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Bahattab A, Trentin M, Hubloue I, Della Corte F, Ragazzoni L. Humanitarian health education and training state-of-the-art: a scoping review. Front Public Health 2024; 12:1343867. [PMID: 39135925 PMCID: PMC11317244 DOI: 10.3389/fpubh.2024.1343867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 07/15/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction In the past decade, humanitarian emergencies have been increasing, leading to an higher demand for humanitarian health professionalization. Education and training are critical for preparing these workers to provide effective care during crises. Understanding the current state-of-the-art in humanitarian health education is essential to inform research and development of future educational programs. This review surveys the peer-reviewed literature to provide insights into the current thinking in the field. Methods A review was conducted in March 2023 and updated in May 2024 using PubMed, Web of Science, Scopus, and Education Resources Information Center databases for English-language peer-reviewed articles published since January 2013. The review followed the Joanna Briggs Institute methodology for scoping reviews and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Data were analyzed using qualitative content analysis and presented as a narrative descriptive summary. Results After screening, 32 articles met the inclusion criteria. The themes of the selected articles focus on education and training frameworks, mapping, and programs. Despite the growing opportunities, most education and training programs are based in the Global North. The gaps identified include a lack of standardized curriculum or competency frameworks and evaluation frameworks to guide the development and evaluation of further standardized training programs. Interdisciplinary and collaborative partnerships, iterative design, and mixed teaching methods and modalities, including e-learning, facilitated successful training. However, logistical and technical constraints and the lack of standardized training frameworks were barriers to developing, implementing, and evaluating such training programs. Conclusion This review provides an overview of the humanitarian health education trends over the last decade and identifies key areas for future educational development and research. The findings emphasize the importance of adapting interdisciplinary and collaborative partnerships and prioritizing the training of local staff through regional centers, local leadership, and accessible e-learning, including e-simulation. The review also highlights the need for continued research and evaluation of humanitarian health education and training programs with standardized metrics to evaluate training programs and identify areas for improvement. These steps will help ensure that humanitarian health professionals receive adequate training to provide effective healthcare in crisis situations.
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Affiliation(s)
- Awsan Bahattab
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Monica Trentin
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Ives Hubloue
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - Francesco Della Corte
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Luca Ragazzoni
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
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Reynolds CW, Hsu PJ, Telem D. Implementation science in humanitarian assistance: applying a novel approach for humanitarian care optimization. Implement Sci 2024; 19:38. [PMID: 38811981 PMCID: PMC11138019 DOI: 10.1186/s13012-024-01367-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 05/23/2024] [Indexed: 05/31/2024] Open
Abstract
Humanitarian assistance is hindered by a lack of strategies to optimize care delivery through research and organized networks. Distinct from global health, humanitarian assistance struggles to address its multifaceted challenges, including duplicative resources, uncoordinated communication, unregulated staff expertise and safety, financial waste, and poor-quality metrics and care delivery. Implementation science provides an exciting and underutilized approach that can be applied to address these challenges, by studying how to effectively design, implement, optimize, and scale evidence-based interventions. Though successful in well-resourced and global health systems, implementation science approaches are rare in humanitarian assistance. Adopting implementation science approaches including identifying determinants, creating accessible evidence-based intervention bundles, adapting study methodologies for the humanitarian context, and partnering with implementation experts could make these promising approaches more accessible for thousands of humanitarian actors delivering healthcare for millions of vulnerable patients worldwide.
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Affiliation(s)
- Christopher W Reynolds
- University of Michigan Medical School, 1301 Catherine St. Ann Arbor, Ann Arbor, MI, 48109, USA.
| | - Phillip J Hsu
- Department of Surgery, University of Michigan, 1500 E Medical Center Dr. Ann Arbor, Ann Arbor, MI, 48109, USA
| | - Dana Telem
- Department of Surgery, University of Michigan, 1500 E Medical Center Dr. Ann Arbor, Ann Arbor, MI, 48109, USA
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Truppa C, Alonso B, Clezy K, Deglise C, Dromer C, Garelli S, Jimenez C, Kanapathipillai R, Khalife M, Repetto E. Antimicrobial stewardship in primary health care programs in humanitarian settings: the time to act is now. Antimicrob Resist Infect Control 2023; 12:89. [PMID: 37667372 PMCID: PMC10476422 DOI: 10.1186/s13756-023-01301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/30/2023] [Indexed: 09/06/2023] Open
Abstract
Fragile and conflict-affected settings bear a disproportionate burden of antimicrobial resistance, due to the compounding effects of weak health policies, disrupted medical supply chains, and lack of knowledge and awareness about antibiotic stewardship both among health care providers and health service users. Until now, humanitarian organizations intervening in these contexts have confronted the threat of complex multidrug resistant infections mainly in their surgical projects at the secondary and tertiary levels of care, but there has been limited focus on ensuring the implementation of adequate antimicrobial stewardship in primary health care, which is known to be setting where the highest proportion of antibiotics are prescribed. In this paper, we present the experience of two humanitarian organizations, Médecins sans Frontières and the International Committee of the Red Cross, in responding to antimicrobial resistance in their medical interventions, and we draw from their experience to formulate practical recommendations to include antimicrobial stewardship among the standards of primary health care service delivery in conflict settings. We believe that expanding the focus of humanitarian interventions in unstable and fragile contexts to include antimicrobial stewardship in primary care will strengthen the global response to antimicrobial resistance and will decrease its burden where it is posing the highest toll in terms of mortality.
