Lebanon, identified as a Fragility, Conflict and Violence (FCV) state by the World Bank, is enduring one of the world's worst economic crises since the mid-19th century. 1 Also known as the Lebanese Republic, it is one of the most densely populated countries in the Mediterranean area bound northeast by Syria, and south by Israel. 1,2 In 2020, GDP shrunk by 20.3% amounting to US$33 billion loss, whereas GDP per capita decreased by 40%. 1 Additionally, inflation has averaged to 84.3%. 1 This economic crisis is projected to be worse in 2021 with an expected 9.5% contraction in GDP. 1 Coupled with a 6.7% decrease in GDP in 2019 and a loss of US$55 billion in 2018, the economic impacts are catastrophic, especially for healthcare workers (HCW). 1 Besides this, the Lebanese pound has lost 81% value since 2019, 3 marking high inflation all whilst coping with a pandemic, recovering from the Beirut Port explosion, and experiencing social unrest. 4 The Beirut Port explosion, which rendered half of the capital's healthcare centres non-functional brought new challenges to health care. 4 Not only this, poverty has increased by 27% from 2019 to 2020. 3 Fiscal mismanagement, a weak healthcare system, inflation, higher rates of poverty, social unrest, scarcity of resources, increasing workload and previous traumas have challenged HCWs trying to battle a pandemic in Lebanon, severely affecting their mental health. 3 Since 2019, 1000 of 15,000 doctors have left Lebanon to neighbouring Iraq and other countries, and alone at American University Beirut Medical Centre in Beirut, 40% emergency staff and 50% nurses have left. 5 As a result of this crisis, HCWs are experiencing a deduction in their salary that amounts to a couple thousand dollars a year. 5 A country that primarily relies on import (80% of medications in Lebanon are imported), the crisis has impacted availability of essential healthcare equipment, and has exacerbated workload for HCWs grappling with financial stress, and insecurity further fuelling their anxieties and contributing to burnout. [4][5][6] In addition, there are only 40 HCWs per 10 ,000 people in Lebanon, reported in 2018 prior to the economic crisis, which contrasts with WHO's requirement of 4.45 HCWs per 1000 people. 3 Mental health needs are poorly addressed as there are only 60 psychiatrists and 100 psychologists per 4 million people, and the country has no national mental health policy. 6 This not only complicates availability of mental health services, it creates issues for a healthcare system that is rapidly losing all its frontline workers. 3 Thus, the aim of this paper is to address the mental health crisis faced by HCWs in Lebanon, the implications of it and provide some recommendations. | DISCUSSIONMajority of the Lebanese people including frontline healthcare workers, elderly, juveniles and grownups suffer from alarming levels of anxiety and stress due to occasional periods of violence, specifically bombings in civilian areas, and political and economic instability. 7 Such pre-existing challenges h...

ABSTRACT. The United Nations has declared Yemen as the world’s worst humanitarian crisis with 21 million people in need of humanitarian assistance. Due to the convergence of severe economic instability exacerbated by the COVID-19 pandemic, stifling war, and spiking food prices, the Yemeni people are at the brink of famine with women and children especially malnourished. Desperate to feed their families, civilians are forced to resort to begging, participate in child marriages, or plunge into debt. An inflated currency has significantly diminished the purchasing power of the Yemeni population, and COVID-19 restrictions have made acquisition of food and essential commodity imports arduous. Immediate action by global and local governments is essential to prevent the deaths of thousands of people in the wake of severe food scarcity.

Pakistan is currently facing two outbreaks, dengue and COVID-19; both have strained its healthcare system resulting in multiple concerns including the co-diagnosis of two. Due to poor healthcare capacity, low vaccination rate, increasing COVID-19 variants, socioeconomic disparities, and misinformation, it is inevitable that implications will prove to be damaging to both healthcare workers and civilians. Among these challenges, it is important to note the need for stronger epidemiological surveillance for both COVID-19 and dengue and the implementation of public health measures without endangering sources of livelihood. To sustain this, cooperation between WHO and Pakistan's government must continue through smart lockdowns, dengue awareness campaigns, and double laboratory procedures.

BackgroundVaccine hesitancy (VH) is prevalent in conflict zones due to a lack of essential resources and knowledge, thereby escalating the coronavirus disease of 2019 (COVID-19) cases in these territories. This has resulted in a higher incidence of cases from exposure to a single COVID-19 positive case and further burdens the health care system of conflict zones which are already on the brink of collapsing.AimThis narrative review aims to determine VH to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in five conflict zones that include Somalia, Yemen, Palestine, Syria, and Afghanistan.MethodologyA Boolean search was carried out in MEDLINE-PubMed from inception till 6 June 2022. The search was performed by using the following keywords: “(SARS-CoV-2 OR covid OR covid 19) AND (vaccine hesitancy OR covid vaccine acceptance OR intention to vaccinate) AND (Syria OR Yemen OR Palestine OR Afghanistan OR Somalia”). The full text of all relevant articles in English along with their supplementary material was extracted.ResultsAll the included studies reported at least 30% or more increase in vaccine hesitancy among conflict settings. VH was mostly due to a lack of available resources, lack of appropriate knowledge, and believing misleading rumors about the vaccine.DiscussionConsidering the massive amount of reluctance among people residing in conflict zones, the need to take effective measures against VH is undoubtedly apparent. This can be accomplished by carrying out mass vaccinations by the governments and proper health education through raising the public awareness regarding vaccines, thereby eliminating rumors that exacerbate the fear of adverse effects.ConclusionThe approach described in this article to combat VH can be implemented to increase vaccination rates and significantly alleviate R0 across the globe.

No abstract

No abstract

Healthcare workers (HCWs) have faced an increased amount of mental health struggles amidst the COVID-19 pandemic. However, those in conflict-based settings with fragile healthcare systems meet additional challenges. This study reviews violence, conflict and mental health among HCWs in five countries: Syria, Palestine, Yemen, Afghanistan and Lebanon. Our study reports that HCWs are targeted by violence, bombings, mistreatment and different forms of abuse, including verbal and physical. With the additional burdens of the pandemic including prolonged working hours, limited resources and insufficient humanitarian aid, the healthcare workers fall victim to increased levels of burnout and mental illnesses. The situation leads to dire consequences on their personal lives and professional development, compelling them to quit their job or country all together. Although healthcare workers remain resilient in these conflict-based settings, immediate interventions are required to prevent violence against them and cater to their rapidly declining mental health.

Decades of political turmoil and stifling war, among other issues, has turned Afghanistan into the world's largest humanitarian crisis. Just 4 months after the Taliban seized control, the majority of the Afghan population face starvation, with >3.3 million children unable to afford basic food resources, leading to dozens of deaths every week. Restrictions on humanitarian assistance, withholding of vital food supplies and inadequate medical care play a major role in exacerbating the rates of malnutrition in the vulnerable paediatric population. Global interference is warranted to avoid unfathomable consequences in mitigating this public health catastrophe.