Introduction:An estimated two billion people are currently affected by war, with civilian populations increasingly exposed to the hazards of armed conflict. While the effect of explosive remnants of conflict is well documented, the impacts of the toxic remnants of war on civilian health are less well understood.Methods:This study was a scoping review examining the human health impacts of exposure to toxic remnants of war. Toxic remnants of war refer to any toxic or radiological substances arising from military activities. In this study, however, the focus was limited to the health effects of exposure to toxic substances and explosive by-products from munitions fired, dropped, or abandoned during conflict. The following databases were searched: Embase PubMed, Scopus, and Web of Science. The Mixed Methods Appraisal Tool (MMAT) was used to assess the methodological quality of studies that met the inclusion criteria.Results:Common toxicants reported on were Tetrachlorodibenzo-p-dioxin TCDD, white phosphorus, depleted uranium, lead, mercury, and sulfur mustard. Common health effects included respiratory diseases as well as cutaneous, cardiovascular, reproductive, and congenital effects. Posttraumatic stress disorder, depression, anxiety, cognitive impairments, and decreased quality of life were also commonly reported. The evidence base, however, is mixed with heterogeneity in study design and outcome measures. Lack of baseline data and inadequate exposure models make establishing an adverse causal relationship between an agent and a disease challenging.Discussion:Civilian exposures to toxic remnants of conflict remain understudied and under-addressed. The study suggests assessment of the human health impacts of toxicants should be part of a post-conflict response, especially given the potential long-term intergenerational effects. The current lack of recognition of the human health impacts of toxic remnants of conflict also limits the amount of global resources assigned to post-conflict decontamination.

Study/Objective: Personal preparedness is a cardinal step to a better prepared community. For the purposes of personal preparedness planning mind maps can be strategically implemented in personal preparedness efforts to structure and synthesize key information. Background: Mind-mapping is a tool, which visually organizes information portraying complex hierarchies and relationships. As applied to personal-preparedness context, mind maps have potential for: 1) structuring existing information framework 2) conveying knowledge to the public in an accessible intuitive format. Demonstrated mastery of personal and family preparedness for disasters and public health emergencies includes certain objectives, all of which may be tracked or maintained through mind mapping technology. Mind-mapping is vastly superior to traditional checklists in its capability to highlight how, when and what needs to be done. Not only can mind maps be constructed with modest effort to visual-spatially represent and organize relevant information and interrelationships but can also serve as a living document. Methods: A mixed methods approach was adopted. First, competency sets addressing personal preparedness planning were identified through the peer-reviewed literature. Existing checklists from a variety of sources including ready.gov, FEMA, the American Red Cross and academic centers were systematically reviewed. Commercially available software, TheBrain v9.0 beta (Los Angeles, CA, 2016), was used to develop a draft personal preparedness template. https://www.thebrain.com/ products/thebrain/ Results: Mind maps enable visual-spatial representation of both concrete and abstract elements of personal preparedness planning. The software features an intuitive interface, collapsible windows and hyperlinks as well as embedded notes and collaborative sharing. Each section of a personal preparedness plan developed in this way, can be examined in further detail and in turn should be continually updated and revised. Conclusion: Mind mapping offers a feasible alternative to traditional modes of information management for disaster preparedness and personal preparedness planning. Study/Objective: These days, the human world copes with global (warming, agricultural drought, armament, displacements, terrorism, etc.) issues. Even if any issue is a regional one, it fastly becomes a global concern and affects the world over.When a problem occurs, not only does it affects the poor, the indigents, but also the wealthiest. Unfortunately, wars cause more deaths, casualties, and orphan populations than earthquakes and hurricanes. In this day and age, on one hand, advanced technologies make life easier for humanity; on the other hand, it leads the human world vulnerable to man-made disasters never-before-seen. The study aims to define the risks for the future and determine solutions for mankind. Background: An outlook to the world panorama shouts the fact: deaths, victims, casualties, orphans, and narcotic addicts are due to ongoing wars, terrors, conflicts, forcibly...

