Telemedicine interventions in six conflict-affected countries in the WHO Eastern Mediterranean region: a systematic review.

BACKGROUND: The COVID-19 pandemic has escalated the use of telemedicine in both high and low resource settings however its use has preceded this, particularly in conflict-affected settings. Several countries in the WHO Eastern Mediterranean (EMR) region are affected by complex, protracted crises. Though telemedicine has been used in such settings, there has been no comprehensive assessment of what interventions are used, their efficacy, barriers, or current research gaps. MAIN BODY: A systematic search of ten academic databases and 3 grey literature sources from January 1st 2000 to December 31st 2020 was completed, identifying telemedicine interventions in select EMR conflict-affected settings and relevant enablers and barriers to their implementation. Included articles reported on telemedicine use in six conflict-affected EMR countries (or territories) graded as WHO Health Emergencies: Afghanistan, Gaza, Iraq, Libya, Syria and Yemen. Data were extracted and narratively synthesised due to heterogeneity in study design and outcomes. Of 3419 articles identified, twenty-one peer-reviewed and three grey literature sources met the inclusion criteria. We analysed these by context, intervention, and evaluation. CONTEXT: eight related to Afghanistan, eight to Syria and seven to Iraq with one each in Yemen and Gaza. Most were implemented by humanitarian or academic organisations with projects mostly initiated in the United States or Europe and mostly by physicians. The in-country links were mostly health professionals rather than patients seeking specialist inputs for specialities not locally available. INTERVENTIONS: these included both SAF (store and forward) and RT (real-time) with a range of specialities represented including radiology, histopathology, dermatology, mental health, and intensive care. EVALUATION: most papers were observational or descriptive with few describing quality measures of interventions. CONCLUSIONS: Telemedicine interventions are feasible in conflict-affected settings in EMR using low-cost, accessible technologies. However, few implemented interventions reported on evaluation strategies or had these built in. The ad hoc nature of some of the interventions, which relied on volunteers without sustained financial or academic investment, could pose challenges to quality and sustainability. There was little exploration of confidentiality, ethical standards, data storage or local healthcare worker and patient acceptability.

The role of war trauma survivors in managing their own mental conditions, Syria civil war as an example.

War trauma leads to a wide range of psychological consequences and disorders that can be quite disabling to individuals and their families. At times of war, existing resources become strained to cope with all demands of trauma sufferers. The survivors' role of managing their own mental conditions becomes highly important and relevant as a way of reducing the resulted suffering. Unfortunately, this role is often ignored or trivialized by all concerned. The self-efficacy and resilience of people are the factors not to be underestimated and should be built upon. Reaching solutions are generally more satisfying and long-lasting when the affected person has taken a positive active part in finding them. Encouraging the use of own resources and experiences and using own problem-solving skills can be all that is needed for survivors to feel enabled. Engaging survivors and focusing on promoting recovery and social inclusion along with the use of self-help skills make them feel more positive about their own conditions. Being more involved, taking even small steps reduces the development of learned helplessness and reduces the psychiatric morbidities.

Mental health and psychosocial needs of Syrian refugees and the role of Syrian non-governmental organisations.

Almost 5 million Syrians have been registered as refugees since the conflict started in 2011. Their mental health and psychosocial needs continue to grow as the situation at home gets more complicated. Syrian non-governmental organisations (NGOs) and mental health professionals have been offering their support to help meet these needs. They have set up various centres and teams on the ground that focus their efforts on the most needy individuals. They train and supervise healthcare volunteers, encourage self-management and build on people's resilience. These NGOs require support to deal with the consequences of this unprecedented crisis.