51
|
Diggle E, Welsch W, Sullivan R, Alkema G, Warsame A, Wafai M, Jasem M, Ekzayez A, Cummings R, Patel P. The role of public health information in assistance to populations living in opposition and contested areas of Syria, 2012-2014. Confl Health 2017; 11:33. [PMID: 29299054 PMCID: PMC5740952 DOI: 10.1186/s13031-017-0134-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 10/30/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Syrian armed conflict is the worst humanitarian tragedy this century. With approximately 470,000 deaths and more than 13 million people displaced, the conflict continues to have a devastating impact on the health system and health outcomes within the country. Hundreds of international and national non-governmental organisations, as well as United Nations agencies have responded to the humanitarian crisis in Syria. While there has been significant attention on the challenges of meeting health needs of Syrian refugees in neighbouring countries such as Jordan, Lebanon and Turkey, very little has been documented about the humanitarian challenges within Syria, between 2013 and 2014 when non-governmental organisations operated in Syria with very little United Nations support or leadership, particularly around obtaining information to guide health responses in Syria. METHODS In this study, we draw on our operational experience in Syria and analyse data collected for the humanitarian health response in contested and opposition-held areas of Syria in 2013-4 from Turkey, where the largest humanitarian operation for Syria was based. This is combined with academic literature and material from open-access reports. RESULTS Humanitarian needs have consistently been most acute in contested and opposition-held areas of Syria due to break-down of Government of Syria services and intense warfare. Humanitarian organisations had to establish de novo data collection systems independent of the Government of Syria to provide essential services in opposition-held and contested areas of Syria. The use of technology such as social media was vital to facilitating remote data collection in Syria as many humanitarian agencies operated with a limited operational visibility given chronic levels of insecurity. Mortality data have been highly politicized and extremely difficult to verify, particularly in areas highly affected by the conflict, with shifting frontlines, populations, and allegiances. CONCLUSIONS More investment in data collection and use, technological investment in the use of M- and E-health, capacity building and strong technical and independent leadership should be a key priority for the humanitarian health response in Syria and other emergencies. Much more attention should be also given for the treatment gap for non-communicable diseases including mental disorders.
Collapse
Affiliation(s)
| | | | - Richard Sullivan
- Cancer Policy and Global Health, King’s Health Partners, King’s College London, London, UK
| | | | | | - Mais Wafai
- Assistance Coordination Unit, Gaziantep, Turkey
| | | | | | | | - Preeti Patel
- Global Health and Security, Department of War Studies, King’s College London, London, UK
| |
Collapse
|
52
|
Blanchet K, Ramesh A, Frison S, Warren E, Hossain M, Smith J, Knight A, Post N, Lewis C, Woodward A, Dahab M, Ruby A, Sistenich V, Pantuliano S, Roberts B. Evidence on public health interventions in humanitarian crises. Lancet 2017; 390:2287-2296. [PMID: 28602563 DOI: 10.1016/s0140-6736(16)30768-1] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Recognition of the need for evidence-based interventions to help to improve the effectiveness and efficiency of humanitarian responses has been increasing. However, little is known about the breadth and quality of evidence on health interventions in humanitarian crises. We describe the findings of a systematic review with the aim of examining the quantity and quality of evidence on public health interventions in humanitarian crises to identify key research gaps. We identified 345 studies published between 1980 and 2014 that met our inclusion criteria. The quantity of evidence varied substantially by health topic, from communicable diseases (n=131), nutrition (n=77), to non-communicable diseases (n=8), and water, sanitation, and hygiene (n=6). We observed common study design and weaknesses in the methods, which substantially reduced the ability to determine causation and attribution of the interventions. Considering the major increase in health-related humanitarian activities in the past three decades and calls for a stronger evidence base, this paper highlights the limited quantity and quality of health intervention research in humanitarian contexts and supports calls to scale up this research.
