eHealth for service delivery in conflict: a narrative review of the application of eHealth technologies in contemporary conflict settings

Abstract

The role of eHealth in conflict settings is increasingly important to address geographic, epidemiologic and clinical disparities. This study categorizes various forms of eHealth usage in conflict and aims to identify gaps in evidence to make recommendations for further research and practice. The analysis was carried out via a narrative hermeneutic review methodology. Articles that fulfilled the following screening criteria were reviewed: (1) describing an eHealth intervention in active conflict or ongoing insurgency, (2) an eHealth intervention targeting a conflict-affected population, (3) an e-learning platform for delivery in conflict settings and (4) non-interventional descriptive reviews relating to eHealth in conflict. Of the 489 papers eligible for screening, 46 merited final inclusion. Conflict settings described include Somalia, Sudan, Afghanistan, Syria, Iraq, Pakistan, Chechnya, Gaza and the Democratic Republic of Congo. Thirty-six studies described specific eHealth initiatives, while the remainder were more generic review papers exploring general principles. Analysis resulted in the elucidation of three final categories of current eHealth activity in conflict-affected settings: (1) eHealth for clinical management, (2) e-learning for healthcare in conflict and (3) eHealth for information management in conflict. Obvious disparities in the distribution of technological dividends from eHealth in conflict are demonstrated by this review. Conflict-affected populations are predominantly subject to ad hoc and voluntary initiatives delivered by diaspora and civil society organizations. While the deployment of eHealth technologies in conflict settings is increasingly normalized, there is a need for further clarification of global norms relating to practice in this context.

Accuracy and Validity of a Single Inertial Measurement Unit-Based System to Determine Upper Limb Kinematics for Medically Underserved Populations

“…Of these fragile and conflict-affected countries, 50% are classified as having low-income economies, and 31.6% are classified as having lower-middle-income economies ( The World Bank, Data, 2022 ), which together account for 880 million people, or 11.10% of the world’s population. That said, technology-enabled solutions that are well-planned and consider the context-specific barriers (e.g., geographical accessibility, public acceptability of services, adequacy of infrastructure, attacks on healthcare facilities) can make a significant impact on the health needs of the target population ( Saleh et al, 2018 ; Bowsher et al, 2021 ).…”

The Development of Electronic Health and Artificial Intelligence in Surgery after the SARS-CoV-2 Pandemic—A Scoping Review

“…Subsequently, eHealth and artificial intelligence adoption in Syria cannot occur, given the increased levels of conflict in the locality. Bowsher et al insisted that although the deployment of electronic health has increased during the pandemic, researchers still need to clarify the global norms applicable in the worldwide realm to ensure the prevalence of eHealth and AI in tumultuous regions [ 46 ].…”

The role of digital innovation in improving healthcare quality in extreme adversity: an interpretative phenomenological analysis study

“…14 Indeed, literature shows that initiatives for digital health solutions in areas of extreme adversity are largely initiated on an ad hoc basis, without a structured process for sustained delivery. 22 More specifically, it has been suggested that contextual pressures, such as immediate needs in unstable conflict conditions, drive providers and organisations to deliver ad hoc, unregulated services. 22 Certain elements are required for a successful scale-up of digital health initiatives.…”

“…22 More specifically, it has been suggested that contextual pressures, such as immediate needs in unstable conflict conditions, drive providers and organisations to deliver ad hoc, unregulated services. 22 Certain elements are required for a successful scale-up of digital health initiatives. 14 These include the ability to plan for sustainability upon initial launch, identify the real needs of the target audience, collaborate with other similar organisations to avoid duplication, engage end users in the development to support uptake, align programs with existing priorities, and maintain flexibility to adapt to changing needs.…”

“…21 Areas of extreme adversity, such as conflict settings, are particularly underrepresented in the literature and, therefore, are excluded from reaping the health benefits new digital solutions offer. 22 However, there is a responsibility to leverage the features of these innovations that can improve access and deliver an appropriate level of quality care for patients in such settings. As the quality agenda extends to areas where it is needed most, it is necessary to develop the evidence base of how quality can be improved and what tools are available to support this.…”