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Affiliation(s)
- Claudia Truppa
- International Committee of the Red Cross, Geneva, Switzerland.
- CRIMEDIM Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, University of Eastern Piedmont, Novara, Italy.
| | | | - Kate Clezy
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | | | - Carole Dromer
- International Committee of the Red Cross, Geneva, Switzerland
| | - Silvia Garelli
- International Committee of the Red Cross, Geneva, Switzerland
| | | | | | | | - Ernestina Repetto
- Médecins Sans Frontières, Geneva, Switzerland
- Service des Maladies Infectieuses, Clinique Hospitalière Universitaire Saint Pierre, Bruxelles, Belgium
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Witter S, Diaconu K, Bou-Orm I, Jamal Z, Shroff ZC, Mahmoud A, Daher M, Varma V. Evolution and lessons from an integrated service delivery network in North West Syria. Confl Health 2023; 17:12. [PMID: 36964578 PMCID: PMC10037359 DOI: 10.1186/s13031-023-00510-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/15/2023] [Indexed: 03/26/2023] Open
Abstract
Background Northwest Syria (NWS) is a complex and extremely fragile operating environment, with more than 2.8 million people needing humanitarian assistance. To support a common standard of care delivery and enable coordination among the multiple providers in NWS, WHO developed an Essential Health Services package (EHSP) in 2016-17 and subsequently supported a facility network model to deliver the EHSP. This article provides an evaluation of the network to date, aiming to inform further development of the network and draw wider lessons for application of similar approaches in complex emergency settings. Methods This mixed method study included document review, participatory, qualitative and quantitative data, gathered in the first half of 2021. Participatory data came from two group model building workshops with 21 funders and implementers. Semi-structured interviews with 81 funders, health professionals and community members were also conducted. Analyses of the workshops and interviews was inductive, however a deductive approach was used for synthesising insights across this and the document review. The final component was a survey of health providers (59 health care professionals) and service users (233 pregnant women and 214 persons living with NCDs) across network and other comparable facilities, analysed using routine descriptive and inferential statistics. Findings across all methods were triangulated. Results The study finds that the network and its accompanying essential service package were relevant to the dynamic and challenging context, with high but shifting population needs and multiple uncoordinated providers. Judged in relation to its original goals of comprehensive, coordinated services, equitable access and efficient service delivery, the data indicate that gains have been made in all three areas through the network, although attribution is challenging, given the complex environment. The context remains challenging, with shifting boundaries and populations displaced by conflict, difficulties in retaining staff, the need to import medicines and supplies across borders, and governance gaps. Conclusion This study adds to a very limited literature on coordinated network approaches used to raise care quality and improve referrals and efficiency in a complex emergency setting. Although areas of ongoing challenge, including for sustainability, are noted, the network demonstrated some resilience strategies and can provide lessons for other similar contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-023-00510-3.
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Affiliation(s)
- Sophie Witter
- grid.104846.fInstitute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- ReBUILD for Resilience research consortium, Liverpool, UK
| | - Karin Diaconu
- grid.104846.fInstitute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- ReBUILD for Resilience research consortium, Liverpool, UK
| | - Ibrahim Bou-Orm
- grid.104846.fInstitute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Zeina Jamal
- grid.104846.fInstitute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Zubin Cyrus Shroff
- grid.3575.40000000121633745Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Abdulbaki Mahmoud
- World Health Organisation Field Presence in Gaziantep, Gaziantep, Turkey
| | - Mahmoud Daher
- World Health Organisation Field Presence in Gaziantep, Gaziantep, Turkey
| | - Vinod Varma
- World Health Organisation Field Presence in Gaziantep, Gaziantep, Turkey
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White S, Heath T, Mutula AC, Dreibelbis R, Palmer J. How are hygiene programmes designed in crises? Qualitative interviews with humanitarians in the Democratic Republic of the Congo and Iraq. Confl Health 2022; 16:45. [PMID: 36056391 PMCID: PMC9438112 DOI: 10.1186/s13031-022-00476-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hygiene behaviour change programmes are complex to design. These challenges are heightened during crises when humanitarian responders are under pressure to implement programmes rapidly despite having limited information about the local situation, behaviours and opinions-all of which may also be rapidly evolving. METHODS We conducted in-depth interviews with 36 humanitarian staff involved in hygiene programme design in two crisis-affected settings-one a conflict affected setting (Iraq) and the other amid a cholera outbreak (Democratic Republic of the Congo). Interviews explored decision-making in each phase of the humanitarian project cycle and were thematically analysed. RESULTS Participants considered the design and implementation of hygiene programmes in crises to be sub-optimal. Humanitarians faced sector-specific challenges as well as more general constraints associated with operating within the humanitarian system. Programme-design decisions were made naturalistically and relied heavily on the intuitions and assumptions of senior staff. National organisations were often side-lined from programme design processes despite being in a better position to gather situational data. Consequently, programme design and decision-making processes adopted by humanitarians were similar across the two settings studied and led to similar types of hygiene promotion activities being delivered. CONCLUSION Hygiene programming in crises-affected settings could be strengthened by initiatives targeted at supporting humanitarian staff during the pre-implementation programme design phase. This may include rapid assessment tools to better understand behavioural determinants in crisis-affected contexts; the use of a theory of change to inform the selection of programme activities; and funding mechanisms which encourage equitable partnerships, phased programming, regular adaptation and have programmatic components targeted at sustainability and sector capacity building. Initiatives aimed at sector reform should be cognisant of inter and intra-organisational dynamics, the ways that expertise is created and valued by the sector, and humanitarian habits and norms that arise in response to system constraints and pressures. These micro-organisational processes affect macro-level outcomes related to programme quality and acceptability and determine or limit the roles of national actors in programme design processes.
