Conflict Settings Research Articles

Association between severity of symptoms and minimum mental health treatment duration in humanitarian contexts: a retrospective observational study

Understanding and optimising mental health and psychosocial support (MHPSS) interventions in humanitarian crises is crucial, particularly for the most prevalent mental health conditions in conflict settings: anxiety, depression, and post-traumatic stress disorder. However, research on what is the most appropriate length of psychological intervention is lacking in this setting. We aimed to establish which factors are most closely related to improvement and to determine the required number of consultations needed to achieve this improvement. We retrospectively analysed records from 9028 patients allocated to treatment for anxiety, depression, and post-traumatic symptoms from the MHPSS programme in Borno State, Nigeria, from January 2018 to December 2019. Patient characteristics, severity (Clinical Global Impression of Severity Scale, CGI-S scale), and clinical improvement were assessed by an attending counsellor (CGI-I scale) and by the patient (Mental Health Global State, MHGS scale). Improvement was defined as scores 1, 2, and 3 in the Clinical Global Impression of Improvement (CGI-I) scale, and as a decrease of at least 4 points in the MHGS scale. We investigated the associations between the category of symptoms, the severity of illness, and improvement of symptoms using multivariable logistic regression. We used Kaplan-Meier (KM) curves to assess the number of consultations (i.e., time of treatment) needed to achieve improvement of symptoms, by symptom category and symptom severity. The patients included were referred to treatment for anxiety (n=3462), depression (n=3970), or post-traumatic symptoms (n=1596). Median age was 31 years (range 16-103), and 84.3% were female. Patients categorised as severe were less likely to present improvement according to the CGI-I scale (OR 0.11, 95% CI 0.05-0.25), while none of the other categories of symptoms showed significant results. Overall, three or more consultations were associated with improvement in both scales (OR 3.55, 95% CI 1.47-8.57 for CGI-I; and OR 3.04, 95% CI 2.36-3.90 for MHGS). KM curves for the category of symptoms showed that around 90% of patients with anxiety, depression, or post-traumatic symptoms, as well as those with mild or moderate severity, presented improvement after three consultations, compared with six consultations for those with severe symptoms. Classification by severity among patients with anxiety, depression, or post-traumatic symptoms could predict the probability of improvement, whereas classification by symptoms could not. Our study highlights the importance of classifying patient severity in MHPSS programmes to plan and implement the appropriate duration of care. A major limitation was the number of patients lost to follow up after the first consultation and excluded from the logistic regression and KM analysis. The study was funded and staffed entirely by Médicos Sin Fronteras (Médecins Sans Frontières), Spain.

A circulating vaccine-derived poliovirus type 2 outbreak in a chronic conflict setting: a descriptive epidemiological study in South Sudan – 2020 to 2021

BackgroundIn this study, we describe the epidemiological profile of an outbreak of the circulating Vaccine Derived Polio Virus type 2 in South Sudan from 2020 to 2021.MethodWe conducted a retrospective descriptive epidemiological study using data from the national polio/AFP surveillance database, the outbreak investigation reports, and the vaccination coverage survey databases stored at the national level.ResultsBetween September 2020 and April 2021, 59 cases of the circulating virus were confirmed in the country, with 50 cases in 2020 and 9 cases in 2021. More cases were males (56%) under five (93%). The median age of the cases was 23.4 ± 11.9 months, ranging from 1 to 84 months. All states, with 28 out of the 80 counties, reported at least one case. Most of the cases (44, 75%) were reported from five states, namely Warrap (31%), Western Bahr el Ghazal (12%), Unity (12%), Central Equatoria (10%), and Jonglei (10%). Four counties accounted for 45.8% of the cases; these are Gogrial West with 12 (20%), Jur River with 5 (8.5%), Tonj North with 5 (8.5%), and Juba with 5 (8.5%) cases.The immunization history of the confirmed cases indicated that 14 (24%) of the affected children had never received any doses of oral polio or injectable vaccines either from routine or during supplemental immunization before the onset of paralysis, 17 (28.8%) had received 1 to 2 doses, while 28 (47.5%) had received 3 or more doses (Fig. 4). Two immunization campaigns and a mop-up were conducted with monovalent Oral Polio Vaccine type 2 in response to the outbreak, with administrative coverage of 91.1%, 99.1%, and 97% for the first, second, and mop-up rounds, respectively.ConclusionThe emergence of the circulating vaccine-derived poliovirus outbreak in South Sudan was due to low population immunity, highlighting the need to improve the country’s routine and polio immunization campaign coverage.

