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Bernal O, Garcia-Betancourt T, León-Giraldo S, Rodríguez LM, González-Uribe C. Impact of the armed conflict in Colombia: consequences in the health system, response and challenges. Confl Health 2024; 18:4. [PMID: 38172982 PMCID: PMC10762784 DOI: 10.1186/s13031-023-00561-6] [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: 12/08/2022] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION In Colombia, research on health and conflict has focused on mental health, psychosocial care, displacement, morbidity, and mortality. Few scientific studies have assessed health system functioning during armed conflicts. In a new period characterized by the implementation of the peace agreement with the Revolutionary Armed Forces of Colombia (FARC) armed group, understanding the effects of armed conflict on the health system, the functions, and institutions shaped by the conflict is an opportunity to understand the pathways and scope of post-conflict health policy reforms. Therefore, this study was conducted to assess the effects of armed conflict on the health system, response, and mechanisms developed to protect medical missions during armed conflict in Colombia. METHODS This research was conducted using a qualitative approach with semi-structured interviews and focus group discussions. The qualitative guide collected information in four sections: (1) conflict and health system, effects and barriers in health service provision, (2) actions and coordination to cope with those barriers, (3) health policies and armed conflict, and (4) post-accord and current situation. Twenty-two people participated in the interviews, including eight policymakers at the national level and seven at the local level, including two NGOs and five members of international organizations. An academic project event in December 2019 and four focus groups were developed (World Cafe technique) to discuss with national and local stakeholders the effects of armed conflict on the health system and an analytical framework to analyze its consequences. RESULTS The conflict affected the health-seeking behavior of the population, limited access to healthcare provision, and affected health professionals, and was associated with inadequate medical supplies in conflict areas. The health system implemented mechanisms to protect the medical mission, regulate healthcare provision in conflict areas, and commit to healthcare provision (mental and physical health services) for the population displaced by conflict. CONCLUSION The state's presence, trust, and legitimacy have significantly reduced in recent years. However, it is crucial to restore them by ensuring that state and health services are physically present in all territories, including remote and rural areas.
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Affiliation(s)
- Oscar Bernal
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, 11711, Colombia
| | | | - Sebastián León-Giraldo
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, 11711, Colombia.
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Diaz J, Taboada I, Abreu A, Vargas L, Polanco Y, Zorrilla A, Beatty N. Evaluating Rural Health Disparities in Colombia: Identifying Barriers and Strategies to Advancing Refugee Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6948. [PMID: 37887686 PMCID: PMC10606581 DOI: 10.3390/ijerph20206948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
Health disparities within rural communities, notably those affecting migrant and refugee populations, are well-documented. Refugees often grapple with high disease burdens and mortality rates due to limited access to primary healthcare and their vulnerable socio-economic and political situations. This issue is particularly acute in the rural areas around Medellin, Colombia, where the refugee influx exacerbates the existing public health challenges. Studies highlight a substantial gap between community needs and public health policies, resulting in inadequate healthcare access. Our study, utilizing the Delphi technique, aimed to identify common barriers and strategies to enhance rural healthcare for refugees. Through consensus-building with community leaders, we identified six primary barriers to healthcare access and five barriers to healthcare quality. Community leaders endorsed five strategies to address the access barriers and eight strategies to improve healthcare quality. This research provides valuable insights for optimizing resource allocation and designing effective support programs for these vulnerable populations.
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Affiliation(s)
- John Diaz
- Gulf Coast Research and Education Center, University of Florida, Plant City, FL 33563, USA
| | - Isabel Taboada
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (I.T.); (A.A.); (L.V.); (A.Z.); (N.B.)
| | - Adriana Abreu
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (I.T.); (A.A.); (L.V.); (A.Z.); (N.B.)
| | - Lara Vargas
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (I.T.); (A.A.); (L.V.); (A.Z.); (N.B.)
| | - Ysabel Polanco
- Faculty of Medicine, University of Antioquia, Medellin 050010, Antioquia, Colombia;
| | - Alex Zorrilla
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (I.T.); (A.A.); (L.V.); (A.Z.); (N.B.)
| | - Norman Beatty
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (I.T.); (A.A.); (L.V.); (A.Z.); (N.B.)