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Affiliation(s)
- Sian White
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
| | - Thomas Heath
- Independent Consultant, Goma, Democratic Republic of the Congo
| | | | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer Palmer
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Schedwin M, Furaha AB, Kapend R, Akilimali P, Malembaka EB, Hildenwall H, Alfvén T, Tylleskär T, Mapatano MA, King C. Under-five mortality in the Democratic Republic of the Congo: secondary analyses of survey and conflict data by province. Bull World Health Organ 2022; 100:422-435. [PMID: 35813509 PMCID: PMC9243684 DOI: 10.2471/blt.22.287915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To compare coverage of key child health policy indicators across provinces and to explore their association with under-five mortality and level of conflict in the Democratic Republic of the Congo. Methods We made a secondary analysis of nationally representative data from 1380 health facilities and 20 792 households in 2017-2018. We analysed provincial-level data on coverage of 23 different indicators for improving common causes of childhood mortality, combined into mean scores for: newborn health, pneumonia, diarrhoea, malaria and safe environment. Using negative binomial regression we compared the scores with provincial-level under-five mortality. With binary logistic regression at the individual level we compared indicators (outcome) with living in a conflict-affected province (exposure). Findings All grouped coverage scores demonstrated large ranges across the 26 provinces: newborn health: 20% to 61%; pneumonia: 26% to 86%; diarrhoea: 25% to 63%; malaria: 22% to 53%; and safe environment: 4% to 53%. The diarrhoea score demonstrated the strongest association with under-five mortality (adjusted coefficient: -0.026; 95% confidence interval: -0.045 to -0.007). Conflict-affected provinces had both the highest as well as the lowest mortality rates and indicator coverages. The odds of coverage were higher in conflict-affected provinces for 13 out of 23 indicators, whereas in provinces unaffected by conflict only one indicator had higher odds of coverage. Conclusion Conflict alone is a poor predictor for child health. Ensuring that children in unaffected provinces are not neglected while addressing the needs of the most vulnerable in conflict settings is important. Prevent, protect and treat strategies for diarrhoeal disease could help improve equity in child survival.
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Affiliation(s)
- Mattias Schedwin
- Department of Global Public Health, Karolinska Institutet, Tomtebogatan 18a, 17177, Stockholm, Sweden
| | - Aurélie Bisumba Furaha
- Paediatric Department, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Richard Kapend
- School of Criminology and Criminal Justice (SCCJ), University of Portsmouth, Portsmouth, England
| | - Pierre Akilimali
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Espoir Bwenge Malembaka
- Center for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Helena Hildenwall
- Department of Global Public Health, Karolinska Institutet, Tomtebogatan 18a, 17177, Stockholm, Sweden
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Tomtebogatan 18a, 17177, Stockholm, Sweden
| | | | - Mala Ali Mapatano
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Tomtebogatan 18a, 17177, Stockholm, Sweden
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Lokot M, Bou-Orm I, Zreik T, Kik N, Fuhr DC, El Masri R, Meagher K, Smith J, Asmar MK, McKee M, Roberts B. Health System Governance in Settings with Conflict-Affected Populations: A Systhematic Review. Health Policy Plan 2022; 37:655-674. [PMID: 35325120 DOI: 10.1093/heapol/czac027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Health system governance has been recognised as critical to strengthening healthcare responses in settings with conflict-affected populations. The aim of this review was to examine existing evidence on health system governance in settings with conflict-affected populations globally. The specific objectives were: (i) to describe the characteristics of the eligible studies; (ii) to describe the principles of health system governance; (iii) to examine evidence on barriers and facilitators for stronger health system governance; and (iv) to analyse the quality of available evidence. A systematic review methodology was used following PRISMA criteria. We searched six academic databases, and used grey literature sources. We included papers reporting empirical findings on health system governance among populations affected by armed conflict, including refugees, asylum seekers, internally displaced populations, conflict-affected non-displaced populations and post-conflict populations. Data were analysed according to the study objectives and informed primarily by the Siddiqi et al. (2009) governance framework. Quality appraisal was conducted using an adapted version of the Mixed Methods Appraisal Tool. Of the 6,511 papers identified through database searches, 34 studies met eligibility criteria. Few studies provided a theoretical framework or definition for governance. The most frequently identifiable governance principles related to participation and coordination, followed by equity and inclusiveness and intelligence and information. The least frequently identifiable governance principles related to rule of law, ethics and responsiveness. Across studies, the most common facilitators of governance were collaboration between stakeholders, bottom-up and community-based governance structures, inclusive policies, and longer-term vision. The most common barriers related to poor coordination, mistrust, lack of a harmonised health response, lack of clarity on stakeholder responsibilities, financial support, and donor influence. This review highlights the need for more theoretically informed empirical research on health system governance in settings with conflict-affected populations that draws on existing frameworks for governance.
