Interventions to promote mental health in the Occupied Palestinian Territories and Palestinian refugees: A scoping review.

BACKGROUND: The long history of the Palestinian-Israeli conflict has resulted in a public and mental health crisis. Despite the significant mental health burdens facing the Palestinian population in the Occupied Palestinian Territories (OPT) and refugee camps, this issue remains comprehensively unexplored. AIMS: This scoping review identified mental health interventions and assessed their effectiveness among populations in the OPT and Palestinian refugee camps, while addressing delivery challenges. METHOD: A scoping review was conducted using 14 databases to include relevant studies published through March 2024 using PRISMA guidelines for scoping reviews. RESULTS: Analyzing 31 intervention studies meeting the inclusion/exclusion criteria, revealed varied outcomes in interventions targeting post-traumatic stress disorder, depression, and overall mental well-being. CONCLUSIONS: While some interventions showed potential, others had limited effectiveness, underscoring the complexity of mental health needs in conflict zones. Gender- and risk-specific effectiveness was observed, emphasizing the need for tailored approaches. Challenges like low attendance rates and systemic barriers hindered intervention success. The profound impact of war on children stresses the urgency for targeted interventions. Empowerment and community connectedness are vital for resilience, along with the importance of family and community involvement and research that balances the need for strong evaluation designs with the need for ongoing mental health services. Advocacy for systemic changes is crucial to implement the complex sustainable interventions necessary to assure mental health in any population. This review highlights the importance of holistic, contextually relevant approaches for mental health intervention in OPT and refugee camps, emphasizing rigorous evaluations and community-driven approaches.

Coping styles in refugees with PTSD: Results from a randomized trial comparing EMDR therapy and stabilization.

BACKGROUND: While treatment of posttraumatic stress disorder (PTSD) in refugees is generally effective, many refugees remain symptomatic after treatment. Coping styles could be relevant to PTSD treatment response and as such may be a potential focus of PTSD treatment. AIMS: The study aims to examine 1) if baseline coping styles are related to treatment response after EMDR therapy or stabilization, and 2) if coping styles change during these treatments. METHOD: Seventy-two refugees with PTSD were randomly allocated to 12 hours of EMDR therapy or stabilization. A coping questionnaire (COPE-easy) and clinical interview for PTSD (CAPS-IV) were administered before and after treatment and at three-month follow-up. The association between baseline coping styles and PTSD symptom change was examined using regression analysis and a t-test. Changes in coping styles were analyzed using mixed design ANOVA. RESULTS: No significant relations between baseline coping style levels and PTSD symptom changes were found. Additionally, coping style levels did not change significantly after either treatment. CONCLUSION: Contrary to the hypothesis, we did not find any evidence that treatment was related to (changes in) coping style. Addressing pre-treatment coping styles among refugees receiving short-term therapy, may not be required for reducing PTSD. Changing coping styles may need a longer or different type of treatment.

Child mental health predictors among camp Tamil refugees: Utilizing linear and XGBOOST models.

While the association between migration and deteriorated refugee mental health is well-documented, existing research overwhelmingly centers on adult populations, leaving a discernible gap in our understanding of the factors influencing mental health for forcibly displaced children. This focus is particularly noteworthy considering the estimated 43.3 million children who are forcibly displaced globally. Little is known regarding the association between family processes, parental and child wellbeing for this population. This study addresses these gaps by examining the relationship between parental mental health and child mental health among refugees experiencing transmigration. We conducted in-person structured survey interviews with 120 parent-adolescent dyads living in the Trichy refugee camp in Tamil Nadu, India. Descriptive, multivariate analysis (hierarchical regression), and Machine Learning Algorithm (XGBOOST) were conducted to determine the best predictors and their importance for child depressive symptoms. The results confirm parental mental health and child behavioral and emotional factors are significant predictors of child depressive symptoms. While our linear model did not reveal a statistically significant association between child mental health and family functioning, results from XGBOOST highlight the substantial importance of family functioning in contributing to child depressive symptoms. The study's findings amplify the critical need for mental health resources for both parents and children, as well as parenting interventions inside refugee camps.

Psychosocial and emotional well-being of Syrian refugee children and adolescents in Jordan: In-camp versus out-of-camp comparative analysis.

