Several population-based studies have shown the immediate health impact of the Kosovo war on the con- flict-affected population [11-14]. The pre-war and post- war experience of ethnic conflict is endogenous, embedded within a complex personal, socio-economic and political matrix. Some victims have resumed a nor- mal life in post-war Kosovo, but others still suffer from both the direct consequences of the war and the asso- ciated violence and from long-term effects on their development and well-being. The Kosova Rehabilitation Centre for Torture Victims (KRCT) provided treatment for 1,772 trauma victims across Kosovo from 2004 to 2008 and intends to improve its facility-based service and community health programme. In developing a rehabilitation strategy, it is important to document trau- matic experience and to assess its long-lasting effects for the emotional and physical fitness and social functioning of victims of massive violence, and secondly, to look at the factors that help survivors to cope with the trauma. In our household survey in 2008 , we found that nearly 20% of the population of Mitrovicë district suf- fered from physical or mental pain. Families affiliated with the Kosovo Liberation Army were especially likely to have been subjected to massive violence and human
It is not within the scope of this paper to adequately review the interventions that may be of benefit in pre- venting the future adverse effects of war, but we have tried to summarize the main categories in Box 2. Many of these are the same as those required for the current population, but the imperative to protect certain groups, such as pregnant women, is reinforced. Past conflicts may have led to positive changes, such as the removal of oppressive regimes, as well as negative impacts. How- ever, our discussion highlights the importance of minim- izing the likelihood of conflict when seeking such positive changes. Interventions to break the cycle of transmission should be examined at the point at which governing bodies and non-state actors are considering going to war, and in its aftermath, as well as during con- flict. In examining the health of a population, previous insults need to be considered in order to understand fully the situation and to initiate solutions. Importantly, policy makers should bear in mind that a population may take multiple generations for the adverse healtheffects of conflict to be negated as a region attempts to return to its premorbid state or moves on to a new post- conflict one and it is possible that a return to the previ- ous state may never happen if conflict changes the status quo within a given area. Conflict-related public health interventions need to be sustained for a number of years and adapted over time to cope with changing needs.
To be able to compare closer if certain district characteristics may vary substantially, I do various regressions for each type of districts on their selected observable characteristics. Table A.8 shows the coefficients of these regressions. The dependent variable is labelled one if the district belongs to each of the conflict-intensity districts. The first column reports the coefficient of a regression for high-intensity districts on various characteristics averaged at the district level. The table shows that urban coefficient is statistically significant for all type of districts even for non-affected. However the sign of the coefficient differs. For high and low districts the coefficient is positive while for medium and non-affected the coefficient is negative. This reflects the fact that violence hit urban and capital districts harder. Other characteristics such as number of household members, electricity availability, and access to water are significant for at least three of the four types of districts. Although this might pose problems, and one would question any kind of selectivity, I net out this effect by controlling for various household characteristics and by including district fixed-effects. Moreover, because violence affected (richer) urban centres one can assume that, before the war, health status of children was greater in these areas than in low-intensity conflict areas. The estimates below are therefore not contaminated by a (poor) rural area effect. This evidence is confirmed in the subsequent section.
In conclusion, our results indicate that the outcomes of work under shared war reality among social workers are not related to the frequency and intensity of exposure to the missile attacks. The results raise the possibility, sub- ject to additional research, that a strong sense of belong- ing, terrorism preparedness and extensive training in trauma treatment interventions may serve as protective factors for the social workers operating in Otef Gaza. The major implication of this study is the importance of preparing social workers to cope with the challenges and complexities of work under shared war reality and pro- viding assistance to terror victims. This may be done by incorporating courses on war-related trauma treatment interventions into the curriculum of undergraduate social work programs as well as by developing advanced courses for qualified social workers focusing on evidence-informed interventions for terror victims.
The main limitation of this study is the cross-sectional and retrospective nature of the survey. The information on violence and trauma was self-reported. Selection bias existed as we only interviewed household heads or their spouses, and they may not necessarily know everything about the family members, especially as regards the per- ception of physical and mental pain, which is highly sub- jective with high inter-household variability. Memory bias is a potential limitation for war survivors, although major events happened around 10 years ago, and a 10 year-recall is considered reliable among general popula- tions without post-trauma stress disorder [36,37]. Mem- ory block and avoidance symptom may have accounted for the very low reporting of sexual crimes. We believe that it was more socially acceptable to report sexual crime during the war or immediately afterwards, whereas in a post-war setting they are likely to remain unrevealed for years, because the victims want to regain a normal life. A further limitation is that the Serb population was likely under-sampled in our survey. Since many Serbs in this area have emigrated, it is difficult to have a good esti- mate of Serb population. The fact that the sample popula- tion was limited to a major ethnic group in one district in Kosovo further limited the generalizability of our findings to other ethnic groups and other districts.
