Conflict Settings Research Articles

The consequences of Sudan’s armed conflict on public health: a closer look at the devastating impact

The consequences of Sudan’s armed conflict on public health: a closer look at the devastating impact

An Assessment of the Russo-Ukrainian Conflict on the European Cereal Exports Using Network Theory

Abstract Cereal grains are basic nutrients in the human diet. Given the production capacity gap between countries, food security is subject to global challenges. The Russian invasion of Ukraine from February 2022 has inevitably raised concerns on the resilience of the agro-food system. In this paper, we use network theory to examine the export flows of the European producers of wheat, maize, and barley. Based on annual data from the United Nations Comtrade database, we build specific weighted and directed networks to comparatively assess the dynamics of cereal exporting patterns. We employ centrality metrics for network statistics and modularity for community detection. The central hub for all three cereals remained unchanged. Our results show the following core countries Russia for wheat, France for barley and Ukraine for maize. Their main export destination is also the same, from Russia to Türkiye, France to China and Ukraine to China respectively. Compared to the previous year, several destinations including low-income countries worldwide did not appear as recipients of the Ukrainian exports, but additional countries located in Europe and interconnected by land emerged as partners. This study provides a general assessment of the European exports to support a better understanding of the community structure under the Russo-Ukrainian conflict setting.

Prevalence and risk factors of obstetric violence in the Gaza strip: A retrospective study from a conflict setting.

To assess the prevalence and risk factors of obstetric violence (OV) among laboring women in the past 5 years in the Gaza Strip (GS). Women who delivered between January 2017 and December 2021 were invited to complete an anonymous online survey between November 2021 and February 2022 to explore their experiences of labor. Seven hundred twenty-two women completed the online questionnaire. Two-thirds (484; 67.2%) were in their 20s, and half (362; 50.1%) were from low socioeconomic households. A vast majority (508; 70.4%) delivered in a government hospital. Four out of ten (300; 41.6%) reported experiencing at least one form of OV. Among these women, the types of OV reported were physical (143; 47.8%), psychological (122; 40.8%), verbal (109; 36.4%), and sexual (13; 4.4%). Delivery in private facilities (adjusted odds ratio [AOR] 0.45, 95% confidence interval [CI] 0.32-0.74) and prior knowledge of the care provider (AOR 0.37, 95% CI 0.23-0.59) were both independently protective for OV. In contrast, women's awareness of OV increased their likelihood of reporting it (AOR 3.45, 95% CI 2.37-5.01). GS has an alarming prevalence of reported OV. Increasing awareness of OV, identifying its causes, and developing locally led initiatives to eliminate it are urgently needed.

Is terrorism necessarily violent? Public perceptions of nonviolence and terrorism in conflict settings

AbstractDiscussions of terrorism assume actual or threatened violence, but the term is regularly used to delegitimize rivals' nonviolent actions. Yet do ordinary citizens accept descriptions of nonviolence as terrorism? Using a preregistered survey-experiment in Israel, a salient conflictual context with diverse repertoires of contention, we find that audiences rate adversary nonviolence close to terrorism, consider it illegitimate, and justify its forceful repression. These perceptions vary by the action's threatened harm, its salience, and respondents' ideology. Explicitly labeling nonviolence as terrorism, moreover, particularly sways middle-of-the-road centrists. These relationships replicate in a lower-salience conflict, albeit with milder absolute judgments, indicating generalizability. Hence, popular perceptions of terrorism are more fluid and manipulable than assumed, potentially undermining the positive effects associated with nonviolent campaigns.

Politicians, officers and political transition: the case of post 2003 Iraq

This study brings the notion of informal institutions developed by Helmke and Levintsky’s research agenda into the body of literature on civil–military relations. While acknowledged by the existing literature, the link between informal political-security connections and political transition remains largely undertheorised. Based on the case of post­-invasion Iraq, I attempt to fill this gap, building a conceptual understanding of politician-officer personal connections and their role in defining political order in post-authoritarian and conflict settings. Data collected through fieldwork across Iraq helped to build a typology of the informal connections (communal ties, patronage ties or ideologies ties) and the institutional outcomes they generate over time after the fall of Saddam Hussein’s regime (ethno-sectarian state, a patronage state and a Shia-centred state). Personal connections have been relevant since the colonial era in Iraq. But the de-institutionalisation of Iraqi politics, accelerated by sanctions and the US-led invasion, make these connections crucially relevant for understanding the country’s political transition since the fall of Saddam Hussein. The common history that brought these individuals together, the political order and the violent transition they shaped is an untold story that this study aims to tell.

