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BACKGROUND: This study explores the impacts of attacks perpetrated in the context of armed conflict, to female health workers in three Colombian territories. METHODS: We conducted a document review of the reports and databases of the Colombian Truth Commission, 17 in-depth semi-structured interviews with experts on the national and regional armed conflict and the medical mission, and 26 female health workers who were victims of attacks. RESULTS: Experts and female health workers reported attacks to health activities, facilities, equipment, and personnel, including attacks to traditional doctors belonging to indigenous communities. The most frequent attacks were threats and retention of health personnel; theft of supplies and medicines; damage and use of infrastructure and means of transport for purposes other than health care; and hinderance of health service provision. The attacks occurred in a framework of structural violence that intersects with poverty, racism, and gender bias. The impacts of these attacks include gender-based violence, significant disruption of the lives of health workers, and physical, emotional, psychological, social, and economic effects on the victims and their families. The government response to protect victims and populations has been absent or insufficient. CONCLUSIONS: Attacks to health care were reported in all the studied territories obstructing adequate health care. Impacts of these attacks affect negatively the professional and personal life of the workers and are aggravated by structural violence and absent or little institutional response.

Background: Armed conflict severely impacts children's health, leading to malnutrition and increased child mortality. The republic of South Sudan gained independence from Sudan in 2011 and suffered from seven-years civil war between December 2013–2021. The war led to mass population displacement both internally and externally and worsened the health status of the population, especially the children. Aim: To investigate the effect of conflict intensity on global acute malnutrition and under-five crude mortality rate in South Sudan during the civil war between 2014–2021. Methods: The study used an ecological panel data analysis of armed conflict data from Uppsala Conflict Data Program (UCDP) and child health data from Standardized Monitoring and Assessment of Relief and Transitions surveys conducted in 2014–2021. Child health is evaluated as global acute malnutrition (GAM) and under-five crude mortality rate (U5CMR). The study analyzed the correlation between the intensity of conflict and the prevalence of malnutrition and under-five crude mortality on a state level. Internal displacement and food prices were used as indirect effects of conflict. One year lag effect regressions were used to estimate potential correlation between child health and armed conflict. Results: Total number of conflict related deaths between 2014–2021 was on best estimate (9,577), and on high estimate (13,178). The average GAM rate for the same period was (15.29%), and U5CMR was (0.77). Data analysis showed a significant correlation between the high estimate of conflict intensity with GAM (.047), and with U5CMR (.043). Internal displacement and food prices had a significant correlation with GAM (P =.048, P =.016), but no significant correlation was noticed with U5CMR. Best estimate of conflict intensity did not show a significant effect on children health variables. Conclusion: The effect of conflict on children's health outcome is complex and multifactorial. The high estimate of conflict intensity from UCDP showed significant correlation with the health outcome, while best estimate did not have significant correlation, this could be due to limited child health data, underreporting of conflict-related deaths, and a small sample size. The study suggests that other factors such as food prices and displacement might play an additional factor that increases the effect of conflict intensity on child health outcomes. The study underscores the challenge of data scarcity in researching health determinants in South Sudan. [ABSTRACT FROM AUTHOR]

Background: The convergence of global demographic changes and rising humanitarian crises in low- and middle-income countries (LMICs) has raised the number of affected older people (OP). These individuals face the challenges of aging and the adverse conditions of disasters, particularly pronounced in LMICs. This review aims to explore literature on the health and well-being of older populations during humanitarian crises in LMICs. Methods: This scoping review included primary studies on the health and well-being of older populations in humanitarian crises in LMIC. A search was conducted in five bibliographic databases last updated in 2023. A numerical summary and thematic analysis of study characteristics and themes were executed and findings were narratively synthesized. Results: A total of 84 eligible studies were included. The majority of studies were quantitative (n = 56), followed by qualitative (n = 22) and mixed-methods (n = 6). Most literature focuses on the high burden of mental health conditions and their determinants, such as depression, anxiety, and Post-Traumatic Stress Disorder (PTSD). The second most common theme is physical health, discussing high levels of mortality, disability, some non-communicable diseases, and limited evidence on the poor nutritional status. OP lack access to routine healthcare due to cost barriers. The key gaps in the literature are in mental and psychosocial health, especially pertaining to vulnerabilities and risk factors, and to contextualized interventions. Physical health research is relatively narrow lacking a wider range of chronic diseases while no research was performed on communicable diseases other than COVID-19. Conclusions: Findings show the complex vulnerabilities of OP in humanitarian crises which exacerbate their physical, mental, and psychosocial health outcomes. There is a need to strengthen evidence on the effectiveness of interventions, and to investigate determinants of health, especially mental and psychosocial health, across different contexts. Research should also explore cross-cutting issues like gender, access to livelihoods, and equitable access to humanitarian assistance. [ABSTRACT FROM AUTHOR]