There is a notable gap in understanding how different living arrangements influence the psychosocial and emotional well-being of Syrian refugee children and adolescents. Moreover, limited literature exists on the comparison between in-camp and out-of-camp living situations. The aim of this study was to compare the psychosocial and emotional status between camp and non-camp Syrian refugee children and adolescents living in Jordan. A nationwide school survey was conducted in Jordan from December 2022 to April 2023 and targeted children (8-11 years) and adolescents (12-18 years), encompassing Jordanians, Syrians, and Palestinians, both in camps (camp refugees) and urban areas (urban refugees). In this paper, the analysis was limited to Syrian refugees. A total of 1,420 children and 1,249 adolescents were included. Children in camps had higher rates of hyperactivity (12.7% vs 8.3%) and total difficulties (19.3% vs 13.9%) compared to urban dwellers. However, they had lower rates of bedtime problems (12.8% vs 17.0%) and problematic internet use (19.9% vs 34.8%). Camp adolescents had higher rates of separation anxiety disorder (44.0% vs 37.8%) and conduct problems (22.2% vs 15.0%), but lower rates of poor physical functioning (43.3% vs 52.3%) compared to urban adolescents. Adjusted analysis showed lower odds of generalized anxiety disorder (OR=0.59), problematic internet use (OR=0.39), and bedtime problems (OR=0.67) for camp children. However, they had higher odds of emotional symptoms (OR=1.47), hyperactivity (OR=2.08), and overall difficulties (OR=1.50). Camp adolescents had higher odds of overall difficulties (OR=1.49) but lower odds of poor physical functioning (OR=0.67) compared to urban adolescents. In conclusion, children in refugee camps had lower rates of problematic internet use and bedtime issues but higher rates of hyperactivity and overall difficulties than urban children. Similarly, camp adolescents faced more total difficulties but reported better physical functioning than their urban peers. The complex interplay between living conditions and well-being underscores the need for tailored mental health interventions for displaced populations.

Links between ethnic discrimination, mental health, protective factors, and hair cortisol concentrations in asylum seekers living in Germany.

Objective: Asylum seekers often experience ethnic discrimination on the flight or in the host country, which may be associated with chronic stress and impaired mental health. Dysregulation of the hypothalamic-pituitary-adrenal axis, a known physiological correlate of chronic stress, can be assessed using hair cortisol concentrations (HCC). The present study aimed to investigate how different forms of perceived ethnic discrimination are associated with mental health outcomes, HCC, and protective factors in asylum seekers living in Germany.Methods: Somatic symptoms (PHQ-15), symptoms of posttraumatic stress (PDS), depressive symptoms (PHQ-9), different forms of ethnic discrimination (active harm, passive harm, institutional discrimination), and protective factors (in-group identification, social support) were assessed cross-sectionally in 144 asylum seekers (average age 32 years, average duration of stay in Germany nine months; 67% men). HCC were obtained from 68 participants. Multiple regression analyses were conducted and social support and in-group identification were tested as potential moderators.Results: Active ethnic discrimination was positively associated with all assessed mental health outcomes, and all forms of ethnic discrimination positively correlated with depressive symptoms. Ethnic discrimination was not associated with HCC. When controlling for other possible influences (e.g. age, gender, traumatic events), passive harm was negatively associated with depressive symptoms (ß = -0.17, p = .033) and active harm was positively associated (ß = 0.28, p = .022) with somatic symptoms. After the inclusion of the protective factors, the associations were no longer significant. Lower social support was associated with higher depressive symptoms (ß = -0.35, p < .001), posttraumatic stress (ß = -0.77, p < .001), and somatic symptoms (ß = -0.32, p < .001), but did not moderate the associations between ethnic discrimination and the mental health outcomes.Conclusions: Perceived ethnic discrimination may negatively influence asylum seekers' mental health but does not seem to be associated with HCC. Social support was associated with psychological symptom severity, but did not buffer the effects of ethnic discrimination on mental health.

The study examined the relationship between ethnic and institutional discrimination, protective factors (social support and in-group identification), hair cortisol concentrations (HCC) and mental health in asylum seekers.Ethnic discrimination was associated with mental health outcomes and social support, but not with HCC.Lower social support was associated with higher depressive and somatic symptoms, but did not moderate the relationship between ethnic discrimination and mental health.

Self-compassion and association with distress, depression, and anxiety among displaced Syrians: A population-based study.