Intergroup resource allocation among children from minority and majority groups in three settings of former conflict.

Intergroup resource allocation was examined among 333 children aged 7-11 (51.9% female) within three settings of former intergroup conflict (January-June 2021). Children represented both ethno-religious minority and majority groups (Republic of North Macedonia: Albanians, Macedonians; Croatia: Serbs, Croats; Northern Ireland: Catholics, Protestants), from predominantly White and middle-class families. Ingroup bias in average resource allocation amounts was demonstrated by both minority and majority children, across settings, in the context of novel targets (historic conflict rivals). Majority children were also more likely to give equally (which maintains the status quo) than minority children. Giving equally increased with age for both minority and majority children, despite being in "zero-sum," conflict settings. Equitable intergroup resource allocation in such settings has implications for conflict transformation.

Skills, Not Just Knowledge: Infectious Diseases Fellows' Recommendations Regarding Antimicrobial Stewardship Training.

Antimicrobial stewardship (AS) is an important topic in infectious diseases (ID) training, yet many ID fellowships lack formal training, and little is known about fellows' learning preferences. We conducted 24 in-depth interviews with ID fellows across the United States during 2018 and 2019 to explore their experiences with and preferences for AS education during fellowship. Interviews were transcribed, deidentified, and analyzed to identify themes. Fellows had variable exposure to AS before and during fellowship, which impacted their knowledge about and attitude toward stewardship as a career; however, all fellows expressed the importance of learning general stewardship principles during fellowship. Some fellows' training included mandatory stewardship lectures and/or rotations, but most fellows felt their primary stewardship learning occurred through informal experiences in the clinical setting, such as holding the antimicrobial approval pager. Fellows expressed a preference for a standardized, structured curriculum that included in-person practical, interactive discussions with multidisciplinary faculty along with the opportunity to practice and apply their skills; however, they emphasized that time needed to be set aside for those educational activities. Although they wanted to learn the evidence and rationale for stewardship recommendations, they especially wanted training in and feedback on how to communicate stewardship recommendations to other health professionals, particularly in the setting of conflict. ID fellows believe that standardized AS curricula should be included in their fellowship training, and they prefer structured, practical, and interactive learning experiences.

Virtual Immersive Contact: A Field Experiment to Reduce Prejudice and Discrimination in Central African Republic

This present research explores a progressive repurposing of Virtual Reality technology, Virtual Immersive Contact (VIC), in a real-world setting to; explore viability to reduce prejudice and investigate the role of empathy in motivating prosocial behavior. The study employed a between-subjects repeated-measures experimental design of a randomized sample ( n = 113) split into two conditions to reduce prejudice and discrimination in the active conflict area of the Central African Republic (CAR). In line with the study’s hypotheses, VIC produced a significant increase in empathic concern for the Muslim outgroup and intentions to donate to a Muslim family, while also showing that the relationship between empathy and helping behaviours was mostly explained by confounding variables. This research provides both the first evidence of its kind that VIC could be a new form of fostering positive intergroup contact in an active conflict setting, crating a new facet of intergroup contact theory, and further evolving the literature on the empathy, prosocial behaviour relationship.

Drivers of 'voluntary' recruitment and challenges for families with adolescents engaged with armed groups: Qualitative insights from Central African Republic and Democratic Republic of the Congo.

Globally, armed conflicts have increased threefold since 2010. The number of children voluntarily engaging with armed groups is also rising, despite increasing efforts to prevent this grave human rights violation. However, traditional approaches focusing on the prevention, release, and reintegration of children through forced recruitment do not adequately address the complex and interlinking push and pull factors of voluntary recruitment. This qualitative study sought to deepen understanding of the drivers and consequences of voluntary recruitment from the perspectives of adolescents and their caregivers, as well as to explore how to better support families living in conflict settings. In-depth interviews were conducted with 74 adolescents (44 boys and 30 girls) ages 14 to 20 years and 39 caregivers (18 men and 21 women) ages 32 to 66 years in two distinct conflict settings: North Kivu, Democratic Republic of Congo and Ouham-Pendé, Central African Republic. Interviews with adolescents utilized a visual narrative technique. The findings examine the unique perspectives of adolescents engaged with armed groups and their caregivers to understand how conflict experiences, economic insecurity, and social insecurity influence adolescent's engagement with armed groups and reintegration with their families. The study found that families living in conflict settings are subject to traumatic experiences and economic hardship that erode protective family relationships, leaving adolescent boys and girls particularly vulnerable to the systemic and overlapping factors that influence them to engage with and return to armed groups. The findings illustrate how these factors can disrupt protective social structures, and inversely how familial support can act as a potential protective factor against recruitment and break the cycle of reengagement. By better understanding the experiences of adolescents enduring recruitment and how to support caregivers of those adolescents, more comprehensive programming models can be developed to adequately prevent voluntary recruitment and promote successful reintegration, enabling children to reach their full potential.

