Documenting the Effects of Armed Conflict on Population Health

Levy, Barry S.; Sidel, Victor W.

doi:10.1146/annurev-publhealth-032315-021913

Cited by 136 publications

(72 citation statements)

References 27 publications

(20 reference statements)

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“…The already compromised healthcare sector, suffering from extensive neglect and damage, experienced another blow following the rise of ISIS (9). At present, even during a relatively peaceful and stable period, huge knowledge gaps about the health impact of wars and terrorism among civilians remain (3). The United Nations Office for the Coordination of Humanitarian Affairs (UN-OCHA) reported in December 2018 that 5.5 million people needed healthcare but lacked access to health services (39).…”

Section: Discussionmentioning

confidence: 99%

“…The Middle East (where the human toll of old and new violent conflicts has been enormous) is in an unprecedented state of flux. The events of recent decades have had a profound impact on the public health systems of many countries and, therefore, on the health of their populations (2,3). Basic infrastructure has been destroyed, health structures have collapsed, primary healthcare has been disrupted, health professionals have been killed or forced to flee, and resources have been diverted from public investment to belligerent purposes: all of these conditions are contributing both to an increased number of casualties and to the long-term health instability and frailty of these countries (4).…”

Section: Introductionmentioning

confidence: 99%

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Supporting Iraqi Kurdistan Health Authorities in Post-conflict Recovery: The Development of a Health Monitoring System

Gialloreti

Basa

Moramarco

et al. 2020

Front. Public Health

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Background: Iraq has endured several conflicts and socio-political tensions that have disrupted its public health system. Nowadays, because health data are not collected on a routine basis, the country still lacks proper statistics and, consequently, response plans to meet present and future health needs of its population. An international partnership is developing in the Iraqi Kurdistan a Health Monitoring System with the aim of supporting evidence-based health policy decisions. Methods: The pilot phase for assessing the feasibility of the programme was launched in 2015. In 2018 the implementation phase began. The first step was to choose the software platform and the coding system, as well as to identify the public hospitals (PH) and Public Health Centers (PHC) to be included in the e-health system. The technical infrastructure of each PHC or PH was updated. The staff of each center was trained in the use of the e-health system and in disease coding. Several seminars introduced regional and district health managers to the basic concepts of data-driven decision making. A local team of experts was trained to create a highly specialized staff with the objective of "training the trainers" and ensuring the future self-sufficiency of the system. Results: By September 2019, 59 PHC and PH were entering data in the Health Monitoring System, while 258 health operators (medical doctors, administrative staff, nurses, statisticians, IT and public health specialists, pharmacists) have been already trained. Currently, more than 600,000 disease events have been collected. Additionally, further 734 medical doctors, statisticians, and health managers have been trained on the basics of public health practice. The goal during the next 3 years is to reach 120 operative centers within the region, envisaging a subsequent expansion of the system to all Iraq. Emberti Gialloreti et al. Health Monitoring System in Iraq Conclusions: The creation of a functioning health monitoring system is feasible also in regions characterized by socio-political tensions. However, multiple stakeholder partnerships are essential. The provision of an e-health information system, coupled with the establishment of a team of local experts, allows the routinely and timely collection of health information, facilitating prompt responses to present and emerging needs, while guiding the formulation and evaluation of health policies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Supporting Iraqi Kurdistan Health Authorities in Post-conflict Recovery: The Development of a Health Monitoring System

Gialloreti

Basa

Moramarco

et al. 2020

Front. Public Health

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“…There is a vast literature on the health effects of war and armed conflict, and numerous reports attempt to quantify the number of deaths and casualties that they cause among general populations and armed personnel [1][2][3][4][5][6] as well as the impact on mental health of direct exposure, particularly Post-Traumatic Stress Disorder [7][8][9][10]. The other mechanisms by which violence affects health are recognized but under-studied [6], and no studies have investigated the effect of multiple discrete violent events during periods of relative calm.…”