Background: Armed conflicts cause food insecurity and famine by triggering the disruption and destruction of food systems. The conflict that erupted in northern Ethiopia lasted from 2020 to 2022 and affected millions of people. This resulted in severe damage to the food security, livelihoods and social dynamics of communities in the Amhara region. Objective: This study synthesized the impact of the conflict in northern Ethiopia on food security, livelihoods and social dynamics livelihoods in there zones, South Wello, North Wello and North Shewa zones of the Amhara Region. The conflict management response and the scope of humanitarian assistance are also analyzed. Methods: The study used a qualitative case study design. Primary data were collected through semi-structured interviews, focus group discussions and observation. Data were collected from local authorities, representatives of displaced people, government and non-government officials who responded to the crisis and from the community members who were directly affected by the conflict. The primary data were supplemented by a review of reports from credible secondary sources. The research used thematic and narrative analysis techniques to synthesize the impact of armed conflicts on food security, livelihoods, and social dynamics in Amhara region, Ethiopia. Results: Over 5.5 million people found to be affected by acute food insecurity and over half a million people were internally displaced due to the Northern conflict. The monetary value of the damage caused by the armed conflict is estimated at $500 million, due to the damage to basic services and the loss of 14 million quintals of agricultural production. The conflict has disrupted food systems by damaging agricultural infrastructure, causing market distortions and causing food shortages. Livelihoods were threatened by the loss of jobs and the destruction of private and municipal property. The destruction of the basic infrastructure such as health, water and sanitation, agriculture and market institutions inevitably have lasting negative impacts on the overall productivity of the community. Communities' religious and traditional values, informal social networks ​​are affected by the impact of armed conflict, complicating communities' reconstruction efforts. Conclusion and recommendation: The northern armed conflict has significant negative impacts on the food security, livelihoods and social dynamics of people in the Amhara region. Recognizing the multiple impacts of conflict livelihoods in the region is a critical step in developing effective responses. Government, non-governmental organizations, and community-based institutions should play a crucial role in building community resilience and support post-conflict reconstruction efforts. Future studies can capitalize on this qualitative finding and could design a large scale assessment using quantified data to further provide evidence on post-conflict reconstruction efforts. [ABSTRACT FROM AUTHOR]

Modern high-intensity armed conflicts often lead to extensive damage to urban infrastructure. The use of high-resolution remote sensing images can clearly detect damage to individual buildings which is of great significance for monitoring war crimes and damage assessments that destroy civilian infrastructure indiscriminately. In this paper, we propose SOCA-YOLO (Sampling Optimization and Coordinate Attention–YOLO), an automatic detection method for destroyed buildings in high-resolution remote sensing images based on deep learning techniques. First, based on YOLOv8, Haar wavelet transform and convolutional blocks are used to downsample shallow feature maps to make full use of spatial details in high-resolution remote sensing images. Second, the coordinate attention mechanism is integrated with C2f so that the network can use the spatial information to enhance the feature representation earlier. Finally, in the feature fusion stage, a lightweight dynamic upsampling strategy is used to improve the difference in the spatial boundaries of feature maps. In addition, this paper obtained high-resolution remote sensing images of urban battlefields through Google Earth, constructed a dataset for the detection of objects on buildings, and conducted training and verification. The experimental results show that the proposed method can effectively improve the detection accuracy of destroyed buildings, and the method is used to map destroyed buildings in cities such as Mariupol and Volnovaja where violent armed conflicts have occurred. The results show that deep learning-based object detection technology has the advantage of fast and accurate detection of destroyed buildings caused by armed conflict, which can provide preliminary reference information for monitoring war crimes and assessing war losses. [ABSTRACT FROM AUTHOR]