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA
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Reynolds CW, Duarte A, Fricke A, Gómez Restrepo C, Patiño A, Arbelaez C, Moretti K, Aguiar LG. Supporting healthcare workers caring for ex-combatants: incentives among Colombian providers with FARC ex-combatants. Glob Public Health 2022; 17:3005-3021. [PMID: 35132944 DOI: 10.1080/17441692.2022.2037150] [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: 12/15/2022]
Abstract
With the Peace Agreement between Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised healthcare to 13,000 'reincorporating' FARC ex-combatants. Shortages of healthcare workers in reincorporation camps means this promise is in danger of going unfulfilled. More information is needed to determine incentives, disincentives, and recruitment of healthcare providers to address this shortage. Semi-structured interviews were conducted with healthcare providers across FARC reincorporation camps, and a multidisciplinary team conducted analysis in NVivo12 using a team-based coding method. Twenty-four healthcare professionals from 15 camps participated, of which 75% were female. Incentives to work with FARC included improved clinical skills, professional advancement, increased comfort with FARC, and contributing to the peace process. Disincentives included poor living conditions, lack of support, biases, familial commitments, and sacrificing career opportunities. Three-fourths of the sample recommended working with FARC, and 92% reported a shortage of healthcare workers. Recruitment strategies included improved resources and specialised career development for healthcare workers, facilitating interactions between FARC and healthcare professionals outside clinical scenarios, and integrating medicine for vulnerable populations into health education. This study shows the impact that working with FARC ex-combatants can have on healthcare providers and tangible suggestions for increasing provider participation to address the healthcare worker shortage.
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Affiliation(s)
| | - Andrés Duarte
- Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Carlos Gómez Restrepo
- Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Andres Patiño
- Emory University School of Medicine, Atlanta, GA, USA
| | - Christian Arbelaez
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | | | - Leonar G Aguiar
- Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
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Reynolds CW, Ramanathan V, Lorenzana E, Das PJ, Sagal KM, Lozada-Soto KM, Deda LC, Haque AS, Schmitzberger FF, Quiroga G, Raven SA, Heisler M. Challenges and Effects of the COVID-19 Pandemic on Asylum Seeker Health at the U.S.-Mexico Border. Health Equity 2021; 5:169-180. [PMID: 33937602 PMCID: PMC8080921 DOI: 10.1089/heq.2020.0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: The coronavirus disease 2019 (COVID-19) pandemic presents health care challenges to asylum seekers living in congregate encampments, including those along the U.S.-Mexico border. It is necessary to understand the impact of the pandemic among this population to address health care needs, reduce transmission, and diminish COVID-19-related morbidity. Methods: Thirty interviews were conducted with asylum seekers and health care professionals in a temporary camp in Matamoros, Mexico to determine challenges, perceptions, and effects of the COVID-19 pandemic. Interviews were coded in NVivo12 by using a team-based approach. Results: The pandemic caused significant mental health burdens but no perceived adverse physical effects, with the U.S. border closure and health care access barriers as more pressing concerns. Participants reported access to information about COVID-19 but had varied levels of knowledge and adherence to disease reduction strategies due to camp conditions. Most participants believed that they had special protection from COVID-19, including strong immune systems or from God. The nongovernmental organizations providing health care and sanitation faced multiple challenges to implement new policies to manage COVID-19. The institution of required temperature checks and quarantine of COVID-19 positive patients led to distrust, decreased seeking of health care services among asylum seekers, and possible underreporting of COVID-19 cases. Conclusion: Our findings among asylum seekers in a Matamoros camp highlight the challenges to implementing disease reduction policies in low-resource congregate camps. Policies to address disease outbreaks focusing on the social determinants of health, health care access barriers, and community engagement may be more acceptable to asylum seekers, suggesting the need for effective strategies to provide prevention information that complements such measures.
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Affiliation(s)
| | - Vidya Ramanathan
- University of Michigan Asylum Collaborative, Ann Arbor, Michigan, USA.,Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Elena Lorenzana
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Porag J Das
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kyra M Sagal
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | | | - Anisa S Haque
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Grecia Quiroga
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sarah A Raven
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michele Heisler
- Physicians for Human Rights, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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