Section: Introductionmentioning

confidence: 99%

Indirect impact of violent events on Emergency Department utilization and disease patterns

Makhlouf-Obermeyer

Sharara

El-Eid

et al. 2019

Preprint

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Background The health effects of war and armed conflict on casualties and mental health of those directly exposed has been well described, but few studies have explored the indirect health effects of violent events. This paper assesses the indirect health impact of several violent events that took place in Beirut in 2013-2014 on ED visit utilization and disease patterns. Methods As tracked by media reports, there were 9 violent events in Beirut during 2013-2014. We compared visits to the Emergency Department of a major medical center during weeks when violent events happened and weeks without such events (the preceding week and the same week in preceding years). After re-coding de-identified data from the medical records of 23,067 patients, we assessed differences in the volume of visits, severity index, and discharge diagnoses. Individual control charts were used to analyze ED visit trends post-event. Results Comparisons of weeks with violent events and weeks without such events indicate that the socio-demographic characteristics of patients who visited the Emergency Department were similar. Patients seen during violent weeks were significantly more likely to be admitted to the hospital, and to have a lower emergency severity index, indicating greater acuity of their conditions. The discharge diagnoses that were significantly higher during violent event weeks included anxiety disorders, sprains, and gastritis. Daily ED visits dropped post events. Conclusions The results indicate that violent events such as bombs, explosions, and terrorist attacks reverberate through the population, impact patterns of ED utilization immediately post-event and are associated with adverse health outcomes, even among those who are not directly affected by the events.

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“…Globally, all continents have experienced armed conflicts at some period in the past. For example, in Asia; Syria, Afghanistan and Iraq are experiencing the most violent conflicts in recent times [3][4][5][6]. In Africa; the Democratic Republic of Congo, South Sudan and the Central African Republic are experiencing protracted conflicts; and in the Americas, Mexico is experiencing criminal violence [7].…”

Section: Introductionmentioning

confidence: 99%

Health services utilisation before and during an armed conflict; Experiences from the Southwest region of Cameroon

Haddison¹,

Chia

Kagina

2019

Preprint

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BackgroundArmed conflicts are a threat to the health of populations in affected areas. The threat is either by direct injury or disruption of health services delivery and utilisation. There has been an armed 'Anglophone crisis' in the English-speaking regions of Cameroon from 2017. We hypothesized the armed conflict disrupted the utilisation of health services. We present findings of the effects of the armed conflict on health service utilisation in the Southwest region of Cameroon. MethodsA retrospective study of surveillance data was carried out between 2016 and 2018. Regional data for selected routine immunisation, reproductive health, disease surveillance and HIV/AIDS indicators were retrieved from the regional database. Data was presented as frequencies. ResultsGenerally, there was an improvement in health service utilisation indicators from 2016 to 2017 followed by a decline in 2018. The DPT3 vaccination coverage dropped from 90% in 2017 to 55% in 2018; deliveries attended by qualified personnel dropped from 46% in 2017 to 26% in 2018; the absolute number of people tested for HIV dropped from 20,3987 in 2017 to 18,3654 in 2018. ConclusionThe utilisation of health services by the population of the Southwest region was negatively affected by the armed conflict. The negative effects could have a significant impact on the population's health and potentially, affect the set global health targets such as improved vaccination coverage in all districts. Local, national, regional and global authorities must work together to develop risk mitigating interventions in settings with armed conflicts to preserve the utilisation of health services.

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Documenting the Effects of Armed Conflict on Population Health

Cited by 136 publications

References 27 publications

Supporting Iraqi Kurdistan Health Authorities in Post-conflict Recovery: The Development of a Health Monitoring System

Supporting Iraqi Kurdistan Health Authorities in Post-conflict Recovery: The Development of a Health Monitoring System

Indirect impact of violent events on Emergency Department utilization and disease patterns

Health services utilisation before and during an armed conflict; Experiences from the Southwest region of Cameroon

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