Collapse
Affiliation(s)
- Karl Blanchet
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Anita Ramesh
- Faculty of Public Health and Policy and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Severine Frison
- Faculty of Public Health and Policy and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily Warren
- Faculty of Public Health and Policy and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mazeda Hossain
- ECOHOST-The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - James Smith
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Abigail Knight
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Nathan Post
- ECOHOST-The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Aniek Woodward
- ECOHOST-The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - Maysoon Dahab
- ECOHOST-The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - Alexander Ruby
- ECOHOST-The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Bayard Roberts
- ECOHOST-The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK.
| |
Collapse
|
53
|
Aebischer Perone S, Martinez E, du Mortier S, Rossi R, Pahud M, Urbaniak V, Chappuis F, Hagon O, Jacquérioz Bausch F, Beran D. Non-communicable diseases in humanitarian settings: ten essential questions. Confl Health 2017; 11:17. [PMID: 28932259 PMCID: PMC5602789 DOI: 10.1186/s13031-017-0119-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 07/19/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- S. Aebischer Perone
- Health Unit, International Committee of the Red Cross (ICRC), 19, avenue de la Paix, 1202 Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - E. Martinez
- Health Unit, International Committee of the Red Cross (ICRC), 19, avenue de la Paix, 1202 Geneva, Switzerland
| | - S. du Mortier
- Health Unit, International Committee of the Red Cross (ICRC), 19, avenue de la Paix, 1202 Geneva, Switzerland
| | - R. Rossi
- Health Unit, International Committee of the Red Cross (ICRC), 19, avenue de la Paix, 1202 Geneva, Switzerland
| | - M. Pahud
- Health Unit, International Committee of the Red Cross (ICRC), 19, avenue de la Paix, 1202 Geneva, Switzerland
| | - V. Urbaniak
- Health Unit, International Committee of the Red Cross (ICRC), 19, avenue de la Paix, 1202 Geneva, Switzerland
| | - F. Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - O. Hagon
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - F. Jacquérioz Bausch
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - D. Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland
| |
Collapse
|
54
|
Isreb MA, Kaysi S, Rifai AO, Al Kukhun H, Al-Adwan SAS, Kass-Hout TA, Sekkarie MA. The Effect of War on Syrian Refugees With End-Stage Renal Disease. Kidney Int Rep 2017; 2:960-963. [PMID: 29270503 PMCID: PMC5733747 DOI: 10.1016/j.ekir.2017.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/04/2017] [Accepted: 05/19/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Majd A. Isreb
- Peace Health Medical Group, Longview, Washington, USA
| | | | | | | | | | | | - Mohamed A. Sekkarie
- Nephrologist, Nephrology and Hypertension Associates, Bluefield, West Virginia, USA
| |
Collapse
|
55
|
Soydan L, Demir AA, Tunaci A. Frequency of abnormal pulmonary computed tomography findings in asylum seeking refugees in Turkey. Int Health 2017; 9:118-123. [PMID: 28100704 DOI: 10.1093/inthealth/ihw057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/14/2016] [Indexed: 11/13/2022] Open
Abstract
Background Lungs are particularly vulnerable to both acute infections, including TB, and chronic diseases such as chronic obstructive pulmonary disease, as well as to malignancies, all of which require particular attention during war times in which health conditions are far from optimal. Methods This retrospective cross-sectional study included 1149 refugees that underwent thoracic computed tomography (CT) for respiratory symptoms between March 2013 and February 2015 in Turkey. Results At least one positive CT finding was seen in 231 (20.1%) of the patients. The most common findings were chronic pulmonary changes (n=197, 17.2%), followed by findings suggestive of infections (n=39, 3.4%), and mass/nodular lesions (n=16, 1.4%). The rates of the lesions suggestive of active TB and malignancy were 1.0% (n=11) and 0.7% (n=8), respectively. Age 55-64 years was an independent significant predictor for any CT lesion, chronic changes, mass lesions, and lesions suggestive of malignancy. Age>65 years was predictive of any CT lesion and chronic changes. Conclusions The findings of this study indicate the need for implementation of cost-effective screening strategies in refugees, particularly during war times. Screening for TB would improve disease control among both refugees and the host populations. Middle aged and older individuals, in particular, would benefit from more proactive screening tools and strategies for the early diagnosis of pulmonary malignancies and chronic lung diseases.
