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Prior to the intensified civil and armed conflicts in Ethiopia, remarkable progress was made in the health sector, which has persuaded the Ministry of Health to give special focus on building a responsive and resilient health system in the second five-year health sector transformation plan (HSTP II 2021-2025). However, the years-long civil and armed conflicts have been fueling the COVID-19 crisis and have caused multi-sectoral infrastructure damage, human life loss, and economic crisis. In 2021 alone, the conflict causes more than five million internal displacements of persons (IDP) and thousands civilian deaths. Review of reported government data has shown that 3,508 health posts, 750 health centers, and 76 hospitals were partially or completely damaged in four regions. Looting of medical equipment and facilities for amenities was devastating. More than 19 million people were affected by the armed and civil conflicts between 2020 and 2021. Unless peace is ensured across the nation the sooner possible, it is foreseen that the devastation may further worsen, and recovery may be a far-fetched possibility. Therefore, in addition to restoration of the disrupted health services, it is the right time for the Ministry of Health to incorporate the humanitarian-development nexus as a joint strategy with the Disaster Prevention and Preparedness Commission (DPPC) to ensure a resilient health system for similar multifaceted conflict-related health crisis, disasters, and infectious outbreaks., (© 2023 Yifru Berhan, et al.)

I analyze the long-term health impacts of Nepal's 1996-2006 civil conflict. I use information on monthly conflict incidents at the village level, which allows me to identify the effects of exposure to conflict more accurately than prior studies. I exploit the heterogeneity in conflict intensity across villages and birth cohorts to document the impacts on adult stature and intergenerational health. I find that childhood exposure to conflict and, in particular, exposure starting in infancy, negatively impacts attained adult height. Each additional month of exposure decreases a women's adult height by 1.36 millimeters. The impacts are not limited to first-generation - I find that a mother's exposure to conflict in her childhood is also detrimental to her child's health. Mothers exposed to conflict during their childhood have more children and live in less wealthy households, likely reducing their ability to invest during their children's critical period of physical development., (Copyright © 2020. Published by Elsevier B.V.)

Background: The 2004 tsunami, the civil conflict until 2009 and the youth insurrection in the late 1980s in Sri Lanka resulted in many persons being classified as 'missing' as they disappeared and were unaccounted for. Our aim was to compare the prevalence of major depressive disorder (MDD) and prolonged grief disorder (PGD) in families of disappeared individuals, who eventually received the mortal remains and those who did not., Method: An ethically approved cross sectional study was conducted in a purposively selected sample after informed consent. Information on the circumstances of the family member going missing was gathered. Culturally adapted versions of the General Health Questionnaire and the Beck Depression Scale were administered. Those who screened positive were assessed by a psychiatrist on Diagnostic and Statistical Manual of Mental Disorders-5 criteria to arrive at a diagnosis., Results: Of 391 cases of disappearances studied, MDD (17.5% v. 6%) and PGD (22% v. 7%) were significantly higher in those who did not eventually receive the mortal remains of the disappeared person. Among those who did not receive the mortal remains, being unsure whether the disappeared person was dead or alive was highly predictive of MDD and PGD. Mothers and wives, older family members and those with a family history of mental illness were more vulnerable., Conclusions: Family members of missing individuals unsure whether their loved one was alive or dead have higher psychological morbidity in the form of MDD and PGD.

Background: With lingering effects from more than 50 years of war, young children in Colombia are exposed to multiple risk factors such as poverty, civil conflict, and domestic violence. In addition to these environmental stressors, public and legal support for corporal punishment remains high, which is shown by the high prevalence of young children exposed to corporal punishment in Colombia., Objective: The purpose of this study is to identify individual, family, and municipality-level predictors of corporal punishment (i.e., hitting with objects and spanking) in Colombia in order to inform prevention and intervention strategies., Participants and Setting: We use information gathered in 2015 from a representative sample of 11,759 mothers of children younger than five in Colombia., Methods: We employed multi-level models to account for the clustering of families in 217 municipalities., Results: Results show that mothers' prior exposure to corporal punishment by their own parents (β=0.229;p<0.01), attitudes towards domestic violence β=0.013;p<0.05, municipality homicide rates β=0.028;p<0.05 and presence of armed groups β=0.031;p<0.05, household poverty β=0.030;p<0.01 and poverty of the municipality β=0.022;p<0.05 predicted mothers' hitting their young children with an object. However, family β=-0.028;p<0.05 and municipality poverty β=-0.016;p<0.05 had a negative association with mothers' use of spanking., Conclusions: These findings suggest that both family and neighborhood level factors have simultaneous associations with parents' use of corporal punishment. Given the accumulating evidence concerning the adverse effects of corporal punishment on child well-being and development, legislative efforts aimed at reducing and ultimately banning corporal punishment are warranted., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The power of Dante's Divine Comedy is unmistakable, but surprising in view of its theological structure and assumptions that are no longer current among most modern readers. This paper suggests that its power derives from the deep psychological truthfulness with which Dante deals with the painful personal crisis that underlies the poem and is his starting point. It attempts to clarify what may have constituted that crisis, and why the structure of the Comedy, and in particular its use of two guides, Virgil and Beatrice, who might be thought a somewhat incompatible pairing, point significantly to the nature of the solution Dante arrived at. In particular it suggests that the puzzling fictions to do with Statius in the Purgatorio are a clue to Dante's own difficulties in bridging the classical and Christian traditions, and that his highly original solution to these difficulties, by no means conforming to conventional Christian orthodoxy in the 13th/14th century, was needed with special urgency in a time of pervasive civil conflict., (Copyright © 2017 Institute of Psychoanalysis.)