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Affiliation(s)
- Michelle Lokot
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Ibrahim Bou-Orm
- Saint Joseph University of Beirut, B.P. 11-5076 Riad El Solh, Beyrouth 1107 2180, Lebanon
| | - Thurayya Zreik
- War Child Holland, Verdun, Hussein Oweini street, Beirut, Lebanon
| | - Nour Kik
- Ministry of Public Health, Lebanese University Central Directorate, 4th Floor, Museum Square, Beirut 9800, Lebanon
| | - Daniela C Fuhr
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Rozane El Masri
- War Child Holland, Verdun, Hussein Oweini street, Beirut, Lebanon
| | | | - James Smith
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Bayard Roberts
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
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Availability and Characteristics of Humanitarian Health Education and Training Programs: A Web-Based Review. Prehosp Disaster Med 2021; 37:132-138. [PMID: 34928199 DOI: 10.1017/s1049023x21001333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Education and training programs are critical to achieve personnel capacity building and professionalization in the rapidly growing humanitarian health sector. Thus, this study aimed to describe the status of humanitarian health education and training programs world-wide. METHODS A web-based analysis was conducted to identify the available humanitarian health programs. The following characteristics of the training programs were described: geographical location, target audience, prerequisite, qualification, curriculum, content, length, modality of delivery, teaching and assessment methods, and tuition fee. RESULTS The search identified a total number of 142 training programs, most of them available in few countries of the global North. Only seven percent of the identified programs qualified for a master's degree in humanitarian health. Public health was the most identified content (47.2%). Approximately one-half of the training programs (50.7%) were delivered face-to-face. Theoretical knowledge was the most common method used for teaching and assessment. The duration of the training and tuition fees were different for different programs and qualifications, while target audience, prerequisite, and curriculum design were often vaguely described or missing. CONCLUSIONS The study shows a global inequality in access to humanitarian health training programs due to financial and geographical constraints. The study also reveals gaps in program contents, as well as teaching and assessment methods, all issues that could be addressed by developing cost-effective e-learning and online simulation programs. Lastly, the data from this study provide a learning tool that can be used by humanitarian health educators and training centers to further define and standardize the requirements and competencies of humanitarian health professionals.
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Jarrett P, Fozdar Y, Abdelmagid N, Checchi F. Healthcare governance during humanitarian responses: a survey of current practice among international humanitarian actors. Confl Health 2021; 15:25. [PMID: 33838690 PMCID: PMC8035763 DOI: 10.1186/s13031-021-00355-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Large international humanitarian actors support and directly deliver health services for millions of people in crises annually, and wield considerable power to decide which health services to provide, how and to whom, across a vast spectrum of health areas. Despite decades of reform aiming to improve accountability in the sector, public health practice among humanitarian actors is not heavily scrutinized in either the countries where they are headquartered or those where they provide healthcare. We surveyed current healthcare governance practice among large international humanitarian actors to better understand what organisations are doing to ensure oversight and accountability for health services in humanitarian responses. METHODS The term 'healthcare governance' was defined and categorised into seven domains: implementation of health management information systems (HMIS) and use of resulting data; professional development of health sector staff; audits of health service performance; management of clinical incidents; evidence-based practice; pharmaceutical supply; and beneficiary engagement. Senior health professionals at 32 leading international actors providing humanitarian health services were contacted between July and August 2019 to complete a 109-question online survey about their organisation's practice in these domains. RESULTS Respondents from 13 organisations completed the questionnaire. Healthcare governance practices were undertaken to varying degrees by all organisations but were often driven by donor requirements and external factors rather than improvement of programme performance. Common strengths were the inclusion of governance in organisational policies, high availability of technical guidelines, and close monitoring of pharmaceutical services. Recurring weaknesses were poor beneficiary engagement, inconsistent use of health information for decision making, unsystematic implementation of healthcare audits, inconsistent management of clinical incidents, and lack of training and professional development opportunities. CONCLUSIONS To our knowledge, this is the first study to describe healthcare governance practice among humanitarian actors. Leading international humanitarian healthcare providers are already implementing many healthcare governance activities; however, these are inconsistently applied and generally not reflective of systematic policies or earmarked organisational resources. There is a need for sector-wide consensus on how the humanitarian sector defines healthcare governance, the domains that constitute it, which actors in the humanitarian system are implicated, and how malpractice should be systematically addressed.
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Affiliation(s)
- Prudence Jarrett
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Yasin Fozdar
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Nada Abdelmagid
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Francesco Checchi
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Vanholder R, Sükrü Sever M, Lameire N. Kidney problems in disaster situations. Nephrol Ther 2021; 17S:S27-S36. [PMID: 33910695 DOI: 10.1016/j.nephro.2020.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/12/2020] [Indexed: 11/30/2022]
Abstract
Mass disasters, particularly earthquakes, cause many medical problems, including kidney problems, but an organized approach to cope with them was initiated only at the end of previous century, subsequent to the Armenian Spitak earthquake in 1988. Originally, interventions were focused on acute kidney injury (AKI) following crush injury and rhabdomyolysis in victims who had been trapped under the debris of collapsed buildings. However, similar problems were also registered in the context of other catastrophic events, especially man-made disasters like wars and torture. Other kidney-related problems, such as the preservation of treatment continuity in chronic kidney disease (CKD), especially in maintenance dialysis patients, deserved attention as well. Specific therapeutic principles apply to disaster-related kidney problems and these may differ from usual day-to-day clinical practice. Those approaches have been formulated in global and specific country-related guidelines and recommendations. It is clear that a well-conceived and organized management of kidney diseases in disasters benefits outcomes. Furthermore, it may be useful if the model and philosophy that were applied over the last three decades could be adapted by broadening the scope of disasters leading to intervention. Actions should be guided and coordinated by a panel of experts steering ad hoc interventions, rather than applying the "old" static model where a single coordinating center instructs and uses volunteers listed long before a potential event occurs.