BackgroundThe presence of landmines and explosive remnants of war (ERW) including unexploded ordnance (UXO) poses a serious public health risk for populations living in conflict-affected and contaminated areas. Current analysis, however, provides only a partial view of the burden. In this study, we examined the multivariable relationship between year of injury, activity at the time of the incident, case fatalities and casualty rates in order to provide decision-makers with a more fine-grained understanding of landmines and ERW injuries in the Lao PDR.MethodsUsing data from a retrospective, national household survey, frequency tables, logistic and Poisson regressions were performed using STATA 13 to predict the case fatality and population-standardized incidence rates for ERW casualties.ResultsThe findings indicated that most casualties were male (86.75%), with the majority of incidents (74.7%) occurring during the conflict period (1964–1979). The odds of death for the conflict period was 1.5 times that of the post-conflict period (1980–2008). The highest odds of death during the conflict period was associated with big bombs (OR = 1.38, 95% CI: 1.243–1.522, p < 0.01), and landmine injuries were more common during conflict compared to the post-conflict period (IRR = 1.42, 95% CI: 1.368–1.477, p < 0.01). Post conflict, cluster munitions had the highest incidence rate for death or injury (IRR = 1.07, 95%CI: 1.006–1.143, p = 0.03). Scrap collection which is often the target of mine risk education and thought to be one of the main activities at time of injury had the second lowest incidence rate of the activities related to incident during post-conflict period.ConclusionsAs the first study of this nature in Lao PDR, this research provides information essential for planning services and prevention. This study suggests more effort needs to be directed towards addressing the geographical regions and population subgroups experiencing increased casualty numbers and odds of death. Further research is required to improve the documentation and understanding of the health and socio-economic consequences of landmine and ERW injuries.

Introduction:Following humanitarian crises (e.g. armed conflict), reliable population health metrics are vital to establish health needs and priorities. However, the challenges associated with accurate health information and research in conflict zones are well documented. Often working within conflict settings are authorities and non-government organizations (NGOs) who frequently collect data under the context of operations. This operational data is a potentially untapped source of hard-to-reach data that could be utilized to provide a better insight into conflict affected populations. The Hard to Reach Data (HaRD) framework highlights the process of identifying and engaging with these stakeholders collaboratively to develop research capacity.Method:The HaRD framework was developed from literature searches of health and social sciences databases. The framework which provides a structure to gain access to data in hard-to-reach settings was applied to humanitarian mine action to identify and collect existing but underutilized data.Results:Guided by the HaRD framework we compiled the world’s first global casualty dataset for casualties of landmines and explosive remnants of war. The framework provided a structured approach to identify and engage with key stakeholders. An adaptive approach was needed for stakeholder engagement with trust building and transparency important factors in developing a collaborative partnership. Appropriate communication of research findings is important to ensure reciprocity.Conclusion:The HaRD framework can identify potential data sources and guide access in hard-to-reach data settings. Operational data is often available but hidden; a systematic approach to identifying and engaging with stakeholders can assist in developing successful research partnerships between academia and humanitarian organizations.

Introduction:Explosive hazards like landmines are known to contaminate over sixty countries and continue to threaten the health of affected communities across generations. The current study is the first to consider the impact of landmines and explosive remnants of war by drawing on global casualty data to determine mortality patterns.Method:This study is a retrospective analysis of secondary multi-source data on over 100,000 explosive hazard casualties from 17 low and middle income conflict-affected countries. This data was collected from mine action centers, international non-governmental organizations, and international bodies (e.g., United Nations), and include surveillance data, retrospective and prospective survey, and data collected through organizational operations.Results:The global case fatality rate was 38.8 deaths per 100 casualties. Males represented 87.4% (n = 34,642) of those killed, however females had higher odds of death when involved in an explosive incident (OR = 1.29, 95% CI: 1.24 – 1.34, p < 0.01). Adults experienced higher odds of death compared to children (OR = 1.60 95% CI: 1.55 – 1.64, p < 0.01). Case fatality ranged between countries with Lao PDR, Angola and Ukraine the countries with the highest proportion of deaths. Improvised explosive devices (IEDs) and ERW had higher odds of death compared to antipersonnel landmines (OR = 1.78, 95% CI: 1.67 – 1.91, p < 0.01; OR = 1.55, 95% CI: 1.50 – 1.60, p < 0.01).Conclusion:Mortality from landmines and other explosive hazards remains a public health issue in conflict impacted countries. This study addresses the lacunae of global data for explosive hazard casualties and provides an understanding of how fatal injury is endured. Adult males represent the most deaths globally, however case fatality ranges across conflicts. ERW and IED had the highest risk of death. These findings underscore the need for a global health response and strengthen advocacy measures for conflict affected communities as well as weapons prohibition campaigns.