Gender-based violence (GBV) in wartime is relatively common and is associated with depression, anxiety, and post-traumatic stress disorder (PTSD), but there are limited scalable, culture-specific interventions for these common mental health problems in low-resource settings. We conducted a pilot intervention, a pre- and post-intervention design among war-affected married women with elevated PHQ-9, GAD-7, and PCL-5 scores in Woldia, northern Ethiopia. After completing a baseline survey, 20 women participated in a five-week group intervention. It combined individual psychosocial support by psychologists with spiritually focused content facilitated by a religious leader. Symptom scales were administered at baseline, post-intervention, and at the end of a one-month follow-up. Changes were evaluated using paired t-tests and repeated-measures models. The majority of the participants experienced lifetime or wartime GBV and low social support. The intervention demonstrated large reductions in mean scores and large effect sizes in depression, anxiety, and PTSD scores from baseline to endline. The mean score persisted lower at one month, with all changes statistically significant. Sociodemographic features did not significantly moderate these patterns, but women’s education status and social support might be associated with greater reductions in depressive symptoms from the multivariate models. This pilot trial indicates that a short-term, culturally adapted psychosocial and spiritual group intervention seems to be effective in reducing common mental health symptoms in GBV-exposed women in a conflict setting and warrants further investigation through larger controlled trials.
Low- and middle-income countries (LMICs) host most of the world’s refugees but often have limited mortality information systems. Consequently, evidence on the long-term mortality trajectories of self-settled refugees and the contribution of socioeconomic disadvantage to mortality inequalities remains scarce. To examine long-term mortality patterns, cause-specific mortality and the contribution of socioeconomic status (SES) to mortality differentials among Mozambican self-settled refugees, South Africans, Mozambican migrant workers and the population of Manhiça, Mozambique. We analysed longitudinal data from the Agincourt Health and Demographic Surveillance System (1994–2018) and the Manhiça Health and Demographic Surveillance System (1999–2018). Age-standardised death rates were used to describe mortality trends across population groups, while logistic and multinomial logistic regression models examined all-cause and cause-specific mortality after adjustment for age, sex, time period and household socioeconomic status. Mortality increased across all populations during the HIV pandemic, peaking in 2004–2008 before declining thereafter. During 1994–1998, mortality among Mozambican self-settled refugees was broadly comparable to that of South Africans but subsequently exceeded both South Africans and Mozambican labour migrants during the HIV pandemic. By 2014–2018, mortality among refugees had converged towards that of the South African host population. Mozambican labour migrants consistently experienced the lowest mortality. Adjustment for household SES largely explained the overall mortality difference between refugees and South Africans, although refugees remained at higher risk of HIV/AIDS and TB and other communicable disease mortality. Mortality among Mozambican self-settled refugees progressively converged towards that of the South African host population over the 25-year study period. Socioeconomic disadvantage explained an important proportion of the observed mortality inequalities, highlighting the importance of policies that reduce socioeconomic disparities while maintaining equitable access to healthcare.
Droughts and conflict-related crises have frequently affected Somali states over the past three decades. Analyzing the drivers of displacement during crisis can provide critical insights for governmental and humanitarian efforts aimed at mitigating these effects. The study aimed to identify the risk factors associated with population movement in Somalia. An ecological analysis was conducted using secondary panel data stratified by month and district. The analysis covered the entire population of Somalia between 2016 and 2023. The number of new internally displaced persons (IDPs) in each district and month was used to establish the outcome. Armed conflict, combined drought index (CDI), food insecurity, and water prices were the risk factors included. Negative binomial mixed-effects regression models, with district included as a random effect, were used for the analysis. Between 2016 and 2023, the proportion of IDPs increased from 9.1
The provision of maternity and child health (MCH) services is severely hampered by Ethiopia’s humanitarian problems, which are caused by natural catastrophes, displacement, and conflict. Improving health outcomes for disadvantaged communities requires an understanding of the barriers to receiving these services. We followed the standards of PRISMA 2020 guideline when conducting our systematic review and meta-analysis. The databases PubMed, Scopus, Embase, and CINAHL were searched. Grey literature and Google Scholar were used to find articles published from 2015 to 2025. Tools from the Joanna Briggs Institute were used to evaluate quality. A socio-ecological model (SEM) was used to synthesize the narrative. Twenty-four studies were deemed eligible for inclusion. According to the evaluation, a number of complex obstacles significantly impeded the availability and use of maternity and child health (MCH) services in Ethiopia’s conflict-affected areas. Individual barriers were low maternal education, fear of insecurity, and a lack of knowledge about accessible options. Household decision-making processes, a lack of spouse support, and gender-based limitations that impede women’s autonomy were examples of interpersonal hurdles. Long distances, disruptions in transit, the destruction of infrastructure, and prevalent cultural or religious views were all considered community-level concerns. Access to MCH services is restricted in Ethiopia’s humanitarian contexts by a number of interconnected barriers. Strengthening mobile health teams, restoring functional referral systems, expanding maternity waiting homes, and supporting community health workers may improve access to essential maternal and child health services in humanitarian settings in Ethiopia.
