Complex Humanitarian Emergencies Research Articles

Can Military Become an Accountable Humanitarian Actor?: Perception of Humanitarian Norms and Modus Operandi of the ROK Army and Japan Self Defense Force

Purpose: The study aims to investigate the extent to which these military entities, the ROK Army (ROKA) and the Japan Self Defense Forces (JSDF) perceive humanitarian norms and operational guidelines as accountable humanitarian actors.
 Originality: Given that the role of military in offshore humanitarian action has become both prominent and complex, understanding the sensitization of these organizations to key humanitarian principles is a critical facet of assessing their capacity to engage in relief operations in an ethical and legitimate manner.
 Methodology: The survey with structured questionnaires was administered to 104 officers from the ROKA and 101 veteran officers from the JSDF including focus group interviews. Independent sample t-tests were conducted to identify differences in perceptions between the two groups, utilizing SPSS 25 as the analytical tool.
 Result: Both the ROKA and the JSDF demonstrated a relatively high level of awareness and commitment to humanitarian principles, though variations in perception were observed. Notably, differences emerged in their perceptions of guidelines for the use of military assets in humanitarian operations, with the ROKA exhibiting a comparatively higher level of perception in certain areas. The JSDF, on the other hand, showed higher levels of perception regarding the impacts of complex humanitarian emergencies, particularly natural disasters.
 Conclusions and Implication: These findings underscore the need for tailored training of humanitarian action, and transparent communication and coordination strategies with civilian agencies to enhance their effectiveness in addressing humanitarian crises in fragile contexts.

The epidemiological profile of incidence and mortality from epidemics in complex humanitarian emergencies from 1990 to 2022 - A scoping review.

This study aimed to investigate the impact of communicable diseases with epidemic potential in complex emergency (CE) situations, focusing on the epidemiological profile of incidence and mortality and exploring underlying factors contributing to increased epidemic risks. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines, we conducted a scoping review of articles published between 1990 and 2022. The search included terms related to complex emergencies, communicable diseases, outbreaks, and epidemics. We identified 92 epidemics related to CE occurring in 32 different countries. Communicable diseases like Shigellosis, Cholera, Measles, Meningococcal meningitis, Yellow Fever, and Malaria caused significant morbidity and mortality. Diarrhoeal diseases, particularly Cholera and Shigellosis, had the highest incidence rates. Shigella specifically had an incidence of 241.0 per 1000 (people at risk), with a mortality rate of 11.7 per 1000, while Cholera's incidence was 13.0 per 1000, with a mortality rate of 0.22 per 1000. Measles followed, with an incidence of 25.0 per 1000 and a mortality rate of 0.76 per 1000. Meningococcal Meningitis had an incidence rate of 1.3 per 1000 and a mortality rate of 0.13 per 1000. Despite their lower incidences, yellow fever at 0.8 per 1000 and malaria at 0.4 per 1000, their high case fatality rates of 20.1% and 0.4% remained concerning in CE. The qualitative synthesis reveals that factors such as water, sanitation, and hygiene, shelter and settlements, food and nutrition, and public health and healthcare in complex emergencies affect the risk of epidemics. Epidemics during complex emergencies could potentially lead to a public health crisis. Between 1990 and 2022, there have been no statistically significant changes in the trend of incidence, mortality, or fatality rates of epidemic diseases in CE. It is crucial to understand that all epidemics identified in CE are fundamentally preventable.

Speaking of Civilians: Automated Text Analysis of the United Nations’ Framing of Complex Humanitarian Emergencies

Since the end of the Cold War, the protection of civilians has increased its weight on the United Nations (UN) agenda. This article (1) maps the evolution of civilian protection within the UN framework as an indicator of its shifting priorities, (2) identifies breakpoints in the prevalence and character of the protection discourse, and (3) explores how internal processes of policy development and real-world triggers (namely conflicts and peacekeeping operations) shaped this transformation. The article uses Structural Topic Modeling (STM) to analyze an original corpus of Security Council and General Assembly resolutions on complex humanitarian emergencies since 1990. The analysis uncovers two distinct forms of protection, labeled as “Ground protection” and “Political–legal protection,” which are characterized by contrasting temporal and geographic trajectories. Moreover, critical junctures in the protection rhetoric (during the years 2000, 2005, and 2008) coincide with policy watersheds rather than conflict outbreaks or trends in peacekeeping deployment. This article offers a comprehensive analysis of the intricate evolution of civilian protection using text-as-data methods, which uses its theory-building design to encourage further explorations on the interplay between internal and external factors in shaping its progression within the UN framework.

