Acute Stress Disorder among 2022 Ukrainian war refugees: a cross-sectional study

Introduction

Fleeing from war can be terrifying and result in Acute Stress Disorder (ASD), a mental health condition that can occur in the first month after a traumatic event. The study aimed to identify the prevalence of ASD among Ukrainian refugees and identify its risk factors to create a profile of the most vulnerable refugees.

Methods

This cross-sectional study of 637 Ukrainian war-displaced persons and refugees in 2022 used the Acute Stress Disorder Scale.

Results

The prevalence of ASD among participants was high (93.5%). Several factors increasing the risk of developing ASD in the sample were identified, e.g., witnessing Russian attacks (OR 2.92, 95% CI 1.26-6.78), insufficient financial resources (OR 3.56, 95% CI 1.61-7.91), and feeling of loneliness in the host country (OR 3.07, 95% CI 1.58-8.69). Pre-existing depression and the death of a close person, among others, were found to significantly (p < 0.05) exacerbate the ASD symptoms. At the same time, neither age, the distance traveled, time spent on fleeing the country, nor the type of companionship during refuge (escaping alone, with children, pets or the older adults) correlate with the severity of symptoms.

Conclusion

The study shows extreme levels of trauma among Ukrainian war refugees and displaced persons. Knowledge regarding ASD vulnerabilities in the present conflict may facilitate prompt and adequate psychological help. Since ASD can be an antecedent of PTSD and several autoimmune disorders, these results may also serve as a predictor of future challenges for Ukrainian society.

Rapidly adapted community health strategies to prevent treatment interruption and improve COVID-19 detection for Syrian refugees and the host population with hypertension and diabetes in Jordan

BACKGROUND

We evaluated community health volunteer (CHV) strategies to prevent non-communicable disease (NCD) care disruption and promote coronavirus disease 2019 (COVID-19) detection among Syrian refugees and vulnerable Jordanians, as the pandemic started.

METHODS

Alongside medication delivery, CHVs called patients monthly to assess stockouts and adherence, provide self-management and psychosocial support, and screen and refer for complications and COVID-19 testing. Cohort analysis was undertaken of stockouts, adherence, complications and suspected COVID-19. Multivariable models of disease control assessed predictors and non-inferiority of the strategy pre-/post-initiation. Cost-efficiency and patient/staff interviews assessed implementation.

RESULTS

Overall, 1119 patients were monitored over 8 mo. The mean monthly proportion of stockouts was 4.9%. The monthly proportion non-adherent (past 5/30 d) remained below 5%; 204 (18.1%) patients had complications, with 63 requiring secondary care. Mean systolic blood pressure and random blood glucose remained stable. For hypertensive disease control, age 41-65 y (OR 0.46, 95% CI 0.2 to 0.78) and with diabetes (OR 0.73, 95% CI 0.54 to 0.98) had decreased odds, and with baseline control had increased odds (OR 3.08, 95% CI 2.31 to 4.13). Cumulative suspected COVID-19 incidence (2.3/1000 population) was suggestive of ongoing transmission. While cost-efficient (108 US${\$}$/patient/year), funding secondary care was challenging.

CONCLUSIONS

During multiple crises, CHVs prevented care disruption and reinforced COVID-19 detection.

Enhancing Respiratory Disease Surveillance to Detect COVID-19 in Shelters for Displaced Persons, Thailand-Myanmar Border, 2020-2021

We developed surveillance guidance for COVID-19 in 9 temporary camps for displaced persons along the Thailand-Myanmar border. Arrangements were made for testing of persons presenting with acute respiratory infection, influenza-like illness, or who met the Thailand national COVID-19 Person Under Investigation case definition. In addition, testing was performed for persons who had traveled outside of the camps in outbreak-affected areas or who departed Thailand as resettling refugees. During the first 18 months of surveillance, May 2020-October 2021, a total of 6,190 specimens were tested, and 15 outbreaks (i.e., >1 confirmed COVID-19 cases) were detected in 7 camps. Of those, 5 outbreaks were limited to a single case. Outbreaks during the Delta variant surge were particularly challenging to control. Adapting and implementing COVID-19 surveillance measures in the camp setting were successful in detecting COVID-19 outbreaks and preventing widespread disease during the initial phase of the pandemic in Thailand.