When armed conflicts disrupt urban water supply, local communities are forced to find other ways to fulfill their domestic water needs. In this paper, we analyze the development of decentralized water infrastructure as a coping strategy during armed conflict in five cities across Iraq, Syria and Yemen. We discuss the implications of conflict-driven decentralization on the resilience of urban water supply infrastructure, addressing its functionality, its recovery in case of disruption, and its sustainability on the long term. The results indicate that decentralized water supply systems developed throughout conflict uphold a basic level of functionality and minimize their vulnerability to conflict-related shocks. However, short-term resilience gains come at the cost of health risks and high water prices, and undermine system sustainability due to a lack of coordination. We conclude that decentralization processes implemented within the constraints of armed conflict are often detrimental to infrastructure resilience, particularly over longer timeframes. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of brief self-report parenting measures validated for use in low- and middle-income countries (LMICs). We developed the Brief Parenting Questionnaire (BPQ), a 24-item self-report measure for use with parents of children ages 3–12. Objective: We describe the development and evaluation of the psychometric properties of the BPQ, which was designed to include two subscales: warm and responsive parenting (WRP) and harsh parenting (HP). Participants and setting: The sample included an equal number of male and female caregivers (n = 480) from 240 families in North Lebanon that took part in a randomized controlled trial (RCT) of the Caregiver Support Intervention. Study participants were primarily Syrian (95.2%); others were Lebanese (4.2%) and Palestinian (0.6%). Methods: The development of the BPQ is described. To assess its psychometric properties, we used data from the RCT for which the instrument was developed. Confirmatory factor analysis (CFA) was used to examine the factor structure of the BPQ. The reliability of the BPQ and its potential subscales was assessed by examining the internal consistency using Cronbach's alpha and McDonald's omega. Multi-group CFA was conducted to identify if the same two constructs were being measured across mothers and fathers. Results: A two-factor model best fit the data, with 16 items loading on WRP and seven items on HP, corresponding to the two parenting dimensions the scale was designed to assess. Internal consistency was good: full scale ɑ=0.83, WRP ɑ=0.86, and HP ɑ=0.76. One item not loading on either subscale was retained for theoretical reasons. Conclusions: The BPQ is a brief culturally grounded self-report measure of parenting validated for use with Middle Eastern Arabic speaking parents. The data for this paper come from a pre-registered trial: ISRCTN33665023. [ABSTRACT FROM AUTHOR]

This paper examines the political aspects and reasoning behind collective organization during the contemporary armed conflict in Colombia, focusing on three key historical moments. The first section explores the emergence of collaborative groups within the context of the conflict, while the second section delves into the history of collective resistance to violence. Finally, we discuss the various tactics, networks, and community-based initiatives that have been established as active responses to the pain caused by the conflict in Colombia. We hypothesize that these associations should be viewed through a pluralistic lens, recognizing their inclination towards exploring new living possibilities and capabilities development. [ABSTRACT FROM AUTHOR]

Background: Many older adults in Colombia have lived through violent and stressful life events, particularly in areas of poverty. The aim of this qualitative study was to understand the impact of stressful life events on the mental health and wellbeing of older Colombians living in areas of relative poverty. Methods: Older adults (aged 60+) living in the Turbo region in Colombia were interviewed face-to-face between August and December 2021. Transcripts were coded in Spanish and English by at least two researchers, using inductive thematic analysis. Results: Twenty-six older adults participated in the study. Four overarching themes were generated: Living in violent and dangerous communities; Disturbing gender violence and gender roles; Lack of mental health awareness; Coping mechanisms. Older adults experienced a long narrative of stressful life events. Younger generations appeared to disrespect older members of Society. Without any mental health support, older adults coped by accepting the extreme situations or seeking solace in their faith. Conclusions: The health system and Government need to build up trust and generate an awareness of mental health, as older Colombians will not approach psychological support otherwise. Intergenerational community-based interventions may provide a first avenue of mental health support. [ABSTRACT FROM AUTHOR]

Armed conflict has tragically become commonplace in the lives of many children. Children do not only witness conflict violence and are subjected to it, but are also sometimes forced to perpetrate violence themselves. Recently, scholars from different fields have examined these experiences. However, few scholars have considered the experiences of girls or have compared these experiences to those of boys. This is surprising given the increased focus of the international community on the protection of girls. This exploratory study is an attempt to overcome this by examining the experiences of boys and girls during conflict and whether these gendered experiences have influenced social relationships in the aftermath of war. Empirically, we rely on 315 structured interviews with Congolese boys and girls. Some of these children were actively involved in armed groups in the Eastern provinces of the Democratic Republic of the Congo. Our descriptive analysis shows remarkable differences between boys and girls. This work has important consequences for the study of the effect of conflict on children, the role of girls during and after conflict, and the international policy community. [ABSTRACT FROM AUTHOR]

Protest is a low-intensity form of political conflict that can precipitate intrastate armed conflict. Data on protests should therefore be informative in systems that provide early warnings of armed conflict. However, since most protests do not escalate to armed conflict, we first need theory to inform our prediction models. We identify three theoretical explanations relating to protest-repression dynamics, political institutions and economic development as the basis for our models. Based on theory, we operationalize nine models and leverage the political Violence Early Warning System (ViEWS) to generate subnational forecasts for intrastate armed conflict in Africa. Results show that protest data substantially improves conflict incidence and onset predictions compared to baseline models that account for conflict history. Moreover, the results underline the centrality of theory for conflict forecasting: our theoretically informed protest models outperform naive models that treat all protests equally. [ABSTRACT FROM AUTHOR]

