Conflict-affected Areas Research Articles

War and oncology: cancer care in five Iraqi provinces impacted by the ISIL conflict.

War and cancer have been intertwined in Iraq for over three decades, a country where the legacies and ongoing impacts of conflict have been commonly associated with both increased cancer rates as well as the deterioration of cancer care. Most recently, the Islamic State of Iraq and the Levant (ISIL) violently occupied large portions of the country's central and northern provinces between 2014 and 2017, causing devastating impacts on public cancer centers across central and northern Iraq. Focusing on the five Iraqi provinces previously under full or partial ISIL occupation, this article examines the immediate and long-term impacts of war on cancer care across three periods (before, during, and after the ISIL conflict). As there is little published data on oncology in these local contexts, the paper relies primarily upon the qualitative interviews and lived experience of oncologists serving in the five provinces studied. A political economy lens is applied to interpret the results, particularly the data related to progress in oncology reconstruction. It is argued that conflict generates immediate and long-term shifts in political and economic conditions that, in turn, shape the rebuilding of oncology infrastructure. The documentation of the destruction and reconstruction of local oncology systems is intended to benefit the next generation of cancer care practitioners in the Middle East and other conflict-affected regions areas in their efforts to adapt to conflict and rebuild from the legacies of war.

Fighting with words: humanitarian security and the changing role of law in contemporary armed conflict.

Violence against humanitarians is a commonplace phenomenon in contemporary armed conflict. This paper examines how the manipulation of international legal principles for political or military purposes, a practice known as 'lawfare', impacts humanitarian security in conflict-affected areas. Drawing on a case study of the Syrian conflict (2011-), it finds that lawfare has been used to legitimate systematic civilian targeting by pro-government forces and to delegitimise the delivery of aid to opposition-held areas of the country. Efforts to use legal measures to promote civilian welfare-by way of sanctions or demands for cross-border humanitarian access-have been taken as evidence of Western attempts to politicise humanitarian considerations and international law. In practice, this has meant increased security risks for aid workers and impunity for those implicated in the violence. The paper concludes by calling for more critical research on lawfare and politicisation of international law as part and parcel of civilian protection in conflict-affected areas.

Community policing in areas of limited statehood: The case of Lebanon

ABSTRACT This article explores the impact of community policing on democratic policing in conflict-affected areas of limited statehood with divisive politics by way of a case study of Lebanon from 2008 to 2016. It argues that community policing leads to unequal empowerment and that it reflects and reproduces the existing politics of the context in which it is applied rather than promoting democratic changes, as the proponents of community policing usually claim. Specifically, the analysis of two cases of community policing in Lebanon shows that it reflects policing aimed against perceived threats to the country’s consociational power-sharing arrangement and the sectarian balance on which it is based, namely Palestinian and Syrian refugees as outsiders who do not fit into consociational categories. The community policing projects in the Palestinian Nahr al-Bared camp and the urban Ras Beirut area of Beirut represent different contexts within Lebanon and so also show variation in the state’s intent behind, and approach to, community policing. Still, the similarity in outcome in both cases, policing of ‘outsiders’ as threats to the consociational order, suggests that community policing exhibits flaws independently of where, how, and why it is being applied.

Assessment of laboratory capacity in conflict-affected low-resource settings using two World Health Organization laboratory assessment tools.

Laboratory diagnostic services are essential to drive evidence-based treatment decisions, manage outbreaks, and provide population-level data. Many low- and middle-income countries (LMICs) lack sufficient diagnostic capacity, often further exacerbated in conflict-affected areas. This project assessed laboratory services in conflict-affected LMICs to understand gaps and opportunities for improving laboratory capacity. The World Health Organization Laboratory Assessment Tool Facility Questionnaire (WHO Laboratory Tool) and Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) checklist were used to assess five laboratories in Eastern Democratic Republic of the Congo (DRC) and five in Gaza, Palestine. Total scores and percentage outcomes by indicator were calculated. Average WHO Laboratory Tool score across all facilities was 41% (range 32-50%) in DRC and 78% (range 72-84%) in Gaza. Lowest scoring indicators in DRC were Biorisk management (13%, range 8-21%), Documentation (14%, range 6-21%), and in Gaza, were Facilities (59%, range 46-75%) and Documentation (60%, range 44-76%). Highest scoring indicators in DRC were Facilities (70%, range 45-83%) and Data and Information Management (61%, range 38-80%), and in Gaza were Data Information and Management (96%) and Public Health Function (91%, range 88-94%). In DRC, no laboratory achieved a SLIPTA star rating. In Gaza, two laboratories had a 3-star SLIPTA rating, one had a 2-star rating and two had a 1-star rating. Laboratory systems in conflict-affected LMICs have significant gaps. Implementating improvement strategies in such settings may be especially challenging.