Affective materiality of women's markets: The role of objects in conflict and post-conflict settings

This paper explores the agentic capacities of inanimate objects and their role in shaping the affective atmospheres of women's markets in a post-conflict setting. To analyse this material affectivity, I draw on women's markets of Swat in Pakistan and the role of four selected objects including posters/notices, bras, mannequins and curtains in the generation, transmission and manipulation of affect. I ask, how objects matter in shaping the affectivity of women's markets during and after Swat's conflict? To answer this question, I draw on 36 semi-structured interviews with men traders ( N = 18) and women customers ( N = 18) along with my field notes. I found that centring our analyses upon gendered materiality of mundane objects allow us to capture nuances of unruly capacities and gendered affectivities of objects in the context of war and post-conflict environments. Moreover, my findings suggest that focussing on agentic capacities of objects enhance our understanding of the affective materiality of women's markets in the post-conflict setting.

The politics and spaces of public-private partnerships in humanitarian tech innovations

The past decade has seen a growing engagement of tech companies in conflict settings to develop multifaceted technological innovations, including digital biometric identification to register refugees, commercial drones to deliver cargo, and big data-fuelled algorithms to predict the spread of crises. Humanitarian technology has been largely acclaimed as a way of making aid more effective and of triggering a paradigm shift in humanitarian governance by putting crisis-affected communities in what is claimed to be the driving seat of aid programmes. Critics are however wary about the negative impacts these innovations have on humanitarian practices and crisis-affected population. This paper contributes to this debate by assessing whether technological innovations fundamentally alter the politics and spaces of humanitarian governance. To do so, it analyses the way public private partnerships (PPPs) mediate between the interests of the various stakeholders of tech experiments and distribute power among them. Drawing upon the exploratory analysis of 22 tech projects in crisis settings, a typology of PPPs is formalised based on the way they distribute power and resources among their stakeholders. The results show that only one type of PPPs - community-based digital humanitarianism – has the potential of increasing the ownership of crisis-affected communities over aid programmes and localising projects in so-called Global South societies. The two other types – technologising the humanitarian business and externalising the lab to crisis settings – appear as a continuation of neo-colonial practices with a digital touch.

Forms of sexual violence perpetrated in conflict and post-conflict settings against South Sudanese men resettled in two communities in Uganda: an exploratory qualitative study

BackgroundConsideration for men as survivors of sexual violence in conflict and post-conflict settings has gained some prominence in the last decade. There remains a paucity of empirical data on forms of sexual violence from the survivors’ perspective, and no study has considered the context of the 2013 South Sudan conflict specifically.MethodsThis paper reports the findings of an exploratory qualitative study on the forms of sexual violence perpetrated against men in conflict and post-conflict settings, with the survivors as the main participants. A purposive sampling technique was used to recruit 26 South Sudanese male sexual violence survivors who have resettled in two refugee resettlement communities in Uganda since the onset of the 2013 South Sudan conflict. In-depth semi-structured interviews were used to collect the data from the male survivors. Six humanitarian aid workers who support sexual violence survivors also participated as key informants. Thematic data analysis was performed on the qualitative data.ResultsThe 26 survivors reported experiencing eight direct and two indirect forms of sexual violence in conflict and post-conflict settings. The direct forms include (1) striping men naked; (2) male rape; (3) exchange of sex for favours; (4) forcing men to rape other people; (5) genital mutilation; (6) genital beating; (7) insertion of objects into men’s anus, and (8) taking men as wives. The indirect forms were forcing men to witness the rape of a female relative and forcing men to cheer or assist during the rape of other people.ConclusionTo maximize positive health outcomes for survivors, stakeholders must consider both direct and indirect forms of male-directed conflict-related sexual violence in policy and practice.

