Difficulties of doing research during armed conflicts

Health systems research in fragile and conflict affected states: a qualitative study of associated challenges

BACKGROUND

High quality health systems research (HSR) in fragile and conflict-affected states (FCAS) is essential to guiding the policies and programmes that will improve access to health services and, ultimately, health outcomes. Yet, conducting HSR in FCAS is challenging. An understanding of these challenges is essential to tackling them and to supporting research conducted in these complex environments. Led by the Thematic Working Group on Health Systems in FCAS, the primary aim of this study was to develop a research agenda on HSR in FCAS. The secondary aim was to identify the challenges associated with conducting HSR in these contexts. This paper presents these challenges.

METHODS

Guided by a purposely-selected steering group, this qualitative study collected respondents' perspectives through an online survey (n = 61) and a group discussion at the Third Global Symposium on HSR in September 2014 (n = 11). Respondents with knowledge and/or experience of HSR in FCAS were intentionally recruited.

RESULTS

Of those ever involved in HSR in FCAS (45/61, 75%), almost all (98%) experienced challenges in conducting their research. Challenges fall under three broad thematic areas: (1) lack of appropriate support; (2) complex local research environment, including access constraints, weak local research capacity, collaboration challenges and lack of trust in the research process; and (3) limited research application, including rapidly outdated findings and lack of engagement with the research process and results.

CONCLUSIONS

This study shows that those familiar with HSR in FCAS face many challenges in gaining support for and in conducting and applying high-quality research. There is a need for more sustainable support, including commitment to and long-term funding of HSR in FCAS; investment in capacity building within FCAS to meet the challenges related to implementation of research in these complex environments; relationship and trust building among stakeholders involved in HSR, particularly between local and international researchers and between researchers and participants; and innovative and flexible approaches to research design and implementation in these insecure and rapidly changing contexts.

Organochlorine pesticide exposure among agricultural workers in Colombian regions with illegal crops: an exploration in a hidden and dangerous world

A previous study suggested that banned organochlorine pesticides were being used to protect illegal crops from pests. The study herein explored the exposure of individuals living in a region with such crops. Samples from 99 individuals were collected during 2005 and 2006 and organochlorine pesticides were quantified using chromatography in serum samples. We detected heptachlor (72.73%), 4,4-DDE (19.19%), aldrin (15.15%), γ-chlordane (12.12%), dieldrin (11.11%), α-chlordane (10,10%), α-endosulfan (8.08%), endosulfan (6.06%), β-endosulfan (5.05%), oxychlordane (3.03%), 4,4-DDT (3.03%), and 2,4-DDT (2.02%). Heptachlor had a skewed and negative distribution (median: 8.69 ng/l and maximum: 43.8 ng/l). A two-dimensional biplot suggested that mixtures present were endosulfan/4,4-DDT, aldrin/γ-chlordane, and oxychlordane/β-endosulfan/dieldrin. We did not identify variables associated with exposure levels. These data suggest that banned organochlorine pesticides are used. This is an example of research in a war context, where the problems related with pesticides are complex, and their implications go beyond a toxicological or epidemiological viewpoint.

High-Impact Medical Journals and Peace: A History of Involvement

The aim of this study is to explore the positions of five leading general medical journals (The Lancet, British Medical Journal--BMJ, Journal of American Medical Association--JAMA, New England Journal of Medicine--NEJM, and Annals of Internal Medicine--AIM) toward the issues of collective violence. We calculated the proportion of war-related articles in the total number of articles published in these five high-impact journals, and in the total number of articles indexed in PubMed during the last 60 years. The results showed a continuous increase in the proportion of war-related articles. Our findings suggest that the leading general medical journals have taken an active editorial stance toward the issues of war and peace. We conclude that high-impact medical journals can make an important contribution to efforts aimed at reducing the risks and consequences of war and violence.