Displaced communities are at increased risk of poor mental health with limited resources for treatment. Self-compassion moderates the impacts of stressors on mental health in high-income country general population samples, but its impact has not been described among people who have experienced displacement and associated trauma. The aim of this study was to characterize the associations between self-compassion, mental health, and resilience in a sample of displaced Syrian adults living in Jordan. This is a cross-sectional study using four validated survey tools measuring self-compassion, resilience, mental health, and traumatic exposure. Syrian adults who presented to four different community organizations serving refugees within Amman, Jordan were invited to participate. A total of 272 displaced Syrians were included in the final analysis. A majority of those surveyed were positive for emotional distress (84.6%), depression (85.7%), and anxiety (76.5%). In univariate analysis there was a significant lower risk of emotional distress, depression, and anxiety, with both higher resilience and self-compassion. However, in the multivariate model only self-compassion remained significantly associated with less emotional distress, depression, and anxiety, independent of resilience and other covariates. Female gender, poor financial stability, and high levels of traumatic exposure were also identified as persistent predictors of mental health morbidity. The findings of this study suggest that self-compassion is associated with less distress, depression, and anxiety in displaced individuals; suggesting it might be protective against poor mental health. Self-compassion is a modifiable factor that can be utilized as a tool by healthcare professionals and communities caring for refugees to promote positive mental health outcomes.

Pushing the Boundaries: African LGBTQ+ Migrants Navigating Dislocation and Disparities in Canada.

There is an urgency to advocate for lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (LGBTQ+) racialized migrants and Canadian policy reform due to the rise in human rights violations globally for LGBTQ+ community members as they fight for constitutional change. Canada projects itself as a world leader in the protection of LGBTQ+ rights and is promoted as an ideal destination for those fleeing persecution. Contrary to this image, Canada has received harsh public criticism for its failure to live up to the expectations of a benevolent refugee-receiving country. The arrival of African LGBTQ+ migrants creates a lens for us to examine these cracks in our Canadian system and the resulting health disparities experienced by this group.

Effects of a self-guided digital mental health self-help intervention for Syrian refugees in Egypt: A pragmatic randomized controlled trial.

BACKGROUND: Digital mental health interventions for smartphones, such as the World Health Organization (WHO) Step-by-Step (SbS) program, are potentially scalable solutions to improve access to mental health and psychosocial support in refugee populations. Our study objective was to evaluate the effectiveness of SbS as self-guided intervention with optional message-based contact-on-demand (COD) support on reducing psychological distress, functional impairment, symptoms of posttraumatic stress disorder (PTSD), and self-identified problems in a sample of Syrian refugees residing in Egypt. METHODS AND FINDINGS: We conducted a 2-arm pragmatic randomized controlled trial. A total of 538 Syrians residing in Egypt with elevated levels of psychological distress (Kessler Psychological Distress Scale; K10 > 15) and reduced psychosocial functioning (WHODAS 2.0 > 16) were randomized into SbS + CAU (N = 266) or CAU only (N = 272). Primary outcomes were psychological distress (Hopkins Symptom Checklist 25) and impaired functioning (WHO Disability Assessment Schedule 2.0) at 3-month follow-up. Secondary outcomes were symptoms of PTSD (PTSD Checklist for DSM-5 short form, PCL-5 short) and self-identified problems (Psychological Outcomes Profiles Scale, PSYCHLOPS). Intention-to-treat (ITT) analyses showed significant but small effects of condition on psychological distress (mean difference: -0.15; 95% CI: -0.28, -0.02; p = .02) and functioning (mean difference: -2.04; 95% CI: -3.87, -0.22; p = .02) at 3-month follow-up. There were no significant differences between groups on symptoms of PTSD and self-identified problems. Remission rates did not differ between conditions on any of the outcomes. COD was used by 9.4% of participants for a median of 1 contact per person. The main limitations are high intervention dropout and low utilization of COD support. CONCLUSIONS: The trial provides a real-world implementation case, showing small positive effects of a digital, potentially scalable and self-guided mental health intervention for Syrian refugees in Egypt in reducing psychological distress and improving overall functioning. Further user-centered adaptations are required to improve adherence and effectiveness while maintaining scalability. TRIAL REGISTRATION: German Register for Clinical Studies DRKS00023505.