This discussion paper outlines an approach to developing and evaluating an educative programme primarily delivered by lay `citizen trainers' in educating student nurses, and student midwives to the impact of and experience of extended and extensive civil unrest within their communities (`the Troubles' ). This is drawn from experience within the Northern Ireland `Troubles' and all of the citizen trainers were directly affected physically/psychologically. The programme was intended to both educate but primarily to help facilitate student nurses and student midwives to better understanding to experience and context and to more effective care delivery to those affected by/damaged by `the Troubles'. Evaluation of the teaching and learning by the students was significantly positive., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Civil conflicts devastate public health both in the short run and in the long run. Analyzing novel data sets that include yearly information on public health and the availability of health professionals across provinces in Turkey in the 1964-2010 period, we provide empirical evidence for our theoretical argument that a major mechanism through which civil conflicts exert their long term negative influences on public health is by discouraging medical personnel to practice in conflict regions. We also assess the effectiveness of certain policy measures that Turkish governments have tried out over the years to counteract this mechanism. Our results reveal that the long running civil conflict in Turkey has been driving away doctors and other highly trained medical personnel from conflict areas and that mandatory service requirements do help counteract this flight., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Despite considerable improvements in reproductive and newborn health throughout the world, relatively poor outcomes persist in areas plagued by conflict or political instability., Objectives: To assess the contribution of areas of conflict and instability to global patterns of stillbirths and newborn deaths and to identify opportunities for effective intervention in these areas., Methods: Analysis of the available data on stillbirths and neonatal mortality in association with conflict and governance indicators, and review of epidemiological and political literature pertaining to the provision of health and public services in areas of conflict and instability., Results: Of the 15 countries with the highest neonatal mortality rates in the world, 14 are characterized by chronic conflict or political instability. If India and China are excluded, countries experiencing chronic conflict or political instability account for approximately 42% of all neonatal deaths worldwide. Efforts to address adverse reproductive and newborn outcomes in these areas must adapt recommended intervention protocols to the special security and governance conditions associated with unstable political environment., Conclusion: Despite troubling relative and absolute indicators, the special requirements of improving reproductive and neonatal outcomes in areas affected by conflict and political instability have not received adequate attention. New integrated political and technical strategies will be required. This should include moving beyond traditional approaches concerned with complex humanitarian emergencies. Rather, global efforts must be based on a deeper understanding of the specific governance requirements associated with protracted and widespread health requirements. A focus on women's roles, regional strategies which take advantage of relative stability and governance capacity in neighbouring states, virtual infrastructure, and assistance regimens directed specifically to unstable areas may prove useful.

A sizeable economics literature explores the effect of prenatal shocks on later health or socioeconomic status. Work in other disciplines, following the seminal contribution of Trivers and Willard (1973), suggests that prenatal shocks may increase fetal loss and reduce the number of boys relative to girls at birth. This has been largely ignored in the economics literature and could affect the interpretation of estimates of the effect of prenatal shocks and that of gender in other applied economics contexts. This paper analyzes the effect of in utero exposure to a shock - civil conflict in Nepal - on (i) fetal loss, and (ii) gender and (iii) health at birth. Maternal fixed effects estimates show that exposed pregnancies are more likely to result in a miscarriage and in a female birth, but exposed newborns are neither smaller nor more subject to neonatal mortality., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Sri Lanka has recently emerged from nearly three decades of protracted conflict, which came to an end five years ago in 2009. A number of researchers have explored the devastating effect the conflict has had on public health, and its impact on Sri Lanka's health system - hailed as a success story in the South Asian region. Remarkably, no attempt has been made to synthesize the findings of such studies in order to build an evidence-informed research platform. This review aims to map the 'research landscape' on the impact of conflict on health in Sri Lanka. Findings highlight health status in select groups within affected communities and unmet needs of health systems in post-conflict regions. We contend that Sri Lanka's post-conflict research landscape requires exploration of individual, community and health system resilience, to provide better evidence for health programs and interventions after 26 years of conflict.

Guatemala's 36-year civil war officially ended in December 1996 after some 200,000 deaths and one million refugees. Despite the ceasefire, Guatemala continues to be a violent country with one of the highest homicide rates in the world. We investigated potential associations between violence, mental health, and substance abuse in post-conflict Guatemala using a community-based survey of 86 respondents living in urban and rural Guatemala. Overall, 17.4% of our respondents had at least one, direct violent experience during the civil war. In the post-conflict period, 90.7% of respondents reported being afraid that they might be hurt by violence, 40.7% screened positive for depression, 50.0% screened positive for PTSD, and 23.3% screened positive for alcohol dependence. Potential associations between prior violent experiences during the war and indicators of PTSD and aspects of alcohol dependence were found in regression-adjusted models (p < 0.05). Certain associations between prior civil war experiences, aspects of PTSD and alcohol dependence in this cohort are remarkable, raising concerns for the health and safety of the largely indigenous populations we studied. Higher than expected rates of depression, PTSD, and substance abuse in our cohort may be related to the ongoing violence, injury and fear that have persisted since the end of the civil war. These, in turn, have implications for the growing medical and surgical resources needed to address the continuing traumatic and post-traumatic complications in the post-conflict era. Limitations of the current study are discussed. These findings are useful in beginning to understand the downstream effects of the Guatemalan civil war, although a much larger, randomly sampled survey is now needed.