The Psychosocial Impact of Compounding Humanitarian Crises Caused by War and COVID-19 Informing Future Disaster Response

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has caused the greatest global loss of life and economic impact due to a respiratory virus since the 1918 influenza pandemic. While health care systems around the world faced the enormous challenges of managing COVID-19 patients, health care workers in the Republic of Armenia were further tasked with caring for the surge of casualties from a concurrent, large-scale war. These compounding events put a much greater strain on the health care system, creating a complex humanitarian crisis that resulted in significant psychosocial consequences for health care workers in Armenia.

Emergency Medical Services Preparedness in Dual Disasters: War in the Era of COVID-19 in Armenia

“…Accounts from health care workers describe the emotional demands of caring for very ill patients with COVID-19 while fearing becoming infected themselves, having to treat patients even when being personally infected, and working shifts that were nearly 24 hours long with little sleep during the pandemic. 6 In the present study, 77.1% of participants reported not having access to the PPE they felt they needed to treat patients. With the outbreak of war, providers found themselves treating gruesome war injuries, transporting war casualties up to six hours, and https://doi.org/10.1017/S1049023X22001522 Published online by Cambridge University Press additionally tending to wounded or deceased colleagues as ambulances, health care workers, and medical facilities became the target of enemy drone attacks and artillery.…”

“…Prior to the COVID-19 pandemic, 40% of EMS responses were "double calls," in which a second ambulance is dispatched after the first team completes its evaluation for the purpose of providing specialty treatment such as cardiac, neurologic, or psychiatric care, 5 thereby ideally matching a provider with pertinent training to the patient's pathology. However, in the case of this dual disaster response, during which there was a physician shortage forcing EMS physicians to work long hours without substantial backup help, 6 providers of all sorts of specialty backgrounds were responding to potentially critically ill patients often outside of their scope of expertise.…”

“…8,13,16 Armenia's EMS system, already stretched to capacity by the COVID-19 pandemic, was given the additional burden of caring for and evacuating war casualties, sometimes requiring ambulances dispatched from Yerevan six hours away. 6 During the height of the pandemic, YMAS calls increased to 1,000-1,200 calls daily. 10 There is a paucity of literature that examines disaster preparedness within the Armenian EMS system or the effect of a simultaneous war and pandemic on any EMS system.…”

“…5 The Armenian health care system was confronted with a unique challenge during the simultaneous SARS-CoV-2/coronavirus disease 2019 (COVID-19) pandemic and recent war with Azerbaijan, tasking the EMS system with war casualty care during a pandemic that was already overwhelming the country's medical system. 6 The need for EMS system modernization was identified in 1991 when the country first declared independence from the Soviet Union. 7,8 Although a regional EMS training center was subsequently established in 1994 through United States Agency for International Development (USAID; Washington, DC USA) funding, in partnership with Boston University (Boston, Massachusetts USA), the University of Massachusetts (Worcester, Massachusetts USA), and the Ministry of Health (Yerevan, Armenia), 9 there has been little progress in updating EMS education.…”

Risk Perception and Health Precautions Towards COVID-19 Among Older Culturally and Linguistically Diverse Adults in South Australia: A Cross-Sectional Survey

“…The findings of this study are consistent with earlier studies, which found that the fear that people experienced during the pandemic affects their perceptions of risk and the older CALD people may be prone to perceive a greater risk on the basis of a sense of uncertainty, vulnerability, and lack of control, 9 , 10 or fear of unknown. 6 It provides important understanding of the compounding nature of intersecting vulnerabilities, such as age, gender or culture, in the context of COVID-19, and contributes to global perspectives on the psychosocial impact of COVID-19 where there may also be social vulnerability, 56 humanitarian crisis, 57 or extreme weather events. 58 …”