Crisis at the intersection of four countries: healthcare access for displaced persons in the Lake Chad Basin region

For a decade, the Lake Chad Basin (LCB) region, which is at the intersection of four countries and home to ethnic groups in Cameroon, Chad, Niger and Nigeria, has been occupied by Boko Haram. The lax borders and deprivation in the region contributed to the emergence and expansion of Boko Haram's insurgency. While much is known about the human casualties of the invasion, little is known about the accessibility of healthcare for the displaced persons. This qualitative study adopted Penchansky and Thomas' ([1981]. "The Concept of Access: Definition and Relationship to Consumer Satisfaction." Medical Care 19 (2): 127-140) theory of access as its conceptual framework (with the following components: geographical accessibility, availability, financial accessibility, acceptability and accommodation) to explore the experiences of the displaced persons in the LCB with respect to access to healthcare. One-on-one interviews (n = 51) and two focus group discussions (n = 16) were conducted with 67 refugees and internally displaced persons recruited from nine host communities in Nigeria and Cameroon, who shared their perceptions of their healthcare access. The displaced persons faced barriers to their access to the healthcare in the LCB. It was found that for each of the components of the theory of access, the study participants encountered barriers to healthcare access. For example, with regard to financial accessibility (affordability), poverty was identified as the main personal barrier to the displaced persons' healthcare access, and with regard to acceptability, it was communication that was reported to be a barrier. The limitations of the study, the recommendations for future research and the implications of the findings are discussed in detail.

Viral Hepatitis E Outbreaks in Refugees and Internally Displaced Populations, sub-Saharan Africa, 2010-2020

Hepatitis E virus is a common cause of acute viral hepatitis. We analyzed reports of hepatitis E outbreaks among forcibly displaced populations in sub-Saharan Africa during 2010–2020. Twelve independent outbreaks occurred, and >30,000 cases were reported. Transmission was attributed to poor sanitation and overcrowding.

A call for nurses and interdisciplinary collaborators to urgently respond to the health and well-being needs of refugees across the world

The COVID-19 pandemic is compounding the distress of millions of refugees (made up of displaced persons, forced migrants, refugees and asylum seekers) throughout the world. This discursive paper pitches a challenge for the global nursing profession, within the multidisciplinary context, to consider its collective agency in responding to the health and well-being needs of a priority portion of the global population. Nursing leaders are encouraged to renew their commitment to the International Council of Nurses' Code of Ethics and consider the role of their profession in assisting global refugees, because the extent of present need has become an escalating major global humanitarian crisis. The nursing profession comprises half the world's healthcare workforce. The World Health Organization considers that nurses play a fundamental role in ensuring access to universal healthcare as a basic human right, addressing the global need for health promotion care, disease prevention and primary and community healthcare (International Council of Nurses, The ICN code of ethics for nurses; 2012). It is a human right to seek asylum from persecution, and in doing so, people should not be subjected to cruel, inhumane or degrading treatment or circumstances. Nurses are increasingly interested in fostering a healthy and adaptive environment in which people can thrive, despite personal, political, emotional, physical or social adversity. Nursing care is indispensable for the easement of human distress and for the promotion of comfort and coping. Nurses have an essential role in advocating for policies that will enhance immigrants' access to health/mental health services and address barriers irrespective of migrant/refugee/asylum seeker status. These are challenging times as the world responds to the pandemic crisis, and nurses are called to rise to global and local leadership roles and join with other health and social care colleagues in addressing the universal human health, social and political crisis of our time. The global nursing collective must come to terms with the need to initiate additional compelling ways to improve and integrate health and social care processes so that nursing care, mental health and social care augment a holistic achievement of appropriate care for refugees.

DANGER! Crisis Health Workers at Risk

The occupational hazards of health workers (HWs) in standard work environments have been well defined in both the developed and developing world during routine working conditions. Less defined are the hazards to HWs during pandemics, epidemics, natural disasters, wars, conflicts, and other crises. How do crises affect the infrastructure of medical systems? What are the distinct needs of the patient population during crises? What are the peculiarities of the Crisis Health Worker (CHW)? What are the known CHWs’ occupational risks? What are the protective factors? By means of a PubMed search, we synthesized the most relevant publications to try to answer these questions. Failures of healthcare infrastructure and institutions include CHW shortages, insufficient medical supplies, medications, transportation, poorly paid health workers, security concerns, and the absence of firm guidance in health policy. Healthcare needs affecting the patient population and CHWs include crisis-induced injury and illness, hazardous exposures, communicable diseases, mental healthcare, and continuity of care for pre-crisis medical conditions. CHWs’ occupational hazards include supply deficiencies, infectious disease transmission, long working hours, staff shortages, financial reimbursements, mental fatigue, physical exhaustion, and inconsistent access to clean water, electricity, and Internet. CHWs suffer from injuries and illnesses that range from immediate, debilitating injuries to chronic, unforeseen effects like mental fatigue, physical exhaustion, anxiety, burnout, and even post-traumatic stress syndrome (PTSD). Protective factors include personal traits such as adaptability and resilience as well as skills learned through structured education and training. Success will be achieved by constructively collaborating with local authorities, local health workers, national military, foreign military, and aid organizations.

