War in Nagorno-Karabakh highlights the vulnerability of displaced populations to COVID-19

Balalian, Arin A.; Berberian, Alique; Chiloyan, Araz; DerSarkissian, Maral; Khachadourian, Vahe; Siegel, Eva Laura; Mehranbod, Christina A.; Hovsepian, Vaneh; Deckelbaum, Richard J.; Factor-Litvak, Pam; Daniel, Sharon; Shafir, Shira; Dorian, Alina; Hekimian, Kim

doi:10.1136/jech-2020-216370

Cited by 11 publications

(13 citation statements)

References 10 publications

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“…However, the Government of Bangladesh continued to enforce policies that deprioritized and undermined comprehensive services for survivors of SGBV [ 38 , 39 ]. We see similar challenges reflected in the experiences of other displaced populations including increased risk of COVID-19, limited access to services, and increased difficulty accessing information; however this study is unique in that it seeks to understand the impact of the Government of Bangladesh’s restrictions on services for SGBV survivors [ 40 – 42 ].…”

Section: Discussionmentioning

confidence: 99%

Health professionals’ perspectives on the impact of COVID-19 on sexual and gender-based violence (SGBV) and SGBV services in Rohingya refugee communities in Bangladesh

Chowdhury¹,

McHale

Green

et al. 2022

BMC Health Serv Res

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Background The COVID-19 pandemic has acutely affected Rohingya refugees living in camps in Cox’s Bazar, Bangladesh. Reported increases in sexual and gender-based violence (SGBV) were attributed in part to pandemic-related public health measures. In addition, the Government of Bangladesh’s restrictions to prevent the spread of COVID-19 have impacted the provision of comprehensive care for survivors of sexual violence. This study sought to understand how the COVID-19 pandemic affected SGBV and the provision of services for Rohingya survivors in Bangladesh. Methods Interviews were conducted with 13 professionals who provided or managed health care or related services for Rohingya refugees after the onset of the COVID-19 pandemic in March 2020. Results At the outset of the COVID-19 pandemic, organizations observed an increase in the incidences of SGBV. However, health care workers noted that the overall number of survivors formally reporting or accessing services decreased. The pandemic produced multiple challenges that affected health workers’ ability to provide essential care and services to Rohingya survivors, including access to the camps, initial designation of SGBV-related services as non-essential, communications and telehealth, difficulty maintaining confidentiality, and donor pressure. Some emerging best practices were also reported, including engaging Rohingya volunteers to continue services and adapting programming modalities and content to the COVID-19 context. Conclusions Comprehensive SGBV services being deemed non-essential by the Government of Bangladesh was a key barrier to providing services to Rohingya survivors. Government restrictions adversely affected the ability of service providers to ensure that comprehensive SGBV care and services were available and accessible. The Government of Bangladesh has not been alone in struggling to balance the needs of displaced populations with the necessary precautions to prevent the spread of COVID-19 and its response can provide lessons to others overseeing the provision of services during epidemics and pandemics in other humanitarian settings. The designation of comprehensive services for survivors of SGBV as essential is vital and should be done early in establishing disease prevention and mitigation strategies.

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Section: Discussionmentioning

confidence: 99%

Health professionals’ perspectives on the impact of COVID-19 on sexual and gender-based violence (SGBV) and SGBV services in Rohingya refugee communities in Bangladesh

Chowdhury¹,

McHale

Green

et al. 2022

BMC Health Serv Res

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“…On September 27, 2020, the "44-day war" broke out between Armenia and Azerbaijan over the disputed territory of Nagorno-Karabakh, a region historically inhabited by ethnic Armenians but internationally recognized as part of Azerbaijan. 11 The war claimed the lives of more than 5,000 soldiers from the two sides and at least 143 civilians, 12 as well as resulting in substantial population displacement as the majority of the 75,000 inhabitants of Nagorno-Karabakh migrated to Armenia, 13 thereby exacerbating the growing humanitarian crisis. 14 The six-week war saw at least a seven-fold increase in the daily number of cases of COVID-19, [13][14][15] as population displacement, overcrowded living spaces, war, and social mobilization encouraged disease proliferation.…”

Section: Introductionmentioning

confidence: 99%

“…11 The war claimed the lives of more than 5,000 soldiers from the two sides and at least 143 civilians, 12 as well as resulting in substantial population displacement as the majority of the 75,000 inhabitants of Nagorno-Karabakh migrated to Armenia, 13 thereby exacerbating the growing humanitarian crisis. 14 The six-week war saw at least a seven-fold increase in the daily number of cases of COVID-19, [13][14][15] as population displacement, overcrowded living spaces, war, and social mobilization encouraged disease proliferation. 8,13,16 Armenia's EMS system, already stretched to capacity by the COVID-19 pandemic, was given the additional burden of caring for and evacuating war casualties, sometimes requiring ambulances dispatched from Yerevan six hours away.…”

