BackgroundIn August 2014, the so-called Islamic State of Iraq and Syria (ISIS) attacked the Yazidi religious minority living in the area of Mount Sinjar in Nineveh governorate, Iraq. We conducted a retrospective household survey to estimate the number and demographic profile of Yazidis killed and kidnapped.Methods and findingsThe survey covered the displaced Yazidi population from Sinjar residing in camps in the Kurdistan Region of Iraq. Fieldwork took place between 4 November and 25 December, 2015. A systematic random sample of 1,300 in-camp households were interviewed about the current household composition and any killings and kidnappings of household members by ISIS. Of the 1,300 interviewed households, 988 were Yazidi from Sinjar. Yazidi households contained 6,572 living residents at the time of the survey; 43 killings and 83 kidnappings of household members were reported. We calculated the probability of being killed and kidnapped by dividing the number of reported killings and kidnappings by the number of sampled Yazidis at risk, adjusting for sampling design. To obtain the overall toll of killings and kidnappings, those probabilities were multiplied by the total Yazidi population living in Sinjar at the time of the ISIS attack, estimated at roughly 400,000 by the United Nations and Kurdish officials. The demographic profile of those killed and kidnapped was examined, distinguishing between children and adults and females and males. We estimated that 2.5% of the Yazidi population was either killed or kidnapped over the course of a few days in August 2014, amounting to 9,900 (95% CI 7,000–13,900) people in total. An estimated 3,100 (95% CI 2,100–4,400) Yazidis were killed, with nearly half of them executed—either shot, beheaded, or burned alive—while the rest died on Mount Sinjar from starvation, dehydration, or injuries during the ISIS siege. The estimated number kidnapped is 6,800 (95% CI 4,200–10,800). Escapees recounted the abuses they had suffered, including forced religious conversion, torture, and sex slavery. Over one-third of those reported kidnapped were still missing at the time of the survey. All Yazidis were targeted regardless of age and sex, but children were disproportionately affected. They were as likely as adults to be executed but constituted 93.0% (95% CI 71.9–98.6) of those who died on Mount Sinjar. Moreover, children only accounted for 18.8% (95% CI 8.4–36.9) of those who managed to escape captivity. A sensitivity analysis suggests that the actual toll of killings and kidnappings may be underestimated in our data because of survival bias. The uncertainty associated with inference from a small sample of in-camp households and the reliance on a rough figure of 400,000 for extrapolation to the total Yazidi population of Sinjar at the time of the ISIS attack are the main limitations of this study.ConclusionsConsistent with other existing evidence, our data provide a clear indication of the severity of the ISIS attack against the Yazidis in terms of both the number and demographic profile ...

ObjectivesEvidence on whether removing fees benefits the poorest is patchy and weak. The aim of this paper is to measure the impact of user fee reforms on the probability of giving birth in an institution or undergoing a caesarean section (CS) in Ghana, Burkina Faso, Zambia, Cameroon and Nigeria for the poorest strata of the population.SettingWomen's experience of user fees in 5 African countries.Primary and secondary outcome measuresUsing quasi-experimental regression analysis we tested the impact of user fee reforms on facilities’ births and CS differentiated by wealth, education and residence in Burkina Faso and Ghana. Mapping of the literature followed by key informant interviews are used to verify details of reform implementation and to confirm and support our countries’ choice.ParticipantsWe analysed data from consecutive surveys in 5 countries: 2 case countries that experienced reforms (Ghana and Burkina Faso) by contrast with 3 that did not experience reforms (Zambia, Cameroon, Nigeria).ResultsUser fee reforms are associated with a significant percentage of the increase in access to facility births (27 percentage points) and to a much lesser extent to CS (0.7 percentage points). Poor (but not the poorest), and non-educated women, and those in rural areas benefitted the most from the reforms. User fees reforms have had a higher impact in Burkina Faso compared with Ghana.ConclusionsFindings show a clear positive impact on access when user fees are removed, but limited evidence for improved availability of CS for those most in need. More women from rural areas and from lower socioeconomic backgrounds give birth in health facilities after fee reform. Speed and quality of implementation might be the key reason behind the differences between the 2 case countries. This calls for more research into the impact of reforms on quality of care.

BackgroundThe increasing caseload of non-communicable diseases (NCDs) in displaced populations poses new challenges for humanitarian agencies and host country governments in the provision of health care, diagnostics and medications. This study aimed to characterise the prevalence of NCDs and better understand issues related to accessing care among Yazidis and other minority groups displaced by ISIS and currently residing in camps in the Kurdistan Region of Iraq.MethodsThe study covered 13 camps managed by the Kurdish Board of Relief and Humanitarian Affairs. A systematic random sample of 1300 households with a total of 8360 members were interviewed between November and December 2015. Respondents were asked whether any household members had been previously diagnosed by a health provider with one or more of four common NCDs: hypertension, diabetes, cardiovascular disease and musculoskeletal conditions. For each household member with an NCD diagnosis, access to health care and medications were queried.ResultsNearly one-third of households had at least one member who had been previously diagnosed with one or more of the four NCDs included in this study. Hypertension had the highest prevalence (19.4%; CI: 17.0–22.0), followed by musculoskeletal conditions (13.5%; CI: 11.4–15.8), diabetes (9.7%; CI: 8.0–11.7) and cardiovascular disease (6.3%; CI: 4.8–8.1). Individual NCD prevalence and multimorbidity increased significantly with age. Of those with an NCD diagnosis, 92.9% (CI: 88.9–95.5) had seen a health provider for this condition in the 3 months preceding the survey. In the majority of cases, care was sought from private clinics or hospitals rather than from the camp primary health care clinics. Despite the frequent access to health providers, 40.0% (CI: 34.4–46.0) were not taking prescribed medications, costs being the primary reason cited.ConclusionNew strategies are needed to strengthen health care provision for displaced persons with NCDs and ensure access to affordable medications.