72 However, the TFR reflects both the level and timing of fertility, and its stability over time can conceal underlying changes in the age patterns of childbearing. To uncover possible variations in fertility trends among women of different age groups, figure 3.2a displays age-specific fertility rates (ASFRs) from the 2006 and 2011 I-MICS. Birth histories from the 2011 I-MICS can be used to calculate retrospective fertility rates back to 1997 for the age groups 15–19, 20–24, 25–29 and 30–34. This means that, for these groups of women, the estimated ASFRs from the two surveys can be compared for nine years. Over this longer time period and at this less aggregate level, fertility trends are consistent. The 95 per cent confidence intervals of fertility estimates fail to overlap in 2005 only for the age groups 20–24 and 30–34. For all other age groups of women, and in particular for those aged 15–19, estimates from the two surveys agree remarkably well for all nine years. Figure 3.2b presents the estimated ASFRs pooling data from the two surveys. This figure reveals that the stability of the TFR before and after the onset of the war was the result of countervailing fertility trends among younger and older women. To examine these trends in more detail, figure 3.3 displays the annual changes in ASFRs relative to the 1997 rates. The figure shows an abrupt shift in the timing of births toward younger ages. From 1997 to 2003, adolescent fertility was stable at just below 70 births per 1,000 girls aged 15–19. However, soon after the beginning of the war, adolescent fertility rose by more than 30 per cent reaching over 95 births per 1,000 girls in 2010. This increase is striking not only because it moved Iraq from moderate to high adolescent fertility 8 , but also because a
A potential limitation of this study is that some of the non-Gulf veterans may not have been as healthy as those sent to the Persian Gulf, as indicated by the excess number of deaths from HIV infection among non-Gulf veterans. Non-Gulf veterans may have included individuals who were recovering from surgery or had ailments serious enough to preclude them from being deployed but not serious enough to require their dismissal from the military. To evaluate the magnitude of this potential selection bias, we compared the mortality of a group of 106,840 non-Gulf reservists and National Guard veterans who were activated and deployed in locations other than the Persian Gulf with the mortality of 115,478 reserve and National Guard members who were not activated at all (32). Employing the same Cox proportional hazards models, we found no difference in either overall mortality or cause-specific mortality between the two groups, although the adjusted rate ratio for infectious and parasitic diseases (International Classification of Diseases, Ninth Revision, codes 001–139) was 0.43 (95 percent CI: 0.11, 1.62). If there had been significant selection bias, those deployed would have had a significantly lower risk of cause-specific mortality than those not deployed. Gray et al. (33) also reported, on the basis of prewar hospitalization rates among Gulf and non-Gulf veterans, that the effect of the possible selection bias was transient and largely resolved by the conclusion of the war. Gray et al. noted that military personnel in general are healthy and without serious chronic conditions. If they develop a chronic disease that causes a sustained reduction in their ability to perform their military duties, they are eventually separated from military service. We believe that the effect of this potential selection bias would be very limited and could not have accounted for all of our findings.
The Nigerian Civil war which lasted for 30 months killed more than one million people. This was due to the blockade of food supply to the Biafrans during the war which led to severe famine such that over 100, 000 civilians died from hunger and starvation, most whom were women and children. https://www.google.com. It was a deliberate policy by Nigeria to ensure that the Biafrans surrendered. The Nigerian Civil War had eloquent effects on all but most especially the women and children who were the most vulnerable to all types of exploitation and abuses. The Nigerian Civil War destroyed infrastructural facilities such as health, education and other social services. The Nigeria Civil War left significant effects on the families and the individual in the areas. In the families, it led to disintegration and change of roles. It also led to forced migration. It had negative effect on women and children in terms of psychological, social and physical well being. The devastating effects of the Nigerian Civil War on women and children cannot be overemphasized (Emeka, 2017). Women and children suffered emotional burden and they were the worst affected by Nigerian civil war. They were the ones that received the hard end of the stick. Throughout the war, there were instances of terrible abuses against women and children. Many women and female children were raped or killed during the Nigerian Civil War.