Interventions to Vaccinate Zero-Dose Children: A Narrative Review and Synthesis.

Zero-dose children, or children who have not received any routine vaccination, are a priority population for global health policy makers as these children are at high risk of mortality from vaccine-preventable illnesses. We conducted a narrative review to identify potential interventions, both within and outside of the health sector, to reach zero-dose children. We reviewed the peer-reviewed and grey literature and identified 27 relevant resources. Additionally, we interviewed six key informants to enhance the synthesis of our findings. Data were organized into three priority settings: (1) urban slums, (2) remote or rural communities, and (3) conflict settings. We found that zero-dose children in the three priority settings face differing barriers to vaccination and, therefore, require context-specific interventions, such as leveraging slum health committees for urban slums or integrating with existing humanitarian response services for conflict settings. Three predominant themes emerged for grouping the various interventions: (1) community engagement, (2) health systems' strengthening and integration, and (3) technological innovations. The barriers to reaching zero-dose children are multifaceted and nuanced to each setting, therefore, no one intervention is enough. Technological interventions especially must be coupled with community engagement and health systems' strengthening efforts. Evaluations of the suggested interventions are needed to guide scale-up, as the evidence base around these interventions is relatively small.

Adaptive Mechanisms of Health Zones to Chronic Traumatic Events in Eastern DRC: A Multiple Case Study.

The Eastern part of the Democratic Republic of Congo (DRC) has been affected by armed conflict for several years. Despite the growing interest in the impact of these conflicts on health service utilisation, few studies have addressed the coping mechanisms of the health system. The purpose of this study is to describe the traumatic events and coping mechanisms used by the health zones (HZs) in conflict settings to maintain good performance. This multiple case study took place from July to October 2022 in four HZs in the South Kivu Province of DRC. HZs were classified into "cases" according to their conflict profile: accessible and stable (Case 1), accessible but remote (Case 2), unstable (Case 3), and intermediate (Case 4). Eight performance indicators and the amount of funding provided to the HZs by non-governmental organizations (NGOs) were recorded. A graph was created to compare their evolution from 2013 to 2018. A thematic analysis of qualitative data from individual interviews with selected health workers was conducted. Both battle-related events (war and its effects) and non-battle-related events (epidemics, disasters, strikes) were recorded according to the case conflict-profile. Although the cases (3 and 4) most affected by armed conflicts occasionally performed better than the stable ones (1 and 2), their operational action plan was poorly carried out. The coping mechanisms developed in cases 3 and 4 were the deployment of military nurses in preventive and supervisory activities, the solicitations of subsidies from NGOs, the relocation of health care facilities and the implementation of negotiation strategies with the belligerents. Armed conflict results in traumatic events that disrupt the execution of the operational action plan of HZs. The HZs' management team expertise, its strong leadership, and substantial financial support would enable this system to develop reliable and sustainable adaptive mechanisms.