This article presents arguments about the ethics of sending weapons to Ukraine in support of its war of self-defence against Russian aggression. It does so by situating the debate about the rights and wrongs of supplying arms to Ukraine within the frame of jus ad vim (the just use of force-short-of-war). Concentrating on the German debate, which has been particularly polarized, the article demonstrates how the moral vocabulary of jus ad vim can illuminate the difficult moral choices associated with providing lethal aid to Ukraine. In particular, the article shows how the objective of not getting drawn into war with Russia foregrounds the 'probability of escalation' principle of jus ad vim. In addition, the German chancellor's avoidance of the term 'victory' as the desired outcome of his nation's support for Ukraine points to the concept of a 'moral truncated victory' and the re-establishment and containment principles of jus ad vim. However, while the moral vocabulary of jus ad vim leads to a deeper understanding of the ethical challenges NATO leaders are facing in their provision of weapons to Ukraine, the article concludes that the acceptance of moral truncated victory highlights one of the main critiques of this new framework, namely that it risks creating a morally problematic regime of perpetual force, or vis perpetua. [ABSTRACT FROM AUTHOR]

The mass destruction of heritage sites by Islamic State (IS) led to significant advances in the legal and normative frameworks governing global responses to heritage destruction in conflict. However, despite the scale and intensity of these efforts, the overwhelming majority of mandates and resolutions on heritage destruction are gender-blind. By applying a feminist International Relations perspective, we seek to answer the following research questions: how, and to what extent, do gender and heritage destruction intersect in conflict, and what explains the omission of gender in multilateral responses to heritage destruction? To answer these questions, we analyse the responses of key global agencies to the destruction carried out by IS and juxtapose them against results from in-depth semi-structured interviews conducted with a diverse group of Syrian and Iraqi women, all of whom were directly affected by attacks on their heritage. In doing so, we demonstrate the complex ways that women experience heritage destruction in conflict, thereby highlighting the systemic failures of the international community to grasp the gendered implications of such destruction. We also demonstrate how the absence of gender in institutionalized responses to heritage destruction is indicative of the relegation of feminized identities and experiences in contemporary accounts of war. [ABSTRACT FROM AUTHOR]

Mobile money has developed as an indigenous digital innovation in a Somali setting characterized by state weakness and scarcity of local physical currency. On one level, this article presents experiences of this financial technology (and 'cashlessness') from perspectives of marginalized people displaced by conflict and ecological shocks. However, we also analyse these everyday experiences in the context of rapid urbanization, connecting them to the role of the Somali telecoms sector within a wider political economy of conflict and internationalized statebuilding. Leveraging its power as an intermediary transactions platform, the telecoms sector has assumed various state-like functions. This demonstrates how diverse forms of virtual sovereignty may emerge beyond globally dominant centres of technology production. Although humanitarian mobile money aid infrastructure is being positioned by donors to evolve into digitized social protection systems that will empower Somalia's fragile state, this imagined transition is underpinned by a commercial telecoms sector that continues to consolidate its power in the wider economy by capitalizing on the circulation of digital financial flows. Greater policy attention therefore needs to be paid to the capacity of this sector to create conditions that may constrain the (re)construction of state authority vis-à-vis future monetary policy, the conflict economy and (international) governance of recurrent humanitarian crises. [ABSTRACT FROM AUTHOR]

The purpose of this scoping review was to ascertain the scope and nature of the literature focused on intimate partner violence (IPV) among Afghans across contexts, including Afghanistan. The scoping review adopted a systematic approach to search for, identify, and include peer-reviewed articles published in English. Fifty-two articles were retained in the final analysis, which generated results on IPV prevalence; multi-level risk and protective factors; qualitatively derived contextual factors; associations of IPV with adverse physical and psychological outcomes; IPV-related help-seeking behaviors; programs and interventions; the role of religion; IPV-related policies; and the role of fiction. Findings indicate that past-year physical IPV prevalence ranged from 52% to 56% in Afghanistan and 79.8% among Afghan refugees displaced in Iran. Studies conducted in Afghanistan identified a range of IPV risk factors occurring at the individual (e.g., age and employment), interpersonal/household (e.g., acceptance of IPV and violence perpetrated by in-laws), and societal levels (e.g., conflict/displacement). The findings highlight a rich literature on IPV in Afghanistan and significant gaps in IPV research across the Afghan diaspora and in contexts of displacement and resettlement. The results advance understanding of the drivers of IPV in the diverse Afghan population and highlight context-specific gaps, and needs for intervention and future research. These gaps indicate the importance of conducting research elucidating how risk and protective factors associated with IPV shift in forced migration and resettlement, and an urgent need for the development and testing of services and programs that respond to the specific needs of Afghan women experiencing IPV across contexts. [ABSTRACT FROM AUTHOR]

