Syrian Refugees Seeking Hospital Care in Beirut: A Cross-Sectional Study of Reasons for Hospital Admissions

INTRODUCTION

Lebanon has the highest Syrian refugee density worldwide. The influx of Syrian refugees has had various impacts on Lebanon, with one of the most significant effects observed in the already exhausted healthcare system. This study aimed to determine the reasons for hospitalization among registered Syrian refugees in Beirut who were admitted to Rafik Hariri University Hospital (RHUH) between December 2017 and June 2020.

METHODS

Data from 7,480 diagnosed cases were collected from the RHUH archives between December 2017 and June 2020 and were analyzed using SPSS (IBM Corp., Armonk, NY, USA). The collected data included information related to demographics, admission date, primary diagnosis, and other related medical problems. Variations and correlations were then tested.

RESULTS

Of the cases, 73.4% were females; the mean age was 28 ± 16.23 years. Fifty-seven percent of the admitted cases were solely due to pregnancy, childbirth, and puerperium reasons, and 91.14% of the deliveries were single deliveries by cesarean section. Common reasons for hospitalization were injuries (5.8%) and diseases of the digestive system (6.8%), circulatory system (4.7%), and respiratory system (4.4%). Non-communicable diseases (NCDs) constituted 61% of all hospital admissions, while only 6.6% belonged to communicable diseases. Reasons for hospitalization and the type of diagnosed diseases were associated with gender and age groups (p-values <0.001).

CONCLUSION

The major reasons for hospitalization among Syrian refugees were related to pregnancies and NCDs. The burden of the Syrian refugee influx on the Lebanese healthcare system can be alleviated by improving community health education, public health services, and conditions for refugees.

"When It's a Girl, They Have a Chance to Have Sex With Them. When It's a Boy…They Have Been Known to Rape Them": Perceptions of United Nations Peacekeeper-Perpetrated Sexual Exploitation and Abuse Against Women/Girls Versus Men/Boys in Haiti

Peacekeeping missions have been marred by reports of sexual exploitation and abuse (SEA) against local community members. However, there is limited research on how SEA against women/girls versus men/boys is perceived in peacekeeping host societies. In 2017 we collected micro-narratives in Haiti and then conducted a thematic analysis to understand how peacekeeper-perpetrated SEA was perceived by local community members comparing SEA against women/girls versus SEA against men/boys. Both male and female participants used language which suggested the normalization, in Haitian society, of both transactional sex with and rape of women/girls by UN personnel. In contrast, peacekeeper-perpetrated SEA against men/boys was viewed as unacceptable and was associated with homosexuality and related stigmatization. Overall, our results suggest that in Haiti, inequitable gender norms, the commodification of female sexuality, and homophobia result in SEA against males being recognized as a wrong that elicits outrage, while SEA against women/girls has been normalized. It is important to address the normalization of SEA against women/girls to prevent future violence and to recognize that SEA is also perpetrated against men/boys. Survivor-centered programs, sensitive to the needs of both male and female survivors, are required.

Complexity in China’s current role in multilateral orders

Rather than the prescribed scenario of a Thucydides Trap or a Kindleberger Trap, the global system will see a Transitional Reformation process of contestation and cooperation as power transitions from North America and Europe towards Asia and other regions. While acknowledging that power increasingly diffuses from state actors to transnational civil societies and private sectors, this article contends that, in a state-centric global system, it remains significant that US–China competition, and the wider competition, contestation and renegotiation of power relations between established and rising powers, takes place within United Nations multilateral frameworks. In addressing China’s role, potential, and limits in the dynamics of renegotiation, this article identifies three layers, or subprocesses, of complexity in the current role China plays in multilateral orders in flux.

Conceptual and institutional gaps: understanding how the WHO can become a more effective cross-sectoral collaborator

BACKGROUND

Two themes consistently emerge from the broad range of academics, policymakers and opinion leaders who have proposed changes to the World Health Organization (WHO): that reform efforts are too slow, and that they do too little to strengthen WHO's capacity to facilitate cross-sectoral collaboration. This study seeks to identify possible explanations for the challenges WHO faces in addressing the broader determinants of health, and the potential opportunities for working across sectors.