Selecting accepted assertions in partially ordered inconsistent DL-Lite knowledge bases

The problem of inconsistency handling in knowledge bases has received considerable research attention in several settings and has met many applications. Inconsistency usually stems from the fact that the information available for reasoning, query answering and decision-making tasks is obtained from different, scattered and potentially unreliable information sources. Performing these tasks is often computationally expensive, especially for knowledge bases in which the data is endowed with preferences and/or uncertainty. In the context of formal ontologies, enriching the assertions (i.e. the data pieces) with conceptual knowledge makes the query answering task harder computationally. Tractable results have been successfully established for the lightweight languages of the DL-Lite family. In this paper, we present two tractable methods for handling inconsistency in partially ordered lightweight ontologies. In essence, both methods are inspired from the well-known Intersection of ABox Repair (IAR) semantics, which proceeds by replacing the initial inconsistent knowledge base with the intersection of all of its maximally consistent sub-bases. The first method assumes a partial preorder over the knowledge base and identifies the accepted assertions, called ‘elected’, in polynomial time in data complexity. The second method captures uncertainty quantitatively in the framework of possibility theory and identifies the so-called ‘π-accepted’ assertions, also in polynomial time in data complexity. However, both characterisations require the conflict set to be readily available. This constitutes a serious limitation in frameworks and applications where the conflict set cannot be exhibited efficiently. In this paper, we propose a new and equivalent characterisation for each method. We show that the elected assertions and also the π-accepted assertions can be identified in polynomial time in the size of the dataset for lightweight ontologies.

Rethinking the Nexus: DDR and SSR in Post- and Evolving Conflict Contexts in Africa

Disarmament, demobilization, and reintegration (DDR) and security sector reform (SSR) programs are critical components of postwar transitional processes. The interlinkages between the two programs have been essential, especially in determining how combatants in armed groups and armed forces could become part of reconstituted security sector institutions, including the military and the police. Additionally, these links help determine who may be eligible as participants in these processes, and why some actors should be excluded. Over the past four or so decades, academic and policy understanding of postconflict settings has led to the acknowledgment that the two programs reinforce each other and should be designed to ensure fluidity and complementarity. However, there are usually gaps in linking the two, which have negative implications for peace, security, and stability in countries in transition from violence to peace. While there are several studies on the links between DDR and SSR, this paper seeks to examine both previous and current practices in both conflict and postconflict settings, with the aim of interrogating the changes that have been introduced over time to strengthen the links, and some of the gaps that are still existing, or emerging, especially as the nature of armed conflicts continue to change in Africa. Methodologically, the paper adopts a qualitative approach, through which interviews were conducted with practitioners, policy makers, and academics in the fields of DDR and SSR, across countries that previously implemented and those that are currently implementing DDR and SSR programs.

Prevalence of mental disorders and psychological trauma among conflict- affected population in Somalia: a cross-sectional study.

Despite the longstanding psychosocial impact of the interactable conflict in Somalia for the last 30 years, there is lack of epidemiological studies of mental health conditions, especially at the population level. The aim of this study is to fill the epidemiological gap and provide population based data on mental health conditions in the South-Central region of Somalia. The specific objectives were: (1) To determine the epidemiological patterns of mental disorders in three sites; Baidoa, Dolow and Kismayo, (2) Understand the socio-demographic characteristics associated with mental health conditions in the study sites, and (3) To assess the correlates between psychological trauma and the mental wellbeing of the population. This was a cross-sectional study of 713 respondents recruited from the three sites namely Dolow, Baidoa and Kismayo. Data on sociodemographic characteristics and mental disorders were collected using the MINI and sociodemographic questionnaire. Basic descriptive statistics were used to summarize sociodemographic characteristics. Univariable and multivariable logistic regressions were used to examine factors associated with common mental disorders. Statistical significance was considered at a value of p <0.05. Participants' mean age was 32.6 (±10.7) years. More than half (58.5%) of the respondents were male. The overall prevalence of common mental disorders was 557 (78.1%) with panic disorder (39.3%), generalized anxiety disorders (34.9%), major depressive episode current (32.1) and PTSD (29.9%). According to the multivariable logistic regression analysis, being male AOR = 1.74 (95%CI = 1.25, 2.42), having a family size of more than 10 members AOR =1.37 (95% CI = 1.00, 1.89), being unemployed AOR = 1.90 (95%CI = 1.18, 3.06), experienced starvation AOR =3.46 (95%CI = 2.23, 5.37), khat use AOR = 5.87 (955 CI, 1.75-19.65), were identified as predicting factors for the common mental disorders among the study participants. There is a high prevalence of mental disorders with anxiety disorders being the commonest. Findings reflect earlier studies that showed higher rates in conflict and post-conflict settings. It also aligns with past studies in Somalia. As such, there is an urgent need to integrate mental health and psychosocial support within the primary healthcare and other service sectors such as education considering the vast majority of the population are young.

