Publications

2021
Virginia M. Tran, Laila Fozouni, Jana K. Denkinger, Caroline Rometsch, Florian Junne, Patrick Vinck, and Phuong Pham. 7/2021. “Factors influencing utilization and perception of health care: a qualitative study among traumatized Yazidi refugees in Germany.” BMC Psychiatry. Read PublicationAbstract

Background: Ensuring adequate utilization of healthcare services for displaced populations is critical, yet there are well-documented treatment gaps. Yazidi women captured by the Islamic State (IS) were subjected to extreme trauma and violence. This study aims to understand perceptions of healthcare providers and utilization of these services among women who experienced extreme trauma.

Methods: This is a qualitative study with voluntary participation offered to approximately 400 women resettled through the Special Quota Program. An empirical approach was used to collect data and a grounded theory approach was used for content analysis. Participants ranked their interactions with providers on a Likert scale. Posttraumatic stress disorder (PTSD) symptoms were assessed using the impact of event scale-revised questionnaire.

Results: A total of 116 Yazidi women participated in this study. The women experienced an average of 6.8 months of captivity by IS and 93% met criteria for probable PTSD. Eighty-three percent of the women interacted with a physician; 80% found this interaction helpful. Sixty-nine percent interacted with psychologists; 61% found this interaction helpful. Six themes emerged: “reminders of trauma” and “hopelessness” in relation to the traumatic experience; “immediate relief” and “healing through pharmaceutical treatment” in relation to provider interventions, and “support” and “cultural differences” in relation to interactions with providers.

Conclusions: There exist major barriers to care for Yazidi women who experienced extreme trauma, particularly in regards to psychiatric care. Perceptions of healthcare providers and perceived effectiveness of therapy are critical factors that must be taken into consideration to improve healthcare utilization and outcomes.

David Sanderson, Sonny S. Patel, Martin Loosemore, Anshu Sharma, Kelsy Greenwald, and Ronak Patel. 7/2021. “A review of peer-reviewed published research on corruption and disasters in the built environment.” Disasters. Read PublicationAbstract

This paper presents the findings of a review of academic literature concerning the degree to which corruption worsens naturally-triggered disasters in the built environment. The research employed a ‘systematic literature review’ methodology to analyse leading academic databases, resulting in a detailed analysis of 59 peer-reviewed, published papers. It was found that while much of the literature focuses on earthquakes (relating to building and infrastructure collapse), the quality of governance and the drivers of corruption, there is presently limited scholarship concerning the general scope, reach and scale of how disasters are worsened by corruption.

Hanni Stoklosa, Courtney Julia Burns, Abraar Karan, Michelle Lyman, Nathene Morley, Reena Tadee, and Eric Goodwin. 6/2021. “Mitigating trafficking of migrants and children through disaster risk reduction: Insights from the Thailand flood.” International Journal of Disaster Risk Reduction. Read PublicationAbstract

Thailand's flood of 2011 was devastating for the communities and inhabitants of the country, affecting approximately 13 million people and causing damages totaling THB 1.43 trillion (46.5 billion USD). The presence of a natural hazards disaster such as this can magnify individuals' vulnerability to human trafficking, or mitigate it depending on the disaster risk reduction practices of the surrounding community. The Sendai Framework is the United Nations Office for Disaster Risk Reduction's international framework for these situations, outlining targets and priorities for action to reduce negative outcomes, such as trafficking, from natural events. This study aimed to understand how a disaster risk reduction and preparedness lens, based on the Sendai Framework, in the context of the humanitarian response to this 2011 flood, could inform human trafficking prevention efforts for future disasters. Qualitative methodology, utilizing a content analysis approach, was employed. It was found that migrant workers and children were at the greatest risk for trafficking, and resiliency efforts by communities and families, in conjunction with coordinated initiatives by NGOs and the government, were essential in preserving individuals' well-being. Further, the Sendai Framework is a promising tool to address these areas of disaster response in which the windows of opportunity for traffickers can be closed and those at high trafficking risk can be protected. As disasters continue to occur, there remains a strong need to bring forth a more systematic disaster risk reduction and resilience-enhancing approach to trafficking prevention.