Primary healthcare providers' knowledge, practices and beliefs relating to preventive sexual and reproductive health care for women from refugee and asylum-seeking backgrounds in Australia: a national cross-sectional survey.

Background Many refugee women and women seeking asylum arrive in high-income countries with unmet preventive sexual and reproductive health (SRH) care needs. Primary healthcare providers (HCPs) are usually refugee and asylum seekers' first point of care. This study aimed to identify HCP characteristics associated with initiating conversations and discussing SRH opportunistically during other health interactions. Methods An anonymous online survey was distributed nationally to representatives of health professional organisations and Primary Health Networks. Hierarchical logistic regression analysed factors including HCP demographics, knowledge and awareness, perceived need for training and professional experience with refugee women were included in the models. Results Among 163 HCPs, those initiating conversations ranged from 27.3% (contraceptive care) to 35.2% (cervical screening). Opportunistic discussions ranged from 26.9% (breast screening) to 40.3% (contraceptive care). Positively associated factors included offering care to refugee women or women seeking asylum at least once every 2months 7.64 (95% CI 2.41;24.22, P P P P P P Conclusions Direct professional experience, frequency of service provision, years of practice, and part time work positively influence HCPs' SRH care practices. Enhancing bilingual health worker programs, outreach, education, and support for SRH and cultural competency training are essential to improving the preventive SRH care of refugee women and women seeking asylum.

Oral health among refugees and asylum seekers utilizing Médecins du Monde clinics in mainland Greece, 2016-2017.

BACKGROUND: The oral health of refugees and asylum seekers is understudied. However, oral health has important implications for overall health and wellbeing. This study addresses this gap by characterizing oral health care utilization in Médecins du Monde (MdM) clinics across mainland Greece from 2016 - 2017. METHODS: A retrospective cross-sectional study design was used to estimate proportional morbidities for caries, extraction, developmental, periodontal disease, preventive, and other oral health outcomes. The association between physical health conditions and consultations of interest - upper respiratory tract infections (URTIs) and reproductive health consultations - and oral health were compared using odds ratios (OR) and 95% confidence intervals (CIs). Oral health outcomes between Afghans and Syrians were compared using odds ratios and 95% CIs. RESULTS: Caries (39.44%) and extractions (28.99%) were highly prevalent in our study population. The utilization of preventive dental consultations (37.10%) was high, particularly among males. Individuals with at least one upper respiratory tract infection (OR = 1.52; 95% CI: 1.30 - 1.77; Or = 1.90; 95% CI: 1.53 - 2.36) and women and girls with reproductive health consultations (OR = 1.30; 95% CI: 1.03 - 1.66; OR = 2.03; 95% CI: 1.49 - 2.76) were more likely to have any dental or caries specific consultations. The observed patterns in oral health needs differed between Afghans and Syrians, with Afghans more likely to have preventive screenings and less likely to have caries, extractions, or other conditions. CONCLUSIONS: Displaced populations utilizing MdM dental clinics had high levels of oral health needs, particularly for caries and extractions. The connection between oral and overall health was seen in the study population, and these findings reinforce the public health importance of oral health for improving health and wellbeing of displaced populations. Evidence-informed policy, practice, and programming inclusive of oral health are needed to address both oral and overall health of refugees and asylum seekers in Greece. Future research should investigate not only oral health care needs but also knowledge and beliefs that inform utilization patterns among displaced populations.

The transformation of Jordan's healthcare system in an area of conflict.

