Our objective was to compare care-seeking patterns in Mosul, Iraq, in 2018, 1 y after Islamic State of Iraq and Syria (ISIS) control, with findings from neighborhoods that had been sampled in 2017

For this multi-stage randomized cluster household survey, we created one cluster in each of 20 neighborhoods randomly selected from the 40 neighborhoods in the 2016/17 survey; 12 in east Mosul, 8 in west Mosul. In each, 30 households were interviewed beginning at a randomly selected start house. Questions were derived from the 2016/2017 post-ISIS survey.

We interviewed the head of household or senior female in 600 households containing 3375 persons. One year after ISIS, some household demographic shifts had occurred. Diarrhea in children during the past 2 wk decreased from 50.1% to 7.5% (P < 0.001); however, cough/difficulty breathing increased from 15.5% to 33.6% (P < 0.01). Among adults, care-seeking for noncommunicable diseases increased from 22.3% to 43.5% (P < 0.001). Emotional and psychological complaints common in the previous survey were now nearly absent. Pregnancy complications diminished from 65.2% to 15.4% (P < 0.001).

Communicable diseases predominated among children and noncommunicable diseases among adults. Access to health care substantially improved, although barriers remained. Satisfaction with services was mixed, with dissatisfaction expressed about testing, medicine access, and costs, but the work of health providers was rated highly.

ISIS seized Mosul in June 2014. This survey was conducted to assess health status, health needs, and health-seeking behavior during ISIS control and the subsequent Iraqi military campaign.

Forty clusters were chosen: 25 from east Mosul and 15 from west Mosul. In each, 30 households were interviewed, representing 7559 persons. The start house for each cluster was selected using satellite maps. The survey in east Mosul was conducted from March 13–31, 2017, and in west Mosul from July 18–31, 2017.

In the preceding 2 weeks, 265 (5.4%) adults reported being ill. Some 67 (25.3%) complaints were for emotional or behavioral issues, and 59 (22.3%) for noncommunicable diseases. There were 349 (13.2%) children under age 15 reportedly ill during this time. Diarrhea, respiratory complaints, and emotional and behavioral problems were most common. Care seeking among both children and adults was low, especially in west Mosul. During ISIS occupation, 640 (39.0%) women of childbearing age reported deliveries. Of these, 431 (67.3%) had received some antenatal care, and 582 (90.9%) delivered in a hospital. Complications were reported by 417 (65.2%).

Communicable and noncommunicable diseases were reported for both children and adults, with a high prevalence of emotional and behavioral problems, particularly in west Mosul. Care-seeking was low, treatment compliance for noncommunicable diseases was poor, and treatment options for patients were limited. (Disaster Med Public Health Preparedness. 2019;13:758–766)

To identify the most and least commonly cited security management messages that nongovernmental organizations (NGOs) are communicating to their field staff, to determine the types of documentation that NGOs most often use to communicate key security messages, and to distinguish the points of commonality and divergence across organizations in the content of key security messages.

The authors undertook a systematic review of available security policies, manuals, and training materials from 20 international humanitarian NGOs using the InterAction Minimum Operating Security Standards as the basis for a review framework.

The most commonly cited standards include analytical security issues such as threat and risk assessment processes and guidance on acceptance, protection, and deterrence approaches. Among the least commonly cited standards were considering security threats to national staff during staffing decision processes, incorporating security awareness into job descriptions, and ensuring that national staff security issues are addressed in trainings. NGO staff receive security-related messages through multiple document types, but only 12 of the 20 organizations have a distinct security policy document. Points of convergence across organizations in the content of commonly cited standards were found in many areas, but differences in security risk and threat assessment guidance may undermine communication between aid workers about changes in local security environments.

Although the humanitarian community has experienced significant progress in the development of practical staff security guidance during the past 10 years, gaps remain that can hinder efforts to garner needed resources, clarify security responsibilities, and ensure that the distinct needs of national staff are recognized and addressed. (Disaster Med Public Health Preparedness. 2013;7:241-250)

In 2001, the Israeli government announced the construction of the West Bank barrier. The stated purpose of construction to prevent attacks by Palestinians on Israeli citizens. In a subsequent advisory opinion, the International Court of Justice decided the wall would block access to health care and education, and was “contrary to international law”.