Global Health Cluster COVID-19 Task Team. 5/2021. Global Health Cluster Position on COVID-19 Vaccination in Humanitarian Settings. ghc_position_on_covid_19_vaccinations_in_humanitarian_settings_final_1_1.pdf
Sean M. Kivlehan, Kathryne Tenney, Samuel Plasmati, Vincenzo Bollettino, Katie Farineau, Eric J. Nilles, Greg Gottlieb, and Stephanie R. Kayden. 5/2021. “Humanitarian Training with Virtual Simulation during a Pandemic.” Disaster Medicine and Public Health Preparedness. Read PublicationAbstract

There is an ongoing and established need for humanitarian training and professionalization. The COVID-19 pandemic disrupted training programs designed to accomplish this goal, including the Humanitarian Response Intensive Course, which includes a three-day immersive simulation to prepare humanitarian workers for future field work. To provide program continuity, the three day simulation was quickly adapted to a virtual format using a combination of video conferencing, short messaging service, and cloud-based file storage software. Participants were geographically dispersed and participated virtually. Learning objectives were preserved while some components not amenable to a virtual format were removed.

A virtual humanitarian training simulation is a feasible, acceptable, and affordable alternative to an in-person simulation. Participants were engaged and experienced minimal technological disruptions. The majority of students felt the format met or exceeded expectations. However, feedback also emphasized the importance of providing sufficient time for team collaboration and deliverable preparation in the simulation schedule. The virtual format was more affordable than the traditional in-person simulation and diverse expert faculty who could not have attended in-person were able to participate. This format could be used to overcome other barriers to in-person simulation training, including geographic, financial, time, or security.

Jana Katharina Denkinger, Caroline Rometsch, Martha Engelhardt, Petra Windthorst, Johanna Graf, Phuong Pham, Niamh Gibbons, Stephan Zipfel, and Florian Junne. 5/2021. “Longitudinal Changes in Posttraumatic Stress Disorder After Resettlement Among Yazidi Female Refugees Exposed to Violence.” JAMA Network Open.Abstract

Importance: Posttraumatic stress disorder (PTSD) is highly prevalent among refugees surviving mass atrocities, especially among women. Longitudinal studies investigating factors associated with PTSD course are essential to enable adequate treatment yet widely lacking.

Objective: To identify longitudinal changes in PTSD severity and posttraumatic coping among severely traumatized female refugees as well as risk and protective factors for PTSD course.

Design, Setting, and Participants: This prospective cohort study took place in 14 German cities in the context of a humanitarian admission program that resettled 1000 especially vulnerable women and children from northern Iraq to Germany. Approximately 400 adult beneficiaries of the humanitarian admission program were eligible for the study. At baseline, a total of 116 of the 400 beneficiaries (29.0%) participated, with 96 (82.8%) of these women participating in the follow-up assessment. The study included a baseline assessment conducted 2 years after resettlement (September 1, 2017, to January 12, 2018) and a 1-year follow-up (August 29, 2018, to January 15, 2019).

Exposures: Violence and/or captivity during the 2014 genocide in northern Iraq by the so-called Islamic State.

Main Outcomes and Measures: Posttraumatic stress disorder severity and coping strategies were assessed in interpreter-aided interviews using the Impact of Event Scale–Revised.

Results: A total of 116 women (mean [SD] age, 32.2 [8.2] years; 115 [99.1%] Yazidi; 1 [0.9%] Christian) participated at baseline. According to the Impact of Event Scale–Revised, a high PTSD severity was found (mean [SD] raw sum score, 60.88 [15.75] of 88, with higher scores indicating greater distress), with no significant change over time. Helpful coping strategies included prayer, belief in collective strength, and belief in personal strength. Earlier symptoms of intrusions (β = 0.389, P = .007) and longer captivity (β = 0.218, P = .02) were identified as being associated with PTSD severity 1 year later. Longer captivity was associated with PTSD aggravation over time (β = 0.227, P = .04). Posttraumatic strengthening in faith (β = −0.206, P = .05) and in social relationships (β = −0.221, P = .03) were associated with a reduction in PTSD symptoms.