Knowledge, risk perception and uptake of COVID-19 vaccination among internally displaced persons in complex humanitarian emergency setting, Northeast Nigeria

BackgroundOwing to crowded and unsanitary conditions, internally displaced persons (IDPs) have an increased risk of COVID-19 infection. Adoption of COVID-19 preventive measures among this population is premised on accurate information, adequate knowledge, and risk perception. We assessed COVID-19 knowledge and risk perception and investigated the association between risk perception and COVID-19 preventive measures, including vaccination among IDPs in Northeast Nigeria.MethodsWe conducted a cross-sectional study during July–December 2022 and sampled 2,175 IDPs using stratified sampling. We utilized a 12-point assessment tool to evaluate COVID-19 knowledge. Participants who scored ≥ 6 points were considered to have adequate knowledge. We used a 30-item Risk Behavior Diagnosis Scale to assess COVID-19 risk perception and evaluated each item on a 5-point Likert scale. Participants were divided into risk perception categories by the median of Likert scale scores. We performed weighted logistic regression analysis to identify factors associated with risk perception. Pearson’s chi-squared with Rao-Scott adjustment was used to determine the relationship between risk perception and COVID-19 preventive measures.ResultsOf 2,175 participants, 55.7% were 18–39 years old, 70.9% were females, and 81.7% had no formal education. Among the IDPs, 32.0% (95% CI: 28.8 – 35.0) were considered to have adequate COVID-19 knowledge, and 51.3% (95% CI: 47.8 – 54.8) perceived COVID-19 risk as high. Moreover, 46.3% (95% CI: 42.8 – 50.0) had received one dose of COVID-19 vaccine, and 33.1% (95% CI: 29.8 – 36.0) received two doses. Adequate knowledge (Adjusted Odds Ratio (AOR) = 2.10, [95% CI: 1.46 – 3.03]) and post-primary education (AOR = 3.20, [95% CI: 1.59 – 6.46]) were associated with risk perception. Furthermore, high risk perception was significantly associated with wearing face masks (χ2 = 106.32, p-value < .001), practicing hand hygiene (χ2 = 162.24, p-value < .001), physical distancing (χ2 = 60.84, p-value < .001) and vaccination uptake (χ2 = 46.85, p-value < .001).ConclusionsThis study revealed gaps in COVID-19 knowledge, risk perception, and vaccination uptake but demonstrated a significant relationship between risk perception and COVID-19 preventive practices. Health education and risk communication should be intensified to improve knowledge, elicit stronger risk perception, and enhance COVID-19 preventive practices.

Complex Humanitarian Emergencies in Africa

The concept of Epidemiological Surveillance in a Complex Humanitarian Emergency would depend upon the emergency itself and where it is taking place. The history of epidemiology goes to back to the eighteenth century when a disease was finally tracked to its origins and therefore the treatment involved the removal of the causative agents. The study of epidemiology expanded in the recent turn of the century when newer diseases, infectious and nutritional were studied prospectively and retrospectively. The study even went on to traumatology where similar models were used to find the cause and prevention. Natural disasters and epidemiological case models were used to build an infrastructure of investigation, mitigation, prevention and treatment [1].

Factors associated with health-seeking patterns among internally displaced persons in complex humanitarian emergency, Northeast Nigeria: a cross-sectional study