Studies were included in the review if they: i) investi- gated a community adult sample of war refugees 5 years or longer after displacement; ii) had a sample larger than 30 participants; and iii) reported quantita- tive estimates of depression, PTSD, and/or anxiety or reported on their associative factors. There were no restrictions regarding the language. Populations were identified as being war refugees if they migrated from a country subjected to armed conflict. A minimum sample size of 30 was chosen to achieve a representa- tive distribution in line with the central limit theorem . To exclude the effects of age-differential vulner- abilities for trauma-related disorders, studies were ex- cluded if the majority of the sample were younger than 12 years at the time of the last war-related trau- matic event [21–23]. Case reports, qualitative studies or studies assessing clinical samples were excluded. Qualitative and quantitative research is grounded in different methodological paradigms and reviewing qualitative studies would have required a different methodology. Therefore, the inclusion of qualitative studies was beyond the scope of this review. Furthermore, these studies were excluded because the intention of the review was to perform a quantitative meta-analysis. Inclu- sion of clinical samples – that is inpatient, outpatient or help seeking groups - could potentially bias results and lead to an overestimation of mental health problems in refugees. When different population groups than those of interest (e.g. immigrants) were included in a study, studies were included only if refugee data were reported separ- ately. Where multiple publications presented identical
The data were retrospective and self-reported, and con- sequently subject to recall and social desirability biases. Although recall bias is expected to be less extreme in a survey of adolescents than adults or younger children, recall bias is still a possibility in retrospective reports of childhood adversities and stressful war experiences. The cross-sectional design precludes both causal inference (as event reporting may be confounded by current psycho- logical functioning and age) and the longitudinal analysis of adjustment trajectories . The generalizability of our findings is limited to only school-going adolescents. Fur- thermore, given that active war ended in 2006, the ex- tended time frame (four years post-war) created a situation in which post-war factors, such as post-war trauma could occur and compete for explained variance. The time frame also sampled youths 9 to 17 years old at the end of the war – a group that was possibly less se- verely exposed than older adolescents. This may have led to low endorsement rates for some event types (e.g., phys- ical violence) that prevented their predictive effects from being adequately tested . As a consequence, factors
The War variable itself has no effect in the not including province dummies but become significant once these province fixed effects are included. Given that most of the province variables are significant and jointly significant, I find that the war in Afghanistan increases they risk of dying by roughly two percent for the provinces experiencing very high levels of violence. This includes particu- larly the provinces Kabul, Kandahar and Helmland. The effect itself is smaller in magnitude for individuals in provinces experiencing high level of violence. However, the effect itself is not very high in magnitude overall. This could be because households have got used to the constant level of violence and along with this, the extremely low level of development in Afghanistan. Nonethe- less, they had time to learn how to cope for more than 30 years (e.g. through consumption smoothing), and have very likely developed coping strategies mit- igating the possibly negative effects of daily hardships (Rose 1999, Bove and Gavrilova 2014).
Abboud, S. N. (2016). Syria. Cambridge: Polity Press. Alayan, S., Rohde, A., & Dhouib, S. (Eds.). (2012). Curricula, The Politics of Educaation Reform in the Middle East: Self and Other in Textbooks and. New York : Berghahn Books. Children's Living Nightmares. (2017). (Save the Children Foundation Inc.) Retrieved from Save the Children. Fazel, M., Reed, R. V., Panter-Brick , C., & Stein, A. (Jan 2012). Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. The Lancet, 379(9812), 266-282. Immerstein, S., & Al-Shaikhly, S. (2016, April 4). Education in Syria. Retrieved March 2017, from World Education News and Reviews: http://wenr.wes.org/2016/04/education- in-syria Labi, A. (2014, November 7). Scholars in Danger Join World's Refugees. Chronicles of Higher Education, 19. Ladika, S. (2017, March/April). Empowering Refugees Through Education. International Educator, 26(2), 32-39. Mansel, P. (2016). Aleppo: The Rise and Fall of Syria's Great Merchant City. London: I.B. Tauris & Co. Ltd. Mettelsiefen, M. (Director). (2016). Frontline: Children of Syria [Motion Picture]. Ritzer, G., & Dean, P. (2015). Gloalization: A Basic Text. (B. P. Ltd, Ed.) West Sussex: John Wiley & Sons Ltd. Sinclair, M. (2011). Education in emergencies. Learning for a future: Refugee education in developing countries, 1-84. Timm, M. (2016). The Integration of Refugees into the German Education System: A Stance for Cultural Pluralism and Multicultural Education. JEP: EJournal of Education Policy, 1-7.
