Working conditions enabled violence irrespective of mode of entry. Profound unmet needs exist for safety and access to justice irrespective of trafficking history.

BackgroundWith 90% of the burden of injuries concentrated in low- and middle-income countries (LMICs), the impact on individuals, families, and society, especially in the case of non-fatal injuries, is exacerbated by the absence of insurance or social support mechanisms. There is a dearth of information in the literature on the occurrence of non-fatal injuries, and their long-term consequences. This study aims to understand the health (disability), social and economic impact of injuries in LMICs.MethodsThis is a prospective cohort study of 4200 moderate to severely injured patients at seven government hospitals in four LMICs (Cambodia, Kenya, Malaysia, and Vietnam). We administer a baseline and four follow-up surveys at home (at 1, 2, 4, and 12 months after discharge) to participants about their injury, functioning and disability, medical costs, employment, household composition and roles, as well as support systems (social & economic).ResultsThe on-going study has enrolled 2293 individuals at the seven hospitals (Cambodia: 595, Kenya: 320, Malaysia: 284, and Vietnam: 1094). Participants are 72–84% male, with an average age of 30–42 years. The top cause of injury across all countries is road traffic injury (47–72%). The second leading cause is falls (17–20%), except for Kenya, where assaults rank second (20%) and falls rank third (16%). Changes in levels of disability, health care costs, productivity, household economic status, and roles of family members, as well as the respective influencing factors will be examined using marginal models with Generalised Estimating Equations (GEE) approach.ConclusionsInjury predominantly affects young males at their prime, having a significant impact not only on themselves, but their family as well as the society. This study will lead to a better understanding of the far reaching health, social, and economic impact of injuries. Data collected could be used to guide policy and programs in each of the implementing countries.

BackgroundOver the last decade, the number of international migrants has increased by more than 60% globally (150 to 232 million). Generally low-skilled or un-skilled, they are concentrated in “3D” (dirty, dangerous, difficult) jobs in the unregulated sector where they face increased risk of illness, injury and abuse. As international migration rates rise, so does the need for the generation of high-quality data. To date, research has centred predominately on the regulated sector, posing a barrier to the development of effective services for this large, yet overlooked population.MethodsThis mixed-methods study (Oct. 2013–Jul. 2015) sought to increase the evidence-base on the occupational health and safety of migrants in Kuala Lumpur, Malaysia. More than 2,500 case files documenting labour rights violations were analysed to identify trends and patterns from 2005 to 2015. In-depth interviews (n = 58) and focus groups (n = 6) were conducted with migrants in the manufacturing, service, construction and domestic work sectors to develop a more nuanced understanding of their experiences with occupational injury and contextual factors impacting care. Interviews covered a range of topics were conducted in a structured, but open-ended manner.ResultsFindings illustrate that the majority of workers migrated from Bangladesh (43.7%), Indonesia (12.8%) and Nepal (7.5%). 91.3% experienced working conditions different from what had been promised and only 18.7% had a regular day off. 88.8% did not possess their passports and 4.7% could gain access to them if necessary. Females were more likely to experience verbal (11.5% vs. 65%) and physical (29.8% vs. 17.6%) abuse.ConclusionsFindings illustrate the urgent need to build the evidence base on the occupational health and safety risks faced by migrant workers. This information is critical to improving the health of migrant workers globally.