METHODS

This qualitative study used a mixed methods approach of semi-structured interviews and document review. Five interviewees were selected by stratified purposive sampling within a sampling frame of approximately 45 potential interviewees, and a targeted document review was conducted. All interviewees were senior WHO staff at the department director level or above. Thematic analysis was used to analyze data from interview transcripts, field notes, and the document review, and data coded during the analysis was analyzed against three central research questions. First, how does WHO conceptualize its mandate in global health? Second, what are the barriers and enablers to enhancing cross-sectoral collaboration between WHO and other intergovernmental organizations? Third, how do the dominant conceptual frames and the identified barriers and enablers to cross-sectoral collaboration interact?

RESULTS

Analysis of the interviews and documents revealed three main themes: 1) WHO's role must evolve to meet the global challenges and societal changes of the 21st century; 2) WHO's cross-sectoral engagement is hampered internally by a dominant biomedical view of health, and the prevailing institutions and incentives that entrench this view; and 3) WHO's cross-sectoral engagement is hampered externally by siloed areas of focus for each intergovernmental organization, and the lack of adequate conceptual frameworks and institutional mechanisms to facilitate engagement across siloes.

CONCLUSION

There are a number of external and internal pressures on WHO which have created an organizational culture and operational structure that focuses on a narrow, technical approach to global health, prioritizing disease-based, siloed interventions over more complex approaches that span sectors. The broader approach to promoting human health and wellbeing, which is conceptualized in WHO's constitution, requires cultural and institutional changes for it to be fully implemented.

Literature Review and Profile of Cancer Diseases Among Afghan Refugees in Iran: Referrals in Six Years of Displacement

BACKGROUND

There is a paucity of research on the profile of cancers among displaced populations, specifically Afghan refugees in Iran. This study illustrates the pattern of cancers in this population, and highlights the challenges of cancer care in displaced people with the intent that this data will facilitate appropriate allocation of resources to improve care in this population.

MATERIAL AND METHODS

This was a retrospective cross-sectional study, in which we collected the demographics and profile of cancers among Afghan refugees from 2005 to 2010 from referrals to the United Nations High Commissioner for Refugees (UNHCR) offices in Iran. Accrued evidence by other studies published between January 1993 and July 2014 pertaining to cancer diagnoses in refugees from Afghanistan, Tibet, Syria, Jordan, and Iraq was reviewed.

RESULTS

Cancer diagnoses accounted for 3083 of 23 152 total referrals, with 49% female and 51% male cases; 23.3% were 0-17 years of age, 61.2% were 18-59, and 15.5% were above 60. The most common health referral for females and males (0-17) was malignant neoplasms of lymphatic and hematopoietic tissue, accounting for 34.2%. In the age groups 18-59 and above 60 for both male and females it was malignant neoplasm of the digestive system, occurring in 26.3% and 48.7%, respectively.

CONCLUSIONS

In the setting of humanitarian crises especially war, cancer diagnoses among refugees is a major health burden both on the host countries and the international community with serious implications considering the recent growing trend in the Middle Eastern countries. The prevalence of certain cancer diagnoses among refugees, like gastrointestinal, respiratory, breast, and genitourinary cancers necessitates a multidirectional approach, primarily aimed at prevention and early detection. International partnerships are essential for improvement in cancer surveillance service availability, and delivery of the standard of care, in an overall effort to reduce the human cost, monetary, and resource associated burdens of cancer. Recommendations to implement effective prevention and management goals as well as improved record keeping in the refugee setting and the acquisition of secure and sustainable funding sources should be implemented in collaboration with global humanitarian agencies like UNHCR.

How can health remain central post-2015 in a sustainable development paradigm?