Collapse
Affiliation(s)
- Levent Soydan
- Department of Radiology, Haydarpasa Numune Research and Training Hospital, 34668, Istanbul, Turkey
| | - Ali Aslan Demir
- Department of Radiology, Capa Medical Faculty, Istanbul University, 34093, Istanbul, Turkey
| | - Atadan Tunaci
- Department of Radiology, Capa Medical Faculty, Istanbul University, 34093, Istanbul, Turkey
| |
Collapse
|
56
|
Sweileh WM. Bibliometric analysis of medicine - related publications on refugees, asylum-seekers, and internally displaced people: 2000 - 2015. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2017; 17:7. [PMID: 28320410 PMCID: PMC5360014 DOI: 10.1186/s12914-017-0116-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 03/11/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Wars and violent domestic conflicts have forced millions of people to move outside their homes. Meeting the basic health needs of those people requires an understanding of research activity and research output on this topic. The objective of this study was to shed light on the quantity and impact of medicine - related publications on refugees, asylum seekers and internally displaced people (IDP). METHOD Scopus database was used to retrieve required data. Specifically, the number of publications, top productive countries and institutions, highly cited articles, citation analysis, international collaboration, and journals involved in publishing articles on refugees, asylum seekers and IDP were reviewed and analyzed. The time span for the study was set from year 2000 to 2015. RESULTS Two thousands five hundred and thirty publications were retrieved. The h-index of retrieved articles was 64. A steep rise in number of publications was noticed after 2011. Top productive countries were the United States of America, Australia and the United Kingdom. The American public health institute (Centers for Disease Control and Prevention) and the United Nations refugee agency were among the top active organizations on this topic. Active journals in publishing on health of refugees, asylum seekers and IDP were those on mental health, psychology, public health and general medicine. Publications on Somali, Afghani, Iraqi, and Syrian refugees received a significant share of medicine-related publications. Analysis of publications based on region showed that publications on refugees from Middle East is rising sharply and is approaching those on African refugees. CONCLUSION Bibliometric analysis reveals that research publications on refugees have been increasing in a dramatic way and articles are being published in journals with high impact factor and international reputation, not only in general medicine and public health, but also mental health and psychology journals. Analysis of publications related to refugees can be helpful to international health agencies and governments not only to document the psychological trauma of fled people, but also to identify best mental health programs to face the consequences of wars and aggression that led to this refugee crisis.
Collapse
Affiliation(s)
- Waleed M Sweileh
- Department of Physiology, Pharmacology, and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| |
Collapse
|
57
|
Martin DN, Lam TK, Brignole K, Ashing KT, Blot WJ, Burhansstipanov L, Chen JT, Dignan M, Gomez SL, Martinez ME, Matthews A, Palmer JR, Perez-Stable EJ, Schootman M, Vilchis H, Vu A, Srinivasan S. Recommendations for Cancer Epidemiologic Research in Understudied Populations and Implications for Future Needs. Cancer Epidemiol Biomarkers Prev 2017; 25:573-80. [PMID: 27196089 DOI: 10.1158/1055-9965.epi-15-1297] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/10/2016] [Indexed: 11/16/2022] Open
Abstract
Medically underserved populations in the United States continue to experience higher cancer burdens of incidence, mortality, and other cancer-related outcomes. It is imperative to understand how health inequities experienced by diverse population groups may contribute to our increasing unequal cancer burdens and disparate outcomes. The National Cancer Institute convened a diverse group of scientists to discuss research challenges and opportunities for cancer epidemiology in medically underserved and understudied populations. This report summarizes salient issues and discusses five recommendations from the group, including the next steps required to better examine and address cancer burden in the United States among our rapidly increasing diverse and understudied populations. Cancer Epidemiol Biomarkers Prev; 25(4); 573-80. ©2016 AACR SEE ALL ARTICLES IN THIS CEBP FOCUS SECTION, "MULTILEVEL APPROACHES TO ADDRESSING CANCER HEALTH DISPARITIES".