Creating a difference – a role for the arts in addressing child wellbeing in conflict-affected areas

ABSTRACT Background Details findings from a project on the potential for arts activities and art therapy to support the mental health and wellbeing of children living in Kashmir. Methods The intervention engaged 30 school children over the course of one year who produced various forms of artwork and performances. In this paper, we report on project impacts, drawing on some of our qualitative measures including observations and interviews. Results Our research details impacts and improvements in areas of emotional expression, belonging, and agency. We also found an important role for schools to create safe, secure, and caring spaces to allow students to express themselves and work through traumatic feelings in a non-judgemental way. Conclusions School-based arts interventions can play an important role in the mental health and wellbeing of children. Critical here, however, are dedicated space, time, and resources to provide a supportive environment and to sustain activity in long-term.

Methods Of Teaching Islamic Values Education Amid Conflict Situation: The Case Of Bangsamoro Development Agency (BDA) In Mindanao

Teaching Islamic values education is considered by Muslim educators as the solution to moral crisis encountered by contemporary Muslim society including the Bangsamoro in the conflict-affected area of Mindanao, Philippines. The purpose of the present paper is to re-examine the Bangsamoro Development Agency's (BDA) methods of teaching Islamic values education among its Muslim stakeholders in Mindanao. Through the use of the qualitative method of study, like content analysis of data gathered through library research and participant observation, the researcher found out that the BDA-tasked to determine, lead and manage development projects in conflict-affected areas of Mindanao-had successfully integrated Islamic values by applying the traditional Islamic method of education such as ta'lim, tarbiyyah, and ta'dib but through the language of modern education theory, adapted to the kind of situation they are in. Instead of using Islamic terminologies as such, the BDA used such term as experiential-learning method (lecturette, workshop, reflection and demonstration, and follow-through scheme). With this, the BDA had able to play its assigned role with the acceptance of its different stakeholders including government and non-government organizations. The present Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), which is established as a product of the MILF’s struggle, may also consider BDA’s experience to institutionalize its moral governance initiative to address the perceived corruption, manipulation, and ill-governance in this government. Keywords: Bangsamoro Development Agency, teaching methods, Islamic values, Values education, Mindanao (Philippines)

Metaverse!

This study aimed to synthesize the literature on Metaverse to highlight its current research, opportunities, and applications in e-healthcare and education to reduce inequalities and for delivering fair and equal opportunities and solutions. The authors employed preferred reporting items for systematic reviews and meta-analyses (PRISMA) to rapidly map the field of a metaverse in health and education. Two major application domains emerged in the literature from the 88 research publications, which include (1) Metaverse in healthcare and (2) Metaverse in education. This study will act as a road map to help academics who desire to continue their research work in the Metaverse for various healthcare and educational services. However, its implementation is required in the future to improve mental healthcare and the effectiveness of mental health services, particularly in low and medium-income (LMIC) and conflict-affected areas.

Eye movement desensitization reprocessing as a treatment for PTSD in conflict-affected areas.