Health Diplomacy as a Tool to Build Resilient Health Systems in Conflict Settings—A Case of Sudan

Attacks on health have become a significant concern for non-belligerents of war, including healthcare personnel and facilities, as witnessed in the ongoing Sudan conflict. About 1.5 billion people in fragile and conflict-affected settings (FCAS) have a heightened need for essential health services. Conflicts often lead to the disruption of the building blocks of health systems, a lack of access to health facilities, the failure of essential medical supply chains, the collapse of political, social and economic systems, the migration of health care workers, and upsurges in illness. While health indicators often decline in conflict, health can also bring peace and harmony among communities. An investment in building resilient health systems and health diplomacy is a neutral starting point for mitigating the repercussions of conflicts. The international commitment towards Sustainable Development Goals (SDGs) provides the impetus to emphasise the relationship between health and peace with the amalgamation of SDG 3, SDG 16, and SDG 17. The inspection of how health diplomacy should be used as a ‘tool for peace’ and not as leverage in conflict settings must be reiterated by the international community.

A machine learning approach to deal with ambiguity in the humanitarian decision‐making

One of the major challenges for humanitarian organizations in response planning is dealing with the inherent ambiguity and uncertainty in disaster situations. The available information that comes from different sources in postdisaster settings may involve missing elements and inconsistencies, which can hamper effective humanitarian decision‐making. In this paper, we propose a new methodological framework based on graph clustering and stochastic optimization to support humanitarian decision‐makers in analyzing the implications of divergent estimates from multiple data sources on final decisions and efficiently integrating these estimates into decision‐making. To the best of our knowledge, the integration of ambiguous information into decision‐making by combining a cluster machine learning method with stochastic optimization has not been done before. We illustrate the proposed approach on a realistic case study that focuses on locating shelters to serve internally displaced people (IDP) in a conflict setting, specifically, the Syrian civil war. We use the needs assessment data from two different reliable sources to estimate the shelter needs in Idleb, a district of Syria. The analysis of data provided by two assessment sources has indicated a high degree of ambiguity due to inconsistent estimates. We apply the proposed methodology to integrate divergent estimates in making shelter location decisions. The results highlight that our methodology leads to higher satisfaction of demand for shelters than other approaches such as a classical stochastic programming model. Moreover, we show that our solution integrates information coming from both sources more efficiently thereby hedging against the ambiguity more effectively. With the newly proposed methodology, the decision‐maker is able to analyze the degree of ambiguity in the data and the degree of consensus between different data sources to ultimately make better decisions for delivering humanitarian aid.

Scale Worlds: Iterative refinement, evaluation, and theory-usability balance of an immersive virtual learning environment

Feedback-based iterative refinement is important in the development of any human-computer interface. The present work aims to evaluate and iteratively refine an immersive learning environment called Scale Worlds (SW), delivered via a head-mounted display (HMD). SW is a virtual learning environment encompassing scientific entities of a wide range of sizes that enables students an embodied experience while learning size and scale. Five usability experts performed think aloud while carrying out four interactive tasks in SW and compared three different design options during A/B testing. Improvement features based on the feedback from an earlier SW usability evaluation as well as HMD-specific features were examined. Usability experts completed the post-study system usability questionnaire, the NASA task load index, and a bipolar laddering survey that collected subjective perception of specific SW features. Results show that the progress panel (an improvement feature) was informative while the instructions (another improvement feature) caused clutter. The experts indicated clear usability preferences during A/B testing, which helped resolve three sets of theory-usability conflicts. The overall assessment of SW paved a path for theory-usability balance and provided valuable insights for designing and evaluating usability in immersive virtual learning environments.