Conclusions and Relevance: These findings suggest that female refugee survivors of genocide are at high risk for severe and chronic PTSD beyond the initial years of resettlement. The findings provide suggestions for mental health care specialized for particularly vulnerable populations.

Longitudinal Changes in Posttraumatic Stress Disorder.pdf
P.N. Pham, L. Fozouni, and al-Saiedi. 4/8/2021. “Association between distress and displacement settings: a cross-sectional survey among displaced Yazidis in northern Iraq.”  BMC Public Health, 21, 679. Publisher's VersionAbstract

Background
Globally 70.8 million people have been forcibly displaced from their homes and are at disproportionally high risk for trauma. At the time of this study, there was an estimated 1.6 million internally displaced persons (IDP) in Iraq, more than two-thirds of whom reside in private, urban settings. This study aims to understand the impact of post-displacement accommodation on mental well-being of the Yazidi minority group displaced in Iraq.

Methods
Multi-stage stratified sampling was used to randomly select IDPs in camp and out of camp settlements in northern Iraq. Standardized questionnaires evaluated factors including exposure to violence and self-reported distress symptoms (measured by Impact of Event Scale-Revised). A multi-variate linear model assessed the relationship between settlement setting and distress symptoms.

Results
One thousand two hundred fifty-six displaced Yazidi participants were included in the study: 63% in camps and 37% out of camps. After controlling for exposure to violence, social cohesion, unemployment, and access to basic services, IDPs in camps were predicted to have a 19% higher mean distress symptom score compared to those out of camps.

Conclusions
This study provides a framework to investigate post-displacement accommodation as a potential intervention to improve well-being for displaced populations. With a shift towards new models of emergency and long-term housing, it is important to understand the potential and limitations of more decentralized models, and identify effective methods to maintain access to basic services while improving living conditions for both displaced populations and their host communities.

s12889-021-10734-8.pdf
Sonny S. Patel, Bernard McCaul, Gabriela Cáceres, Laura E.R. Peters, Ronak Patel, and Aaron Clark-Ginsberg. 4/2021. “Delivering the promise of the Sendai Framework for Disaster Risk Reduction in fragile and conflict-affected contexts (FCAC): A case study of the NGO GOAL's response to the Syria conflict.” Progress in Disaster Science. Read PublicationAbstract

The Sendai Framework for Disaster Risk Reduction (SFDRR) has helped to reduce global disaster risk, but there has been a lack of progress in disaster risk reduction (DRR) for people living in fragile and conflict affected contexts (FCAC). Given the mounting evidence that DRR cannot be implemented through conventional approaches in FCAC, serious efforts must be made to understand how to meet SFDRR's goals. This paper offers a case study of international non-governmental organization GOAL's programming that responds to the protracted crisis in Syria, with a critical discussion on SFDRR and how to adapt humanitarian relief and disaster resilience.

Adrienne Fricke and Rahaf Safi. 3/2021. Window of Hope: Sustaining education of health professionals in northwest Syria.Abstract
This report is based on a comprehensive needs assessment carried out remotely by the HHI team in Syria in 2019. The OSF HESP grant was awarded to a larger project to understand the impact of humanitarian emergencies, including armed conflict, on students enrolled in medical and nursing programs. The goal is to produce a needs assessment toolkit to help support professional health care education programs during conflict. In addition to Syria, where the conflict is ongoing, the project examines Colombia, a recent post-conflict setting, and Rwanda, a developed post-conflict setting.
hhi_woh_final.pdf
Amir Khorram-Manesh, Phatthranit Phattharapornjaroen, Luc J Mortelmans, and Frederick M. Burkle Jr. 2/2021. “Current Perspectives and Concerns Facing Hospital Evacuation: The Results of a Pilot Study and Literature Review.” Disaster Medicine and Public Health Preparedness. Read PublicationAbstract

Objective: To analyze the evacuation preparedness of hospitals within the European Union (EU).

Method: This study consisted of 2 steps. In the first step, a systematic review of the subject matter, according to the PRISMA flow diagram, was performed. Using Scopus (Elsevier, Amsterdam, Netherlands), PubMed (National Library of Medicine, Bethesda, MD), and Gothenburg University´s search engine, 11 questions were extracted from the review and were sent to representatives from 15 European Union (EU)- and non-EU countries.