______________________________________________________________________________________________________ In nearly six years of armed conflict, more than 250,000 Syrians have lost their lives and there were over 1 million Syrian refugees who had been registered in Lebanon in 2016. It has been reported that exposure to war causes injury, illness and breakdown in the health care structures especially to children. This paper attempts to evaluate the impact of war on health in children and to explore their experience living with health problems. A qualitative data from semi structured interview was conducted among mothers in refugee camp in Bekaa Valley, Lebanon Participants were purposefully sampled and asked to share their impact on war to health of their children. All interviews were written manually and analysed thematically. Ten participants were involved in this study. There were three main themes were identified, each of which led to health risks for the children; antepartum, intrapartum and postpartum. There was variety of health problems reported ranging from neurological, musculoskeletal disorder to ocular problems. The experience living with health problems were understood through construction of three thematic categories emerged; psychological burden, disruption of daily living and economic effect. In additional, the participants also highlighted the intergenerational impact of war on health predominantly mental disorder, congenital abnormalities, infectious disease and complication in pregnancy. In general, this paper provides an important understanding of impact of wars on health among vulnerable group which is children. The effects of wars on health and health care services are substantial. All these issues should be explored more to ensure the children received adequate health care. The results generated form this study can inspire new collaboration with many authorities in the design and implementation intervention to improve health status in war zone.
Given the inherent inter-relatedness between super ordinate lessons, failure to implement a single foundational lesson can have a cascading effect that significantly erodes capability to meet basic needs. Predictable outcomes include high incidence of unmet mental health and social needs, social reintegration difficulty, suicide spikes, chronic co-morbid injuries and disability in the context of clear erosion of system capacity to meet needs (e.g., staffing shortages, attrition, delayed access to care, etc.). Sustained neglect, prolonged warfare, delayed recognition, and continued disregarding of foundational psychiatric lessons will always devolve into costly mental health catastrophes, posing significant long-term harm, costs, and public health risks. Herculean efforts by Congress to deal with the effects of crisis cannot overcome the damage from inordinate delay and decades of neglected war lessons, therefore the crisis deepens as greater numbers of the military population with untreated war stress injuries exit the military and chronicity of problems escalate in co-morbidity (e.g., relationship strain, suicide, unemployment, etc.). For instance, “400 Ex-Soldiers New York Suicides (The New York Times, 1921), and late WWII headlines “Bradley Demands Aid for Veterans: Say Community Must Help or Create Conditions That Can Breed Psycho-Neurotics” (The New York Times, 1944b) and “Communities Held Failing Veterans: Social Service Experts Find a Lack of Help in Solving Readjustment Problems” (The New York Times, 1945c), all reflect real-world consequences of delayed action and failure to learn war trauma lessons. Similar reports were available late in the Vietnam War, “Veterans Battle Emotional Strain: Vietnam Returnees Discuss Problems of Dislocation” (The New York Times, 1973); and repeated by 21st century news media “Military Update: VA fails to meet vets PTSD needs” (Philpott, 2011) and “The Army’s Continuing Dearth of Mental-Health Workers” (Thompson, 2012).
The same thematic punch line is more vividly expressed in “Anthem for Doomed Youth”, “Mental Cases” and in “Dulce et Decorum Est”. In the last poem Owen ignores and strongly opposes the popular song that it was sweet and fitting to die for one’s fatherland or country. His force of argument comes from the effects of the argument of force on the battlefield, having witnessed the pains, woes, worries, blues and pathetic death of soldiers in combat. The poem narrates a particular gas bombing experience where soldiers “bent double, like old beggars under sacks”, “knock- kneed”, “coughing like hags”, pass through “sludge”“trudge”, “march asleep”, having “lost their boots”, “limped on, blood-shod”, “lame”, “blind”, “Drunk with fatigue”, and “death” are gassed with “Five-Nines” (a kind of gas shell, 5.9 calibre explosive shells). The above diction reveals the physical and mental state of the soldiers. They are not only completely exhausted but they are equally helpless and senseless. They are in a very pathetic physical state that in itself speaks of the terrible mental experiences they have witnessed in combat. Araujo (2014) writes that Owen’s poem is one of the most scathing indictments of the war. This is true given that the poem’s title is an ironic portrayal of the pity of war and the pity war distils as well as the distrusts of that traditional ideology that has kept soldiers fighting.