BackgroundCurrently, over two million persons are internally displaced because of the complex humanitarian emergency in Nigeria’s northeast region. Due to crowded and unsanitary living conditions, the risk of communicable disease transmission, morbidity, and mortality among this population is high. This study explored patterns and factors associated with health-seeking among internally displaced persons (IDPs) in northeast Nigeria to inform and strengthen disease surveillance and response activities.MethodsIn a cross-sectional study conducted during June–October 2022, we employed stratified sampling technique to select 2,373 IDPs from 12 IDPs camps. A semi-structured tool was used to collect data on health-seeking patterns, socio-demographics, households, and IDPs camps characteristics. We classified health-seeking patterns into three outcome categories: ‘facility care’ (reference category), ‘non-facility care’ (patent medicine vendors, chemists, traditional healers, religious centers), and ‘home care/no care’. We performed complex survey data analysis and obtained weighted statistical estimates. Univariate analysis was conducted to describe respondents’ characteristics and health-seeking patterns. We fitted weighted multivariable multinomial logistic regression models to identify factors associated with health-seeking patterns.ResultsOf 2,373 respondents, 71.8% were 18 to 39 years old, 78.1% were females, and 81.0% had no formal education. Among the respondents, 75.7% (95% CI: 72.9–78.6) sought ‘facility care’, 11.1% (95% CI: 9.1–13.1) sought ‘non-facility care’, while 13.2% (95% CI: 10.9–15.4) practiced ‘home care/no care’. Respondents who perceived illness was severe (Adjusted Odds Ratio (AOR) = 0.15, [95% CI: 0.08–0.30]) and resided in officially-recognized camps (AOR = 0.26, [95% CI: 0.17–0.39]) were less likely to seek ‘non-facility care’ compared to ‘facility care’. Similarly, respondents who resided in officially-recognized camps (AOR = 0.58, [95% CI: 0.36–0.92]), and received disease surveillance information (AOR = 0.42, [95% CI: 0.26–0.67) were less likely to practice ‘home care/no care’ rather than seek ‘facility care’.ConclusionsThis population exhibited heterogeneous patterns of health-seeking at facility and non-facility centers. Perception of illness severity and camps’ status were major factors associated with health-seeking. To enhance surveillance, non-facility care providers should be systematically integrated into the surveillance network while ramping up risk communication to shape perception of illness severity, prioritizing unofficial camps.

A cluster-randomised controlled equivalence trial of the Surprise Soap handwashing intervention among older children living in a refugee settlement in Sudan

IntroductionIncreasing handwashing with soap (HWWS) among older children in emergency settings can have a large public health impact, however, evidence on what works is limited. One promising approach is the...

Responding to cholera outbreaks in Somalia in 2017-2019.

Somalia reported repeated cholera outbreaks between 2017 and 2019. These outbreaks were attributed to multiple risk factors which made response challenging. To describe lessons from the preparedness and response to the cholera outbreaks in Somalia between 2017 and 2019. We reviewed outbreak response reports, surveillance records and preparedness plans for the cholera outbreaks in Somalia from January 2017 to December 2019 and other relevant literature. We present data on cholera-related response indicators including cholera cases and deaths and case fatality rates for the 3 years. Qualitative data were collected from 5 focus group discussions and 10 key informant interviews to identify the interventions, challenges and lessons learnt from the Somali experience. In 2017, a total of 78 701 cholera cases and 1163 related deaths were reported (case fatality rate 1.48%), in 2018, 6448 cholera cases and 45 deaths were reported (case fatality rate 0.70%), while in 2019, some 3089 cases and 4 deaths were reported in Somalia (case fatality rate 0.13%). The protracted conflict, limited access to primary health care, and limited access to safe water and proper sanitation among displaced populations were identified as the main drivers of the repeated cholera outbreaks. Periodic assessment of response to and preparedness for potential epidemics is essential to identify and close gaps within the health systems. Somalia's experience offers important lessons on preventing and controlling cholera outbreaks for countries experiencing complex humanitarian emergencies.

Control of emerging and re-emerging zoonotic and vector-borne diseases in countries of the Eastern Mediterranean Region