Results: The findings indicate that there is neither a full preparedness nor a standard guideline for evacuation within the EU or other non-EU countries in this study. A major shortcoming revealed by this study is the lack of awareness of the untoward consequences of medical decision-making during an evacuation. Some countries did not respond to the questions due to the lack of relevant guidelines, instructions, or time.

Conclusion: Hospitals are exposed to internal and external incidents and require an adequate evacuation plan. Despite many publications, reports, and conclusions on successful and unsuccessful evacuation, there is still no common guide for evacuation, and many hospitals lack the proper preparedness. There is a need for a multinational collaboration, specifically within the EU, to establish such an evacuation planning or guideline to be used mutually within the union and the international community.

Krzysztof Goniewicz, Mariusz Goniewicz, Frederick M. Burkle Jr., and Amir Khorram-Manesh. 1/2021. “Cohort research analysis of disaster experience, preparedness, and competency-based training among nurses.” PLoS ONE. Read PublicationAbstract

Introduction: It is expected that in unforeseen situations, nurses will provide appropriate medical interventions, using their expertise and skills to reduce the risks associated with the consequences of disasters. Consequently, it is crucial that they are properly prepared to respond to such difficult circumstances. This study aimed to identify the factors influencing the basic competences of nurses in disasters.

Materials and methods: The survey was directed to 468 nurses from all medical centres in Lublin. IBM SPSS Statistics version 23 was used for statistical analyses, frequency analysis, basic descriptive statistics and logistic regression analysis. The classical statistical significance level was adopted as α = 0.05.

Results: Based on the logistic regression analysis, it was found that work experience, workplace preparedness, as well as training and experience in disaster response are important predictors of preparedness.

Conclusions: These findings indicate that the nurses' core competencies for these incidents can be improved through education and training programmes which increase their preparedness for disasters. Nurses are among the most important groups of healthcare professionals facing a disaster and should be involved in all phases of disaster management, such as risk assessment and pre-disaster planning, response during crisis situations and risks’ mitigation throughout the reconstruction period.

Krzysztof Goniewicz, Mariusz Goniewicz, Anna Włoszczak-Szubzda, Frederick M. Burkle Jr., Attila J. Hertelendy, Ahmed Al-Wathinani, Michael Sean Molloy, and Amir Khorram-Manesh. 1/2021. “The importance of pre-training gap analyses and the identification of competencies and skill requirements of medical personnel for mass casualty incidents and disaster training.” BMC Public Health.Abstract

Background: Effective preparedness to respond to mass casualty incidents and disasters requires a well-planned and integrated effort by all involved professionals, particularly those who are working in healthcare, who are equipped with unique knowledge and skills for emergencies. This study aims to investigate and evaluate the level of knowledge and skills related to mass casualty and disaster management in a cohort of healthcare professionals.

Methods: A cross-sectional brief study was conducted using a validated and anonymous questionnaire, with a sample of 134 employees at a clinical hospital in Lublin, Poland.

Results: The findings of this study may indicate a need for standardization of training for hospitals employees. It also suggests a knowledge gap between different professional groups, which calls for adjusting such general training, to at least, the weakest group, while special tasks and mission can be given to other groups within the training occasion.

Conclusion: Pre-Training gap analyses and identification of participants’ competencies and skills should be conducted prior to training in mass casualty incidents and disasters. Such analyses provides an opportunity to develop training curriculum at various skill and knowledge levels from basic to advance. All training in mass casualty incidents and disasters should be subject to ongoing, not just periodic, evaluation, in order to assess continued competency.

importance_of_pre-training_gap_analyses.pdf
Amir Khorram-Manesh, Krzysztof Goniewicz, and Frederick M. Burkle Jr. 1/2021. “Unrecognized risks and challenges of water as a major focus of COVID-19 spread.” Journal of Global Health . Read PublicationAbstract

The unpredictable emergence of Coronavirus 2019 has proven to be challenging for many countries and their preparedness systems. In the heat of the current pandemic, initial interventions have been directed to the medical component of pandemic management, while other parameters such as tracing, retaining, and controlling the infection have been dismantled. It must be remembered that a defective water management system for drinking or personal use cannot only worsen the medical management of an emergency but can also contribute to spreading the disease or other water-borne conditions. This report highlights the significant use of water as a necessity for life and for controlling the pandemic.