Protracted armed conflict in the Gaza Strip has severely disrupted household food access, potentially amplifying the population’s mental health burden. This study examined the relationship between household hunger and symptoms of depression, anxiety, and stress among Palestinian respondents during the 2023–2025 war. An online cross-sectional survey was conducted among Palestinian respondents living in the Gaza Strip from 15 July to 25 August 2025 (n = 250 individual respondents). Participants were recruited using convenience and snowball sampling through WhatsApp and Telegram networks. The unit of analysis was the individual respondent: household hunger was assessed as a respondent-reported household-level exposure using the Household Hunger Scale, while depression, anxiety, and stress symptoms were assessed at the individual level using the Arabic DASS-21. Three multivariable linear regression models were used to estimate associations between household hunger categories and DASS-21 depression, anxiety, and stress scores, adjusting for sociodemographic and war-related variables. Among online survey respondents, 87.6
Conducting research in settings marked by violence is essential for generating credible knowledge to improve humanitarian responses. While its importance is widely acknowledged, the practice of health research, and implementation research in particular, is rarely itself a focus of research endeavors, limiting the understanding of the complexities of research conduct in conflict-induced humanitarian settings. This narrative review aims to synthesize and conceptualize the literature reflecting on research conduct in such settings through an analytical lens of trust, adopted after an initial synthesis of the literature, and offers a preliminary theoretical framework to guide researchers’ efforts in conflict-affected settings. We conducted a systematic search of Google Scholar, Scopus, PubMed, and Web of Science to identify studies reflecting on the research conduct process in conflict-induced humanitarian settings, focusing on implementation research and the broader health-related field. Twenty-seven studies were included. The data were synthesized thematically through the lens of trust. The included studies covered eight world regions and diverse conflict-affected settings, fragile and conflict-affected states, displacement and refugee situations, and complex humanitarian crises. Nearly half reflected on the research conduct process, while others focused on specific interventions; the methodologies were largely qualitative, and six of the included papers were identified as having implementation research characteristics. We identified nine key constructs of research practice in such settings, organized into relational, systemic, and societal aspects of trust. We examined the relationships and interactions of these constructs with the research process, illustrated them in a conceptual model, and presented an epistemological dilemma: trust operates both as a precondition enabling research initiation and as a result of the research practice, continuously shaped through researchers’ engagement, interaction, and decision-making within a given context. The findings underscore the importance of reflexive researcher positioning, attention to power dynamics, and collaborative, context-sensitive, inclusive approaches to support ethical and credible knowledge production. This review demonstrates that trust plays a central and dynamic role in conducting research, including implementation research, in conflict-induced humanitarian settings. A preliminary theoretical framework, developed as an outcome of this review, requires further refinement to guide meta-implementation research to support research practices in adverse settings.