Collapse
Affiliation(s)
- Damali N Martin
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland.
| | - Tram Kim Lam
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| | - Katy Brignole
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| | - Kimlin T Ashing
- Center for Community Alliance for Research and Education, City of Hope Cancer Center, Duarte, California
| | - William J Blot
- Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee. International Epidemiology Institute, Rockville, Maryland
| | - Linda Burhansstipanov
- Native American Cancer Research Corporation, Denver, Colorado. Native American Cancer Initiatives, Incorporated, Colorado
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mark Dignan
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California
| | - Maria Elena Martinez
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Alicia Matthews
- School of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Eliseo J Perez-Stable
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Mario Schootman
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Hugo Vilchis
- Burrell College of Osteopathic Medicine/Burrell Institute for Health Policy & Research, Las Cruces, New Mexico
| | - Alexander Vu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| |
Collapse
|
58
|
Slama S, Kim HJ, Roglic G, Boulle P, Hering H, Varghese C, Rasheed S, Tonelli M. Care of non-communicable diseases in emergencies. Lancet 2017; 389:326-330. [PMID: 27637675 DOI: 10.1016/s0140-6736(16)31404-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 08/02/2016] [Accepted: 08/09/2016] [Indexed: 11/21/2022]
Affiliation(s)
- Slim Slama
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | | | | | | | - Heiko Hering
- United Nations High Commission for Refugees, Geneva, Switzerland
| | | | - Shahnawaz Rasheed
- Department of Surgery, Imperial College London, London, UK; The Royal Marsden Hospital, London, UK
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
59
|
Al-Smadi AM, Halaseh HJ, Gammoh OS, Ashour AF, Gharaibeh B, Khoury LS. Do Chronic Diseases and Availability of Medications Predict Post-traumatic Stress Disorder (PTSD) among Syrian Refugees in Jordan? ACTA ACUST UNITED AC 2016. [DOI: 10.3923/pjn.2016.936.941] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
60
|
Kebudi R, Bayram I, Yagci-Kupeli B, Kupeli S, Sezgin G, Pekpak E, Oymak Y, Ince D, Emir S, Tugcu D, Ozek G, Bay A, Kupesiz FT, Vural S, Ocak S, Yaman Y, Koksal Y, Timur C, Unal S, Vergin C. Refugee children with cancer in Turkey. Lancet Oncol 2016; 17:865-867. [PMID: 27396633 DOI: 10.1016/s1470-2045(16)30211-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Rejin Kebudi
- Istanbul University, Cerrahpasa Medical Faculty and Oncology Institute, Pediatric Hematology-Oncology, Istanbul, Turkey.
| | - Ibrahim Bayram
- Cukurova University Faculty of Medicine, Pediatric Oncology and Pediatric Bone Marrow Transplantation Unit, Adana, Turkey
| | - Begul Yagci-Kupeli
- Adana Numune Training and Research Hospital, Pediatric Hematology-Oncology, Adana, Turkey
| | - Serhan Kupeli
- Cukurova University Faculty of Medicine, Pediatric Oncology and Pediatric Bone Marrow Transplantation Unit, Adana, Turkey
| | - Gulay Sezgin
- Cukurova University Faculty of Medicine, Pediatric Oncology and Pediatric Bone Marrow Transplantation Unit, Adana, Turkey
| | - Esra Pekpak
- Gaziantep Children's Hospital, Pediatric Hematology-Oncology, Gaziantep, Turkey
| | - Yesim Oymak
- Dr BehcetUz Children's Hospital, Pediatric Hematology-Oncology Clinic, Izmir, Turkey
