1
|
Ibrahim S, Al-Dahir S, Al Mulla T, Lami F, Hossain SMM, Baqui A, Burnham G. Resilience of health systems in conflict affected governorates of Iraq, 2014-2018. Confl Health 2021; 15:76. [PMID: 34663395 PMCID: PMC8521490 DOI: 10.1186/s13031-021-00412-2] [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: 01/14/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives The objective of this study was to assess the resilience of health systems in four governorates affected by conflict from 2014 to 2018, and to convey recommendations.
Methods Health managers from Al Anbar, Ninawa, Salah al-Din, and Kirkuk governorates discussed resilience factors of Primary Health Care services affected by the 2014–2017 ISIS insurgency in focus groups, and general discussions. Additional information was gathered from key informants and a UNICEF health facility survey. Three specific aspects were examined: (1) meeting health needs in the immediate crisis response, (2) adaptation of services, (3) restructuring and recovery measures. Data from a MoH/UNICEF national health facility survey in 2017 were analyzed for functionality.
Results There were many common themes across the four governorates, with local variations. (1) Absorption The shock to the public sector health services by the ISIS invasion caught health services in the four governorates unprepared, with limited abilities to continue to provide services. Private pharmacies and private clinics in some places withstood the initial shock better than the public sector. (2) Adaptation After the initial shock, many health facilities adapted by focusing on urgent needs for injury and communicable disease care. In most locations, maternal, neonatal, and child health (MNCH) preventive and promotive PHC services stopped. Ill persons would sometimes consult health workers in their houses at night for security reasons. (3) Restructuring or transformative activities In most areas, health services recovery was continuing in 2020. Some heavily damaged facilities are still functioning, but below pre-crisis level. Rebuilding lost community trust in the public sector is proving difficult. Conclusion Health services generally had little preparation for and limited resilience to the ISIS influx. Governorates are still restructuring services after the liberation from ISIS in 2017. Disaster planning was identified by all participants as a missing component, as everyone anticipated future similar emergencies.
Collapse
Affiliation(s)
- Shaimaa Ibrahim
- UNICEF Iraq Country Office, UN Compound, Baghdad, 10011, Iraq
| | - Sara Al-Dahir
- Xavier University of Louisiana, 1 Drexel Dr, New Orleans, LA, 70125, USA
| | - Taha Al Mulla
- UNICEF Iraq Country Office, UN Compound, Baghdad, 10011, Iraq
| | - Faris Lami
- University of Baghdad, Medical City, Baghdad, 00964, Iraq
| | | | - Abdullah Baqui
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21210, USA
| | - Gilbert Burnham
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21210, USA.
| |
Collapse
|
2
|
Health Care and Care-Seeking in Mosul 1 Year After Defeat of ISIS. Disaster Med Public Health Prep 2021; 16:1524-1531. [PMID: 34284845 DOI: 10.1017/dmp.2021.112] [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: 11/06/2022]
Abstract
OBJECTIVE Our objective was to compare care-seeking patterns in Mosul, Iraq, in 2018, 1 y after Islamic State of Iraq and Syria (ISIS) control, with findings from neighborhoods that had been sampled in 2017. METHODS For this multi-stage randomized cluster household survey, we created one cluster in each of 20 neighborhoods randomly selected from the 40 neighborhoods in the 2016/17 survey; 12 in east Mosul, 8 in west Mosul. In each, 30 households were interviewed beginning at a randomly selected start house. Questions were derived from the 2016/2017 post-ISIS survey. RESULTS We interviewed the head of household or senior female in 600 households containing 3375 persons. One year after ISIS, some household demographic shifts had occurred. Diarrhea in children during the past 2 wk decreased from 50.1% to 7.5% (P < 0.001); however, cough/difficulty breathing increased from 15.5% to 33.6% (P < 0.01). Among adults, care-seeking for noncommunicable diseases increased from 22.3% to 43.5% (P < 0.001). Emotional and psychological complaints common in the previous survey were now nearly absent. Pregnancy complications diminished from 65.2% to 15.4% (P < 0.001). CONCLUSIONS Communicable diseases predominated among children and noncommunicable diseases among adults. Access to health care substantially improved, although barriers remained. Satisfaction with services was mixed, with dissatisfaction expressed about testing, medicine access, and costs, but the work of health providers was rated highly.