Section: Introductionmentioning

confidence: 99%

“…14 The six-week war saw at least a seven-fold increase in the daily number of cases of COVID-19, [13][14][15] as population displacement, overcrowded living spaces, war, and social mobilization encouraged disease proliferation. 8,13,16 Armenia's EMS system, already stretched to capacity by the COVID-19 pandemic, was given the additional burden of caring for and evacuating war casualties, sometimes requiring ambulances dispatched from Yerevan six hours away. 6 During the height of the pandemic, YMAS calls increased to 1,000-1,200 calls daily.…”

Section: Introductionmentioning

confidence: 99%

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Emergency Medical Services Preparedness in Dual Disasters: War in the Era of COVID-19 in Armenia

Woodward

Hertelendy

Hart

et al. 2022

Prehosp. Disaster med.

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Introduction: Emergency Medical Services (EMS) is a critical part of Disaster Medicine and has the ability to limit morbidity and mortality in a disaster event with sufficient training and experience. Emergency systems in Armenia are in an early stage of development and there is no Emergency Medicine residency training in the country. As a result, EMS physicians are trained in a variety of specialties. Armenia is also a country prone to disasters, and recently, the Armenian EMS system was challenged by two concurrent disasters when the 2020 Nagorno-Karabakh War broke out in the midst of the SARS-CoV-2/coronavirus disease 2019 (COVID-19) pandemic. Study Objective: This study aims to assess the current state of disaster preparedness of the Armenian EMS system and the effects of the simultaneous pandemic and war on EMS providers. Methods: This was a cross-sectional study conducted by anonymous survey distributed to physicians still working in the Yerevan EMS system who provided care to war casualties and COVID-19 patients. Results: Survey response rate was 70.6%. Most participants had been a physician (52.1%) or EMS physician (66.7%) for three or less years. The majority were still in residency (64.6%). Experience in battlefield medicine was limited prior to the war, with the majority reporting no experience in treating mass casualties (52.1%), wounds from explosives (52.1%), or performing surgical procedures (52.1%), and many reporting minimal to no experience in treating gunshot wounds (62.5%), severe burns (64.6%), and severe orthopedic injuries (64.6%). Participants had moderate experience in humanitarian medicine prior to war. Greater experience in battlefield medicine was found in participants with more than three years of experience as a physician (z-score -3.26; P value <.01) or as an EMS physician (z-score -2.76; P value <.01) as well as being at least 30 years old (z-score -2.11; P value = .03). Most participants felt they were personally in danger during the war at least sometimes (89.6%). Conclusion: Prior to the COVID-19 pandemic and simultaneous 2020 Nagorno-Karabakh War, EMS physicians in Armenia had limited training and experience in Disaster Medicine. This system, and the frontline physicians on whom it relies, was strained by the dual disaster, highlighting the need for Disaster Medicine training in all prehospital medical providers.

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“…This conflict, coinciding with the rapid spread of COVID-19 in NKR and Armenia, interrupted access to cancer care and essential palliative medications. 1,2 Armen was bedridden with intolerable pain and a dwindling supply of analgesics. The encroaching sounds of high-intensity blasts further amplified his anguish and suffering.…”

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confidence: 99%

Cancer and Armed Conflict: Crossing Realities

Kamalyan¹,

Margaryan²,

Arakelyan

et al. 2022

JCO

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In 2007, Armen, a 6-year-old boy from a village in the mountainous Nagorno-Karabakh Republic (NKR), was diagnosed with Hodgkin lymphoma. NKR is a de facto independent state located in the South Caucasus which has historically been inhabited by Armenians and declared its independence after the collapse of Soviet Union in 1991. 1 Armen's hometown had a small clinic offering only routine health care services. To receive treatment for lymphoma, he and his family had to travel 350 kms to the Hematology Center in Yerevan, the capital of Armenia. The journey was long and exhausting, but every visit to the Hematology Center filled him with hope, and, ultimately, he achieved a complete remission.Thirteen years later, Armen, now a young man, returned to the Hematology Center for evaluation of rapid weight loss, persistent pain, and chronic fatigue and was diagnosed with osteosarcoma. First-line chemotherapy and surgery were ineffective, as was second-line therapy with high-dose methotrexate, doxorubicin, and cisplatin. The tumor was growing and spreading rapidly, causing unbearable pain.

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War in Nagorno-Karabakh highlights the vulnerability of displaced populations to COVID-19

Cited by 11 publications

References 10 publications

Health professionals’ perspectives on the impact of COVID-19 on sexual and gender-based violence (SGBV) and SGBV services in Rohingya refugee communities in Bangladesh

Health professionals’ perspectives on the impact of COVID-19 on sexual and gender-based violence (SGBV) and SGBV services in Rohingya refugee communities in Bangladesh

Emergency Medical Services Preparedness in Dual Disasters: War in the Era of COVID-19 in Armenia

Cancer and Armed Conflict: Crossing Realities

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