Socioeconomic Status as Oral Health State Determinant of the Active Working Displaced Persons and Domicile Inhabitants

Introduction:

Socioeconomic changes have a significant impact on the health of the population. Socioeconomic development of society is one of the basic determinants of the health condition and needs of the individual and in the population as well.

Aim:

To explore the existence of differences in indicators of oral health status between the displaced persons and domicile population, considering the socioeconomic status (SES) of the respondents.

Patients and Methods:

A total of 310 people, aged 35-44 (mean 40.19 ± 3.60), were interviewed and examined, with 157 of them in a subsample of domicile inhabitants and other 153 respondents in displaced persons subsample. The SES of respondents was determined using a survey. After conducted examinations in study participants, determined results were recorded as dental status (DMFT Index), and periodontal status (CPI Index).

Results:

There was a significant difference in the mean value of caries existence between displaced persons of low and middle SES. In domicile inhabitants, there were no statistically significant differences in mean values of caries existence between the individuals with low and middle SES, while the differences existed between the individuals with low and high and between the middle and high SES. Domicile inhabitants with high SES had significantly less carious lesions than those with lower SES. Domicile inhabitants with high SES had significantly fewer extractions and more teeth with fillings.

Conclusion:

People with low SES have worse oral health status. Displacement and low socioeconomic status significantly influence the state of oral health.

Population-Level Effect of Cholera Vaccine on Displaced Populations, South Sudan, 2014

Following mass population displacements in South Sudan, preventive cholera vaccination campaigns were conducted in displaced persons camps before a 2014 cholera outbreak. We compare cholera transmission in vaccinated and unvaccinated areas and show vaccination likely halted transmission within vaccinated areas, illustrating the potential for oral cholera vaccine to stop cholera transmission in vulnerable populations.

The 2018 Inter-agency field manual on reproductive health in humanitarian settings: revising the global standards

Since the 1990s, the Inter-agency field manual on reproductive health in humanitarian settings (IAFM) has provided authoritative guidance on reproductive health service provision during different phases of complex humanitarian emergencies. In 2018, the Inter-Agency Working Group on Reproductive Health in Crises will release a new edition of this global resource. In this article, we describe the collaborative and inter-sectoral revision process and highlight major changes in the 2018 IAFM. Key revisions to the manual include repositioning unintended pregnancy prevention within and explicitly incorporating safe abortion care into the Minimum Initial Service Package (MISP) chapter, which outlines a set of priority activities to be implemented at the outset of a humanitarian crisis; stronger guidance on the transition from the MISP to comprehensive sexual and reproductive health services; and the addition of a logistics chapter. In addition, the IAFM now places greater and more consistent emphasis on human rights principles and obligations, gender-based violence, and the linkages between maternal and newborn health, and incorporates a diverse range of field examples. We conclude this article with an outline of plans for releasing the 2018 IAFM and facilitating uptake by those working in refugee, crisis, conflict, and emergency settings.

Effect of Sanitary-Environmental Conditions of Diabetic Hypertension Incidence in Displaced Persons

BACKGROUND:

The abnormal conditions of life and genetic factors often play a major role in the incidence of “diabetes - diabetes”, heart disease and vascular disease, jaundice and posttraumatic stress.

AIM:

Trauma and posttraumatic stress are most common in the displaced persons, and the focus of this paper is to focus on this issue regarding cases in former Yugoslavia, and now in our country. These diseases are caused by increased beta-cell sensitivity to viruses, the development of autoimmune antibodies attacking their pancreas cells, degenerative changes in cells that result in the change of structure and of insulin production.

MATERIALS AND METHODS:

In this paper, we have taken into account the traumatic events and long-term psychosocial consequences for internally displaced persons, several years after displacement, and found a high level of PTSD symptoms.

RESULTS:

This stress is present in almost 1/3 of internally displaced persons, and every sixth person has suffered from PTSD in the past. Respondents suffer from symptoms of intrusion, but there was a large number of symptoms, such as avoidance and increased arousal. We also found that gender, age and education are related to the symptoms.

CONCLUSION:

Females, and older respondents and internally displaced persons with lower levels of education show a higher level of PTSD symptoms.

Formal and informal material aid following the 2010 Haiti earthquake as reported by camp dwellers

Following the 2010 Haiti earthquake, more than two million people moved to temporary camps, most of which arose spontaneously in the days after the earthquake. This study focuses on the material assistance people in five Port-au-Prince camps reported receiving, noting the differences between assistance from formal aid agencies and from 'informal' sources such as family. Seven weeks after the earthquake, 32% of camp dwellers reported receiving no assistance whatsoever; 55% had received formal aid, typically a tent or tarpaulins; and 40% had received informal aid, usually in the form of cash transfers from family living abroad. While people were grateful for any material aid, cash was more frequently considered timely and more effective than aid-in-kind. Should this study be indicative of the greater displaced population, aid agencies should consider how they might make better use of cash transfers as an aid modality.