Agro-extractivism and neoliberal conservation: campesino abandonment in the Boyacá páramos, Colombia

Colombia is in the midst of an important shift: trying to balance its society and economy in the wake of the 2016 peace-agreement, with protection and restoration of important ecological regions. The mountainous Andean páramos ecosystem and paramuno/paramero campesinos of Boyacá have found themselves at the centre of some of these challenges. The páramos and their people – predominantly socio-economically precarious campesino farmers – are facing conservation policies to delimit, protect and control their livelihoods. Using a combination of qualitative methods, including interviews and participant-observation, to foreground campesinos' experiences, this paper explores the socio-environmental tensions emerging amidst this context of conservation. This paper argues that the delimitation process is constitutive of neoliberal conservation, which prioritises land sparing, ecosystem service payments and other ‘green business’. Furthermore, the delimitation process does not address the structural factors driving environmental degradation in the páramos, which is linked to an agro-extractivist model. Over recent decades, campesinos have been driven into increasingly agro-extractivist farming which encourages specialisation, monocropping, intensification, and dependence on external inputs. Spatially this has pushed them up to expand the agricultural frontier, as well as pushed them down within and out of the páramos and farming livelihoods. Now additionally squeezed by conservation restrictions, the delimitation is exacerbating historic inequality and mistrust. As a mountainous, small-scale farming case-study, in a conflict setting, this is a novel and unique addition to agro-extractivism research. Analysing the delimitation process through neoliberal conservation and agro-extractivism provides a systemic approach, which highlights the inconsistencies and contradictions of the policies promoted in the páramos. The paper thus demonstrates how the neoliberal conservation agenda is not only compatible with but integral to the agro-extractivist landscape, as it compensates for environmental spill-overs without questioning the prevailing market model. Rather than seek more socio-ecologically just farming practices, it opens new frontiers for capital and compromises socio-environmental peace.

“Otherwise … he will be a beggar”: a focus group study to understand the Perspectives of physiotherapists about measuring rehabilitation outcomes and impact in low-resource and conflict-affected settings

Purpose Rehabilitation outcomes are important for patients, professionals and policy makers. Most outcome measures (OMs) were developed for “Western” contexts and may be inadequate for low-resource and conflict settings, where the ability to demonstrate impact would be critical to strengthening the sector. This study aims to understand perspectives of physiotherapists from challenging environments regarding current practices, value, barriers, and facilitators of measuring rehabilitation outcomes. Materials & methods Focus group discussions were held in English with 35 physiotherapists from 18 countries. Audio recordings were transcribed verbatim, anonymised, and analysed using reflexive thematic analysis. Results Four themes emerged illustrating the levels at which outcomes and measures were discussed: User (patients, families), provider (physiotherapists, rehabilitation workers), application (OMs), and structure (management, health system). Participants discussed diversity in current practices and patient populations, utility of OMs and a neglected rehabilitation sector lacking investment. Barriers to progressing outcome measurement included lacking patient health literacy, rehabilitation provider training, valid OMs, and leadership. Participants suggested improved patient involvement, routine outcome measurement by using, developing, or adapting simple, context- and stakeholder-relevant OMs, and support from management. Conclusions These insights illustrate the need of and provide robust recommendations for context-adapted development of rehabilitation outcome measurement in various challenging contexts.

Impact of armed conflicts on HIV treatment outcomes in sub-Saharan Africa: protocol for a systematic review and meta-analysis

IntroductionArmed conflicts have significant negative impacts on the entire healthcare system in general and HIV care system in particular. Sub-Saharan Africa is suffering from a disproportionate double burden of armed...