Scott A. Goldberg, Rebecca E. Cash, Gregory Peters, Scott G.Weiner, P. Gregg Greenough, and Raghu Seethala. 2021. “The impact of COVID‐19 on statewide EMS use for cardiac emergencies and stroke in Massachusetts.” JACEP Open. Publisher's VersionAbstract

Objective

To evaluate the impact of coronavirus disease 2019 (COVID‐19) on emergency medical services (EMS) use for time‐sensitive medical conditions. We examined EMS use for cardiac arrest, stroke, and other cardiac emergencies across Massachusetts during the peak of the COVID‐19 pandemic, evaluating their relationship to statewide COVID‐19 incidence and a statewide emergency declaration.

Methods

A retrospective analysis of all EMS calls between February 15 and May 15, 2020 and the same time period for 2019. EMS call volumes were compared before and after March 10, the date of a statewide emergency declaration.

Results

A total of 408,758 calls were analyzed, of which 49,405 (12.1%) represented stroke, cardiac arrest, or other cardiac emergencies. Average call volume before March 10 was similar in both years but decreased significantly after March 10, 2020 by 18.7% (P < 0.001). Compared to 2019, there were 35.6% fewer calls for cardiac emergencies after March 10, 2020 (153.6 vs 238.4 calls/day, P < 0.001) and 12.3% fewer calls for stroke (40.0 vs 45.6 calls/day, P = 0.04). Calls for cardiac arrest increased 18.2% (28.6 vs 24.2 calls/day, P < 0.001). Calls for respiratory concerns also increased (208.8 vs 199.7 calls/day, P < 0.001). There was no significant association between statewide incidence of COVID‐19 and EMS call volume.

Conclusions

EMS use for certain time‐sensitive conditions decreased after a statewide emergency declaration, irrespective of actual COVID‐19 incidence, suggesting the decrease was related to perception instead of actual case counts. These findings have implications for public health messaging. Measures must be taken to clearly inform the public that immediate emergency care for time‐sensitive conditions remains imperative.

impactcovid19starewideemsrunscardiacstrokema.pdf
Sonny S. Patel, Oleksii Sukhovii, Oleksandr Zvinchuk, Julian H. Neylan, and Timothy Erickson. 2021. “Converging Impact of the Ongoing Conflict and COVID-19 Pandemic on Mental Health and Substance Use Disorders in Ukraine.” Journal of Emergency Management. Read PublicationAbstract

Since the Russian annexation of the Autonomous Republic of Crimea and the subsequent occupation of parts of the Donetsk and Luhansk regions, Ukraine has been facing increasing security and healthcare challenges. The seven-year war in East Ukraine has led to a rise in substance and alcohol use and increasing addiction rates among veterans, internally displaced persons, and civilian survivors. This article examines the combined impact of the ongoing Russo–Ukrainian conflict and COVID-19 pandemic on substance use in Ukraine. It also gives an overview of the institutions in place to monitor and improve mental health in the country. The article highlights the urgent need for further funding and research on substance and alcohol addiction, with vulnerable populations affected by the conflict during the COVID-19 pandemic. Frontline healthcare workers in this region should anticipate an increased burden of patients suffering from substance use disorders who are in need of emergency management intervention and proper behavioral health referrals.