Disclosure and help-seeking are critical to mitigating the adverse health and social outcomes of sexual violence among survivors. However, evidence regarding these experiences remains scarce in refugee settings. We aimed to examine disclosure and help-seeking experiences among survivors of childhood sexual violence in refugee settings across Ethiopia and Uganda. This study used data from the Humanitarian Violence Against Children Surveys (HVACS) conducted in Ethiopia (2024) and Uganda (2022). Both surveys involved females and males aged 13–24 years living in refugee settings. It included 249 childhood sexual violence survivors from Ethiopia and 268 from Uganda, totaling 517 participants. Logistic regression identified factors associated with both disclosure and help-seeking experiences. Disclosure experience was reported by 41·27
Polio is targeted for global eradication by 2029. Immunization campaigns face significant challenges in humanitarian emergencies due to instability, population displacement, and health infrastructure collapse. The two primary vaccines used, Inactivated Polio Vaccine (IPV) and Oral Polio Vaccine (OPV), have distinct delivery requirements. This scoping review maps key implementation barriers for each delivery mechanism in disaster settings and assesses reported coverage outcomes to inform vaccine selection in emergencies. Following the PRISMA extension for Scoping Reviews (PRISMA-ScR), we searched PubMed, EMBASE, Web of Science, and Cochrane Library (CENTRAL), supplemented by a targeted grey-literature search. Studies were included if they focused on OPV and/or IPV campaigns in humanitarian crises, provided data on coverage or logistics, and were published in English within the last 20 years. Included studies were appraised using JBI Critical Appraisal Tools. The search identified 1604 studies, of which 24 met inclusion criteria. Key IPV implementation barriers were higher operational costs, the requirement for skilled health workers, reliance on fixed-post delivery, and complex cold chain requirements. Prominent OPV barriers included bans on campaigns by armed groups, misinformation leading to vaccine refusal, and restricted access to populations due to insecurity. Three studies reported high IPV coverage (80
Limited research exists on mental health among displaced populations in sub-Saharan Africa. As one of the largest hosts of refugees worldwide, Uganda provides an opportunity to conduct research and examine health outcomes in this context. This study aimed to understand which factors were associated with probable depression and anxiety among refugees in Uganda and which forms of support correlate with better mental health in this population. The 2021 Uganda Refugee Population-based HIV Impact Assessment was a cross-sectional survey of households in refugee settlements in Uganda. Heads of households were asked whether they had received government or humanitarian support in the past 12 months. Patient Health Questionnaire-4 screenings were used to assess probable depression and anxiety. Descriptive statistics were used to evaluate sociodemographic differences in mental health and in whether respondents received support. A survey-weighted logistic regression model was used to assess the relationship between receipt of support and depression or anxiety. Of 2,555 participants with complete data, 54.6
Palestinians in Gaza have been subject to a genocide that resulted in unprecedented loss of human lives, with over 38,000 women and girls killed were reported between October 7th, 2023 to April 2026, and produced inhumane living conditions. While the entire population of Gaza was affected by these living conditions, women and girls suffered the most. This has created higher risks for worse maternal and reproductive health outcomes, including adverse pregnancy and delivery experiences and outcomes. This study explores women’s experiences of war hardships and living conditions and their impact on maternal and reproductive health. This was a cross-sectional study conducted in March 2025. A questionnaire was used to collect information on socio-demographics, war-related hardships and living conditions, obstetrics history, Gynecological history, and menstrual hygiene assessment. A convenience sampling method was adopted due to the critical situation. Descriptive data were calculated as frequencies, percentages and means with standard deviations. Bivariate associations between war conditions and reproductive outcomes were assessed using Spearman correlations, and multiple logistic regression models were constructed to examine associations between the composite war hardship score and reproductive outcomes. 206 women participated in this study with a mean age of 30.3 years. The mean composite war hardship score was 5.7 (SD = 2.0), with 56.8
Physical intimate partner violence (IPV) remains a major public health concern among refugee women living in humanitarian settings characterised by displacement, poverty, and weakened protection systems. This study examined the extent and determinants of reported physical IPV among married and cohabiting refugee women in Bidibidi Refugee Settlement, Uganda. A cross-sectional mixed-methods study was conducted among 382 refugee women selected through stratified random sampling. Quantitative data were collected using interviewer-administered questionnaires adapted from the World Health Organization Violence Against Women instrument and analysed using logistic regression. Composite index variables underwent reliability assessment before inferential analysis. Qualitative data from nine key informants were analysed thematically to contextualise the quantitative findings. The findings indicate a high prevalence of physical intimate partner violence (IPV), with 67.3