BACKGROUND: The Jordanian healthcare system has evolved over the past decades expanding its services, technological, and educational resources. A comprehensive view of this system is lacking. The objective of this report is to describe the structure of the Jordanian healthcare system, the challenges facing it, and the current and recommended health policies. MATERIALS AND METHODS: This study reviewed the current status of the Jordanian healthcare system. The following parameters were analyzed: health indicators, infrastructure, human resources, insurance system, pharmaceutical expense, health education system, and medical tourism. Data were collected from various relevant official institutions and related published literature. RESULTS: Jordan has a young population with a median age of 23.8 years. Life expectancy is 78.8 years for females and 77.0 years for males. The Jordanian healthcare system is divided into three major categories: (1) Governmental Insurance (i.e., the Ministry of Health (MOH), the Royal Medical Services (RMS) and semi-governmental insurance); (2) Private Insurance; and (3) Refugee Insurance, including the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the United Nations High Commissioner for Refugees (NHUR). The Governmental Insurance covers 64.30% of the total population. Health expenditure is 6.37% of the gross domestic product (GDP). Pharmaceutical expenses make up 26.6% of the total national healthcare budget. Human resource assessment shows a high ratio of medical staff per 10.000 inhabitants, especially concerning physicians (31.7), dentists (7.9), and pharmacists (15.1). However, the ratio of nursing staff per 10.000 inhabitants is considered low (37.5). The Hospital bed/1000 population ratio is also relatively low (1.4). Healthcare accreditation is implemented through the Joint Commission International (JCI) accreditation which was achieved by 7 hospitals and by the National Health Care Accreditation Certificate (HCAC) achieved by 17 hospitals and 42 primary healthcare centers. Postgraduate medical education covers almost all medical and surgical fields. Medical tourism is currently well-established. CONCLUSIONS: Assessment of the Jordanian healthcare system shows high ratios of physicians, dentists, and pharmacists but a low ratio of nursing staff per 10.000 inhabitants. The hospital bed/1000 population ratio is also relatively low. Pharmaceutical expenses are significantly high and medical tourism is well-developed.

Transactional sex in humanitarian settings: A comparative analysis of livelihood and demographic predictors.

Millions of people have been displaced within or outside their countries. Disruptions associated with displacement often lead to transactional sex with dire social, sexual and reproductive health implications. A common driver of transactional sex is food insecurity among refugees and internally displaced persons (IDPs), yet IDP/refugee settings offer an opportunity for females to challenge and renegotiate gender norms and exercise greater control over their lives and sexuality. We compared predictors of transactional sex across humanitarian settings and found them to be significantly different. Among IDPs, the likelihood of transactional sex reduces with having access to food ration and education, but increases with having 'other sources' of income. Among refugees, transactional sex likelihood reduces with having either/both parent(s) alive but increases with working for money. Hence, multiple factors drive transactional sex in different contexts. Protecting women in humanitarian situations from the risks of transactional sex requires an understanding of these differences.

Des millions de personnes ont été déplacées à l'intérieur ou à l'extérieur de leur pays. Les perturbations associées au déplacement conduisent souvent à des relations sexuelles transactionnelles avec des conséquences désastreuses sur la santé sociale, sexuelle et reproductive. L'insécurité alimentaire parmi les réfugiés et les personnes déplacées à l'intérieur de leur propre pays (PDI) est un facteur courant du sexe transactionnel. Pourtant, les contextes de PDI/réfugiés offrent aux femmes la possibilité de remettre en question et de renégocier les normes de genre et d'exercer un plus grand contrôle sur leur vie et leur sexualité. Nous avons comparé les prédicteurs du sexe transactionnel dans différents contextes humanitaires et nous avons constaté qu'ils étaient significativement différents. Parmi les personnes déplacées, la probabilité de relations sexuelles transactionnelles diminue avec l'accès à la ration alimentaire et à l'éducation, mais augmente avec « d'autres sources ¼ de revenus. Parmi les réfugiés, la probabilité de relations sexuelles transactionnelles diminue lorsque l'un ou les deux parents sont en vie, mais augmente lorsque l'on travaille pour de l'argent. Par conséquent, de multiples facteurs déterminent le sexe transactionnel dans différents contextes. Protéger les femmes dans les situations humanitaires contre les risques liés aux relations sexuelles transactionnelles nécessite une compréhension de ces différences..

Development and effects of the PARENT (Parenting Acceptable Real Empathy Nurture Training) program for mothers who defected from North Korea.

