Children born with congenital colorectal anomalies, such as anorectal malformations and Hirschsprung disease, typically require multiple staged surgical procedures. In conflict-affected settings, surgically-oriented humanitarian aid organizations perform emergency ostomies in pediatric patients as initial life-saving interventions, but often lack mechanisms to ensure subsequent reconstructive care. This article draws on existing literature in global surgery, conflict and humanitarian health, pediatric surgical care, bioethics, and palliative care to critically examine the ethical, structural, and sociocultural implications of this practice. Using the Four Principles of Medical Ethics – beneficence, nonmaleficence, autonomy, and justice – alongside other ethical frameworks, we analyze how care delivered under conditions of extreme constraint may create tension between immediate survival and long-term well-being. While emergency ostomy creation is often ethically justified in the acute setting, the absence of reliable follow-up pathways risks exposing children to foreseeable, long-term harm. Structural barriers, including specialist workforce shortages, fragmented referral systems, and financial constraints in conflict-affected countries, further compound this ethical tension by transforming short-term survival into chronic morbidity. Beyond clinical outcomes, the absence of follow-up care imposes profound sociocultural and financial burdens on patients and their families, including stigma, gendered caregiving responsibilities, and catastrophic out-of-pocket costs, which disproportionately affect already marginalized populations. We weigh these concerns against the strongest counterarguments, including the rule of rescue, before proposing ways forward. Our analysis suggests that the ethical obligations of humanitarian surgical care should extend beyond the initial life-saving intervention to include planning for restoring intestinal continuity and promoting long-term recovery and dignity. We propose three ethically grounded pathways: establishing formal referral linkages for staged surgical care, implementing structured, recurring specialist pediatric surgical programs to ensure continuity, and prioritizing palliative care when reconstructive follow-up is unattainable. These approaches aim to align emergency interventions with long-term ethical responsibility, and offer guidance for more ethically coherent and structurally sustainable models of pediatric surgical care in conflict-affected settings.
The Minimum Initial Service Package (MISP) for Sexual and Reproductive Health (SRH) is essential for delivering life-saving interventions during humanitarian emergencies. This systematic review aimed to assess the implementation of the MISP among female refugees aged 15–49 years in the Eastern Mediterranean Region (EMR) by synthesizing evidence on MISP-related service utilization indicators and maternal and reproductive health outcomes. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted comprehensive searches of multiple electronic databases and reports from United Nations agencies published between 2013 and December 31, 2024. The risk of bias of the included studies was assessed using the Newcastle–Ottawa Scale. Eleven peer-reviewed studies and one report met the inclusion criteria. The included studies demonstrated substantial variation in MISP-related indicators across refugee populations. Unplanned pregnancy rates ranged from 26
In Sub-Saharan Africa, health service delivery is constantly disrupted in fragile and conflict-affected settings (FCAS), necessitating creative solutions to sustain vital health education and service consumption. In these situations, community-based health education (CBHE) has been extensively used as a tactic to raise health awareness and encourage healthy habits. Its overall efficacy and impact mechanisms, however, are still not fully synthesized. This systematic review aimed to assess the effectiveness of CBHE interventions in improving health knowledge, service utilization, and health outcomes in FCAS in Sub-Saharan Africa, and to explore the mechanisms and contextual factors influencing their effectiveness. A systematic review with thematic synthesis of eighteen studies was carried out. A thorough search of PubMed/MEDLINE, Scopus, Embase, CINAHL, Cochrane Library and Google Scholar was conducted and Grey literature search was done for relevant studies. Included were studies that examined CBHE interventions provided in fragile and conflict-affected environments by community health workers (CHWs), peer educators, traditional birth attendants (TBAs), and informal community organizations. Community-based interventions consistently improved health knowledge across maternal, child health, and infectious disease domains. The primary delivery methods were CHWs, peer educators, and TBAs. Accessibility, cultural tolerance, and trust were major factors in their efficacy. Service utilization increased when community actors were integrated into formal health systems, while fragmented or exclusionary methods decreased efficacy. However, systematic limitations including instability, poor coordination, and supply chain interruptions hindered the conversion of better knowledge into long-term health outcomes. CBHE and informal community health systems improve knowledge and strengthen resilience in fragile settings through trusted local actors. However, their impact on health outcomes remains constrained without stronger system integration and sustained structural support.
Although some individual studies have examined the prevalence of zero-dose vaccination, the pooled prevalence of zero-dose vaccination among children in conflict-affected African settings has not yet been estimated. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of zero-dose vaccination among children aged 12–59 months in conflict-affected African settings. A comprehensive systematic search was performed across six major databases: PubMed, Cochrane Library, Scopus, Science Direct, African Journals Online (AJOL), and Google Scholar using Medical Subject Heading (MeSH) terms alongside relevant keywords. Before the screening, all retrieved records were imported into EndNote version 25, and duplicates were removed. Using Covidence software, two reviewers independently carried out data screening and extraction. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to evaluate the quality of the included studies. The extracted data were exported to STATA version 17 for statistical analysis. The pooled prevalence of zero-dose vaccination was estimated using random-effects model and presented using forest plots. The I² statistic was used to assess study heterogeneity, while funnel plot and Egger’s and Begg’s tests were used to evaluate publication bias. Of the 1,087 studies identified, 12 were included in the final analysis, comprising 30,423 children, with sample sizes ranging from 355 to 9,651. The reported prevalence of zero-dose vacccination ranged from 10.7