| | - Dilek Ince
- Dokuz Eylul Oncology Institute, Pediatric Oncology, Izmir, Turkey
| | - Suna Emir
- Ankara Child Health Hematology-Oncology Education and Research Hospital, Pediatric Hematology-Oncology, Ankara, Turkey
| | - Deniz Tugcu
- Istanbul University, Istanbul Medical Faculty, Pediatric Hematology-Oncology, Istanbul, Turkey
| | - Gulcihan Ozek
- Sanliurfa Childrens Hospital, Pediatric Hematology-Oncology, Sanliurfa, Turkey
| | - Ali Bay
- Gaziantep University, Pediatric Hematology, Gaziantep, Turkey
| | - Funda Tayfun Kupesiz
- Diyarbakır Children's Hospital, Pediatric Hematology-Oncology, Diyarbakır, Turkey
| | - Sema Vural
- Sisli Etfal Education and Research Hospital, Pediatric Oncology, Istanbul, Turkey
| | - Suheyla Ocak
- Okmeydani Education and Research Hospital, Pediatric Oncology, Istanbul, Turkey
| | - Yontem Yaman
- Sutcu Imam University, Faculty of Medicine, Pediatric Hematology-Oncology, Kahramanmaras, Turkey
| | - Yavuz Koksal
- Selcuk University, Faculty of Medicine, Pediatric Oncology, Konya, Turkey
| | - Cetin Timur
- Medeniyet University, Pediatric Hematology, Istanbul, Turkey
| | - Selma Unal
- Mersin University, Faculty of Medicine, Pediatric Hematology-Oncology, Mersin, Turkey
| | - Canan Vergin
- Dr BehcetUz Children's Hospital, Pediatric Hematology-Oncology Clinic, Izmir, Turkey
| |
Collapse
|
61
|
Silbermann M, Daher M, Kebudi R, Nimri O, Al-Jadiry M, Baider L. Middle Eastern Conflicts: Implications for Refugee Health in the European Union and Middle Eastern Host Countries. J Glob Oncol 2016; 2:422-430. [PMID: 28717729 PMCID: PMC5493250 DOI: 10.1200/jgo.2016.005173] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Until very recently, health care in conflict settings was based on a model developed in the second half of the twentieth century. Things have changed, and present civil wars, such as those that are currently taking place in the Middle East, do not address the complexity of the ongoing armed conflicts in countries such as Syria, Iraq, and Afghanistan. These conflicts have caused a significant increase in the number of refugees in the region, as well as in Europe. Hundreds of thousands of refugees succeed in settling in mid- and north-European countries, and their health issues are becoming of great importance. Refugees in Europe in the twenty-first century do not suffer so much from infectious diseases but more from noninfectious chronic diseases such as diabetes, cardiac disease, and cancer. These facts profoundly alter the demographics and disease burden of hostility-derived migrants. Thus, host European countries face situations they have never faced before. Hence, new approaches and strategies are urgently needed to cope with this new situation. The efforts to absorb refugees of different traditions and cultural backgrounds often cause increasing ethnic and religious tensions, which frequently escort the emergence of social violence. To date, little attention has been paid to the overall load of distress being experienced, especially among the first-generation refugees. The current ongoing hostilities in the Middle East induce a long-term health impact on people expelled from their homes, communities, traditions, and cultural environment. The realization of collective suffering forces communities and governmental health agencies to develop new programs that include social determinants to overcome the severe cultural gaps of the newcomers in their new European host countries.