This article explores the evolving legal landscape of environmental protection in armed conflict, emphasizing the critical contributions of the ICRC Environmental Guidelines and the principles developed by the International Law Commission's (ILC) on Protection of the Environment in relation to Armed Conflict (PERAC principles). By incorporating scientific insights and increasing environmental awareness, these frameworks encourage a broader understanding of environmental damage that includes direct and indirect impacts on ecosystems. In particular, the PERAC principles' temporal approach, introduced by Special Rapporteur Marie Jacobsson, marks a significant shift towards recognizing environmental harm as a complex, multi-stage issue spanning before, during, and after armed conflict. Drawing on the jurisprudence of the Special Jurisdiction for Peace (the JEP) in the transitional justice context of Colombia, the article underscores how the temporal approach can address also long-lasting environmental consequences on vulnerable populations, particularly Indigenous peoples by being informed by Indigenous law. [ABSTRACT FROM AUTHOR]

The principle of military necessity is a cornerstones of the law of armed conflict, embedded in both codified and customary norms. In many cases, the limited rules that provide environmental protection in armed conflicts are overshadowed by this principle. However, supportive and compatible foundations can be drawn from other principles of humanitarian law, such as the principles of distinction and proportionality. On the other hand, the effects of methods and tools used in armed conflicts, justified by the principle of necessity, can persist for years in the environment of conflict areas and even neighboring territories. The primary mission of international humanitarian law is to protect victims of armed conflicts. Protecting humanity is not possible without considering the necessities of its natural environment. This paper assumes that the legitimacy and manner of invoking the aforementioned principle, specifically to justify environmental damages by perpetrators, deserve attention and examination as some believe that environmental considerations are not prioritized in situations of war and can be overlooked in light on account of military necessities. [ABSTRACT FROM AUTHOR]

Abstract Background Armed conflict severely impacts children's health, leading to malnutrition and increased child mortality. The republic of South Sudan gained independence from Sudan in 2011 and suffered from seven-years civil war between December 2013–2021. The war led to mass population displacement both internally and externally and worsened the health status of the population, especially the children. Aim To investigate the effect of conflict intensity on global acute malnutrition and under-five crude mortality rate in South Sudan during the civil war between 2014–2021. Methods The study used an ecological panel data analysis of armed conflict data from Uppsala Conflict Data Program (UCDP) and child health data from Standardized Monitoring and Assessment of Relief and Transitions surveys conducted in 2014–2021. Child health is evaluated as global acute malnutrition (GAM) and under-five crude mortality rate (U5CMR). The study analyzed the correlation between the intensity of conflict and the prevalence of malnutrition and under-five crude mortality on a state level. Internal displacement and food prices were used as indirect effects of conflict. One year lag effect regressions were used to estimate potential correlation between child health and armed conflict. Results Total number of conflict related deaths between 2014–2021 was on best estimate (9,577), and on high estimate (13,178). The average GAM rate for the same period was (15.29%), and U5CMR was (0.77). Data analysis showed a significant correlation between the high estimate of conflict intensity with GAM (.047), and with U5CMR (.043). Internal displacement and food prices had a significant correlation with GAM (P = .048, P = .016), but no significant correlation was noticed with U5CMR. Best estimate of conflict intensity did not show a significant effect on children health variables. Conclusion The effect of conflict on children’s health outcome is complex and multifactorial. The high estimate of conflict intensity from UCDP showed significant correlation with the health outcome, while best estimate did not have significant correlation, this could be due to limited child health data, underreporting of conflict-related deaths, and a small sample size. The study suggests that other factors such as food prices and displacement might play an additional factor that increases the effect of conflict intensity on child health outcomes. The study underscores the challenge of data scarcity in researching health determinants in South Sudan.