One recommended psychological intervention for trauma treatment in Western countries, including posttraumatic stress disorder (PTSD), is eye movement desensitization reprocessing (EMDR). However, there is a paucity of data regarding treatment interventions in low- and middle-income countries. This study examined the efficacy of EMDR for treating posttraumatic stress (PTS), anxiety, and depression among a cohort of individuals with low socioeconomic status in a conflict-affected middle-income country as well as a smaller refugee cohort. Two hundred and sixty-eight adults residing in Lebanon (male = 65, female = 203, SDgender = 0.43; µage = 30.5, SDage = 10.49; 85% Lebanese, 15% refugees [9.3% from Syria, and 5.7% from Iraq, Palestine, the Philippines, and Other]) received EMDR therapy. Measures of PTS, anxiety, and depression were taken at three time points: before treatment (T0), posttreatment (T1), and 6-month follow-up (T2). Reduction in PTS symptoms from T0 to T1, F(1, 208) = 412.3, p < .01, and T1 to T2, F(1, 46) = 136.1, p < .01. Reduction in anxiety symptoms from T0 to T1, F(1, 208) = 387.0, p < .01, and T1 to T2, F(1, 46) = 153.7, p < .01. Similarly, for depression, a reduction of symptoms from T0 to T1, F(1, 207) = 309.5, p < .01, and T0 to T2, F(1, 46) = 96.0, p < .01. This research supports the use of EMDR for the treatment of PTS, depression, and anxiety symptoms in individuals with low socioeconomic status and refugees, thus contributing to the research base for populations that are under-researched. Mental health services, especially in conflict-affected settings, would benefit from using EMDR therapy to target these pathologies in these populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The effects of crime and violence on food insecurity and consumption in Nigeria

Households living in conflict-affected areas are vulnerable to violence and crime perpetrated by various types of actors. By exploiting variation in the timing, intensity, and spatial distribution of attacks against households in Nigeria, this study finds that becoming a victim leads to higher food insecurity and decreased food and non-food consumption. Property crimes are more detrimental to consumption and food insecurity than violence is. The findings remain robust to accounting for conflict in the geographical proximity to the household. Our results indicate that information on victimization can be used for building safety nets in conflict-affected areas.

Digital transformation strategy for developing higher education in conflict-affected societies

Armed conflict is an evolution in reverse that significantly damages infrastructure, displaces students and faculty, and limits access to resources, necessitating innovative solutions. This research uses Syria as a case study to investigate the potential of a digital transformation strategy to revitalize the higher education system in war-ravaged regions. It proposes a digital transformation framework utilizing a mixed-method approach, including literature reviews, expert interviews, and case analysis, to identify critical challenges faced by Syrian higher education institutions. The framework focuses on developing digital infrastructure, capacity building for educators, e-learning platforms, digital content, and public-private partnerships that increase education access, foster collaboration, enable remote learning and enhance global competitiveness in war-torn areas. The e-learning platforms component explores the potential of Massive Open Online Courses (MOOCs), Learning Management Systems (LMS), and blended learning approaches to enhance the quality and accessibility of higher education. The digital content component highlights the importance of open educational resources, digital libraries, and virtual labs to support learning. Finally, the capacity building component addresses the need for training and upskilling educators and administrators to implement digital solutions effectively. The proposed framework is a roadmap for policymakers, educators, and international organizations to develop and implement digital solutions supporting long-term recovery and growth in conflict-affected areas.

Learning outcomes amidst violent conflict and poverty in India

This paper investigates the relationship between violent conflict, poverty dynamics and learning outcomes in India. Generalized ordered logistic regressions indicate that Naxal violence is associated with lower outcomes in basic literacy and numeracy, though with variations by gender and poverty trajectory. Mixed methods data, involving panel analysis alongside in-depth interviews in conflict-affected areas, point to supply- and demand-side constraints especially for children in impoverished households. Harassment of girls increased school absence, while interactions with Naxals when travelling to school prompted many boys to stay in hostels during holidays thus limiting absences. Conflict also modified teacher incentives. Understanding how conflict affects acquisition of basic skills is critical in contributing to policies better tailored for marginalised girls and boys.

