Table 2 Included studies (n = 26)
From: Emergency care in post-conflict settings: a systematic literature review
Title | Author(s) (year) | Country origin of data | Type of conflict experienced | Study design | Authors’ relevant findings |
|---|---|---|---|---|---|
Rebuilding the health care system in Afghanistan: An overview of primary care and emergency services | Acerra et al. (2009) [16] | Afghanistan | Protracted conflict | Qualitative | While EDs do exist at some district hospitals and community health centers throughout the country, they are staffed by general practitioners with little or no emergency care training. Local emergency department administrators are not trained to manage EDs. This can be a problem for improving day-to-day operations of the departments |
Can patient flow be effectively controlled? | Adini et al. (2011) [17] | Israel | Protracted conflict | Qualitative | It is possible to direct the flow of patients to EDs and rationalize the use of resources, making it possible for patients to be admitted to EDs best able to care for them |
Why women die after reaching the hospital: A qualitative critical incident analysis of the ‘third delay' in postconflict northern Uganda | Alobo et al. (2021) [18] | Uganda | Acute war | Interviews | Five reasons were identified for delays: shortage of medicines and supplies, lack of blood and functionality of operating theatres, gaps in staff coverage, gaps in staff skills, and delays in the interfacility referral system. Shortage of medicines and supplies was central in most of the pathways, characterised by three patterns: delay to treat, back-and- forth movements to buy medicines or supplies, and multiple referrals across facilities |
Barriers in the delivery of emergency obstetric and neonatal care in post-conflict Africa: Qualitative case studies of Burundi and Northern Uganda | Chi et al. (2015) [11] | Burundi, Uganda | Genocide | Interviews and focus group | The barriers in the delivery of quality EmONC services were categorised into two major themes; human resources-related challenges, and systemic and institutional failures. To improve the situation across the sites, efforts are ongoing to improve the training and recruitment of more staff; harmonise and strengthen the curriculum and training; increase the number of EmONC facilities; and improve staff supervision, monitoring and support |
Enhancing governance and health system accountability for people centered healthcare: An exploratory study of community scorecards in Afghanistan | Edward et al. (2015)Â [19] | Afghanistan | Protracted conflict | Survey | Community score cards are a promising tool for enhancing social accountability for patient-centered care. However, the process requires skilled facilitators to effectively engage communities and healthcare providers and adaptation to specific healthcare contexts |
Post-war Kosovo: Part 2 Assessment of emergency medicine leadership development strategy | Eliades et al. (2001) [20] | Kosovo | Acute ethnic civil war | Interviews and focus group | A multi-modal assessment of health systems can provide important information about the need for emergency health system improvements in Kosovo. This methodology may serve as a model for future, system-wide assessments in post-conflict health system reconstruction |
Patterns and determinants of pathways to reach comprehensive emergency obstetric and neonatal care (CEmONC) in South Sudan: Qualitative diagrammatic pathway analysis | Elmusharaf et al. (2017)Â [21] | South Sudan | Protracted conflict | Interviews | Outcomes are better where there is no facility available than when the woman accesses a non-functioning facility, and the absence of a healthcare provider is better than the presence of a noncompetent provider. Visiting non-functioning or partially functioning healthcare facilities on the way to competent providers places the woman at greater risk of dying. Non-functioning facilities and non-competent providers are likely to contribute to the deaths of women |
Development of a community-based maternal, newborn and child emergency training package in South Sudan | Fehling et al. (2013) [22] | South Sudan | Protracted conflict | Interviews and focus group) | Significant consensus emerged regarding the need for greater capacity among previously untrained frontline health workers |
Mental health status among ethnic Albanians seeking medical care in an emergency department two years after the war in Kosovo: a pilot project | Fernandez et al. (2004)Â [23] | Serbia and Kosovo | Acute ethnic civil war | Survey | Mental health problems among ED patients in Kosovo, particularly among specific vulnerable populations, are a significant public health concern 2Â years after the conflict |
Perception of effective access to health services in Territorial Spaces for Training and Reincorporation, one year after the peace accords in Colombia: A cross-sectional study | Fernández-Niño et al. (2020) [24] | Colombia | Protracted conflict | Cross-sectional survey | While residents of Territorial Spaces for Training and Reintegration-Reincorporation regions have a favorable perception of their access to health services, they need to be made aware of extramural and public health activities |
Trauma care systems in South Africa | Goosen et al. (2003) [25] | South Africa | Acute civil unrest | Literature review | Gross inequities exist in the provision of trauma care. Access to pre-hospital care and overloading of tertiary facilities are the major inefficiencies to be addressed |
A model for emergency medicine education in post-conflict Liberia | Hexom et al. (2012) [26] | Liberia | Civil war | Case report | The use of a global consortium can successfully augment and support academic teaching in emergency medicine in Liberia |