Does Transformational Leadership Still Run Effectively in A Conflict Setting?

This article aims to describe the influence of servant and transformational leadership on teacher work productivity and the role of mediating conflict resolution. There is a lot of research on leadership but not much research on how leadership handles conflict. Several research studies have investigated how leaders respond to conflict and the most common conflict management. However, no research is available to determine public preferences for conflict resolution options. The application of transformational leadership is known for its toughness and has been widely discussed. However, there is a phenomenon where school principals experience a decline and schools experience many problems. One of the factors inhibiting school progress is conflict. The author presents how to manage a school or organization in conflict settings by offering a servant leadership style. These matters are discussed in this article. This study used a quantitative survey design with 300 high school teachers as respondents to rate the leadership of school principals from 15 districts in Lampung Province. The results of Amos 23 calculations state that servant leadership has a positive effect on handling conflict (87.5%) and on teacher’s work productivity (37, 4%), while transformational leadership has a positive effect on handling conflict (8.7%) and negative effect on teacher work productivity (-68.8%). The research concludes that (1) servant leadership is a good predictor of teacher work productivity and a solution for conflict resolution in schools; (2) when there is conflict, transformational leadership is not a solution; (3) conflict handling is directly proportional to teacher work productivity; and (4) conflict handling becomes a good mediator for servant leadership and transformational leadership for teacher work productivity.

Pro-Con Debate: Interdisciplinary Perspectives on Industry-Sponsored Research.

Pro: Nearly all new devices and drugs come from industry that provides two-thirds of the funding for medical research, and a much higher fraction of clinical research. Realistically, without corporate-funded studies, perioperative research would stagnate with little innovation and few new products. Opinions are ubiquitous and normal, but do not constitute epidemiologic bias. Competent clinical research includes many protections against selection and measurement bias, and the publication process provides at least moderate protection against misinterpretation of results. Trial registries largely prevent selective data presentation. Sponsored trials are particularly protected against inappropriate corporate influence because they are usually codesigned with the US Food and Drug Administration, and analyses are based on formal predefined statistical plans, as well as being conducted with rigorous external monitoring. Novel products, which are essential for advances in clinical care, largely come from industry, and industry appropriately funds much of the required research. We should celebrate industry's contribution to improvements in clinical care. Con: While industry funding contributes to research and discovery, examples of industry-funded research demonstrate bias. In the setting of financial pressures and potential conflict of interest, bias can influence the type of study design, hypotheses being tested, rigor and transparency in data analysis, interpretation, as well as reporting of the results. Unlike public granting agencies, industry does not necessarily provide funding based on unbiased peer review following an open call for proposals. The focus on success can influence the choice of a comparator, which might not be ideal among the possible alternatives, the language used in the publication, and even the ability to publish. Unpublished negative trials can result in selected information being withheld from the scientific community and the public. Appropriate safeguards are needed to ensure that research addresses the most important and relevant questions, that results are available even when they do not support the use of a product produced by the funding company, that populations studied reflect the relevant patients, that the most rigorous approaches are applied, that studies have the appropriate power to address the question posed, and that conclusions are presented in an unbiased manner.