Despite improvements in the detection and control of infectious diseases, many new pathogens are emerging and re-emerging in various parts of the world. Most of these emerging and re-emerging infections are of zoonotic origin, which highlights the importance of the human–animal interface. Similarly, the rate of vector-borne diseases has increased recently due to changes in human habitats, climate change, deforestation, changes in food production practices, and increased population movement. The risk of spread of these zoonotic and vector-borne diseases is higher in the Eastern Mediterranean Region (EMR) of the World Health Organization due to its topography and geopolitical situation, fragile health systems, complex humanitarian emergencies, and, in some countries, other socioeconomic risk factors. Many countries in the region have reported outbreaks of zoonotic and vector-borne diseases over the last few decades, and some of these diseases have spread to other WHO regions as well. Avian influenza A (H5N1) and Middle East respiratory syndrome coronavirus (MERS-CoV) are among the greatest threats to global health security and both viruses are endemic in the EMR. Countries in the EMR have made significant progress toward the control of zoonotic and vector-borne diseases in recent years, and prevention, preparedness, and response capacities have been improved. However, there are still many challenges associated with the control of these diseases in the EMR, particularly in countries facing humanitarian emergencies. In this paper, we present the current situation of emerging and re-emerging infections in the EMR and discuss progress, challenges, and ways forward.

An approach to the background, methods and challenges of research in disasters

Disasters are phenomena of global distribution and increasing impact, with a social and interdisciplinary nature and that often require the use of quantitative and qualitative methods to be investigated. The purpose of this paper is to explore the historical background of disaster research, the current use of epidemiological methods in disasters, as well as the difficulties and future challenges of research in this field. This study considers bibliographic elements and specific non-bibliographic events that have determined the historical evolution of disaster research, as well as its conceptual framework, particularly in relation to the approaches from which the research has been carried out and the range of methods epidemiological used. This is not a standard review. Current disaster research is developed for a wide variety of purposes, including the identification and characterization of populations exposed or at risk of disaster; the study and establishment of the exposure model for each specific type of disaster; the estimation of the incidence and prevalence of the different types of disaster and the quantification of the impacts in the short, medium and long term. Research is also carried out in the field of disasters to assess needs, plan relevant and efficient types of aid; model and predict the occurrence and to design adequate and efficient prevention, preparedness, mitigation and rehabilitation strategies. Even so, the predominant research on disasters is still very much focused on certain partial aspects of the phenomenon such as the response to the disaster and directed towards specific types of disasters, especially those of rapid onset. There is still little multidisciplinary and collaborative research among researchers from the different areas of interest that constitute the disaster phenomenon. Important challenges persist in disaster research, including the design of a common conceptual framework that allows multidisciplinary research in disasters, the development of specific methods to investigate complex emergencies (complex humanitarian emergencies) or disasters related to climate change; the development of a specific approach to investigate slow-onset disasters and their social, political and cultural factors, as well as research to develop feasible and cost-efficient prevention and response strategies. Solving these challenges will depend to a large extent to which the investigative capacity of managers and heads of organizations and field personnel working in disasters is improved.

An approach to the background, methods and challenges of research in disasters

Disasters are phenomena of global distribution and increasing impact, with a social and interdisciplinary nature and that often require the use of quantitative and qualitative methods to be investigated. The purpose of this paper is to review the historical background of disaster research, the current use of epidemiological methods in disasters, as well as the difficulties and future challenges of research in this field. This study is a review of bibliographic elements and specific non-bibliographic events that have determined the historical evolution of disaster research, as well as its conceptual framework, particularly in relation to the approaches from which the research has been carried out and the range of methods epidemiological used. Current disaster research is developed for a wide variety of purposes, including the identification and characterization of populations exposed or at risk of disaster; the study and establishment of the exposure model for each specific type of disaster; the estimation of the incidence and prevalence of the different types of disaster and the quantification of the impacts in the short, medium and long term. Research is also carried out in the field of disasters to assess needs, plan relevant and efficient types of aid; model and predict the occurrence and to design adequate and efficient prevention, preparedness, mitigation and rehabilitation strategies. Even so, the predominant research on disasters is still very much focused on certain partial aspects of the phenomenon such as the response to the disaster and directed towards specific types of disasters, especially those of rapid onset. There is still little multidisciplinary and collaborative research among researchers from the different areas of interest that constitute the disaster phenomenon. Important challenges persist in disaster research, including the design of a common conceptual framework that allows multidisciplinary research in disasters, the development of specific methods to investigate complex emergencies (complex humanitarian emergencies) or disasters related to climate change; the development of a specific approach to investigate slow-onset disasters and their social, political and cultural factors, as well as research to develop feasible and cost-efficient prevention and response strategies. Solving these challenges will depend to a large extent to which the investigative capacity of managers and heads of organizations and field personnel working in disasters is improved.