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Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 10, Corneel Heymanslaan, B9000 Gent, Belgium.
| | - Mehmet Sükrü Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Millet Caddesi, 34093 Istanbul, Turkey
| | - Norbert Lameire
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 10, Corneel Heymanslaan, B9000 Gent, Belgium
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Lameire N, Sever MS, Van Biesen W, Vanholder R. Role of the International and National Renal Organizations in Natural Disasters: Strategies for Renal Rescue. Semin Nephrol 2020; 40:393-407. [DOI: 10.1016/j.semnephrol.2020.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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12
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Tappis H, Elaraby S, Elnakib S, AlShawafi NAA, BaSaleem H, Al-Gawfi IAS, Othman F, Shafique F, Al-Kubati E, Rafique N, Spiegel P. Reproductive, maternal, newborn and child health service delivery during conflict in Yemen: a case study. Confl Health 2020; 14:30. [PMID: 32514295 PMCID: PMC7254736 DOI: 10.1186/s13031-020-00269-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Armed conflict, food insecurity, epidemic cholera, economic decline and deterioration of essential public services present overwhelming challenges to population health and well-being in Yemen. Although the majority of the population is in need of humanitarian assistance and civil servants in many areas have not received salaries since 2016, many healthcare providers continue to work, and families continue to need and seek care. METHODS This case study examines how reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH+N) services have been delivered since 2015, and identifies factors influencing implementation of these services in three governorates of Yemen. Content analysis methods were used to analyze publicly available documents and datasets published since 2000 as well as 94 semi-structured individual and group interviews conducted with government officials, humanitarian agency staff and facility-based healthcare providers and six focus group discussions conducted with community health midwives and volunteers in September-October 2018. RESULTS Humanitarian response efforts focus on maintaining basic services at functioning facilities, and deploying mobile clinics, outreach teams and community health volunteer networks to address urgent needs where access is possible. Attention to specific aspects of RMNCAH+N varies slightly by location, with differences driven by priorities of government authorities, levels of violence, humanitarian access and availability of qualified human resources. Health services for women and children are generally considered to be a priority; however, cholera control and treatment of acute malnutrition are given precedence over other services along the continuum of care. Although health workers display notable resilience working in difficult conditions, challenges resulting from insecurity, limited functionality of health facilities, and challenges in importation and distribution of supplies limit the availability and quality of services. CONCLUSIONS Challenges to providing quality RMNCAH+N services in Yemen are formidable, given the nature and scale of humanitarian needs, lack of access due to insecurity, politicization of aid, weak health system capacity, costs of care seeking, and an ongoing cholera epidemic. Greater attention to availability, quality and coordination of RMNCAH services, coupled with investments in health workforce development and supply management are needed to maintain access to life-saving services and mitigate longer term impacts on maternal and child health and development. Lessons learned from Yemen on how to address ongoing primary health care needs during massive epidemics in conflict settings, particularly for women and children, will be important to support other countries faced with similar crises in the future.
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Affiliation(s)
- Hannah Tappis
- Center for Humanitarian Health, Johns Hopkins Center for Humanitarian Health, Baltimore, MD USA
| | - Sarah Elaraby
- Center for Humanitarian Health, Johns Hopkins Center for Humanitarian Health, Baltimore, MD USA
| | - Shatha Elnakib
- Center for Humanitarian Health, Johns Hopkins Center for Humanitarian Health, Baltimore, MD USA
| | | | | | | | | | | | | | | | - Paul Spiegel
- Center for Humanitarian Health, Johns Hopkins Center for Humanitarian Health, Baltimore, MD USA
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Leresche E, Truppa C, Martin C, Marnicio A, Rossi R, Zmeter C, Harb H, Hamadeh RS, Leaning J. Conducting operational research in humanitarian settings: is there a shared path for humanitarians, national public health authorities and academics? Confl Health 2020; 14:25. [PMID: 32435274 PMCID: PMC7222467 DOI: 10.1186/s13031-020-00280-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
In humanitarian contexts, it is a difficult and multi-faceted task to enlist academics, humanitarian actors and health authorities in a collaborative research effort. The lack of research in such settings has been widely described in the past decade, but few have analysed the challenges in building strong and balanced research partnerships. The major issues include considering operational priorities, ethical imperatives and power differentials. This paper analyses in two steps a collaborative empirical endeavour to assess health service utilization by Syrian refugee and Lebanese women undertaken by the International Committee of the Red Cross (ICRC), the Lebanese Ministry of Public Health (MoPH) and the Harvard François-Xavier Bagnoud (FXB) Center. First, based on challenges documented in the literature, we shed light on how we negotiated appropriate research questions, methodologies, bias analyses, resource availability, population specificities, security, logistics, funding, ethical issues and organizational cultures throughout the partnership. Second, we describe how the negotiations required each partner to go outside their comfort zones. For the academics, the drivers to engage included the intellectual value of the collaboration, the readiness of the operational partners to conduct an empirical investigation and the possibility that such work might lead to a better understanding in public health terms of how the response met population needs. For actors responding to the humanitarian crisis (the ICRC and the MOPH), participating in a technical collaboration permitted methodological issues to be worked through in the context of deliberations within the wider epistemic community. We find that when they collaborate, academics, humanitarian actors and health authorities deploy their respective complementarities to build a more comprehensive approach. Barriers such as the lack of uptake of research results or weak links to the existing literature were overcome by giving space to define research questions and develop a longer-term collaboration involving individual and institutional learning. There is the need ahead of time to create balanced decision-making mechanisms, allow for relative financial autonomy, and define organizational responsibilities. Ultimately, mutual respect, trust and the recognition of each other's expertise formed the basis of an initiative that served to better understand populations affected by conflict and meet their needs.