The Barrier, with its limited number of gates, has been criticized by humanitarian agencies for limiting access of Palestinians to employment, health care, and education, but was defended by the Israeli government as an important security measure.

A survey of key informants was conducted in May 2004 at 78 health facilities and 121 schools in the northern West Bank districts of Jenin, Qalqilya, and Tulkarem, in order to assess the impact of the Barrier on access and use of health and educational services.

The Barrier negatively affected access to education and health care, in terms of statistically significant increases in distance and travel time to schools and health facilities. In several areas, service utilization, assessed by weekly visits to health facilities and student enrollment, was affected by barrier construction, although these findings were not statistically significant. A significant decrease in staff attendance was observed at health facilities and schools.

The Barrier may have long-term effects on access and utilization of health and educational services among Palestinians in the northern West Bank.

Although the international community currently is focused on Darfur, it is important that the status of other conflict-affected populations throughout Sudan are not overlooked. For the past decade, the Beja population, located along the Sudan-Eritrea border, has been affected by a conflict that has drawn little attention from the international community.

This study assessed crude mortality rates and other demographic characteristics using a mortality study nested within a nutrition assessment using cluster sampling methods.

The crude mortality rate among the Beja population in the National Democratic Alliance (NDA)-controlled territories between October 2003 and October 2004 was estimated at 1.4/10,000/day (95% confidence interval (CI): 1.2–1.6); the under five years of age mortality rate was estimated at 2.7/10,000/day (95% CI: 2.2–3.3). Both of these are elevated rates that exceed the accepted threshold to declare a humanitarian emergency.

When considered with recent reports of elevated malnutrition rates, the status of Beja is critical by international standards. Study findings suggest that: (1) nesting demographic objectives into other planned assessments (such as nutrition) are a feasible and cost-effective means for non-governmental organizations to characterize beneficiary populations; and (2) the Beja residing in the NDA-controlled territories are facing elevated mortality and are in urgent need of humanitarian assistance.

Following years of conflict and neglect, major efforts now are underway to develop health policy and rehabilitate the health facilities in Afghanistan. As part of these efforts, there is a need to better understand the health status and health-seeking behaviors. As part of an effort to assist local non-governmental organizations (NGOs), a household survey of mothers with children under the age of five years was conducted in two rural districts of Herat Province, Karokh and Chesht-e-Sharif.

A two-stage, 30-cluster approach was used for each district. This included 622 mothers of 926 children under the age of five years living in the two districts. Outcome measures included demographic characteristics, antenatal services, immunization coverage, hemoglobin levels of the mothers, nutritional status and practices, environmental health indicators, recent illness, and health seeking behaviors.

The mean value of ages of the mothers was 27 years with an average parity of 6.1. Less than 5% of mothers ever had attended school. Half of women had lost at least one child before the child reached the age of five years. Under-five-year mortality was estimated at 325. Only 29% of the women had attended an antenatal clinic during their last pregnancy. Virtually all deliveries occurred at home. Only 7.6% of women had received three doses of tetanus toxoid. Less than 9% of the children 12–59 months of age were fully immunized. According to the measurements of mid-upperarm circumference (MUAC), 11% of children were malnourished. Although breastfeeding almost was universal, greater than one-third of the women did not start breastfeeding until the second day after delivery. Protected water sources and appropriate control of feces were lacking in both districts. In the previous two weeks, 45.7% of children had experienced diarrhea, and dysentery had occurred in 10%. Fever had been present in one-quarter of the children.

Household health indicators indicate serious maternal and child health concerns in these two districts. Of particular concern is the poor immunization coverage, lack of reproductive health service, and the prevalence of common childhood illness in these populations. The feeding practices for children and the anemia among mothers also raised concerns. Poor environmental health contributes substantially to childhood illness.Without special emphasis, efforts to rebuild the health sector are likely to reach the household level only late in the process. An aggressive program to integrate community development and promotion of sound health practices is needed to improve the health of the Afghanistan people.