Pro-Con Debate: Interdisciplinary Perspectives on Industry-Sponsored Research

ProNearly all new devices and drugs come from industry that provides two-thirds of the funding for medical research, and a much higher fraction of clinical research. Realistically, without corporate-funded studies, perioperative research would stagnate with little innovation and few new products. Opinions are ubiquitous and normal but do not constitute epidemiologic bias. Competent clinical research includes many protections against selection and measurement bias, and the publication process provides at least moderate protection against misinterpretation of results. Trial registries largely prevent selective data presentation. Sponsored trials are particularly protected against inappropriate corporate influence because they are usually codesigned with the US Food and Drug Administration, and analyses are based on formal predefined statistical plans, as well as being conducted with rigorous external monitoring. Novel products, which are essential for advances in clinical care, largely come from industry, and industry appropriately funds much of the required research. We should celebrate industry’s contribution to improvements in clinical care. ConWhile industry funding contributes to research and discovery, examples of industry-funded research demonstrate bias. In the setting of financial pressures and potential conflict of interest, bias can influence the type of study design, hypotheses being tested, rigor and transparency in data analysis, interpretation, as well as reporting of the results. Unlike public granting agencies, industry does not necessarily provide funding based on unbiased peer review following an open call for proposals. The focus on success can influence the choice of a comparator, which might not be ideal among the possible alternatives, the language used in the publication, and even the ability to publish. Unpublished negative trials can result in selected information being withheld from the scientific community and the public. Appropriate safeguards are needed to ensure that research addresses the most important and relevant questions, that results are available even when they do not support the use of a product produced by the funding company, that populations studied reflect the relevant patients, that the most rigorous approaches are applied, that studies have the appropriate power to address the question posed, and that conclusions are presented in an unbiased manner.

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

Challenges and strategies for implementers and evaluators working in conflict settings

Practitioners implementing and evaluating humanitarian programs in conflict zones face unique challenges requiring context-sensitive guidance. Conflict zones—geographical areas with militarized and non-militarized violence, widespread political instability, and state-sanctioned intimidation and genocidal violence—are rife with logistical, methodological, and ethical challenges that impact implementation and evaluation. Although challenges have been well-documented, few solutions or evaluation frameworks exist to help evaluators in conflict zones confront these challenges. This article examines how the application of implementation science frameworks, specifically, Reach, Effectiveness, Adoption, Implementation, and Maintenance and the Consolidated Framework for Implementation Research, offers useful strategies to mitigate some challenges in conducting evaluations in conflict zones. Areas for future research include collaborative team approaches to using these frameworks, ethical guidance, and reporting and dissemination.

O107 Surgical workforce in conflict: qualitative perspectives from the Middle East and North Africa

Abstract Introduction There is a paucity of data regarding the experiences of the local surgical workforce present during conflicts. Whilst we know that surgical trauma burden increases during conflict, little is known about workforce adaptation to new injury modalities, higher caseloads, and additional system pressures. Qualitative research is an effective methodology for elucidating surgical systems in such settings. Methods Medically qualified personnel performing surgery during a conflict, who had worked in this setting before the onset or escalation of conflict, were identified through a pre-interview questionnaire distributed through the Royal College of Surgeons of England and other targeted networks. A structured guide was used to conduct in-depth interviews and a thematic analysis was undertaken. Results Surgical practitioners (male:female 19:2), of different seniority and representing 9 subspecialties, from 9 Middle Eastern and North African countries were interviewed. There were notable differences in the experiences of practitioners within new conflict settings (Libya, Syria, Egypt and Sudan) compared to those with previous conflict experience, where medical education and training were more likely to be uninterrupted. This necessitated training during active situations, which many practitioners regarded as very fruitful. Junior trainees in new conflict areas often had to ‘act up’ under intense pressure, often without adequate supervision whilst practitioners in previous conflict settings have normalized conflicts and developed cultural coping mechanisms. Conclusion This study contributes to the evidence gap on the surgical workforce in conflict settings and highlights the need for innovative and swift support for entire surgical ecosystems to maximize impact.

Adapting Reach Up and Learn in Crisis and Conflict Settings: An Exploratory Multiple Case Study.

In 2019, >71 million children aged <5 had spent their entire lives in conflict-affected settings. Compounding adversities including violence, poverty, and displacement have immediate and long-term effects on early childhood development, health, behavior, and well-being. In response, adaptations of Reach Up have been implemented in conflict and crisis settings. This article uses exploratory multiple case study methodology, drawing from implementation and qualitative data from 3 interventions: a mobile phone-based intervention promoting nurturing care among Rohingya and crisis-affected host communities in Bangladesh; Reach Up amid acute violence and displacement in Northeast Syria; and Reach Up group sessions and home visits integrated with health services for an indigenous population in Venezuela. In Bangladesh, tailoring interactive voice response messages improved responsiveness to the developmental needs of young children, yet complementary in-person services were identified as a key program enhancement. In Syria, rapid adaptations of Reach Up addressed the needs of families in acute crisis, including social-emotional learning games for school-aged children. In Venezuela, Reach Up, coupled with complementary lactation counseling, yielded high rates of uptake and satisfaction, and children's language development was highlighted as a key area of growth. Recommendations to promote early childhood development in crisis and conflict settings include: (1) cultural adaptation based on a holistic understanding of children and caregivers' needs; (2) the integration of child and family safety and linkages with complementary services on the basis of community needs and priorities, and (3) the importance of designing for scale through blended models and costing analyses.