Adding to the contention that Iraq war should not regard as a just war is the justice in war is not epitomized. Many newspapers revealed that the US ally also tortures the prisoners of war. The most prominent example is the Abu Ghraib prison. Prisoners inside subjected to various kind of torments, for instance, some of them confronted walloping by the US privates, while some female pris- oners experienced sexual abuses, such as forced to be taken nude photographs (Meyer, 2004). Hence, how can these inhume conduct of US ally can justify as a just move? Also, the US ally has not followed the rule of proportionality of force used and their goals. Immoderate violence was used amidst the war, for example, a rebel hid on the roof of a building and the US troops blow up the entire build- ing (Goldman & Martinez, 2010). What is more inadmissible is even though the US has an overwhelming advantage on military capacity than Iraq, it still chose to use chemical weapons for invasion. Depleted uranium (DU) weapons, which are regarded as small nuclear bombs, were fired during the war and people suffer from sequelae of radiation (Edwards, 2014). It is not justified that the US undue use of violence. Discrimination between the target and innocent has also been overlooked by the US ally. The secret documents unveiled by Wikileaks suggest US army had not taken innocent life seriously. It is not uncommon to see that a monstrous number of manslaughter occurred during the war. For example, a US patrol got an intelligence that there are suspected “Anti-Iraq Force” members appeared in Eastern Baghdad and they not only did not confirm the reality of the source and they simply shoot anyone when they arrived, and ultimately fourteen civilians were killed (Pugliese, 2013). Julian Assange, the founder of WikiLeaks, contended the number of death in Iraq war is five times more than that in Af- ghanistan war and label it is a “bloodbath” (The Sydney Morning Herald, 2010). Hence, there is not any justice in war can be observed.
The primary limitation of this study is that, since health providers did not code injuries using ICD categories, there could be misclassification. Secondly, the data sources were hand-written/paper reports made during extreme war injury management under pressure and tension, which may produce inaccuracy and incomplete- ness. We believe that completing medical records on a computer is much easier than entering all details by hand in paper record-books. It should be noted that the MOH has recently collaborated with the Norwegian In- stitute of Public Health and the WHO to enhance and strengthen the Palestinian health system network in terms of reporting and registration. Unfortunately, the process has not been completed or even initiated due to the 2014 Gaza war, which has directly affected and re- stricted this significant effort, leading to delays in the implementation of the plan . Another limitation of our study is that we were not able to derive the rate of injury due to absence of person-years. We instead com- puted number of injuries per 1000 population. The iden- tification of the severity of injury was based on physicians perceptions as reported in records of injured patients. The diagnosis may differ from physician to physician without use of ICD codes for injuries, espe- cially with the large number of injuries and limited time and resources in a very stressful situation. We have no further information on the persistence and lifetime se- verity of injury or disability, nor whether the victims have recovered. It is worth mentioning that in a lower and middle income country without an appropriate and computerized healthcare network, during emergencies such as wars, invasion, or conflicts, it is difficult for phy- sicians to report ICD codes of injuries and provide ne- cessary treatment to the war victims with poor medical
maternal blood lead levels measured during the first trimester of pregnancy; the threshold for the effect was 10.5 μg/dL. Alterations in rod function, evidenced by the appearance of central scotoma, also had been reported earlier in lead workers with moderate PbB (mean, 47 μg/dL) (Cavalleri et al. 1982). Changes in ERG components also have been reported in rats (Fox and Chu 1988; Fox and Farber 1988; Fox and Katz 1992; Fox and Rubinstein 1989) and monkeys exposed during development (Bushnell et al. 1977; Kohler et al. 1997; Lilienthal et al. 1988, 1994). Tests conducted in monkeys >2 years after cessation of life exposure to lead revealed alterations in the ERG under scotopic conditions similar to those recorded during lead exposure, and at a time when PbB was below 10 μg/dL (Lilienthal et al. 1994). Since the alteration could be reproduced by treatment with dopamine antagonists, Lilienthal et al. (1994) suggested that the observed effects may be mediated by a permanent change of dopamine function. The series of studies from Fox and coworkers in the rat showed that low-level lead exposure during postnatal development has a detrimental effect on the rods of the retina, but not on cones. They also showed that developing and adult retinas exhibited qualitatively similar structural and functional alterations, but developing retinas were much more sensitive, and in both cases, alterations in retinal cGMP metabolism was the underlying mechanism leading to lead-induced ERG deficits and rod and bipolar cell death (Fox et al. 1997). Using a preparation of rat retina in vitro, Fox and coworkers demonstrated that rod mito chondria are the target site for calcium and lead and that these ions bind to the internal metal binding site of the mitochondrial permeability transition pore, which initiates a cascade of apoptosis in rods (He et al. 2000).