The #COVID19 #response for #vulnerable people in places affected by #conflict and #humanitarian #crises (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary,  edited.]

The COVID-19 response for vulnerable people in places affected by conflict and  humanitarian crises

Published Online May 1, 2020 | DOI:

David Nott,, David Nott Foundation, London W11 4QA, UK


Next year I will have worked full time in the UK’s National Health Service (NHS) for 40  years. I seem to be a survivor not only from the political rollercoaster that various governments have enacted on the NHS, but also from volunteering my surgical skills in  places affected by conflict and natural disasters for the past 25 years. The experiences of  the patients I have served whose lives have been impacted by war, injustice, and  inhumanity during this time have given me insight into what life is really about. Every  person on this planet has a right to live and survive by whatever means possible. Having  seen the adverse health impacts of conflict and humanitarian disaster on patients, I understand the mass movement of unprotected people from war to places of relative  calm. Many of the estimated 70·8 million forcibly displaced people worldwide live in  insanitary and inhospitable conditions,1 sometimes up to six families living in one tent  in a 3 m2 area.2 At a time when so many people are living under lockdown because of  the coronavirus disease 2019 (COVID-19) pandemic, it is important to highlight the  dreadful conditions that displaced people endure, which I have personally witnessed in  refugee camps throughout the world. Apart from difficult living conditions in these  camps, many people share one latrine and washing facilities and hundreds queue for  food every day.3 People tolerate such conditions because they want to live. They have  been forced to live this way by inhumane acts in conflict and authoritarianism.


Keywords: SARS-CoV-2; COVID-19; Society; Poverty; Wars.


#Economic #sanctions and #Iran’s #capacity to respond to #COVID19 (Lancet Pub Health, summary)

[Source: Lancet Public Health, full page: (LINK). Summary, edited.]

Economic sanctions and Iran’s capacity to respond to COVID-19

Adrianna Murphy, Zhaleh Abdi, Iraj Harirchi, Martin McKee, Elham Ahmadnezhad

Open Access | Published: April 06, 2020 | DOI:


Iran was one of the first countries outside China to have a rapid increase in the number of cases of coronavirus disease 2019 (COVID-19). The country’s capacity to respond to the virus is substantially impeded by unilateral economic sanctions re-imposed after the US Administration withdrew from the nuclear deal in May, 2018, and further US sanctions imposed as recently as March 18, 2020.1 As of March 31, 2020, the recorded number of people infected from COVID-19 in Iran was 41 495, with 2757 deaths,2 but these numbers are likely a substantial underestimation.


Keywords: SARS-CoV-2; COVID-19; Iran; Society; Wars.


#Structural #violence in the era of a new #pandemic: the case of the #Gaza Strip (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

Structural violence in the era of a new pandemic: the case of the Gaza Strip

*David Mills, Bram Wispelwey, Rania Muhareb, Mads Gilbert

Boston Children’s Hospital, Boston, MA 02115, USA (DM); Harvard Medical School, Boston, MA, USA (DM, BW); Brigham and Women’s Hospital, Boston, MA, USA (BW); Al-Haq, occupied Palestinian territory (RM); University Hospital of North Norway, Tromsø, Norway (MG); and The Arctic University of Norway, Tromsø, Norway (MG)

Published Online March 26, 2020 | DOI:


“Hope for improving health and quality of life of Palestinians will exist only once people recognise that the structural and political conditions that they endure…are the key determinants of [Palestinian] population health.”1 As the world is consumed by the spread of coronavirus disease 2019 (COVID-19), it should be of no surprise that epidemics  (and indeed, pandemics) are disproportionately violent to populations burdened by poverty, military occupation, discrimination, and institutionalised oppression.2


Keywords: SARS-CoV-2; COVID-19; Gaza; Poverty; Society; Wars.


#COVID19 #battle during the toughest #sanctions against #Iran (Lancet, summary)

[Source: Lancet, full page: (LINK). Summary, edited.]

COVID-19 battle during the toughest sanctions against Iran

Published Online March 17, 2020 | DOI:

We declare no competing interests.

*Amirhossein Takian, Azam Raoofi, Sara Kazempour-Ardebili –

Department of Global Health & Public Policy, School of Public Health (AT), Department of Health Economics & Management, School of Public Health (AT, AR), and Health Equity Research Center (AT), Tehran University of Medical Sciences, Tehran, Iran; and Consultant Endocrinologist, Tehran, Iran (SK-A)


Coronavirus disease 2019 (COVID-19) has spread rapidly throughout the world. WHO declared the outbreak a global pandemic on March 11, 2020.1 In Iran, the first official announcement of deaths from COVID-19 was made on Feb 19, 2020. As of March 16, 2020, 14991 people have been infected with severe acute respiratory syndrome coronavirus 2, and 853 people have died from COVID-19. 4996 people have recovered.2


Keywords: Iran; Wars; Society; SARS-CoV-2; COVID-19.