Development of emergency medicine in Rwanda | Kabeza et al. (2013) [27] | Rwanda | Genocide | N/A | A program can be designed to provide a sustainable source of locally trained physicians that will work with the countries newly launched EMS system to provide emergency and acute care for a population with great need |
Availability of essential health services in post-conflict Liberia | Kruk et al. (2010) Â [28] | Liberia | Civil war | Survey | One-quarter (26.8%) of the respondents could access basic EmOC. Of the 36 county facilities in Nimba, none (0.0%) provided EmOC. Of the three health centres one (33.3%) provided EmOC. Of the four hospitals all four (100.0%) provided EmOC |
Post-war Kosovo: Part 3 Development and rehabilitation of emergency services | Lis et al. (2001)Â [29] | Kosovo | Acute ethnic conflict | Mixed methods | The majority of emergency patients transported themselves to the hospital. Currently, there only are a few trained, prehospital providers in Kosovo, and almost no airway/cardiac equipment is available on any of the ambulance. There is no centralized emergency department and patients left to self triage. There was no formal triage area, and no materials or equipment was designated for the care and stabilization of ill patients |
Punishment attacks in post-ceasefire Northern Ireland: An emergency department perspective | McGarry et al. (2017)Â [30] | Northern Ireland | Acute ethno-nationalist conflict | Retrospective chart analysis | Punishment attacks continue at a significant rate within the province and there is a return to shooting as the primary means of punishment attack, with an increase in total caseload from 1994. Cost remains a substantial drain on department resources |
A mixed methods evaluation of Advanced Life Support in Obstetrics (ALSO) and Basic Life Support in Obstetrics (BLSO) in a resource-limited setting on the Thailand-Myanmar border | McGready et al. (2021) [31] | Thailand, Myanmar | Protracted conflict | Mixed methods | ALSO and BLSO are sustainable, beneficial, EmOC trainings for adult education in protracted, post-conflict, resource-limited settings |
Integrating quantitative and qualitative methodologies for the assessment of health care systems: Emergency medicine in post-conflict Serbia | Nelson et al. (2005)Â [32] | Serbia | Acute ethnic civil war | Mixed methods | Demographic data indicate a loosely ordered network of part-time emergency departments supported by 24-h pre-hospital services and an academic emergency center. Focus groups and questionnaires reveal significant impediments to delivery of care and suggest development priorities |
War-related psychological sequelae among emergency department patients in the former Republic of Yugoslavia | Nelson et al. (2004) [33]Â | Yugoslavia | Acute ethnic conflict | Cross-sectional survey | Three years post-war, symptoms of PTSD and major depression in Serbia remained a significant public health concern, particularly among refugees, those suffering subsequent economic instability, and persons living in rural, remote areas |
Post-war development of emergency medicine in Kosovo | O’Hanlon and Lerner (2007) [34] | Kosovo | Acute ethnic conflict | Interviews | Most respondents believed that emergency medicine as a specialised field was a post-war development |
First Aid and Voluntarism in England, 1945–85 | Ramsden and Cresswell (2019) [35] | England | Acute war | Literature review | Voluntary ambulance services were able to offer solutions to evolving needs and desires such as the increased demand for first-aid training in the workplace, the need for first-aid cover in a more leisure oriented society |
Prehospital injury severity of children evacuated by helicopters from combat zones: A retrospective report | Samuel et al. (2013)Â [36] | Israel | Protracted conflict | Retrospective comparative | In the prehospital setting, children evacuated from combat zones were more severely injured than children who were transported from the scene during peacetime |
Providing emergency care and assessing a patient triage system in a referral hospital in Somaliland: A cross-sectional study | Sunyoto et al. (2014) [37] | Somaliland | Protracted civil war | Cross-sectional | The high proportion of late presenters to the ED suggests considerable barriers to care and lack of awareness amongst patients and the community on the need of early presentation. ED staff was able to use this system accurately and reflecting positively on the training programme provided |
A first aid training course for primary health care providers in Nagorno Karabagh: Assessing knowledge retention | Thompson et al. (2012) [38] | Azerbaijan | Acute ethnic conflict | Survey | The trainees assessed the first- aid training course as effective, and the skills covered as important and well utilized. Knowledge retention was modest, but stable. Refresher courses are necessary to reverse the decay of technical knowledge and to ensure proper application in the field |
Post-war Kosovo: Part 1. Assessment of prehospital emergency services | Vanier et al. (2001) [39] | Kosovo | Acute ethnic conflict | Interviews | By improving the communications, staffing, equipment, and transport patterns in the system, significant progress can be realized in expanding Kosovo's emergency care capabilities |
Existing infrastructure for the delivery of emergency care in post-conflict Rwanda: An initial descriptive study | Wen and Char (2011)Â [40] | Rwanda | Genocide | Interviews | The three most commonly cited problems facing EM infrastructure in Rwanda were lack of resources (94% of respondents), need for specialised EM training (89%), and absence of prehospital care (74%). ongoing challenges, specifically with continuing lack of resources, need for specialised EM training, and deficiency of prehospital care, along with new questions about sources of funding and implications for the healthcare workforce |