The COVID-19 pandemic disrupted labor markets in Latin America, a region characterized by high informality, socioeconomic inequality, and uneven social protection. Shortly afterward, the Russia–Ukraine war generated global uncertainty regarding inflation, commodity prices, supply chains, and economic stability. However, the extent to which geographically distant armed conflicts are perceived as potential labor-related threats by workers in structurally vulnerable regions remains insufficiently understood. To identify sociodemographic factors associated with self-reported high anticipatory perceived labor vulnerability related to the Russia–Ukraine war among workers in Latin America. A cross-sectional, analytical, multicenter secondary analysis was conducted among workers in Latin American countries during the first weeks of the Russia–Ukraine conflict. Participants were asked about their perceptions of the potential impact of that conflict on their work, reflecting an anticipatory and perception-based outcome rather than direct war exposure or objectively measured labor-market change. High anticipatory perceived labor vulnerability was defined as reporting “quite a lot” or “a lot” on a five-category perception item. Descriptive and analytical statistics were performed. Results: Among 1,118 workers, 25.2
Violence against healthcare is a significant public health issue worldwide, yet it remains poorly documented in resource-limited countries, especially in sub-Saharan Africa. This study aims to explore the causes of such violence, types, perpetrators, consequences and mechanisms for its prevention within the post-conflict context of the South Kivu province in eastern Democratic Republic of the Congo (DRC). This exploratory qualitative study was conducted from April to May 2022 in the health zones (HZ) of Kamituga, Katana and Walungu. A diverse group of participants, including health system stakeholders, community members and policy makers were interviewed, through Focus Group Discussion (FGD) and key informant interviews (KII), guided by a pre-established interview guide. A deductive thematic analysis was carried out and the verbatim quotes were used to illustrate the respondents’ comments. A total of 143 participants were interviewed for this study. The types of violence reported included physical, verbal and psychological abuse, threats through communication channels and economic abuse (misappropriation of funds, unpaid discharge). The identified causes included interpersonal dynamics within the healthcare staff and between staff and patients, cultural influences and systemic organisational issues. Aggressors varied, spanning from patients and their companions, to the healthcare workers themselves, alongside political, administrative and customary authorities. The violence has far-reaching negative consequences, affecting the individual health care workers, their colleagues and the overall quality of healthcare delivery. Pre-existing warning and prevention mechanisms include recourse to the hierarchy, silence, the utilization of suggestion boxes, regular meetings at the Central Zone Office and supervisory measures. Violence against healthcare professionals is a well-known but poorly documented issue that affects both their wellbeing and professional performance. Integrated health system reforms addressing accountability, governance, and working conditions are needed to prevent violence against healthcare workers, with engagement of political authorities essential for developing and implementing effective prevention strategies.
Armed conflict disrupts health systems, undermining routine immunization and disease surveillance. These disruptions can delay outbreak detection and allow population susceptibility to accumulate unnoticed. This study assessed the impact of the 2020–2022 conflict in Tigray, Ethiopia, on measles epidemiology, focusing on surveillance reporting, age distribution of cases, and vaccination status. We conducted a retrospective longitudinal analysis of national case-based measles surveillance data from Ethiopia (2018–2024; n = 69,866). Changes in measles surveillance, age distribution, and zero-dose vaccination status across the pre-conflict (2018–2019), conflict peak (2020–2022), and post-conflict recovery (2023–2024) periods were examined. Two-way analysis of variance examined regional differences in age at infection across phases. Multivariable logistic regression estimated adjusted odds ratios (aORs) for confirmed measles cases being unvaccinated (zero-dose), using the pre-conflict period as the reference and adjusting for age and sex. Surveillance quality was assessed using demographic data completeness. During the conflict peak, reported measles cases from Tigray declined to 0.01
Cholera remains a major public health concern in Ethiopia, particularly in conflict-affected agro-pastoral regions where access to healthcare, clean water and vaccination is limited. The main objective was to identify predictors of time to recovery from cholera among patients in a conflict-affected agro-pastoral area of Ethiopia using survival analysis models. Understanding the clinical and epidemiological factors influencing recovery time is critical for improving outcomes and guiding outbreak responses. A retrospective cohort study was conducted using data from cholera treatment centers in a conflict-affected agro-pastoral region. Time to recovery was analyzed using Kaplan-Meier recovery curves, Cox proportional hazards, and Accelerated Failure Time (AFT) models. Variables included clinical signs, demographic factors, vaccination status, and exposure history. Severe dehydration (HR = 0.49, p < 0.0001; TR = 1.49), low pulse rate (HR = 0.69, p = 0.005), and lack of vaccination (HR = 0.56, p < 0.0001) were associated with significantly longer recovery times. Notably, patients with known contact with cholera cases showed slower improvement (HR = 0.63, p = 0.0003), suggesting higher exposure or delayed care-seeking. Vaccinated individuals and those with mild dehydration recovered significantly faster. The log-Normal AFT model confirmed these findings, showing prolonged recovery among high-risk groups. In conflict-affected agro-pastoral settings, clinical severity, vaccination status, and exposure history are key determinants of cholera recovery time. These findings underscore the importance of early case detection, aggressive rehydration, and targeted vaccination, especially among known contacts and high-risk individuals. Public health interventions should prioritize rapid response strategies and contact-based follow-up to reduce disease burden and improve recovery outcomes.