AIM AND BACKGROUND: North Korean refugee mothers struggle with the two-fold burden of adaptation and parenting in a new environment. This study aimed to develop and examine the effects of a parenting program for North Korean refugee mothers. METHODS: This quasi-experimental study was conducted with 65 North Korean refugee mothers who were recruited through the Korea Hana Foundation Center and Sajowi. The experimental and control groups comprised 33, 32 participants respectively. A program was conducted across eight sessions, each lasting about 90-120 min. The data were analyzed using the χ2 test, independent t-test, and paired t-test. RESULTS: Significant differences were observed in the parenting efficacy (t = -10.03, p < .001) and child related stress (sub domain-parenting stress) (t = 3.24, p = .002) scores. While intergroup differences were observed for parenting efficacy (t = 5.48, p < .001), no significant differences were observed for parenting stress (parent related) (t = -0.22, p = .825) and parent-child relationship (t = 0.87, p = .387) and no intergroup differences were observed for parenting stress (t = -1.10, p = .274) and parent-child relationship (t = 1.06, p = .290). CONCLUSION: This study is significant to the field of nursing because North Korean refugee mothers who needed parenting education have high parental efficacy scores after intervention, which expresses confidence in parenting. This study proposed a parenting education intervention framework focusing on emotional empathy for North Korean refugee mothers who want to provide healthy parenting despite the challenges they encounter as immigrants, which will improve their confidence in parenting. It can serve as a source of basic data for designing parenting education intervention frameworks for refugees in the future.

Evaluation of an integration community project for asylum seekers in Sweden: physical activity adherence and changes in character traits and life satisfaction.

Asylum seekers' traumatic experiences in combination with discrimination, social isolation, and exclusion in the host country leads to low adherence from health and integration initiatives. Along with their inability to seek health care and physical inactivity, this situation increases their mental illness and, most importantly, decreases their well-being. In fact, the lack of well-being (e.g., life satisfaction) is a better marker of mortality and morbidity than the presence of mental illness. In this context, one of the major single determinants of well-being is character, a dimension of personality that stands for self-regulation, adaptation, and intentional conscious behavior (i.e., goals and values). Host countries often implement integration initiatives including activities aiming to attenuate mental illness, but only a handful are evaluated and reported, with even fewer addressing character development, increases in life satisfaction, or adherence. Our aim was to evaluate the integration initiative "Health for Everyone-Sport, Culture, and Integration", a 10-week physical activity community project. Specifically, we investigated changes in life satisfaction and character traits (i.e., Self-Directedness, Cooperativeness, and Self-Transcendence) and if these variables, at baseline, predicted adherence and changes in physiological health (i.e., cardiorespiratory fitness, skeletal muscle mass, body fat mass, and visceral fat). Participants (n = 269) answered (pre and post measurements) the Satisfaction with Life Scale, the Short Character Inventory, and undertook physiological tests. In addition, their attendance to the physical activity sessions was registered throughout the project (i.e., adherence). Participants showed no significant increases in Self-Directedness, Cooperativeness, or life satisfaction, but significant decreases in Self-Transcendence. Moreover, higher life satisfaction and lower Self-Transcendence at baseline predicted higher adherence to the activity. However, neither character traits nor life satisfaction predicted changes in physiological health. We argue that low frequency physical activity initiatives may improve this population's physical health because participants probably have a sedentary life and low levels of physical health due to their asylum conditions (e.g., unemployment, low income, poor housing and social network). Furthermore, physical activity per se may not improve the well-being of asylum seekers. Hence, promoting well-being and character development might require person-centered initiatives focusing on the whole individual in order to fit programmes to the needs and life situation of this population.

Navigating wellness through integration: coping strategies for depression among Syrian refugees in Norway.

BACKGROUND: Refugees frequently face the challenges of adapting to unfamiliar environments and new cultural contexts. Such adaptations emphasize the importance of coping strategies during resettlement and for individuals to successfully integrate in the new communities. Particularly for Syrian refugees in Norway, many of whom have escaped war and conflict, understanding their ways of coping with mental health problems, such as depression, is pivotal. METHOD: This study used a cross-sectional study design to explore the relationship between integration aspects and coping strategies for depression from the Syrian population living in Norway. Syrian participants (N = 96) answered questions from the Brief COPE, the Hopkins symptom checklist (HSCL-13), and the Immigration Policy Lab index (IPL-12/24). RESULTS: Hierarchical multiple regression analysis indicated that employing a problem-focused coping strategy was significantly associated with better psychological and social integration outcomes among Syrian refugees in Norwegian society. CONCLUSION: The study suggests that certain aspects of integration, such as feeling a sense of belonging and actively seeking help, significantly improve mental health outcomes for Syrian refugees. Emphasizing problem-focused coping strategies could be vital in facilitating the successful integration of refugees into Norwegian society.

Traumatic experience and loss: A brief therapy with a traumatized refugee boy and his parents in exile.