Evolution of the Etiologies of Purulent Meningitis in Children over a Period of 24 Months in Conflict-Affected Rural Areas of the Central African Republic after the Introduction of 2 New Vaccines in the Expanded Vaccination Program

Evolution of the Etiologies of Purulent Meningitis in Children over a Period of 24 Months in Conflict-Affected Rural Areas of the Central African Republic after the Introduction of 2 New Vaccines in the Expanded Vaccination Program

УЧАСТЬ ЄС У ВРЕГУЛЮВАННІ ВІРМЕНО-АЗЕРБАЙДЖАНСЬКОГО КОНФЛІКТУ ЗА НАГІРНО-КАРАБАСЬКИЙ РЕГІОН

The article highlights the reasons for the conflict between Armenia and Azerbaijan over the Nagorno-Karabakh region. The position of the European Union regarding this conflict is analyzed. It has been found that since the beginning of the conflict, the European Union has not actively participated in its settlement and its policy has been weak. The EU has often expressed its support for the negotiation process under the auspices of the OSCE Minsk Group. The change in the attitude of the EU to this conflict after the introduction of the Eastern Partnership program, which included both Armenia and Azerbaijan, is characterized. An assessment of the consideration of the Armenian-Azerbaijani conflict at the Eastern Partnership summits is given, namely, at the Eastern Partnership Summit in 2021, the EU’s attitude to the Armenian-Azerbaijani conflict is changing, the EU’s participation in the peaceful settlement of the conflict is increasing. The importance of the created initiative «European Political Community» in the negotiation process regarding the settlement of this conflict was considered. In the course of the study, it was concluded that from 2021, the European Union will become an active participant in the negotiation process regarding the settlement of the Armenian-Azerbaijani conflict. After Russia’s full-scale invasion of Ukraine, the EU is further strengthening its mediation in the negotiation process. At the current stage, three rounds of negotiations between the parties to the conflict took place with the mediation of the EU, thus, the European Union is trying to reduce the influence of Russia in the (not) settlement of the conflict. In turn, from 2022, Armenia is also interested in greater influence of the EU in the negotiation process and at her request; the civilian mission of the European Union in Armenia – EUMA Armenia – was created. Through its presence, EUMA Armenia contributes to the security of people in conflict-affected areas of Armenia and makes an impact on the strengthening of trust on the ground. The country also contributes to the creation of an environment favorable to the normalization of relations between Armenia and Azerbaijan with EU support.

Sleep habits and quality among war and conflict-affected Palestinian adults in the Gaza strip

Objectives/backgroundSleep may be affected by traumatic experiences leading to an increased risk of poor quality of life and daily functioning. However, studies related to sleep habits and problems in conflict-affected areas are still sparse. The present study attended to describe sleep habits, estimate the prevalence rate of sleep disturbances, and identify associated factors in the Gaza strip. Patients/methodsA population-based cross-sectional study including 1458 Palestinian adults aged ≥18 years living in the Gaza strip was carried out during the period between 18 February and March 31, 2022. An electronic survey through the free-of-charge Google Forms tool was used for data collection. A range of self-report measures related to sleep, mood, and subjective quality of life were used: the Pittsburgh Sleep Quality Index (PSQI), the World Health Organisation-Five Well-Being Index (WHO-5), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ)-9. ResultsThree out of five of participants (n = 882, 60.5%) were females and the mean age was 34.8 ± 12.77 years. More than one-third of participants (n = 556, 38.1%) had poor well-being as assessed by the WHO-5 and 108 (7.4%) had a PHQ-9 score ≥ 20 indicating severe depression. The prevalence of poor sleep quality was 52.8% when defined as PSQI ≥ 6 and 30.5% when defined as PSQI ≥ 8. The prevalence of excessive daytime sleepiness (EDS), short sleep duration, severe depression, and poor well-being were 43.6%, 26.4%, 7.1%, and 38.1% respectively. Women and the youngest participants reached the highest prevalence rates for sleep and mood disturbance as well as for daytime dysfunction. Using multivariate binary logistic regression analysis, severe depression, being divorced, a history of psychological disease, poor well-being and previous war injuries were identified as the strongest predictors of poor sleep quality. ConclusionPoor sleep quality, EDS, severe depression, and poor well-being in our sample were strikingly increased. Females and the youngest participants were the most affected. The conflict-affected situation in the Gaza strip combined with the high population density and worsening socio-economic conditions may play an important role in sleep disturbances, mainly because of a high prevalence of mood disturbances. Sleep and mood disturbances also adversely affect the quality of life.