Abstract Background Armed conflicts cause food insecurity and famine by triggering the disruption and destruction of food systems. The conflict that erupted in northern Ethiopia lasted from 2020 to 2022 and affected millions of people. This resulted in severe damage to the food security, livelihoods and social dynamics of communities in the Amhara region. Objective This study synthesized the impact of the conflict in northern Ethiopia on food security, livelihoods and social dynamics livelihoods in there zones, South Wello, North Wello and North Shewa zones of the Amhara Region. The conflict management response and the scope of humanitarian assistance are also analyzed. Methods The study used a qualitative case study design. Primary data were collected through semi-structured interviews, focus group discussions and observation. Data were collected from local authorities, representatives of displaced people, government and non-government officials who responded to the crisis and from the community members who were directly affected by the conflict. The primary data were supplemented by a review of reports from credible secondary sources. The research used thematic and narrative analysis techniques to synthesize the impact of armed conflicts on food security, livelihoods, and social dynamics in Amhara region, Ethiopia. Results Over 5.5 million people found to be affected by acute food insecurity and over half a million people were internally displaced due to the Northern conflict. The monetary value of the damage caused by the armed conflict is estimated at $500 million, due to the damage to basic services and the loss of 14 million quintals of agricultural production. The conflict has disrupted food systems by damaging agricultural infrastructure, causing market distortions and causing food shortages. Livelihoods were threatened by the loss of jobs and the destruction of private and municipal property. The destruction of the basic infrastructure such as health, water and sanitation, agriculture and market institutions inevitably have lasting negative impacts on the overall productivity of the community. Communities’ religious and traditional values, informal social networks ​​are affected by the impact of armed conflict, complicating communities’ reconstruction efforts. Conclusion and recommendation The northern armed conflict has significant negative impacts on the food security, livelihoods and social dynamics of people in the Amhara region. Recognizing the multiple impacts of conflict livelihoods in the region is a critical step in developing effective responses. Government, non-governmental organizations, and community-based institutions should play a crucial role in building community resilience and support post-conflict reconstruction efforts. Future studies can capitalize on this qualitative finding and could design a large scale assessment using quantified data to further provide evidence on post-conflict reconstruction efforts.

Abstract Background On April 15th, 2023, intense clashes involving heavy weapons and airstrikes occurred between the Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF) in Khartoum, the capital of Sudan, leading to the displacement of almost 8.1 million people. The ongoing armed conflict in Sudan has led to a worsening humanitarian catastrophe, posing serious challenges to the country’s health-care system and even its collapse. Healthcare facilities have been severely affected, with barely one-third of hospitals operating in conflict zones. Hemodialysis patients are among the most affected by this war’s aftermath, which ranges from obvious dangers like violence-related injuries and deaths to more indirect effects like the suspension of access to preventive and curative medical care. Methods This was a descriptive cross-sectional multicenter health facility-based study aiming to study the impact of the April 15 war on hemodialysis patients in Sudan. The study was conducted in five centers in four different states in Sudan, including Gezira State, Red Sea State, River Nile State, and Kassala State. The study included 316 participants. Data was collected using structured interviews guided by a questionnaire. The questionnaire encompassed five primary domains: demographic data, healthcare access (Levesque’s Conceptual Framework of Access), physical implications, psychological impact (Generalized Anxiety Disorder scale and Patient health questionnaire), and quality of life (Kidney disease quality of life 36 scales). Statistical Package for the Social Sciences (SPSS) version 26 was used for data analysis. Results This study involved 316 participants, with an average age of 47.14 and 63.9% being males. After the war, 74.7% reported being unemployed. 30.1% of participants had to flee their homes, and 18.7% had a renal ailment limiting their travel. Among the components of healthcare access affordability, it received the lowest score (5.6 out of 10). More than half of the participants were unable to maintain their regular hemodialysis sessions (56.9%) throughout the war, and 65.2% of the participants developed medical complications as a result. The GAD assessment showed 62.7% of participants had significant anxiety symptoms, while 40.5% had significant depression symptoms. Conclusion Hemodialysis patients’ suffering has increased as a result of the war. Hemodialysis patients experience severe mental health problems in addition to physiological problems, including depression and anxiety, as a result of internal displacement and their inability to continue regular hemodialysis sessions. The study advocates for the implementation of a permanent ceasefire in conflict zones to ensure the delivery of critical humanitarian medical aid, particularly hemodialysis care. The study encourages stronger advocacy for hemodialysis in war-torn areas as well as collaboration with international organizations to provide such specialized care. Finally, it encourages the use of telemedicine services as a backup plan to provide continuous hemodialysis consultation and care in the event of conflict disruptions.