In this paper, the author portrays the psychoanalytic therapy with a twelve-year-old refugee boy and his parents, prior to which the boy had been traumatised by the deaths of both his brothers in the civil war. In 2015 he had travelled with his father to Austria, where he was warmly received in a small community. The author examines how this child reacted to the traumatising experiences, as well as which resilience factors played a role in overcoming them. The psychoanalytic process is illuminated in a detailed analysis of the therapy sessions, which created a space for overcoming the helplessness, mourning the loss and furthering the integration process of the identity, disturbed after the traumatic experiences.

Conflict and fragmented public health emergency management system in Tigray region of Northern Ethiopia: A double burden to accommodate resilient and advanced public health emergency management. A commentary review for policy-makers and a call to action.

An estimated 2.5 million people have been internally and externally displaced in the Tigray region of northern Ethiopia in conflict and post-conflict settings. This induced a loss of access to basic and essential healthcare services. The situation was overwhelming, causing service inaccessibility, inadequate health facilities, unstable security to access the services, shortage of supplies and drugs, and medical equipment's in the region. The regional public health emergency management is one service delivery set up for the critically ill. It is characterized by weak emergency management capacities, poor coordination and integration. In addition, the system falls in to two independent sectors in the Tigray Health Bureau (THB), Tigray Health Research Institute (THRI). This leads to a fragmented system, an unclear leadership and governance role and a poor service delivery setup and tracking mechanism. The situation leads to resource duplication and poor business practice. Indeed, this type of service delivery setup secures personal and professional interest more than community interest. The situation exacerbated the occurrence of recurrent outbreaks in the region, with, for instance, zoonotic diseases (anthrax and rabies), acute watery diarrhoea, measles, malaria, yellow fever, and coronavirus disease 2019 (COVID-19) approaching to their level of epidemic. Moreover, they will spike as an epidemic in the future. All these circumstances made it evident that the system need reform to adhere with legal global, national, and regional frameworks, guidelines and proclamations. The system should have one service delivery set up at regional level. It must fall into regional public health institutes (PHIs) to adhere its service packages to the current advancements. Furthermore, integrated effort need from program implementers, relevant stakeholders and policy-makers should be committed and work together in the review and reform process.

"The police came in white protective suits and with batons, it was pure disaster" - a multi-stakeholder perspective on infection control in reception centers for asylum seekers during the COVID-19 pandemic in Germany.

BACKGROUND: The COVID-19 pandemic presented unprecedented challenges, particularly for vulnerable populations residing in confined settings such as refugee shelters: Physical distancing measures were challenging to implement in shelters due to shared rooms or communal use of kitchens and sanitary facilities, which increased the risk of infections. Meanwhile, individuals' capabilities for individual protection strategies were severely impaired by the structure of the shelters. Consequently, shelters had the duty to develop and implement strategies for the prevention and handling of SARS-CoV-2 infections. The aim of this study was to explore the perspectives of refugees, NGO employees, and shelter directors regarding COVID-19-related measures in German refugee shelters. The study aimed to identify challenges and conflicts arising from implemented measures, as well as expectations for improved support during the pandemic. METHODS: Semi-structured and narrative interviews were conducted with 6 refugees, 6 facility managers, 12 NGO staff, and 2 social service agency staff from February to August 2022. Qualitative content analysis was employed to analyze the data, identifying overarching themes and codes. RESULTS: The study uncovered challenges and conflicts resulting from pandemic measures, particularly mass quarantine orders, within refugee shelters. Lack of transparency and ineffective communication worsened tensions, with refugees feeling distressed and anxious. The quarantine experience had a negative impact on refugees' mental health, which was exacerbated by limited social interaction and leisure-time activities. Shelter managers encountered administrative challenges when implementing measures due to facility constraints and limited resources, while NGO employees encountered obstacles in providing immediate assistance due to legal regulations and a lack of cooperation from shelter managers. CONCLUSIONS: The study highlights that shelters are problematic institutions from a public health perspective. It shows the importance of implementing customized pandemic interventions in refugee shelters that take account of the diverse needs and experiences of both refugee and staff. To achieve this, we recommend to establish an ethics committee and involve various stakeholders in decision-making processes. Additionally, enhancing information dissemination to promote transparency and public understanding of measures is crucial. These insights can help develop comprehensive and effective pandemic plans for refugee shelters, ensuring better preparedness for future public health crises.