Reporting Safely in Crisis Zones: Medical First Response for Journalists and Filmmakers

Introduction:Journalists work in dangerous places. In recent years, the risk of illness and injury while reporting has increased, whether in the setting of conflict, protest, extreme weather, or environmental disaster. Journalists are targeted more than ever before. Working safely in remote and dangerous settings, especially without the protection of a large organization, requires a wide range of skills related to safety and security. For several years, the Dart Center for Journalism and Trauma at Columbia University has offered brief, intensive courses focused on personal safety, self defense, cyber-security and medical skills for freelance journalists working in dangerous settings.Method:We re-conceptualized the medical first responder portion of the Dart Center's "Reporting from Crisis Zones" course to emphasize basic skills related to acute injury and illness, from trauma resuscitation (e.g, hemorrhage control) to environmental exposure and medical illness. We identified the most common medical concerns that these learners might encounter and incorporated feedback from prior courses to develop a one-day curriculum meant to address the most pressing needs of incidental first responders with minimal medical training, and whose primary mission is not providing medical care to others.Results:The resulting 8-10 hour curriculum focuses on hemorrhage control, basic airway and respiratory maneuvers and wound care, with additional focus on medical illness, indications for evacuation, and communication and prevention techniques. The re-structured curriculum was first offered in Spring 2022. Feedback from learners was positive.Conclusion:Basic first responder skills are critical for journalists working in dangerous settings, who represent a unique population of learners with specific needs and objectives. Next steps include developing a better understanding of the medical and traumatic problems truly encountered by this population in the field, assessing the long-term educational impact of the course, and developing ongoing opportunities to reinforce learning via online resources, refresher sessions, and guideline development.

The Hard-to-Reach Data (HaRD) Framework: a Case Study in Humanitarian Mine Action

Introduction:Following humanitarian crises (e.g. armed conflict), reliable population health metrics are vital to establish health needs and priorities. However, the challenges associated with accurate health information and research in conflict zones are well documented. Often working within conflict settings are authorities and non-government organizations (NGOs) who frequently collect data under the context of operations. This operational data is a potentially untapped source of hard-to-reach data that could be utilized to provide a better insight into conflict affected populations. The Hard to Reach Data (HaRD) framework highlights the process of identifying and engaging with these stakeholders collaboratively to develop research capacity.Method:The HaRD framework was developed from literature searches of health and social sciences databases. The framework which provides a structure to gain access to data in hard-to-reach settings was applied to humanitarian mine action to identify and collect existing but underutilized data.Results:Guided by the HaRD framework we compiled the world’s first global casualty dataset for casualties of landmines and explosive remnants of war. The framework provided a structured approach to identify and engage with key stakeholders. An adaptive approach was needed for stakeholder engagement with trust building and transparency important factors in developing a collaborative partnership. Appropriate communication of research findings is important to ensure reciprocity.Conclusion:The HaRD framework can identify potential data sources and guide access in hard-to-reach data settings. Operational data is often available but hidden; a systematic approach to identifying and engaging with stakeholders can assist in developing successful research partnerships between academia and humanitarian organizations.

Construction Conditions and Practices during War in Afghanistan

Reconstruction during the recent conflict in Afghanistan involved extensive construction of public infrastructure alongside an ongoing civil war. This article sheds light on some practical effects on construction projects of political instability, violence, and associated economic and governance conditions in conflict-affected settings in general. It contributes to knowledge on construction in conflict settings by identifying generic relationships that connect prevailing conflict-affected conditions with responding dysfunctional construction project practices. Through interviews with 32 practitioners engaged in construction projects during the recent war in Afghanistan, nine widespread dysfunctional practices were identified: fraudulent testing of materials, corrupt certification, excessive underpricing, fraudulent bidding, partial and complete tender subversion, contract reassignment, inadequate superintendence, and intimidation of superintendents. While these practices that were common in Afghanistan are not exclusive to conflict scenarios, they appear to increase in prevalence amid weakened regulatory systems that characterize conflict-affected situations in general. The expanded prevalence of these practices amidst conflict can crowd-out diligent contracting practices from construction markets. In addition to undermining project outcomes and associated political objectives in the short- and medium-term, potential persistence of such dysfunctional practices has long-term implications for construction industry development and infrastructure investment in places emerging from conflict.

Water for All: Community, Property, and Revolution in Modern Bolivia

Water for All: Community, Property, and Revolution in Modern Bolivia