The Effect of Armed Conflict on Treatment Interruption, Its Outcome and Associated Factors Among Chronic Disease Patients in North East, Amhara, Ethiopia, 2022.

The health services delivery system is debilitated in conflict setting areas due to damage of health facilities and attack on health care providers. Armed conflict is a complex phenomenon which causes a large amount of death and disability worldwide. However, there is lack of information towards treatment interruption among chronic disease patients in conflict areas. Hence, this study was conducted to assess the prevalence of armed conflict induced treatment interruption and its outcome among chronic disease patients. A mixed cross sectional study design was conducted on a total of 399 sample size at North Wollo and Waghimra zone hospitals. To select study participants a consecutive sampling method was used. Multiple logistic regressions were computed to evaluate the association and thematic analysis was used to analyse qualitative data. From the total 399 study participants, 264 (64.6%) study participants interrupted their medication. Treatment interruption is significantly associated with poor service availability and perceived high stress. War has detrimental health effects, both immediate and long term, on populations. Treatment interruptions due to armed conflict were caused by poor health care access, lack of medications and lack of transport and displacement of hospital staff, insecurity and fear. Treatment interruption results in morbidity, mortality, lifelong complications, disability, psychological and economic impact.

Does armed conflict lead to lower prevalence of maternal health-seeking behaviours: theoretical and empirical research based on 55 683 women in armed conflict settings

BackgroundWomen and children bear a substantial burden of morbidity and mortality due to armed conflict. Life-saving maternal and child health (MCH) services are low-quality in most conflict-affected regions. Previous studies...

Between “Victims” and Their “Saviors”: Process-Based Leadership and Trust Building in Civil–Military Relations in Northern Nigeria

Northern Nigeria has been plagued by the nefarious activities of terrorist groups, including Boko Haram, its affiliates, and armed bandits. Beyond its kinetic operations, the military has since deployed several strategies toward trust building across the region. This article contributes to the literature, by adopting process-based leadership as a social psychology conceptual and analytical lens. As a departure from traditional conceptualizations of civil–military relations, process-based leadership identifies where influence exists and how it is being exchanged toward the attainment of mutually linked security goals and objectives, between the military and society, in conflict settings. A central argument of the article is that improving civil–military relations in conflict settings is largely dependent on trust building, and achieving this is a function of the exchange of influence and the establishment of mutuality between the military and society.

Using machine learning and remote sensing to track land use/land cover changes due to armed conflict

Armed conflicts have detrimental impacts on the environment, including land systems. The prevailing understanding of the relation between Land Use/Land Cover (LULC) and armed conflict fails to fully recognize the complexity of their dynamics – a shortcoming that could undermine food security and sustainable land/water resources management in conflict settings. The Syrian portion of the transboundary Orontes River Basin (ORB) has been a site of violent conflict since 2013. Correspondingly, the Lebanese and Turkish portions of the ORB have seen large influxes of refugees. A major challenge in any geoscientific investigation in this region, specifically the Syrian portion, is the unavailability of directly-measured “ground truth” data. To circumvent this problem, we develop a novel methodology that combines remote sensing products, machine learning techniques and quasi-experimental statistical analysis to better understand LULC changes in the ORB between 2004 and 2022. Through analysis of the resulting annual LULC maps, we can draw several quantitative conclusions. Cropland areas decreased by 21–24 % in Syria's conflict hotspot zones after 2013, whereas a 3.4-fold increase was detected in Lebanon. The development of refugee settlements was also tracked in Lebanon and on the Syrian/Turkish borders, revealing different LULC patterns that depend on settlement dynamics. The results highlight the importance of understanding the heterogenous spatio-temporal LULC changes in conflict-affected and refugee-hosting countries. The developed methodology is a flexible, cloud-based approach that can be applied to wide variety of LULC investigations related to conflict, policy and climate.