Coping with COVID-19 in United Nations peacekeeping field hospitals: increased workload and mental stress for military healthcare providers

Abstract

IntroductionThis study aimed to explore the impact of COVID-19 on the United Nations peacekeeping field hospitals where medical supply and manpower are extremely insufficient.MethodsA level II hospital was deployed in Wau, South Sudan, as the regional referral centre of the United Nations Mission in South Sudan (UNMISS). It had a total strength of 63 personnel with 47 medical staff (average age 38.3±8.0 years, 33 men). A new ‘appointment–triage–disinfection’ work pattern was adopted to cope with the COVID-19 outbreak in the mission. Data on medical service statistics and workload before/after the outbreak were collected and compared. The mental health of staff was analysed from the quarterly psychological survey, including Perceived Stress Scale (PSS)-10, Generalised Anxiety Disorder (GAD)-7 and Patient Health Questionnaire (PHQ)-9.ResultsThe number of outpatients decreased slightly after the COVID-19 outbreak (41.9±11.9 to 37.6±11.8 per week, p=0.49), whereas the weekly hospital length of stay of inpatients increased significantly (0.4±1.0 to 3.1±3.9 days, p=0.02). Total weekly working hours increased from 1884.9±34.1 to 2023.5±67.3 hours (p<0.001). Elevated mental stress (PSS-10: 4.3±2.4 in February to 7.5±3.9 in May, p<0.001; GAD-7: 4.0±2.3 to 9.4±4.0, p<0.001; PHQ-9: 2.1±1.2 to 3.2±2.4, p<0.001) was documented among healthcare providers after the outbreak. The threat of COVID-19 infection, delay in rotation and family-related concerns constituted the main stressors.ConclusionCOVID-19 imposes a huge pressure on peacekeeping field hospitals. Increased workload and mental stress among frontline healthcare providers deserve the attention of UNMISS officials. Facilitating the rotation of the medical staff might potentially improve the operational readiness of the hospital by bringing in well-trained personnel and sufficient medical supplies.

Effects of the COVID-19 pandemic and previous pandemics, epidemics and economic crises on mental health: systematic review

“…45,46 These were conducted on population-based samples (151–336 52 participants); 17,18,22,29,33,39,40,43 more specific healthy populations of various ages, life stages or occupations (93–7527 participants); 14,15,21,23–27,34,36–39,41,42 and patients/populations with various somatic or psychiatric diagnoses (46–1 854 742 participants). 16,19,20,28,30–32,35 The studies were conducted in Hong Kong, 26,33 the USA, 15,17–19,22,24,30,34,40,42 the UK, 21,29,30,34,39 Germany, 31,43 China, 36,37 Italy, 14,20,25 Australia, 32,38 Bangladesh, 23 India, 27 Switzerland, 44 South Sudan, 41 Canada, 30 France, 30 Singapore, 35 Serbia 28 and The Netherlands. 16 Among these studies, four were of high quality 21,27,29,31 and 27 were of fair quality.…”

“…2(a) ), 31 found increases during the COVID-19 pandemic 14 – 44 and two found increases in subgroups of participants. 45 , 46 These were conducted on population-based samples (151–336 52 participants); 17 , 18 , 22 , 29 , 33 , 39 , 40 , 43 more specific healthy populations of various ages, life stages or occupations (93–7527 participants); 14 , 15 , 21 , 23 – 27 , 34 , 36 – 39 , 41 , 42 and patients/populations with various somatic or psychiatric diagnoses (46–1 854 742 participants). 16 , 19 , 20 , 28 , 30 – 32 , 35 The studies were conducted in Hong Kong, 26 , 33 the USA, 15 , 17 – 19 , 22 , 24 , 30 , 34 , 40 , 42 the UK, 21 , 29 , 30 , 34 , 39 Germany, 31 , 43 China, 36 , 37 Italy, 14 , 20 , 25 Australia, 32 , 38 Bangladesh, 23 India, 27 Switzerland, 44 South Sudan, …”

“…45,46 These were conducted on population-based samples (151-336 52 participants); 17,18,22,29,33,39,40,43 more specific healthy populations of various ages, life stages or occupations (93-7527 participants); 14,15,21,[23][24][25][26][27]34,[36][37][38][39]41,42 and patients/populations with various somatic or psychiatric diagnoses (46-1 854 742 participants). 16,19,20,28,[30][31][32]35 The studies were conducted in Hong Kong, 26,33 the USA, 15,[17][18][19]22,24,30,34,40,42 the UK, 21,29,30,34,39 G...…”

“…16 Among these studies, four were of high quality 21,27,29,31 and 27 were of fair quality. [14][15][16][17][18][19][20][22][23][24][25][26]28,30,[32][33][34][35][36][37][38][39][40][41][42][43][44] A fair-quality study of adolescents and parents from The Netherlands found increased negative affect only in parents, 45 and a fair-quality study of people with cancer from the UK found increased rates of depression only among those with certain cancer types. 46 Altogether, five studies with more defined samples of various ages, occupations and health conditions, with 25-3983 participants, found no change in affective disorders.…”

Developing a conceptual framework for the health protection of United Nations peacekeepers against the COVID-19 pandemic from global health perspectives

“…Furthermore, the UN coordinated COVID-19 humanitarian vaccination for peacekeepers and citizens in host countries, as the coronavirus kept mutating into Delta, Omicron, and other variants [ 15 , 16 ]. However, host countries, the UN, and UN peacekeepers have limited knowledge and capacity to fight the COVID-19 pandemic [ 17 ]: host countries seem to have inefficient medical and health systems for UN peacekeepers’ health protection against COVID-19 [ 18 ]. Although there are training materials provided for peacekeepers by the UN, knowledge, and training regarding features of COVID-19 seem insufficient; UN peacekeepers from different countries with various cultural backgrounds may have conflicting perceptions and take inconsistent actions against the COVID-19 pandemic [ 19 ].…”