Collapse
Affiliation(s)
- Michael Silbermann
- , Technion-Israel Institute of Technology, Middle East Cancer Consortium, Haifa; , Assuta Medical Center, Tel Aviv, Israel; , University of Balamand, Saint George Hospital, Beirut, Lebanon; , Oncology Institute, Istanbul, Turkey; , Ministry of Health, Amman, Jordan; and , Children's Welfare Teaching Hospital, Medical City, Baghdad, Iraq
| | - Michel Daher
- , Technion-Israel Institute of Technology, Middle East Cancer Consortium, Haifa; , Assuta Medical Center, Tel Aviv, Israel; , University of Balamand, Saint George Hospital, Beirut, Lebanon; , Oncology Institute, Istanbul, Turkey; , Ministry of Health, Amman, Jordan; and , Children's Welfare Teaching Hospital, Medical City, Baghdad, Iraq
| | - Rejin Kebudi
- , Technion-Israel Institute of Technology, Middle East Cancer Consortium, Haifa; , Assuta Medical Center, Tel Aviv, Israel; , University of Balamand, Saint George Hospital, Beirut, Lebanon; , Oncology Institute, Istanbul, Turkey; , Ministry of Health, Amman, Jordan; and , Children's Welfare Teaching Hospital, Medical City, Baghdad, Iraq
| | - Omar Nimri
- , Technion-Israel Institute of Technology, Middle East Cancer Consortium, Haifa; , Assuta Medical Center, Tel Aviv, Israel; , University of Balamand, Saint George Hospital, Beirut, Lebanon; , Oncology Institute, Istanbul, Turkey; , Ministry of Health, Amman, Jordan; and , Children's Welfare Teaching Hospital, Medical City, Baghdad, Iraq
| | - Mazin Al-Jadiry
- , Technion-Israel Institute of Technology, Middle East Cancer Consortium, Haifa; , Assuta Medical Center, Tel Aviv, Israel; , University of Balamand, Saint George Hospital, Beirut, Lebanon; , Oncology Institute, Istanbul, Turkey; , Ministry of Health, Amman, Jordan; and , Children's Welfare Teaching Hospital, Medical City, Baghdad, Iraq
| | - Lea Baider
- , Technion-Israel Institute of Technology, Middle East Cancer Consortium, Haifa; , Assuta Medical Center, Tel Aviv, Israel; , University of Balamand, Saint George Hospital, Beirut, Lebanon; , Oncology Institute, Istanbul, Turkey; , Ministry of Health, Amman, Jordan; and , Children's Welfare Teaching Hospital, Medical City, Baghdad, Iraq
| |
Collapse
|
62
|
War is the Enemy of Health. Pulmonary, Critical Care, and Sleep Medicine in War-Torn Syria. Ann Am Thorac Soc 2016; 13:147-55. [DOI: 10.1513/annalsats.201510-661ps] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
63
|
Otoukesh S, Mojtahedzadeh M, Figlin RA, Rosenfelt FP, Behazin A, Sherzai D, Cooper CJ, Nahleh ZA. Literature Review and Profile of Cancer Diseases Among Afghan Refugees in Iran: Referrals in Six Years of Displacement. Med Sci Monit 2015; 21:3622-8. [PMID: 26592372 PMCID: PMC4662241 DOI: 10.12659/msm.895173] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/04/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There is a paucity of research on the profile of cancers among displaced populations, specifically Afghan refugees in Iran. This study illustrates the pattern of cancers in this population, and highlights the challenges of cancer care in displaced people with the intent that this data will facilitate appropriate allocation of resources to improve care in this population. MATERIAL AND METHODS This was a retrospective cross-sectional study, in which we collected the demographics and profile of cancers among Afghan refugees from 2005 to 2010 from referrals to the United Nations High Commissioner for Refugees (UNHCR) offices in Iran. Accrued evidence by other studies published between January 1993 and July 2014 pertaining to cancer diagnoses in refugees from Afghanistan, Tibet, Syria, Jordan, and Iraq was reviewed. RESULTS Cancer diagnoses accounted for 3083 of 23 152 total referrals, with 49% female and 51% male cases; 23.3% were 0-17 years of age, 61.2% were 18-59, and 15.5% were above 60. The most common health referral for females and males (0-17) was malignant neoplasms of lymphatic and hematopoietic tissue, accounting for 34.2%. In the age groups 18-59 and above 60 for both male and females it was malignant neoplasm of the digestive system, occurring in 26.3% and 48.7%, respectively. CONCLUSIONS In the setting of humanitarian crises especially war, cancer diagnoses among refugees is a major health burden both on the host countries and the international community with serious implications considering the recent growing trend in the Middle Eastern countries. The prevalence of certain cancer diagnoses among refugees, like gastrointestinal, respiratory, breast, and genitourinary cancers necessitates a multidirectional approach, primarily aimed at prevention and early detection. International partnerships are essential for improvement in cancer surveillance service availability, and delivery of the standard of care, in an overall effort to reduce the human cost, monetary, and resource associated burdens of cancer. Recommendations to implement effective prevention and management goals as well as improved record keeping in the refugee setting and the acquisition of secure and sustainable funding sources should be implemented in collaboration with global humanitarian agencies like UNHCR.