Collapse
|
3
|
Muhialdin BJ, Filimonau V, Qasem JM, Algboory H. Traditional foodstuffs and household food security in a time of crisis. Appetite 2021; 165:105298. [PMID: 33989697 DOI: 10.1016/j.appet.2021.105298] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/19/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022]
Abstract
Traditional foodstuffs play an important role in household food security. No research has, however, attempted to examine traditional foodstuffs in light of disasters and crises. Such research can provide a useful outlook on how traditional foodstuffs can aid households in a situation of disrupted food supply. This outlook becomes relevant in view of future disastrous events that can undermine household food security, especially in poor disadvantaged communities. This study examined the role of traditional foodstuffs during a major crisis. The study adopted an ethnographic perspective and the method of semi-structured household interviews to explore how traditional foodstuffs were used by communities in the city of Mosul, Iraq, under the ISIS administration and during the liberation war (2016-2017). The study showcased the critical role of traditional foodstuffs in survival of local households. It highlighted the importance of cross-generational knowledge of traditional foodstuffs in community preparedness for disasters and crises. The study proposed to integrate traditional foodstuffs into governmental strategies on household food security in Iraq, and beyond. It suggested including traditional foodstuffs in the humanitarian food supply chains in the regions prone to disasters and crises. Future research should examine the prerequisites for such inclusion, especially from the viewpoint of societal and political acceptance of traditional foodstuffs and methods of their production.
Collapse
Affiliation(s)
- Belal J Muhialdin
- Department of Food Science, Faculty of Food Science and Technology, Universiti Putra Malaysia, 43400, UPM Serdang, Selangor, Malaysia; Halal Products Research Institute, Universiti Putra Malaysia, 43400, UPM Serdang, Selangor, Malaysia.
| | - Viachaslau Filimonau
- Faculty of Management, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset, BH12 5BB, UK
| | - Jamal M Qasem
- Agriculture Directorate of Naynawa, Ministry of Agriculture, 41001, Mosul, Nainawa, Iraq
| | - Hussein Algboory
- Faculty of Food Science, Al-Qasim Green University, 51001, Hillah, Babylon, Iraq
| |
Collapse
|
4
|
Chadwick S, Townes DA, Perrone LA. Utility of Point of Care and Rapid Diagnostics in Humanitarian Emergencies. J Appl Lab Med 2020; 6:236-246. [DOI: 10.1093/jalm/jfaa180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/09/2020] [Indexed: 12/16/2022]
Abstract
Abstract
Background
In 2019, there were 70.8 million forcibly displaced people worldwide. Among the top causes of morbidity and mortality were measles, diarrhea, respiratory illness, and malaria. Availability of accurate diagnostics that are of low complexity, affordable, and produce timely results on site without the need for expensive laboratory equipment, extensive training, or distant transport of samples, are essential tools in the response to humanitarian emergencies (HE). Early detection of infectious diseases with epidemic potential and coordinated outbreak response, can result in significant decrease in morbidity and mortality.
Content
This review explores the utility of point of care and rapid diagnostic tests (POCT/RDTs) in HE and presents a review and analysis of the low complexity, availability, and ease of use of these diagnostic modalities that make them helpful tools in these settings, despite the generally lower test performance metrics associated with them over conventional laboratory-based assays. We review the literature to understand how POCT/RDTs have been used in HE response to produce lifesaving information without the need for a robust system for transporting test samples to more sophisticated laboratories, as this is often prohibitive in areas affected by conflict or natural disasters.