Critical Analysis of Economic Evaluation of the Childhood Rotavirus Vaccination in Low- and Lower-Middle-Income Countries: A Systematic Review

ObjectivesTo identify, critically appraise, and summarize the use of different methods and results of economic evaluations to assess the efficiency of rotavirus vaccination programs in low- and lower-middle-income countries. MethodsA systematic literature search was performed in 3 bibliographic databases, including PubMed, ProQuest, Cochrane Library, and Science Direct (Elsevier) journal website, using key search terms. The study selection process was based on predefined inclusion criteria. The search results were presented using the research flow diagram based on guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The quality assessment of the selected studies was carried out using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklist. ResultsA total of 21 studies were selected for review. All the studies, except 1, reported rotavirus vaccination to be a cost-effective intervention and a high-impact strategy to reduce substantial rotavirus disease burden. A decision analysis model was considered appropriate by all studies, although there were variabilities in the analytic horizon used. Lack of country-level data was highlighted by most studies. Multiples of gross domestic product of respective countries were used as a threshold to interpret cost-effectiveness. ConclusionsRotavirus vaccination was found to be cost-efficient in most settings, including complex humanitarian emergencies. The use of thresholds for interpreting incremental cost-effectiveness ratios and lack of local-level disease incidence and cost of illness data remains a point of contention. Lack of reporting probabilistic sensitivity analysis renders limited robustness to study results.

The surge of spreading harmful information through digital technologies: a distressing reality in complex humanitarian emergencies

The surge of spreading harmful information through digital technologies: a distressing reality in complex humanitarian emergencies

The feasibility and acceptability of implementing and evaluating a caregiver group intervention to address child mental health: A pilot study in Iraq

Complex humanitarian emergencies have a significant negative impact on the prevalence and severity of child mental health. The capacity of primary caregivers to provide care to their children is often adversely affected. There is a lack of evidence-based interventions to guide primary caregivers. This study assessed the feasibility and acceptability of implementing and evaluating a caregiver group counselling intervention, and provided an indication of its potential benefits. A single arm pilot study was conducted in Northern Iraq. Primary caregivers of a child aged 8–12 years with concern about their child's mental health attended the caregiver group intervention. Quantitative and qualitative outcome measures were completed by caregivers and children at pre-intervention, post-intervention, and 12-week follow-up. The intervention was found to be feasible and acceptable to implement. Twelve participants were recruited, of which ten started the intervention and eight completed the intervention. All eight participants reported finding the intervention helpful. Evaluation of the intervention was found to be feasible and acceptable. Indicative results showed potential improvements across child and caregiver mental health. Limitations are that the small sample size limits the range of perspectives, lack of control group means observed changes could be due to factors other than the intervention, and potential bias exists due to self-completed fidelity monitoring and possible response bias. The caregiver group intervention was feasible and acceptable to implement and evaluate in a humanitarian setting, and showed potential to positively impact child and caregiver mental health, warranting further research on its effectiveness.

Exploring food security/insecurity determinants within Venezuela's complex humanitarian emergency.

The complex humanitarian emergency that Venezuela has been going through for several years has deteriorated the quality of life of its citizens, deepened food insecurity in households and has promoted migratory movements of almost six million people to neighboring countries. To analyze food security in Venezuelan households to identify the determinant factors that might contribute to the design of evidence-based public policies. A non-probabilistic survey of national scope was used in 2,041 urban and non-urban households. A descriptive statistical test was performed to analyze demographic variables and the three component indicators of the food security index (FSI): food consumption, economic vulnerability and coping strategies. The FSI was built according to the World Food Program (WFP) methodology, and a segmentation analysis was applied using the Chi-squared Automatic Interaction Detection (CHAID) algorithm to specify the influence of some variables as the best predictor at each level. Only 9% of the households presented food security, 69% classified as marginally secure, and 22% presented moderate or severe food insecurity. The food consumption score (FCS) was the variable that best discriminated the level of food security, followed by coping strategies and the percentage of spending on food. Conclusion: Most of the households studied sacrifice their livelihoods to feed themselves and cover the minimum of their nutritional requirements. This needs attention to stop and reverse the deterioration within a framework of respect for the human rights to health and food.