The current study sought to contribute to the discussions relating to the destruction of cultural heritage in armed conflicts. The relationship between cultural heritage and national identity cannot be separated. The 21st century particularly 2022 has experienced the most violent and radical Russian-Ukraine war from which the spillover effects go beyond geographical borders. The study argues that at the expense of Russia's geopolitical interests, the destruction of cultural heritage is a global protection crisis. By using secondary data sources, this study sought to analyse the challenges of protecting cultural heritage during armed conflicts. The findings present that cultural heritage, both tangible and intangible is an important representation of national identity and promotes cultural diversity. The Russian-Ukraine war has witnessed the destruction of heritage sites, churches and monuments in Ukraine. From a comprehensive point of view, the study presents that regional and international organizations should establish effective efforts and rethinking for the preservation of cultural heritage. The paper argues that technological advancement has also complicated the protection of cultural heritage in global politics thereby threatening the achievement of sustainable development goals.

Abstract Background Food insecurity is an important aspect of human suffering during wartime. Besides its ferocity, the Gaza conflict of 2023–2024 has been marked by severe food and medication shortages that exacerbated the human toll and worsened the suffering of the population. Methods A cross-sectional, mixed methods study that in April 2024 collected quantitative and qualitative data to assess food insecurity and malnutrition among residents of the Northern part of the Gaza Strip during the first seven months of the war. Quantitative data assessed weight loss among participants as a marker of starvation. Qualitative interviews evaluated food availability, food variability, and changing eating habits. Demographics were represented as counts and percentages. Weight was reported as mean ± SD. The Spearman Correlation Coefficient evaluated potential correlations of weight loss with sex, place of residence, and age. Statistical significance was set at a p-value less than 0.05. Results 497 participants were recruited, including 330 males (66.4%) and 167 females (33.6%). The age range was (13–83 years). The mean baseline weight was 84.94 kg ± 20.06, with a weight range (35–180 kg). In April 2024, the mean weight had dropped to 66.22 kg ± 14.34, representing an average decline of 18.72 kg (new weight range 28–142 kg). Age was associated with a weak positive correlation with weight loss (r = .204, p = .000). Qualitative interviews with 95 breadwinners or homemakers revealed a high prevalence of hunger and severe shortages in food quantity, quality, and variability. Physical and financial barriers significantly impacted food sourcing. Also, due to food shortages, most participants reported high consumption of edible wild plants and unconventional types of flour such as corn flour or grounded animal feed. Conclusions The study demonstrated high levels of weight loss and marked food insecurity in the Northern Gaza Strip during the conflict. The quantitative and qualitative food shortages outlined in this study present a risk for a host of potentially serious and irreversible future complications.

Abstract Background War causes severe suffering and harm to the civilian population. Knowledge about civilian injury patterns constitutes a part of the dimensioned planning and preparedness for medical care and civilian defence in times of war. This systematic review is conducted on request from The Swedish National Board of Health and Welfare and includes civilian injury patterns in modern war. Methods The aim of the study is to describe civilian injury patterns in war 1973–2023. We have conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The protocol has been registered 2023-05-06 in PROSPERO (CRD4202321483). Results The search resulted in 3455 identified articles. 1226 of those were duplicates. 2229 studies were assessed, and 1817 papers were excluded. 412 papers went through full text assessment resulting in 63 remaining papers. Injuries to the extremities constitutes 50%, followed by head injuries (26%) and injuries to the chest (18%). Notably, 23% of the wounded are children. Discussion There is no standardized classification or method to report and describe civilian war injuries and the injury panorama. Variations in how the injuries were reported made synthesis of the results difficult. In the present survey we haven’t investigated mortalities and causes of death. Reliable data from recent wars, such as the ongoing war in Ukraine and Gaza, was missing from the open literature. Conclusions The distribution of injuries seems comparable with data from World War II and the conflict in Korea. There is no standardized simple protocol to report civilian injuries in war. Ideally, a protocol should include even the severity impact of the injuries. Knowledge of civilian injury pattern and estimate of the total number of wounded is important to plan the civilian health care capabilities in war time.