In two years, the uncompleted tasks of the Millennium Development Goals will be merged with the agenda articulated in the 2012 United Nations Conference on Sustainable Development. This process will seek to integrate economic development (including the elimination of extreme poverty), social inclusion, environmental sustainability, and good governance into a combined sustainable development agenda. The first phase of consultation for the post-2015 Sustainable Development Goals reached completion in the May 2013 report to the Secretary-General of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda. Health did well out of the Millennium Development Goal (MDG) process, but the global context and framing of the new agenda is substantially different, and health advocates cannot automatically assume the same prominence. This paper argues that to remain central to continuing negotiations and the future implementation, four strategic shifts are urgently required. Advocates need to reframe health from the poverty reduction focus of the MDGs to embrace the social sustainability paradigm that underpins the new goals. Second, health advocates need to speak--and listen--to the whole sustainable development agenda, and assert health in every theme and every relevant policy, something that is not yet happening in current thematic debates. Third, we need to construct goals that will be truly "universal", that will engage every nation--a significant re-orientation from the focus on low-income countries of the MDGs. And finally, health advocates need to overtly explore what global governance structures will be needed to finance and implement these universal Sustainable Development Goals.

Health and human rights in today's fight against HIV/AIDS

The development of the health and human rights framework coincided with the beginning of the rapid spread of HIV/AIDS. Since then, the international community has increasingly turned to human rights language and instruments to address the disease. Not only are human rights essential to addressing a disease that impacts marginalized groups most severely, but the spread of HIV/AIDS itself exacerbates inequality and impedes the realization of a range of human rights. Policy developments of the past decade include the United Nations (UN) Committee on Economic, Social and Cultural Rights' General Comment on the 'Right to Health', the UN Declaration of Commitment on HIV/AIDS, and the UN's International Guidelines on HIV/AIDS and Human Rights, among others. Rights-related setbacks include the failure of the Declaration and its 5-year follow-up specifically to address men who have sex with men, sex workers, and intravenous drug users, political restrictions placed on urgently needed US President's Emergency Plan for AIDS Relief (PEPFAR) funds, and the failure of many countries to decriminalize same-sex sex and outlaw discrimination against people living with HIV/AIDS. Male circumcision as an HIV prevention measure is a topic around which important debate, touching on gender, informed consent and children's rights, serves to illustrate the ongoing vitality of the health and human rights dialogue. Mechanisms to increase state accountability for addressing HIV/AIDS should be explored in greater depth. Such measures might include an increase in the use of treaty-based judicial mechanisms, the linking of human rights compliance with preferential trade agreements, and rights requirements tied to HIV/AIDS funding.

The chernobyl accident 20 years on: an assessment of the health consequences and the international response

BACKGROUND

The Chernobyl accident in 1986 caused widespread radioactive contamination and enormous concern. Twenty years later, the World Health Organization and the International Atomic Energy Authority issued a generally reassuring statement about the consequences. Accurate assessment of the consequences is important to the current debate on nuclear power.

OBJECTIVES

Our objectives in this study were to evaluate the health impact of the Chernobyl accident, assess the international response to the accident, and consider how to improve responses to future accidents.

DISCUSSION

So far, radiation to the thyroid from radioisotopes of iodine has caused several thousand cases of thyroid cancer but very few deaths ; exposed children were most susceptible. The focus on thyroid cancer has diverted attention from possible nonthyroid effects, such as mini-satellite instability, which is potentially important. The international response to the accident was inadequate and uncoordinated, and has been unjustifiably reassuring. Accurate assessment of Chernobyl's future health effects is not currently possible in the light of dose uncertainties, current debates over radiation actions, and the lessons from the late consequences of atomic bomb exposure.

CONCLUSIONS

Because of the uncertainties over the dose from and the consequences of the Chernobyl accident, it is essential that investigations of its effects should be broadened and supported for the long term. Because of the problems with the international response to Chernobyl, the United Nations should initiate an independent review of the actions and assignments of the agencies concerned, with recommendations for dealing with future international-scale accidents. These should involve independent scientists and ensure cooperation rather than rivalry.