North Korea as a complex humanitarian emergency: Assessing food insecurity

North Korea is a complex humanitarian emergency with food insecurity at its core. As of August 2022, both quantity and price data point to a deteriorating situation, made worse by the regime's self-isolating response to the COVID-19 pandemic and the war in Ukraine. Food availability has likely fallen below minimum human needs, and on one metric is the worst since the 1990s famine. Food insecurity in North Korea is not only a humanitarian issue, but it is a strategic issue as well. In this context, the diplomatic leverage conferred by aid is unclear, nor is North Korea's priority as a recipient, in light of competing needs elsewhere. Resolution of North Korea's chronic food insecurity would require changes in the regime's domestic and foreign policy commitments, but this seems unlikely due to enablement by China and Russia.

Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review

BackgroundChildhood vaccination is among the most effective public health interventions available for the prevention of communicable disease, but coverage in many humanitarian settings is sub-optimal. This systematic review critically evaluated peer-review and grey literature evidence on the effectiveness of system-level interventions for improving vaccination coverage in protracted crises, focusing on how they work, and for whom, to better inform preparedness and response for future crises.MethodsRealist-informed systematic review of peer-reviewed and grey literature. Keyword-structured searches were performed in MEDLINE, EMBASE and Global Health, CINAHL, the Cochrane Collaboration and WHOLIS, and grey literature searches performed through the websites of UNICEF, the Global Polio Eradication Initiative (GPEI) and Technical Network for Strengthening Immunization Services. Results were independently double-screened for inclusion on title and abstract, and full text. Data were extracted using a pre-developed template, capturing information on the operating contexts in which interventions were implemented, intervention mechanisms, and vaccination-related outcomes. Study quality was assessed using the MMAT tool. Findings were narratively synthesised.Results50 studies were included, most describing interventions applied in conflict or near-post conflict settings in sub-Saharan Africa, and complex humanitarian emergencies. Vaccination campaigns were the most commonly addressed adaptive mechanism (n = 17). Almost all campaigns operated using multi-modal approaches combining service delivery through multiple pathways (fixed and roving), health worker recruitment and training and community engagement to address both vaccination supply and demand. Creation of collaterals through service integration showed generally positive evidence of impact on routine vaccination uptake by bringing services closer to target populations and leveraging trust that had already been built with communities. Robust community engagement emerged as a key unifying mechanism for outcome improvement across almost all of the intervention classes, in building awareness and trust among crisis-affected populations. Some potentially transformative mechanisms for strengthening resilience in vaccination delivery were identified, but evidence for these remains limited.ConclusionA number of interventions to support adaptations to routine immunisation delivery in the face of protracted crisis are identifiable, as are key unifying mechanisms (multi-level community engagement) apparently irrespective of context, but evidence remains piecemeal. Adapting these approaches for local system resilience-building remains a key challenge.

COVID-19 vaccination in the Gaza Strip: a cross-sectional study of vaccine coverage, hesitancy, and associated risk factors among community members and healthcare workers