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Affiliation(s)
- Enrica Leresche
- International Committee of the Red Cross Delegation, Beirut, Lebanon
| | - Claudia Truppa
- International Committee of the Red Cross Delegation, Beirut, Lebanon
| | - Christophe Martin
- International Committee of the Red Cross Delegation, Beirut, Lebanon
| | | | - Rodolfo Rossi
- International Committee of the Red Cross, Geneva, Switzerland
| | - Carla Zmeter
- International Committee of the Red Cross Delegation, Beirut, Lebanon
| | - Hilda Harb
- Lebanese Ministry of Public Health, Beirut, Lebanon
| | | | - Jennifer Leaning
- Harvard François Xavier Bagnoud Center for Health and Human Rights, Boston, USA
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14
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Drevin G, Mölsted Alvesson H, van Duinen A, Bolkan HA, Koroma AP, Von Schreeb J. "For this one, let me take the risk": why surgical staff continued to perform caesarean sections during the 2014-2016 Ebola epidemic in Sierra Leone. BMJ Glob Health 2019; 4:e001361. [PMID: 31406584 PMCID: PMC6666802 DOI: 10.1136/bmjgh-2018-001361] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/28/2019] [Accepted: 06/01/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction Routine health service provision decreased during the 2014–2016 Ebola virus disease (EVD) outbreak in Sierra Leone, while caesarean section (CS) rates at public hospitals did not. It is unknown what made staff provide CS despite the risks of contracting EVD. This study explores Sierra Leonean health worker perspectives of why they continued to provide CS. Methods This qualitative study documents the experiences of 15 CS providers who worked during the EVD outbreak. We interviewed surgical and non-surgical CS providers who worked at public hospitals that either increased or decreased CS volumes during the outbreak. Hospitals in all four administrative areas of Sierra Leone were included. Semistructured interviews averaged 97 min and healthcare experience 21 years. Transcripts were analysed by modified framework analysis in the NVivo V.11.4.1 software. Results We identified two themes that may explain why providers performed CS despite EVD risks: (1) clinical adaptability and (2) overcoming the moral dilemmas. CS providers reported being overworked and exposed to infection hazards. However, they developed clinical workarounds to the lack of surgical materials, protective equipment and standard operating procedures until the broader international response introduced formal personal protective equipment and infection prevention and control practices. CS providers reported that dutifulness and sense of responsibility for one’s community increased during EVD, which helped them justify taking the risk of being infected. Although most surgical activities were reduced to minimise staff exposure to EVD, staff at public hospitals tended to prioritise performing CS surgery for women with acute obstetric complications. Conclusion This study found that CS surgery during EVD in Sierra Leone may be explained by remarkable decisions by individual CS providers at public hospitals. They adapted practically to material limitations exacerbated by the outbreak and overcame the moral dilemmas of performing CS despite the risk of being infected with EVD.
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Affiliation(s)
- Gustaf Drevin
- Centre for Research on Health Care in Disasters, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Alex van Duinen
- Faculty of Medicine and Health Sciences, Department of Cancer Research and Molecular Medicine, NTNU Fakultet for ingeniorvitenskap og teknologi Trondheim, Trondheim, Norway.,Department of Surgery, Sankt Olavs Hospital Universitetssykehuset i Trondheim, Trondheim, Norway
| | - Håkon A Bolkan
- Faculty of Medicine and Health Sciences, Department of Cancer Research and Molecular Medicine, NTNU Fakultet for ingeniorvitenskap og teknologi Trondheim, Trondheim, Norway.,Department of Surgery, Sankt Olavs Hospital Universitetssykehuset i Trondheim, Trondheim, Norway
| | - Alimamy P Koroma
- Department of Obstetrics and Gynecology, Princess Christiana Maternity Hospital, Freetown, Sierra Leone
| | - Johan Von Schreeb
- Centre for Research on Health Care in Disasters, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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15
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Exploring Working Relationships Between National and Expatriate RNs on Humanitarian Aid Missions: The Perspectives of Liberian Nurses. Am J Nurs 2019; 119:49-60. [PMID: 31135433 DOI: 10.1097/01.naj.0000559806.91187.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Purpose: This qualitative study was conducted to explore the perceptions and concerns of Liberian RNs who work for international nongovernmental organizations (NGOs) in Liberia, and to elicit insights and suggestions about how to improve collaboration between national and expatriate nursing staff. METHODS Five focus groups involving 19 nurses and an individual interview with one nurse were conducted. A semistructured interview guide was used to gather perspectives and garner suggestions. A phenomenological approach was used to identify emergent themes. RESULTS Regarding positive experiences, participants from all 10 NGOs reported that working with expats gave them opportunities to be mentored, learn new skills, and try out new techniques and equipment. Negative experiences included problems with disrespect and expats' lack of cultural competency. Participants spoke of adverse patient outcomes that resulted when expats made assumptions and wouldn't listen to national staff. CONCLUSIONS The findings indicate that changes are warranted in the current work culture between national and expatriate nursing staff. Improving collaboration between national and expatriate RNs could lead to higher-quality care and better patient outcomes. Predeployment training for expatriates that incorporates the voices of national staff is recommended; this would raise awareness of the realities of nursing in low-resource settings and promote respect for national staff.