Shelter and settlement are critical determinants of health in humanitarian crises, yet their impacts on health outcomes remain underexplored. This review synthesizes published evidence on how shelter and settlement interventions impact health outcomes in humanitarian crises. A systematic review of peer-reviewed literature was conducted to identify studies examining the association between shelter and settlement interventions and health outcomes in humanitarian crises. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines a protocol was developed and three databases were searched for studies published between 2005 and 2025. Relevant data were extracted and thematically analysed. A total of 138 articles were found. Thematic analysis identified six themes (living conditions, accommodation type, camp and site planning, displacement status, essential household items and cash-based interventions). Three cross cutting themes of gender, climate change and vulnerability were also identified. Two themes (living conditions and accommodation type) are presented here. Poor living conditions including damaged shelters, poor housing design and materials were associated with increased risks of communicable diseases such as malaria, diarrhoea, and soil-transmitted helminth infections while overcrowding heightened injury risk and psychological distress. Accommodation type influenced health outcomes with short-term shelters linked to acute mental health challenges and increased injuries; medium-term shelters with increased risk of non-communicable disease; and long-term housing with deteriorations in chronic disease management. This systematic review synthesises the evidence base showing how shelter and settlement interventions play a role in influencing health outcomes in humanitarian crises. It shows that shelter is a critical yet often under recognised determinant of health in these settings. Health outcomes are influenced by housing quality, accommodation type and duration, camp and settlement planning, displacement dynamics including frequency and length of displacement, and access to essential household items. Poor shelter conditions are likely to increase the risk of communicable diseases and mental health issues and have the potential to worsen chronic disease outcomes and risk. A key contribution of this review is the identification of shelter as a core entry point for public health action, highlighting the need for clearer operational guidance on shelter typologies, minimum standards, and their integration with health, protection and social services.
Abstract Background Armed conflicts severely disrupt cancer care delivery, destroying infrastructure and limiting access to essential diagnostics and treatments. Evidence on service challenges, adaptations, and policy implications remains fragmented. Methods This scoping review of four databases (Scopus, PubMed, ScienceDirect, and CINAHL) was conducted for original peer-reviewed studies published between January 2020 and August 2025. The search focused on the effect of wars on cancer service delivery in conflict zones, and its impact on cancer care. Results Wars in conflict-affected countries like Palestine, Sudan, Syria, Iraq, Ukraine, and Afghanistan caused widespread destruction of cancer infrastructure, unsafe hospitals, and interruptions in chemotherapy, radiotherapy, and surgery. Countries faced shortages of specialized centers, technicians/radiologists, and medical records, alongside high costs and supply chain disruptions. Despite these challenges, healthcare systems demonstrated resilience through adaptations including Ukraine’s MedEvac program for EU treatment evacuation, cross-border referrals (Iraq→Lebanon, Afghanistan→Pakistan), telemedicine, mobile diagnostic units, and community-based care models. Policy responses emphasized international aid coordination, conflict-sensitive health planning, and supply chain restoration. Conclusion Conflicts cause infrastructure destruction, workforce depletion/migration, treatment barriers/delays, drug supply disruptions, and psychosocial/economic impacts, which in turn create urgent policy/governance challenges. Although humanitarian aid may provide temporary relief, sustainable solutions require peace and global commitment, grounded in equity and the fundamental right to health.