PR Chai, EG Ferro, JM Kirshenbaum, BD Hayes, SE Culbreth, EW Boyer, and TB Erickson. 2021. “In Reply to "Hydroxychloroquine Overdose: What Are the Exact Roles of Diazepam and Potassium Infusion?"” J Med Toxicol, 17, 1, Pp. 85-86.
2020
Amir Khorram-Manesh and Frederick M. Burkle Jr. 12/2020. Emergencies and Public Health Crisis Management-Current Perspectives on Risks and Multiagency Collaboration. MDPI.Abstract

Disasters and public health emergencies are inevitable and can happen anywhere and anytime. However, they can be mitigated and their impacts can be minimized by utilizing appropriate measures in all four different phases of disaster management, i.e., mitigation and prevention, preparedness, response, and recovery. Several factors are crucial for achieving successful disaster management. Altogether, this Issue offers new insights into emergency and public health crisis management from a multiagency perspective and allows discussion about new potential risks; lessons learned; and the introduction of new concepts such as flexible surge capacity, and shows some new aspects of practicing multiagency collaboration before, during, and after disasters and public health emergencies.

emergencies_and_public_health_crisis_management.pdf
Krzysztof Goniewicz, Frederick M. Burkle Jr., and Amir Khorram-Manesh. 12/2020. “Implications and limitations of Social Distancing Strategies (SDS) to mitigate the impact of COVID-19 pandemic.” Disaster Medicine and Public Health Preparedness. implications-and-limitations-of-social-distancing.pdf
Erica Nelson, Saira Khan, Swapna Thorve, and P. Gregg Greenough. 12/2020. “Modeling pastoralist movement in response to environmental variables and conflict in Somaliland: Combining agent-based modeling and geospatial data.” PLOS ONE.Abstract

This study explores how pastoralists respond to changing environments in Somaliland . An agent-based model is used to simulate the movement of nomadic pastoralists based on typologically diverse, historical data of environmental, interpersonal, and transactional variables in Somaliland and Puntland between 2008 and 2018. Through subsequent application of spatial analysis such as choropleth maps, kernel density mapping, and standard deviational ellipses, we characterize the resultant pastoralist population distribution in response to these variables.

modeling_nomadic_pastoral_migration_conflict_environment.pdf
Amir Khorram-Manesh, Frederick M. Burkle Jr., Phatthranit Phattharapornjaroen, Milad Ahmadi Marzaleh, Mohammed Al Sultan, Matti Mantysaari, Eric Carlström, Krzysztof Goniewicz, Emelia Santamaria, John David Comandante, Robert Dobson, Boris Hreckovski, Glenn-Egil Torgersen, Luc J. Mortelmans, Mirjam de Jong, and Yohan Robinson. 11/2020. “The Development of Swedish Military Healthcare System: Part II-Re-evaluating the Military and Civilian Healthcare Systems in Crises Through a Dialogue and Study Among Practitioners.” Military Medicine.Abstract

Introduction: Historical changes have transformed Sweden from being an offensive to a defensive and collaborative nation with national and international engagement, allowing it to finally achieve the ground for the civilian–military collaboration and the concept of a total defense healthcare. At the same time, with the decreasing number of international and interstate conflicts, and the military’s involvement in national emergencies and humanitarian disaster relief, both the need and the role of the military healthcare system within the civilian society have been challenged. The recent impact of the COVID-19 in the USA and the necessity of military involvement have led health practitioners to anticipate and re-evaluate conditions that might exceed the civilian capacity of their own countries and the need to have collaboration with the military healthcare. This study investigated both these challenges and views from practitioners regarding the benefits of such collaboration and the manner in which it would be initiated.

Material and Method: A primary study was conducted among responsive countries using a questionnaire created using the Nominal Group Technique. Relevant search subjects and keywords were extracted for a systematic review of the literature, according to the PRISMA model.

Results: The 14 countries responding to the questionnaire had either a well-developed military healthcare system or units created in collaboration with the civilian healthcare. The results from the questionnaire and the literature review indicated a need for transfer of military medical knowledge and resources in emergencies to the civilian health components, which in return, facilitated training opportunities for the military staff to maintain their skills and competencies.

Conclusions: As the world witnesses a rapid change in the etiology of disasters and various crises, neither the military nor the civilian healthcare systems can address or manage the outcomes independently. There is an opportunity for both systems to develop future healthcare in collaboration. Rethinking education and training in war and conflict is indisputable. Collaborative educational initiatives in disaster medicine, public health and complex humanitarian emergencies, international humanitarian law, and the Geneva Convention, along with advanced training in competency-based skill sets, should be included in the undergraduate education of health professionals for the benefit of humanity.

thedevelopmentofswedishmilitaryhealthcaresystem_partii.pdf

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