Response of Anti-trafficking Organisations on the Impact of the La Strada International Risk Assessment and the Challenge of Maintaining Health of Professionals in Ukraine and Neighbouring Countries

This short practitioners' contribution offers a reflection by antitrafficking organisations in Ukraine and Moldova on the local impact of the rapid assessment of risks and gaps in the anti-trafficking response to prevent human trafficking of refugees from Ukraine (contribution by Hoff &amp; De Volder in this issue) and on the challenge and importance of maintaining mental health of professionals in conflict-affected areas (contribution by Rullmann in this issue).

The hypertension cascade of care in the midst of conflict: the case of the Gaza Strip.

Although hypertension constitutes a substantial burden in conflict-affected areas, little is known about its prevalence, control, and management in Gaza. This study aims to estimate the prevalence and correlates of hypertension, its diagnosis and control among adults in Gaza. We conducted a representative, cross-sectional, anonymous, household survey of 4576 persons older than 40 years in Gaza in mid-2020. Data were collected through face-to-face interviews, anthropometric, and blood pressure measurements. Hypertension was defined in anyone with an average systolic blood pressure ≥140 mmHg or average diastolic blood pressure ≥90 mmHg from two consecutive readings or a hypertension diagnosis. The mean age of participants was 56.9 ± 10.5 years, 54.0% were female and 68.5% were Palestinian refugees. The prevalence of hypertension was 56.5%, of whom 71.5% had been diagnosed. Hypertension was significantly higher among older participants, refugees, ex-smokers, those who were overweight or obese, and had other co-morbidities including mental illnesses. Two-thirds (68.3%) of those with hypertension were on treatment with one in three (35.6%) having their hypertension controlled. Having controlled hypertension was significantly higher in females, those receiving all medications for high blood pressure and those who never or rarely added salt to food. Investing in comprehensive but cost-effective initiatives that strengthen the prevention, early detection and timely treatment of hypertension in conflict settings is critical. It is essential to better understand the underlying barriers behind the lack of control and develop multi-sectoral programs to address these barriers.

What was known: Weather forecast availability and communication in conflict-affected countries

Armed conflict increases people's vulnerability to climate extremes. Since many of these climate extremes are predictable beforehand, Early Warning Early Action (EWEA) can help protect people's lives, livelihoods, and wellbeing. While such EWEA systems exist in several countries, there is limited scientific knowledge about EWEA in conflict-affected countries where communities experience the compounding effects of both disaster and conflict risks. By doing a retrospective analysis of the most severe disaster events and historical forecast information, this paper examines whether global forecast models predicted historical floods in conflict-affected regions and whether forecast information was communicated for droughts. It analyses the historical forecast availability and communication for the most severe disaster events in 20 countries affected by protracted conflict over the last 20 years. These 72 disaster events were reported to affect approximately 150 million individuals and more than 150,000 were reported dead. The results show that heavy rainfall was predicted in advance for 48 out of 50 flood events, with lead times of more than three days and probabilities between 10 and 90%. In addition, in 16 out of 20 major drought events a low rainfall forecast was communicated in advance of the disaster declaration. We conclude that forecasts exist and could be used to provide early warnings in conflict-affected areas. Further research is needed as to what extent forecast warnings did lead to early action to protect populations affected by conflict.

Determinants of Under-Five Mortality in an Armed Conflict Setting: Empirical Findings from the Demographic and Health Surveys.