Objective: to illustrate the challenges to international law and the shortcomings of current regulation caused by the rapid development of drone technology, by the example of using unmanned aerial vehicles (drones) in airspace.Methods: the study is based primarily on a set of methods for interpreting the provisions of international law, which allow analyzing the provisions in the field of using unmanned aerial vehicles (drones).Results: based on international air law and humanitarian law, the article examines the issues of unmanned aerial vehicles (drones) using airspace. The main sources of law in this area are analyzed, including the provisions of international air law, especially the Paris, Madrid, Havana and Chicago Conventions. An attempt is made to answer the questions arising from the development of unmanned technologies as to which rules of international law apply to their use and whether existing international law is capable of responding effectively to them. The article shows the current understanding of the legal status of airspace over the territory of a state. The author puts forward the question whether the sphere of unmanned aerial vehicles, automatic and autonomous weapons, which combines scientific and military achievements with new technologies, is exceptional. In this regard, the problem of using unmanned aerial vehicles as a universal weapon in international conflicts is touched upon. A conclusion is made that the use of intelligent, guided and robotic weapons capable of automatic decision-making, such as drones, requires the revision of existing conventions or the establishment of new legal standards for these weapons. It is proposed to consider such drones as military aircraft of a special type.Scientific novelty: international legal responsibility of states for the military use of drones has not received an unambiguous assessment in the doctrine. However, much in this issue depends on the legal interpretation of the most important international legal categories. Further development of this issue is directly related to the issues of international responsibility and the concept of state sovereignty over airspace.Practical significance: the development of unmanned aviation at the present stage demonstrates the imperfection of the existing legal framework, which is designed to regulate these relations. With regard to the study of the global trend in the current international law, the identification of the shortcomings in the provisions of the latter is important primarily for their further modernization, taking into account modern scientific achievements and the development of the concept of a state sovereignty over its airspace.

Cultural heritage is, today, particularly exposed to the devastation resulting from natural phenomena, but it is even more exposed to the destruction caused by man-made ones. Consequently, it is critical to adopt suitable and concrete provisions for its preservation and conservation. The conflict that has been raging in Ukraine since February 2022 has spotlighted problems related to cultural heritage, which is increasingly considered a military target. Digital transformation and technologies integrated with legal tools can contribute to making the system of protection and recovery of cultural assets more effective and efficient by redefining methodologies to safeguard and interact with them. This paper proposes a framework for integrating legal and digital tools that are functional for the preservation, conservation, and enhancement of cultural heritage. To define it, on the one hand, the legal instruments in force were analysed, and on the other, a literature review on the digital technologies currently available was carried out. The role of digital transformation in the cultural sphere was also examined, especially in light of Ukraine’s experience with the application of digital technologies to protect and recover cultural heritage during the current conflict.

Abstract Background The ongoing armed conflict in Sudan has caused mass displacement, affecting mental health. This study aimed to assess the prevalence of posttraumatic stress disorder (PTSD) and trauma among refugees, internally displaced, and nondisplaced people, while also examining the link between displacement type, PTSD severity, and associated factors. Methods This cross-sectional study used the Posttraumatic Stress Disorder Checklist for DSM-5 to assess PTSD symptoms and the General Health Questionnaire-28 to evaluate depression. Data were collected from 642 participants, targeting general social media groups for those within Sudan and specific groups for refugees outside the country. Sociodemographic and trauma event data were also gathered. Data analysis was conducted using SPSS, applying one-way ANOVA and independent t-tests to compare PTSD and depression. Binary logistic regression identified associations between sociodemographic factors and PTSD symptoms. Results Among the 642 participants, 46.3% were internally displaced people (IDP), 42.1% were refugees, and 11.7% were non-displaced individuals. Clinically significant PTSD symptoms were identified in 36.6% of the participants. Refugees had a significantly greater percentage of traumatic events (M = 4.31, SD = 2.605, p

Background. Ongoing military conflicts in various regions of the world have a significant negative impact on women’s health, including access to health services, maternal mortality and general well-being. Objective of the review: to provide a comprehensive understanding of the multifaceted impact of war on refugee women, highlighting key areas such as physical health, mental health, reproductive health and access to basic services. Analysis of literary data. Numerous barriers faced by women in armed conflict are considered. The main problems include insufficient transport connections, financial constraints, poor quality of medical services and cultural norms. The destruction of the health care infrastructure, the lack of medicines and personnel significantly limit the availability of reproductive health care services. These factors contribute to an increase in the number of home births without qualified support, which increases the risk of maternal and child mortality. Also important is the psychological impact of war, including stress, depression and post-traumatic stress disorder, which are common among pregnant women. In addition, malnutrition and environmental toxins further complicate the situation, undermining the health of women and newborns. Thus, conflict-induced food insecurity leads to malnutrition among pregnant and lactating women, causing adverse health outcomes such as anemia, low birth weight, and increased susceptibility to infections. Exposure to environmental toxins from modern weapons, such as heavy metals, poses long-term health risks to pregnant women and their babies. In particular, toxins can affect the emotional and cognitive development of children. Conclusions. This review highlights the urgent need for comprehensive health services, integrated medical and psychosocial support, and targeted interventions to address these challenges. Improving access to quality health care, ensuring food security and mitigating environmental risks are critical to improving maternal and child health.