BackgroundThe Gaza Strip, like other settings of complex humanitarian emergencies, faces immense challenges in vaccinating its population against COVID-19. This study was conducted in October 2021 among Gaza’s adult population and healthcare workers (HCWs). The primary aim was to estimate two indicators, coverage of COVID-19 vaccination and the prevalence of vaccine hesitancy. The secondary aim was to evaluate the two indicators’ associations with globally identified risk factors.MethodsA cross-sectional study was conducted using a population-based survey of adults and a purposive survey of HCWs in Gaza. A multi-stage sampling design was used for the population survey component. For the HCW component, five health facilities were purposively selected as entry points; HCWs in the facilities holding clinical or other specialized positions were approached to participate in the survey. Data were summarized as univariable descriptive statistics with unweighted and weighted point estimates. Logistic regression was used to evaluate associations of risk factors with vaccination status and vaccine hesitancy.ResultsA total of 1075 individuals were surveyed, of whom 906 were community members and 169 were HCWs. Population-weighted vaccine coverage was estimated to be 49.08% (95% CI 43.10–55.08). 89.35% of HCWs were vaccinated. Population-weighted vaccine hesitancy was estimated to be 34.08% (95% CI 28.14–40.56) in the overall population and 67.24% (95% CI 49.04–81.41) among the unvaccinated sub-group. In logistic regression vaccination was independently associated with male sex (aOR 1.88, p = 0.006, 95% CI 1.20–2.95), older age (40+ vs. 18–39 age group) (aOR 1.92, p < 0.001, 95% CI 1.73–2.13), higher education (aOR 2.19, p < 0.001, 95% CI 1.51–3.17), and confidence in the safety of the vaccine (aOR 13.8, p < 0.001, 95% CI 10.1–18.8). Risk factors for hesitancy were similar to those identified for vaccination status, however hesitant individuals were somewhat more likely to obtain vaccine information from family members (aOR 1.29, p = 0.051, 95% CI 1.00–1.67) and less likely to trust healthcare providers (aOR 0.58, p < 0.001, 95% CI 0.49–0.68).ConclusionsThe continued emergence of SARS-CoV-2 variants reinforces the importance of achieving high levels of vaccination coverage globally—a difficult undertaking in Gaza. This study estimated half of Gaza’s adult population received at least one dose of any COVID-19 vaccine by October 2021, and the majority of unvaccinated individuals were hesitant. Disparities in vaccination across the territory’s demographic groups underscore the need for targeted outreach to these populations and messaging through community-based channels to permeate social networks of the unvaccinated.

Risk factors of stunting and wasting in Somali pre-school age children: results from the 2019 Somalia micronutrient survey

BackgroundStunting and wasting in children less than 5 years of age are two key indicators of child malnutrition. Reducing their prevalence is a priority of the global public health community and for Somalia, a country suffering complex humanitarian emergencies such as drought, flooding, conflict and large-scale displacements.MethodsData from the nationally representative cross-sectional Somalia Micronutrient Survey (SMS 2019) on 1947 children were analyzed to assess the prevalence and potential risk factors of stunting and wasting. Bivariate and multivariable analyses were conducted separately for children 0–5 months and 6–59 months, and population attributable fractions were calculated using adjusted risk ratios produced by Poisson regression models.ResultsAmong the 1947 children, the prevalence of stunting and wasting were 17.2% (95% CI: 15.0, 19.6) and 11.0% (95% CI: 9.3, 12.9), respectively. Among children 6–59 months of age, those residing in severely food insecure households had a higher risk of stunting (adjusted risk ratio [aRR] 1.47; CI: 1.12, 1.93) compared to those in food secure households. This risk of stunting was also higher in children with inflammation (aRR 1.75; CI: 1.35, 2.25) and iron deficiency (ID) (aRR 2.09; CI: 1.58, 2.80). For wasting, a dose-response relationship was found with household wealth, with the risk of wasting increasing significantly as the household wealth quintile decreased. On the other hand, the risk of wasting was lower in iron-deficient children (aRR 0.69; CI: 0.49, 0.98) than in iron-replete children. Among children 0–5 months of age no variables remained statistically significantly associated with stunting in the multivariable analysis. Wasting, however, was more common in children with recent diarrhea (aRR 3.51; CI: 1.68, 7.36).ConclusionsNutritional status of children in Somalia may be improved by prevention of diarrhea and other infections and improvements in household food security.

Politicians, pathogens, and other threats to aid workers: a material semiotic analysis of violence against health care in the Syrian conflict

ABSTRACT This paper analyses humanitarian security in the framework of Donna Haraway’s political material semiotics. It begins by arguing that targeted violence against health care constitutes a trope: a figure of speech that challenges and disrupts the established narrative of humanitarian security. Drawing on 20 in-depth expert interviews, the paper explores a case study of weaponisation of health care in the Syrian conflict (2011-present). It illustrates how different material-semiotic actors – such as politicians, pathogens, and medical infrastructure – condition and shape the security of humanitarian health workers in the opposition-held parts of the country. Taking medical facilities as its key unit of analysis, the paper shows how armed violence is not only directed towards these material-semiotic entities but amplified and transformed as it passes through them. In doing so, the paper sheds light on the formative role that nonhuman materialities play in the protection of aid workers and other civilian entities in armed conflict. The paper's findings also contribute towards an improved understanding of how previously under-appreciated variables impact the delivery of medical aid in complex humanitarian emergencies.