Collapse
Affiliation(s)
- Salman Otoukesh
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Mona Mojtahedzadeh
- Department of Psychiatry, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Robert A. Figlin
- Division of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, U.S.A
| | - Fred P. Rosenfelt
- Division of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, U.S.A
| | - Arash Behazin
- United Nations High Commissioner for Refugees, Tehran, Iran
| | - Dean Sherzai
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, U.S.A
| | - Chad J. Cooper
- Department of Internal Medicine/Gastroenterology, University of Kentucky, Lexington, KY, U.S.A
| | - Zeina A. Nahleh
- Division of Hematology/Oncology, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| |
Collapse
|
64
|
Ruby A, Knight A, Perel P, Blanchet K, Roberts B. The Effectiveness of Interventions for Non-Communicable Diseases in Humanitarian Crises: A Systematic Review. PLoS One 2015; 10:e0138303. [PMID: 26406317 PMCID: PMC4583445 DOI: 10.1371/journal.pone.0138303] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 08/28/2015] [Indexed: 12/18/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are of increasing concern in low- and middle-income countries (LMICs) affected humanitarian crises. Humanitarian agencies and governments are increasingly challenged with how to effectively tackle NCDs. Reviewing the evidence of interventions for NCDs in humanitarian crises can help guide future policies and research by identifying effective interventions and evidence gaps. The aim of this paper is to systematically review evidence on the effectiveness of interventions targeting NCDs during humanitarian crises in LMICs. Methods A systematic review methodology was followed using PRISMA standards. Studies were selected on NCD interventions with civilian populations affected by humanitarian crises in low- and middle-income countries. Five bibliographic databases and a range of grey literature sources were searched. Descriptive analysis was applied and a quality assessment conducted using the Newcastle-Ottawa Quality Assessment Scale for observational studies and the Cochrane Risk of Bias Tool for experimental studies. Results The search yielded 4919 references of which 8 studies met inclusion criteria. Seven of the 8 studies were observational, and one study was a non-blinded randomised-controlled trial. Diseases examined included hypertension, heart failure, diabetes mellitus, chronic kidney disease, thalassaemia, and arthritis. Study settings included locations in the Middle East, Eastern Europe, and South Asia. Interventions featuring disease-management protocols and/or cohort monitoring demonstrated the strongest evidence of effectiveness. No studies examined intervention costs. The quality of studies was limited, with a reliance on observational study designs, limited use of control groups, biases associated with missing data and inadequate patient-follow-up, and confounding was poorly addressed. Conclusions The review highlights the extremely limited quantity and quality of evidence on this topic. Interventions that incorporate standardisation and facilitate patient follow-up appear beneficial. However, substantially more research is needed, including data on costs.
Collapse
Affiliation(s)
- Alexander Ruby
- ECOHOST–The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Abigail Knight
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pablo Perel
- Centre for Global Non Communicable Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Karl Blanchet
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bayard Roberts
- ECOHOST–The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| |
Collapse
|
65
|
McKenzie ED, Spiegel P, Khalifa A, Mateen FJ. Neuropsychiatric disorders among Syrian and Iraqi refugees in Jordan: a retrospective cohort study 2012-2013. Confl Health 2015; 9:10. [PMID: 25904979 PMCID: PMC4406163 DOI: 10.1186/s13031-015-0038-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden of neuropsychiatric disorders in refugees is likely high, but little has been reported on the neuropsychiatric disorders that affect Syrian and Iraqi refugees in a country of first asylum. This analysis aimed to study the cost and burden of neuropsychiatric disorders among refugees from Syria and Iraq requiring exceptional, United Nations-funded care in a country of first asylum. METHODS The United Nations High Commissioner for Refugees works with multi-disciplinary, in-country exceptional care committees to review refugees' applications for emergency or exceptional medical care. Neuropsychiatric diagnoses among refugee applicants were identified through a retrospective review of applications to the Jordanian Exceptional Care Committee (2012-2013). Diagnoses were made using International Classification of Disease-10(th) edition codes rendered by treating physicians. RESULTS Neuropsychiatric applications accounted for 11% (264/2526) of all Exceptional Care Committee applications, representing 223 refugees (40% female; median age 35 years; 57% Syrian, 36% Iraqi, 7% other countries of origin). Two-thirds of neuropsychiatric cases were for emergency care. The total amount requested for neuropsychiatric disorders was 925,674 USD. Syrian refugees were significantly more likely to request neurotrauma care than Iraqis (18/128 vs. 3/80, p = 0.03). The most expensive care per person was for brain tumor (7,905 USD), multiple sclerosis (7,502 USD), and nervous system trauma (6,466 USD), although stroke was the most frequent diagnosis. Schizophrenia was the most costly and frequent diagnosis among the psychiatric disorders (2,269 USD per person, 27,226 USD total). CONCLUSIONS Neuropsychiatric disorders, including those traditionally considered outside the purview of refugee health, are an important burden to health among Iraqi and Syrian refugees. Possible interventions could include stroke risk factor reduction and targeted medication donations for multiple sclerosis, epilepsy, and schizophrenia.