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16
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Truppa C, Leresche E, Fuller AF, Marnicio AS, Abisaab J, El Hayek N, Zmeter C, Toma WS, Harb H, Hamadeh RS, Leaning J. Utilization of primary health care services among Syrian refugee and Lebanese women targeted by the ICRC program in Lebanon: a cross-sectional study. Confl Health 2019; 13:7. [PMID: 30923560 PMCID: PMC6420751 DOI: 10.1186/s13031-019-0190-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/28/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The Syrian crisis has put tremendous strain on the Lebanese health system, particularly in the historically underserved border region. The ICRC Primary Health Care program has focused on refugee and host communities in these areas. This study objectives were: 1) to determine whether the ICRC program was reaching the most vulnerable populations; 2) to understand the key perceived health needs in the catchment areas of the ICRC supported facilities; and 3) to identify barriers to utilization of health care services. METHODS Between July and September 2017 we conducted two cross-sectional studies - one randomized household survey and one clinic-based - in the catchment areas of three ICRC-supported facilities, targeting women of reproductive age and caretakers of children under five. Differences between groups were analysed with t-test or chi-squared test. RESULTS In the household survey, similar socio-demographic profiles were observed between Syrian refugee women and vulnerable Lebanese hosts. With regard to the study objectives:The most vulnerable populations were those seen in the ICRC-supported facilities.For both populations, the most common reasons for seeking care were non-communicable diseases (40.6%) and sexual and reproductive health issues (28.6%). Yet the people reaching the ICRC supported facilities were more likely to seek care for communicable diseases affecting their children (37.8%), rather than for the most common reasons expressed in the household survey.In the catchment areas, reported gaps included low immunization coverage and low levels of antenatal care and family planning both for Syrian and Lebanese. Dental care also emerged as an issue. Out of pocket expenditures was reported as a critical barrier for utilization of primary health care services for both populations, while the most important barrier for utilization of ICRC-supported services was lack of awareness. CONCLUSIONS Despite the ICRC reaching the most vulnerable Syrian and Lebanese communities, the population-based survey revealed that important gaps exist in terms of utilization of health care services among women of reproductive age and their children. A stronger outreach component is needed to address lack of awareness. Innovative solutions are also needed to address cost barriers at the levels of both facility and individual user.
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Affiliation(s)
- Claudia Truppa
- The International Committee of the Red Cross, Beirut Delegation, Beirut, Lebanon
| | - Enrica Leresche
- The International Committee of the Red Cross, Beirut Delegation, Beirut, Lebanon
| | - Arlan F. Fuller
- Harvard François Xavier Bagnoud Center for Health and Human Rights, Boston, USA
| | - Ariana S. Marnicio
- Harvard François Xavier Bagnoud Center for Health and Human Rights, Boston, USA
| | - Josyann Abisaab
- Harvard François Xavier Bagnoud Center for Health and Human Rights, Boston, USA
| | - Nicole El Hayek
- The International Committee of the Red Cross, Beirut Delegation, Beirut, Lebanon
| | - Carla Zmeter
- The International Committee of the Red Cross, Beirut Delegation, Beirut, Lebanon
| | - Warda S. Toma
- Harvard François Xavier Bagnoud Center for Health and Human Rights, Boston, USA
- Department of Paediatrics, The University of British Columbia, Vancouver, Canada
| | - Hilda Harb
- Lebanese Ministry of Public Health, Beirut, Lebanon
| | | | - Jennifer Leaning
- Harvard François Xavier Bagnoud Center for Health and Human Rights, Boston, USA
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17
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Erismann S, Gürler S, Wieland V, Prytherch H, Künzli N, Utzinger J, Peterhans B. Addressing fragility through community-based health programmes: insights from two qualitative case study evaluations in South Sudan and Haiti. Health Res Policy Syst 2019; 17:20. [PMID: 30764847 PMCID: PMC6376698 DOI: 10.1186/s12961-019-0420-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fragility can have a negative effect on health systems and people's health, and poses considerable challenges for actors implementing health programmes. However, how such programmes, in turn, affect the overall fragility of a context is rarely considered. The Swiss Red Cross has been active in South Sudan and Haiti since 2008 and 2011, respectively, and commissioned a scoping study to shed new light on this issue within the frame of a learning process launched in 2015. METHODS The study consisted of a document review, qualitative field research undertaken between June and August 2015 in South Sudan and Haiti, and two data triangulation/validation workshops. Semi-structured key informant interviews and focus group discussions included 49 purposively sampled participants who helped build a deeper understanding of what constitutes and drives fragility in the respective countries. Moreover, interviews and focus group discussions served to grasp positive and negative effects that the Swiss Red Cross's activities may have had on the overall state of fragility in the given contexts. RESULTS Qualitative data from the two case studies suggest that the community-based health programmes implemented in South Sudan and Haiti may have influenced certain drivers of fragility. While impacts cannot be measured or quantified in the absence of a baseline (the projects were not originally designed to mitigate overall fragility), the study nevertheless reveals entry points for designing programmes that are responsive to the overall fragility context and contain more specific elements for navigating a more sustainable pathway out of fragility. There are, however, multiple challenges, especially considering the complexity of fragile and conflict-affected contexts where a multitude of local and international actors with different goals and strategies interfere in a rapidly changing setting. CONCLUSIONS Health programmes may not only reach their health objectives but might potentially also contribute towards mitigating overall fragility. However, considerable hurdles remain for aid agencies, especially where scope for action is limited for a single actor and where engagement with state structures is difficult. Thus, cooperation and exchange with other aid and development actors across the spectrum has to be strengthened to increase the coherence of aid policies and interventions of actors both within and across the different aid communities.