Insurgencies like Boko Haram may impact the physical health and well-being of adults and children living in geographic areas under their political control. However, it is difficult to obtain reliable health data in conflict-affected areas. This study explored the potential to use data from the Demographic and Health Surveys (DHS) to examine the determinants of under-five mortality in Northern Nigeria. Data were derived from DHS conducted before and after the start of the Boko Haram insurgency in 2009. A multi-level mixed effects logistic regression model was used to identify predictors of under-five mortality in an armed conflict setting. Results were reported as adjusted odds ratios (aOR) and 95% confidence intervals (CI). Residence in an armed conflict setting was not significantly associated with under-five mortality (aOR = 1.06; 95% CI: 1.00, 1.10). However, twin gestation (aOR = 3.18; 95% CI:2.96, 3.42), wealth index of family (richest versus poorest: aOR = 0.42; 95% CI: 0.37, 0.47), religion of mother (Islam versus Christianity: aOR = 1.50; 95% CI: 1.43, 1.57); highest educational level of mother (higher versus none: aOR = 0.33; 95% CI: 0.29, 0.37), and parity of mother, significantly predicted death before the fifth birthday. Repeated studies are needed to assess the impact of Boko Haram insurgency on physical health outcomes, particularly in areas where primary data collection is difficult or impossible.

Analyzing the Role of Media Causing Conflict in the Conflict-affected Areas, A Case Study of the Northwest Province of Pakistan

This research study deals with the role of media in provoking sectarian violence. Using Random sampling techniques, a sample size of 279 respondents was selected in the district of Hangu Khyber Pakhtunkhwa, Pakistan. Besides sample frequency distribution, chi-square statistics were used to determine the association between independent and dependent variables. The majority of respondents, 262(93.9%), stated that peace is in high demand for people in the area. Similarly, 240 (86.0%) of the respondents argued that without peace, cooperation, and coordination among people is difficult to prevail. Likewise, most respondents, 182 (65.2%), believed that people start fighting over minor issues. Furthermore, at the bivariate level, media can destroy peace at any time (p= .031) was found to be significant with peace in the area. The media has changed the individual mind, and its thoughts (p=.003) were highly substantial with peace in the region. Social Media plays an essential role in peacemaking (p=.000) had a highly significant association with peace in the area. The study concluded that media have a tremendous influence on the stability in the region. It can cultivate hatred between Shia and Sunni on either side, which generates endless conflict between the two sects. The study recommends that the government and concerned authorities confine the broadcasting of media channels and print media activities on factless and sensitive issues which cause the escalation of sectarian conflict between Shia and Sunni in Pakistan. Coordination and cooperation among rival groups can further strengthen the peace process in the area.

COVID-19 and Peace in Conflict-Affected Areas

The relationship between COVID-19 and peace has been considered from a variety of perspectives. In addition, different empirical studies on the link between the pandemic and peace in conflict-affected areas exist. However, little work has been performed on examining these studies to highlight key findings on the theme of COVID-19 and peace in conflict-affected areas. A conflict-affected area is a country, or part of a country, where widespread violence or armed conflict was present when COVID-19 emerged in December 2019, or that was transitioning from recent armed conflict to peace by the time the disease arose. What do we know, so far, about how peace has been affected by the COVID-19 pandemic in conflict-affected areas? To address this question, this paper begins by recognizing the multidimensionality of peace and clarifying that the main aspects of peace in conflict-affected areas being considered in the article are relations between conflict parties, peace efforts, and peace processes. Afterwards, the paper discusses existing evidence regarding the impact of COVID-19 and state responses to it on these components of peace in conflict-affected areas. The conflict-affected areas considered include Afghanistan, Colombia, Iraq, Israel-Palestine, Libya, Myanmar, Nigeria, South Sudan, Syria, the Philippines, Yemen, and other zones. The central finding of the article is that the existing studies on COVID-19 and peace in conflict-affected areas present mixed findings. On the one hand, the virus generated opportunities for cooperation between conflict parties in some cases, such as in the West Bank and Gaza Strip of Israel-Palestine. However, on the other hand, it created conditions that enabled conflict and impeded peace efforts and processes in many or most conflict-affected areas. The paper explains that two factors that determined how the disease affected peace in conflict-affected and non-conflict-affected areas are the pre-COVID-19 political and socio-economic conditions in an area, and how state and non-state actors responded to the pandemic. The article closes with a summary of the discussion and identification of its major limitations.