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      Exploring the health consequences of armed conflict: the perspective of Northeast Ethiopia, 2022: a qualitative study

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          Abstract

          Background

          Conflict is a complicated topic with a multidimensional consequences for community health. Its effects have a broad pattern, starting from direct war-related morbidity and mortality caused by bullets and bombs to indirect consequences due to the interruption of the delivery of preventive and curative health services. This study aimed to explore the health consequences of the northern Ethiopian conflict in the North Wollo zone, northeast Ethiopia, in 2022.

          Methods

          This descriptive qualitative study was conducted from May to June 2022 on six conflict-affected Woredas in the north Wollo zone. A total of 100 purposively selected participants, which included patients, pregnant women, elders, community and religious leaders, and health professionals, were interviewed using IDI and FGD. The data was entered, coded, and analyzed using Open Code version 4.03. Thematic analysis approach employed to conduct the interpretation. Data was presented using descriptive statistics in the form of texts and tables.

          Results

          The findings indicate that the conflict has caused a profound consequence on population health. It has resulted in a wide range of direct and indirect consequences, ranging from war-related casualties, famine, and disruptions of supply chains and forced displacement to instances of violence and rape associated with insecurity. The conflict also caused a breakdown in the health system by causing distraction of health infrastructure, fleeing of health workers and shortage of medication, together with insecurity and lack of transportation, which greatly affected the provision and utilization of health services. Additionally, the conflict has resulted in long-term consequences, such as the destruction of health facilities, interruption of immunization services, posttraumatic stress disorders, and lifelong disabilities. The coping strategies utilized were using available traditional medicines and home remedies, obtaining medications from conflict-unaffected areas, and implementing home-to-home healthcare services using available supplies.

          Conclusion

          The Northern Ethiopian conflict has an impact on community health both directly and indirectly through conflict-related causalities and the breakdown of the health system and health-supporting structures. Therefore, this study recommends immediate rehabilitation interventions for damaged health infrastructure and affected individuals.

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          Most cited references28

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          Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet –American University of Beirut Commission on Syria

          The conflict in Syria presents new and unprecedented challenges that undermine the principles and practice of medical neutrality in armed conflict. With direct and repeated targeting of health workers, health facilities, and ambulances, Syria has become the most dangerous place on earth for health-care providers. The weaponisation of health care-a strategy of using people's need for health care as a weapon against them by violently depriving them of it-has translated into hundreds of health workers killed, hundreds more incarcerated or tortured, and hundreds of health facilities deliberately and systematically attacked. Evidence shows use of this strategy on an unprecedented scale by the Syrian Government and allied forces, in what human rights organisations described as a war-crime strategy, although all parties seem to have committed violations. Attacks on health care have sparked a large-scale exodus of experienced health workers. Formidable challenges face health workers who have stayed behind, and with no health care a major factor in the flight of refugees, the effect extends well beyond Syria. The international community has left these violations of international humanitarian and human rights law largely unanswered, despite their enormous consequences. There have been repudiated denunciations, but little action on bringing the perpetrators to justice. This inadequate response challenges the foundation of medical neutrality needed to sustain the operations of global health and humanitarian agencies in situations of armed conflict. In this Health Policy, we analyse the situation of health workers facing such systematic and serious violations of international humanitarian law. We describe the tremendous pressures that health workers have been under and continue to endure, and the remarkable resilience and resourcefulness they have displayed in response to this crisis. We propose policy imperatives to protect and support health workers working in armed conflict zones.
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            Armed conflict as a public health problem.

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              Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey.

              An excess mortality of nearly 100 000 deaths was reported in Iraq for the period March, 2003-September, 2004, attributed to the invasion of Iraq. Our aim was to update this estimate. Between May and July, 2006, we did a national cross-sectional cluster sample survey of mortality in Iraq. 50 clusters were randomly selected from 16 Governorates, with every cluster consisting of 40 households. Information on deaths from these households was gathered. Three misattributed clusters were excluded from the final analysis; data from 1849 households that contained 12 801 individuals in 47 clusters was gathered. 1474 births and 629 deaths were reported during the observation period. Pre-invasion mortality rates were 5.5 per 1000 people per year (95% CI 4.3-7.1), compared with 13.3 per 1000 people per year (10.9-16.1) in the 40 months post-invasion. We estimate that as of July, 2006, there have been 654 965 (392 979-942 636) excess Iraqi deaths as a consequence of the war, which corresponds to 2.5% of the population in the study area. Of post-invasion deaths, 601 027 (426 369-793 663) were due to violence, the most common cause being gunfire. The number of people dying in Iraq has continued to escalate. The proportion of deaths ascribed to coalition forces has diminished in 2006, although the actual numbers have increased every year. Gunfire remains the most common cause of death, although deaths from car bombing have increased.
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                Author and article information

                Contributors
                mulewodaje@gmail.com
                henokkumsa@gmail.com
                mulushi9894@gmail.com
                abebetare@gmail.com
                mebratuephrem2013@gmail.com
                abaynehtunta@gmail.com
                wolde.t@wldu.edu.et
                imanaddisu@gmail.com
                mollayigzaw33@gmail.com
                lemaryam01@gmail.com
                lebezaa@gmail.com
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                24 October 2023
                24 October 2023
                2023
                : 23
                : 2078
                Affiliations
                [1 ]School of Midwifery, College of Health Sciences, Woldia University, ( https://ror.org/05a7f9k79) Woldia, Ethiopia
                [2 ]School of Medicine, College of Health Sciences, Woldia University, ( https://ror.org/05a7f9k79) Woldia, Ethiopia
                [3 ]Department of Pharmacy, College of Health Sciences, Woldia University, ( https://ror.org/05a7f9k79) Woldia, Ethiopia
                [4 ]Department of Pharmacy, College of Medicine and Health Sciences, Debre Markos University, ( https://ror.org/04sbsx707) Debre Markos, Ethiopia
                [5 ]Department of Medical Laboratory, College of Health Sciences, Woldia University, ( https://ror.org/05a7f9k79) Woldia, Ethiopia
                [6 ]Department of Public health, College of Health Sciences, Injibara University, Injibara, Ethiopia
                [7 ]Department of Public health, College of Health Sciences, Debre Markos University, ( https://ror.org/04sbsx707) Debre Markos, Ethiopia
                [8 ]School of Public Health, College of Health Sciences, Woldia University, ( https://ror.org/05a7f9k79) Woldia, Ethiopia
                Article
                16983
                10.1186/s12889-023-16983-z
                10594710
                37875885
                a9da8e32-a253-417a-bad7-bd07fa3db661
                © BioMed Central Ltd., part of Springer Nature 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 27 March 2023
                : 13 October 2023
                Categories
                Research
                Custom metadata
                © BioMed Central Ltd., part of Springer Nature 2023

                Public health
                armed conflict,health consequence,coping mechanisms,qualitative study,ethiopia
                Public health
                armed conflict, health consequence, coping mechanisms, qualitative study, ethiopia

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