Collapse
Affiliation(s)
- Erica D McKenzie
- Department of Neurology, Massachusetts General Hospital, 165 Cambridge Street, #627, 02114 Boston, MA USA ; School of Medicine, Queen's University, Kingston, ON Canada
| | - Paul Spiegel
- United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Adam Khalifa
- United Nations High Commissioner for Refugees, Damascus, Syrian Arab Republic
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, 165 Cambridge Street, #627, 02114 Boston, MA USA ; Harvard Medical School, Boston, MA USA
| |
Collapse
|
66
|
Lo J, Patel P, Roberts B. A systematic review on tobacco use among civilian populations affected by armed conflict. Tob Control 2015; 25:129-40. [PMID: 25770116 DOI: 10.1136/tobaccocontrol-2014-052054] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/23/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To systematically examine evidence on tobacco use among conflict-affected civilian populations. DATA SOURCES Primary quantitative and qualitative studies published in English up to April 2014. Bibliographic databases searched were EMBASE, Global Health, MEDLINE, PsycEXTRA, PsycINFO, Web of Science, Cochrane; with the main terms of: (Smoke*, tobacco*, cigarette*, nicotine, beedi, bidi, papirosi, dip, chew, snuff, snus, smokeless tobacco) AND (armed-conflict, conflict-affected, conflict, war, refugee, internally displaced, forcibly displaced, asylum, humanitarian). Grey literature was searched using humanitarian databases, websites and search engines. STUDY SELECTION Studies were independently selected by two reviewers, with a study outcome of tobacco use and a population of conflict-affected civilian populations such as internally displaced persons, refugees, residents in conflict-affected areas, residents and returning forcibly displaced populations returning in stabilised and postconflict periods. 2863 studies were initially identified. DATA EXTRACTION Data were independently extracted. The Quality Assessment Tool for Quantitative Studies and the Critical Appraisal Skills Programme for qualitative studies were used to assess study quality. DATA SYNTHESIS 39 studies met inclusion criteria and descriptive analysis was used. Findings were equivocal on the effect of conflict on tobacco use. Evidence was clearer on associations between post-traumatic stress and other mental disorders with nicotine dependence. However, there were too few studies for definitive conclusions. No study examined the effectiveness of tobacco-related interventions. The quantitative studies were moderate (N=13) or weak (N=22) quality, and qualitative studies were moderate (N=3) or strong (N=2). CONCLUSIONS Some evidence indicates links between conflict and tobacco use but substantially more research is required.
Collapse
Affiliation(s)
- Janice Lo
- Faculty of Public Health and Policy, ECOHOST-The Centre for Health and Social Change, The London School of Hygiene and Tropical Medicine, London, UK
| | - Preeti Patel
- Department of War Studies, King's College London, London, UK
| | - Bayard Roberts
- Faculty of Public Health and Policy, ECOHOST-The Centre for Health and Social Change, The London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
67
|
|