Responding to #health #emergencies in the Eastern #Mediterranean #region in times of #conflict (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

Responding to health emergencies in the Eastern Mediterranean region in times of conflict

Richard Brennan, Rana Hajjeh, Ahmed Al-Mandhari

Published: March 02, 2020 / DOI:


WHO’s Eastern Mediterranean region (EMR) is facing emergencies on a scale that is perhaps unprecedented in its history. There is armed conflict in 12 of the region’s 22 countries.1, 2 The region’s 680 million people3 represent 9% of the global population, yet the EMR is home to 43% of those who need humanitarian assistance4  and is the source of 64% of the world’s refugees.5 The health effects of these crises are immense. Direct health consequences include trauma-related deaths and disability, gender-based violence, and mental disorders. Disruption of health systems contributes to increased morbidity and mortality from infectious diseases, malnutrition, obstetric complications, and non-communicable diseases (NCDs). Health indicators in the EMR are among the worst in the world.6



AA-M is WHO Regional Director for the Eastern Mediterranean. We declare no other competing interests.

Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps, content, and institutional affiliations.

Keywords: Society; Poverty; Wars; COVID-19; Pandemic preparedness.


The #exacerbation of #Ebola #outbreaks by #conflict in the #DRC (Proc Natl Acad Sci USA, abstract)

[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]

The exacerbation of Ebola outbreaks by conflict in the Democratic Republic of the Congo

Chad R. Wells, Abhishek Pandey, Martial L. Ndeffo Mbah, Bernard-A. Gaüzère, Denis Malvy, Burton H. Singer, and Alison P. Galvani

PNAS first published October 21, 2019 / DOI:

Contributed by Burton H. Singer, September 9, 2019 (sent for review August 14, 2019; reviewed by David Fisman and Seyed Moghadas)



There is limited understanding of what ramifications conflict events have on disease transmission and control in regions plagued by civil unrest and violence. Furthermore, the multifaceted nature of the conflict events during an epidemic is yet to be characterized. Using conflict data, ethnographic appraisal, and a mathematical model, we provide a descriptive timeline of the events during the ongoing Ebola outbreak in the Democratic Republic of the Congo. We quantified the unrest preceding a conflict event and its subsequent impact on control activities to demonstrate how conflict events are contributing to the persistence of the epidemic. Our model framework can be extended to other infectious diseases in areas that have experienced chronic conflict and violence.



The interplay between civil unrest and disease transmission is not well understood. Violence targeting healthcare workers and Ebola treatment centers in the Democratic Republic of the Congo (DRC) has been thwarting the case isolation, treatment, and vaccination efforts. The extent to which conflict impedes public health response and contributes to incidence has not previously been evaluated. We construct a timeline of conflict events throughout the course of the epidemic and provide an ethnographic appraisal of the local conditions that preceded and followed conflict events. Informed by temporal incidence and conflict data as well as the ethnographic evidence, we developed a model of Ebola transmission and control to assess the impact of conflict on the epidemic in the eastern DRC from April 30, 2018, to June 23, 2019. We found that both the rapidity of case isolation and the population-level effectiveness of vaccination varied notably as a result of preceding unrest and subsequent impact of conflict events. Furthermore, conflict events were found to reverse an otherwise declining phase of the epidemic trajectory. Our model framework can be extended to other infectious diseases in the same and other regions of the world experiencing conflict and violence.

insecurity – healthcare workers  – epidemiology – humanitarian crisis

Keywords: Ebola; DRC; Wars; Society.


Is #war a man-made #publichealth problem? (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

Is war a man-made public health problem?

Oliver Razum, Henrique Barros, Robert Buckingham, Mary Codd, Katarzyna Czabanowska, Nino Künzli et al.

Published: October 16, 2019 / DOI:



Wars and armed conflicts have devastating consequences for the physical and mental health of all people involved, for the social life within and surrounding the war-affected regions, and for the health of the environment. Wars destroy health infrastructure, undoing years of health advancement, and severely compromise health systems’ capacity to respond to the direct and indirect health consequences of fighting. Millions of people have been internally displaced or forced to flee their countries because of armed conflict. Forced migration creates further physical and mental health problems during transit, in enforced encampment, and because of restricted entitlement to health care in countries hosting refugees.1,  2,  3



Copyright © 2019 Bakr Alkasem/Getty Images

OR, HB, RB, MC, KC, NK, KL, and CS are the executive board members of ASPHER; RO is director at ASPHER; JM is president of ASPHER.

Keywords: Wars; Society; Public Health.