Summary
We propose that POCT/RDTs be considered essential healthcare tools provided to countries following a HE and suggest that UN agencies and vulnerable countries include effective RDTs in their essential diagnostics as part of their national preparedness and response plans.
Collapse
Affiliation(s)
- Stephen Chadwick
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA
| | - David A Townes
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA
- Department of Emergency Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Lucy A Perrone
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA
- Department of Laboratory Medicine, School of Medicine, University of Washington, Seattle, WA
| |
Collapse
|
5
|
Happle C, Dopfer C, Ernst D, Kleinert E, Vakilzadeh A, Hellms S, Evlampidou I, Hillermann N, Schmidt RE, Behrens GMN, Müller F, Wetzke M, Jablonka A. Pediatric Healthcare Utilization in a Large Cohort of Refugee Children Entering Western Europe During the Migrant Crisis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224415. [PMID: 31718046 PMCID: PMC6888204 DOI: 10.3390/ijerph16224415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023]
Abstract
: Background: Currently, half of the population displaced worldwide is children and adolescents. Little is known on healthcare demand in underage migrants. MATERIALS AND METHODS We analyzed healthcare utilization in n = 1.411 children and adolescents living in a large German refugee reception in 2015-2016. RESULTS The mean age of all included refugees was 9 years (60.8% male). The majority came from the eastern Mediterranean region. During a mean camp inhabitance of 34 days, 57.6% needed primary healthcare, with a significant inverse correlation of healthcare seeking frequency with age and duration of camp inhabitance. Infants and unaccompanied minors displayed particular high demands for medical help. DISCUSSION Our analysis showed that pediatric primary healthcare in pediatric and adolescent refugees are most sought during the first period upon arrival with particular demand in infants, toddlers, and unaccompanied minors. Based on this data, future care taking strategies should be adapted accordingly.
Collapse
Affiliation(s)
- Christine Happle
- Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany; (C.H.); (C.D.); (M.W.)
- German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH, 30625 Hannover, Germany
| | - Christian Dopfer
- Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany; (C.H.); (C.D.); (M.W.)
- German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH, 30625 Hannover, Germany
| | - Diana Ernst
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany; (D.E.); (R.E.S.); (G.M.N.B.)
| | - Evelyn Kleinert
- Department of General Practice, University Medical Center Göttingen, 37073 Göttingen, Germany; (E.K.); (N.H.); (F.M.)
| | | | - Susanne Hellms
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, 30625 Hannover, Germany;
| | | | - Nele Hillermann
- Department of General Practice, University Medical Center Göttingen, 37073 Göttingen, Germany; (E.K.); (N.H.); (F.M.)
| | - Reinhold E. Schmidt
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany; (D.E.); (R.E.S.); (G.M.N.B.)
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, 30625 Hannover, Germany
| | - Georg M. N. Behrens
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany; (D.E.); (R.E.S.); (G.M.N.B.)
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, 30625 Hannover, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, 37073 Göttingen, Germany; (E.K.); (N.H.); (F.M.)
| | - Martin Wetzke
- Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany; (C.H.); (C.D.); (M.W.)
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, 30625 Hannover, Germany
| | - Alexandra Jablonka
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany; (D.E.); (R.E.S.); (G.M.N.B.)
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, 30625 Hannover, Germany
- Correspondence: ; Tel.: +49-511-532-5337; Fax: +49-511-532-5324
| |
Collapse
|
6
|
Michlig GJ, Lafta R, Al-Nuaimi M, Burnham G. Providing healthcare under ISIS: A qualitative analysis of healthcare worker experiences in Mosul, Iraq between June 2014 and June 2017. Glob Public Health 2019; 14:1414-1427. [DOI: 10.1080/17441692.2019.1609061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Georgia J. Michlig
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Riyadh Lafta
- Department of Community Medicine, Al Mustansiriya University, Baghdad, Iraq
| | - Maha Al-Nuaimi
- Department of Community Medicine, Al Mustansiriya University, Baghdad, Iraq
| | - Gilbert Burnham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|