The Development of Civilian Emergency Medical Care During an Insurgency: Current Status and Future Outlook in Iraq

Donaldson, Ross I.; Hasson, Tariq; Aziz, Sharaf; Ansari, Waleed; Evans, Gerald E.

doi:10.1016/j.annemergmed.2009.12.028

Cited by 6 publications

(12 citation statements)

References 10 publications

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“…In particular, while a large number of physicians felt safe at home and in the general hospital facilities, they found the ED to be particularly unsafe. This is consistent with anecdotal reports of safety concerns within the EDs, 16 now supported by the exceedingly high numbers of reported assaults on ED staff members in our survey.…”

Section: Discussionsupporting

confidence: 92%

“…There was a wide range of training backgrounds, with approximately 20% of respondents consisting of current Iraqi EM residents who were scheduled to take the Arab EM boards upon completion of residency 16 . Of the total respondents, only 63% had performed endotracheal intubation at least once before.…”

Section: Resultsmentioning

confidence: 99%

“…Similar to other conflict-stricken areas, Iraq's national health services have suffered significant deterioration due to this violence 16 . Indeed, insurgents and criminal gangs have purposefully targeted Iraqi physicians in the past, causing a significant exodus from the country 16 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Survey of National Physicians Working in an Active Conflict Zone: The Challenges of Emergency Medical Care in Iraq

Donaldson

Shanovich

Shetty

et al. 2012

Prehosp. Disaster med.

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Section: Discussionsupporting

confidence: 92%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A Survey of National Physicians Working in an Active Conflict Zone: The Challenges of Emergency Medical Care in Iraq

Donaldson

Shanovich

Shetty

et al. 2012

Prehosp. Disaster med.

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“…These studies found that conflict negatively affect the education and training of health workers leading to inadequate competencies, lower quality of education and limited professional development [ 20 - 23 ]. The training areas commonly tackled by the papers were emergency medicine, trauma care, first aid and midwifery [ 20 , 24 - 29 ]. The training were mainly provided by international aid organizations and through distant learning such as tele-education [ 20 , 23 , 28 - 31 ].…”

Section: Resultsmentioning

confidence: 99%

Health Care Workers in the setting of the “Arab Spring”: a scoping review for the Lancet-AUB Commission on Syria

Bou-Karroum

Daou

Nomier

et al. 2018

Journal of Global Health

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Background“Health Care Workers in Conflict Areas” emerged as one of the priority themes for a Lancet Commission addressing health in conflict. The objective of our study was to conduct a scoping review on health workers in the setting of the Syrian conflict, addressing four topics of interest: violence against health care workers, education, practicing in conflict setting, and migration.MethodsConsidering the likelihood of scarcity of data, we broadened the scope of the scoping review to include indirect evidence on health care workers from other countries affected by the “Arab Spring”. We electronically searched six electronic databases. We conducted descriptive analysis of the general characteristics of the included papers. We also used the results of this scoping review to build an evidence gap map.ResultsOut of the 11 165 identified citations, 136 met our eligibility criteria. The majority of the articles tackled the issue of violence against health care workers (63%) followed by practicing in conflict setting (19%), migration (17%) and education (10%). Countries in focus of most articles were: Syria (35%), Iraq (33%), and Bahrain (29%). News, editorials, commentaries and opinion pieces made up 81% of all included papers, while primary studies made up only 9%. All the primary studies identified in this review were conducted on Iraq. Most of the articles about violence against health care workers were on Bahrain, followed by Syria and Iraq. The first and corresponding authors were most frequently affiliated with institutions from non-Arab countries (79% and 79% respectively).ConclusionsResearch evidence on health care workers in the setting of the “Arab Spring” is scarce. This review and the gap map can inform the research agendas of funders and researchers working in the field of health care workers in conflict setting. More well-designed primary studies are needed to inform the decisions of policymakers and other interested parties.

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“…Since most admitted knowing colleagues who were assaulted or having been assaulted themselves during the highly emotional moments that medical emergencies provoke, the addition of further security measures for workers in the hospitals, especially within the public sector hospitals, would allow physicians to feel safer committing more time to emergency sections, such as taking night shifts. Studies in Iraq have found that within the Emergency Department alone, over 80 % of physicians were victims of assault at least once [ 19 ]. Correlations found regarding safety do not again prove causality, but does confirm that workers within conflict zones are being threatened regularly, but in fact may be more willing to commit to night shifts and other less than ideal working conditions if they at least feel safe while there.…”

Section: Discussionmentioning

confidence: 99%

A structured assessment of emergency and acute care providers in Afghanistan during the current conflict

et al. 2015

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BackgroundAfghanistan has struggled with several decades of well-documented conflict, increasing the importance of providing emergency services to its citizens. However, little is known about the country’s capacity to provide such care.MethodsThree native-speaking Afghan-American physicians performed an assessment of emergency care via combined quantitative and qualitative survey tools. Hospitals in Kabul, Afghanistan were selected based on probability proportional to size methodology, in which size was derived from prior work in the country and permission granted by the administering agency and the Ministry of Health. A written survey was given to physicians and nurses, followed by structured focus groups, and multiple days of observation per facility. A descriptive analysis was performed and data analyzed through a combination of variables in eight overarching categories relevant to emergency care.ResultsOne hundred twenty-five surveys were completed from 9 hospitals. One third of respondents (32.8 %) worked full time in the emergency departments, with another 28.8 % working there at least three quarters of the time. Over 63 % of providers believed that the greatest delay for care in emergencies was in the prehospital setting. Differences were noted among the various types of facilities when looking at specific components of emergency care such as skill level of workers, frequencies of assaults in the hospitals, and other domains of service provision. Sum of squares between the different facility types were highest for areas of skill (SS = 210.3; p = .001), confidence in the system (SS = 156.5; p < .005), assault (SS = 487.6; p < .005), and feeling safe in the emergency departments (SS = 193.1, p < .005). Confidence negatively correlated to frequency of assaults (Pearson r = −.33; p < .005) but positively correlated with feeling safe (Pearson r = .51; p < .005) and reliability of equipment (Pearson r = .48; p < .005). The only correlation for access to services was prehospital care (Pearson r = .72, p < .005).ConclusionsThere is a significant need to provide emergency care services in Afghanistan, specifically prehospital care. High variability exists among facility-type in various components of emergency services provision.Electronic supplementary materialThe online version of this article (doi:10.1186/s12245-015-0069-0) contains supplementary material, which is available to authorized users.

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The Development of Civilian Emergency Medical Care During an Insurgency: Current Status and Future Outlook in Iraq

Cited by 6 publications

References 10 publications

A Survey of National Physicians Working in an Active Conflict Zone: The Challenges of Emergency Medical Care in Iraq

A Survey of National Physicians Working in an Active Conflict Zone: The Challenges of Emergency Medical Care in Iraq

Health Care Workers in the setting of the “Arab Spring”: a scoping review for the Lancet-AUB Commission on Syria

A structured assessment of emergency and acute care providers in Afghanistan during the current conflict

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