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Affiliation(s)
- Séverine Erismann
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Sibel Gürler
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland.,swisspeace, CH-3013, Bern, Switzerland
| | | | - Helen Prytherch
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Nino Künzli
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Bernadette Peterhans
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland. .,University of Basel, P.O. Box, CH-4003, Basel, Switzerland.
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18
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Chan EYY, Wright K, Parker M. Health-emergency disaster risk management and research ethics. Lancet 2019; 393:112-113. [PMID: 30638570 DOI: 10.1016/s0140-6736(18)33126-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/04/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Emily Y Y Chan
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
| | | | - Michael Parker
- Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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19
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Bull A, Mayhew E, Reavley P, Tai N, Taylor S. Paediatric blast injury: challenges and priorities. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:310-311. [PMID: 30169263 DOI: 10.1016/s2352-4642(18)30073-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Anthony Bull
- Department of Bioengineering, Imperial College London, London UK
| | - Emily Mayhew
- Department of Bioengineering, Imperial College London, London UK.
| | | | - Nigel Tai
- Barts Health NHS Trust, The Royal London Hospital, London, UK
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20
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Brooks J, Erickson TB, Kayden S, Ruiz R, Wilkinson S, Burkle FM. Responding to chemical weapons violations in Syria: legal, health, and humanitarian recommendations. Confl Health 2018; 12:12. [PMID: 29479374 PMCID: PMC5817898 DOI: 10.1186/s13031-018-0143-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/12/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The repeated use of prohibited chemical weapons in the Syrian conflict poses serious health, humanitarian, and security threats to civilians, healthcare personnel, and first responders. Moreover, the use of chemical weapons constitutes a clear and egregious violation of international law-likely amounting to a war crime-for which continued impunity is setting a dangerous precedent in relation to current and future conflicts. This debate article calls upon concerned states, organizations, and individuals to respond urgently and unequivocally to this serious breach of international legal and humanitarian norms. MAIN BODY Based on health, humanitarian, and legal findings, this article calls for concrete action to: 1) reduce the risk of chemical weapons being used in current and future conflicts; 2) review and support the preparedness equipment and antidote supplies of first responders, humanitarian organizations, and military forces operating in Syria; 3) support international mechanisms for monitoring and enforcing the prohibition on chemical weapons, including through criminal accountability; 4) support civilian victims of chemical weapons attacks, including refugees; and 5) re-commit to the complete elimination of chemical weapons in compliance with the Chemical Weapons Convention (1993), a comprehensive treaty that bans chemical weapons and requires their complete destruction. CONCLUSION All involved states and organizations should take urgent steps to ensure the protection of the most vulnerable victims of conflict, including victims of chemical weapons attacks in Syria, and to reinforce international law in the face of such serious violations.
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Affiliation(s)
- Julia Brooks
- Harvard Humanitarian Initiative, Cambridge, MA USA
| | - Timothy B. Erickson
- Department of Emergency Medicine, Brigham and Women’s Hospital; Harvard Medical School, Harvard Humanitarian Initiative, Cambridge, MA USA
| | - Stephanie Kayden
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School; and Core Faculty, Harvard Humanitarian Initiative, Cambridge, MA USA
| | - Raul Ruiz
- U.S. House of Representatives for California’s 36th congressional district, Washington, D.C. USA
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21
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Affiliation(s)
- Ronald J Waldman
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; Doctors of the World-USA, New York, NY, USA.
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22
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Samarasekera U, Horton R. Improving evidence for health in humanitarian crises. Lancet 2017; 390:2223-2224. [PMID: 28602559 DOI: 10.1016/s0140-6736(17)31353-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
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23
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Hawkins V, Pérache AH. Humanitarian medicine is more than a technical exercise. Lancet 2017; 390:2226-2228. [PMID: 28602561 DOI: 10.1016/s0140-6736(17)31352-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
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24
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O'Mathúna D, Siriwardhana C. Research ethics and evidence for humanitarian health. Lancet 2017; 390:2228-2229. [PMID: 28602560 DOI: 10.1016/s0140-6736(17)31276-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/09/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Dónal O'Mathúna
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland.
| | - Chesmal Siriwardhana
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
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