Climate change presents more dire impacts on food security and health in Africa than any other region worldwide. These impacts are expectedly more pronounced in predominantly agrarian refugee settings like Uganda, which is also the largest refugee host in Africa. However, there is limited contextual evidence regarding the effects of climate change-related hazards in Uganda to guide context-relevant interventions amidst the ongoing aid cuts. We assessed the impact of climate change-related hazards on food security and the health of refugees in three settlements in Uganda. We conducted a cross-sectional study using concurrent mixed methods in Kiryandongo, Nakivale, and Rhino Camp refugee settlements. We collected data from 600 heads of refugee households using a structured questionnaire, conducted 45 in-depth interviews with refugees, and held 14 key informant interviews with program implementers. Quantitative data were analysed using STATA v16, and a modified Poisson regression model was employed to determine significant associations. Qualitative data were analysed inductively using thematic analysis to complement the quantitative findings. Of the 600 respondents, 60.6
Adolescence is a critical developmental stage marked by physical, psychological, and cognitive growth, increasing autonomy, social exploration, and risk-taking behaviors. However, these natural transitions in displacement settings are overshadowed by heightened vulnerabilities such as gender-based violence. In many displacement settings, recurrent exposure to violence leads to its acceptance as an unavoidable part of daily life. Sometimes, violence is normalized, leading to further exacerbation of the crisis. Our study explored the in-depth experiences and normalization of abuse and existing barriers to reporting within the internally displaced persons settlement in Cross River State, Nigeria. Our qualitative study included adolescents and young people aged 15–24 years residing in the Bakassi Internally Displaced Persons camp within the Bakassi Local Government Area. Participants were selected via purposive sampling. Data were collected through 12 individual interviews and 3 focus group discussions. Data were transcribed verbatim, and thematic analysis was conducted using NVivo 14 to identify key themes. Findings from the study reveal participants’ experiences with sexual exploitation, abuse, harassment, and gender-based violence, as well as their perceptions of abuse and how it is normalized. Contextual factors such as self-blame, societal pressure to accept advances from men, and limited accountability contribute to heightened vulnerability within the camps, which result in emotional and psychological impacts. Barriers to reporting and seeking help included fear of repercussions, lack of trust in authorities or services, and stigma associated with victimhood. Our study demonstrates that normalization of abuse, alongside systemic barriers such as fear of repercussions, stigma, and limited trust in authorities, significantly constrains reporting and help-seeking behaviors. Furthermore, our study identifies weak and largely absent accountability mechanisms as a key structural factor enabling continued abuse. To enhance accountability and safeguard vulnerable populations, appropriate legal penalties and enforcement measures should be applied to all forms of abuse. Additionally, future interventions should also address the underlying vulnerabilities that predispose individuals to abuse, ensuring a more comprehensive approach to prevention and protection.
International humanitarian organizations providing surgical care in conflict-affected settings have an ethical obligation to adopt practices that promote sustainable surgical services. Our objective was to evaluate the prevalence of sustainable surgical practices and policies implemented by humanitarian organizations in conflict-afflicted settings, as well as to document instances where surgical services were disrupted or discontinued due to the outbreak of conflict. A review of primary literature was conducted using Medline. Articles were included if they described sustainable surgical practices or policies in conflict-affected settings. Sustainability was defined according to a previously published modified Delphi consensus framework, which outlined key pillars of sustainability in global surgery partnerships. A grey literature review was also performed to identify sustainable policies published by international humanitarian organizations on their online platforms. Of 1,057 articles screened, 29 articles met inclusion criteria, describing 54 surgical programs implemented by 17 international humanitarian organizations —most commonly Médecins Sans Frontières (n = 27) and International Committee of the Red Cross (n = 5). These programs were implemented in 36 conflicts between 1946 and 2023, most commonly in Sub-Saharan Africa (n = 20), the Middle East (n = 11), and Southeast Asia (n = 9). The following six sustainability pillars were explicitly described: context-relevant education (94.4
