Publications

On 20 January 2025, the day of his second inauguration as president, Donald Trump signed an executive order rescinding the Biden era policy that restricted Immigration and Customs Enforcement (ICE) operations at “sensitive” locations, including schools, churches, and healthcare facilities.12 The negative impact has been immediate. Patients are fearful, public health is under threat, and providers are braced for ethical challenges.

There is a dearth of evidence on the scale, scope and quality of midwifery education programs in conflict-affected settings. This study sought to assess the extent to which midwifery pre-service education programs meet national and global standards, and to explore how conflict affects pre-service midwifery education in Yobe State Nigeria and the Benadir and Galgaduud regions of Somalia.

This longitudinal experimental study aimed to profile audiometric hearing loss, explore the feasibility and efficacy of low-cost hearing devices, and examine their social and emotional impact on participants in South Sudan, a low-resource humanitarian setting.

Cholera outbreaks are surging worldwide. Growing research supports case-area targeted interventions (CATIs), whereby teams provide a package of interventions to case and neighboring households, as an effective strategy in cholera outbreak control, particularly in humanitarian settings. While research exists on individual CATI interventions, research gaps exist on outcomes of integrated interventions during CATI responses.

Midwives play an important role in maternal and newborn care, yet are in short supply globally. The shortage in midwives is particularly acute in sub-Saharan African countries, many of which are conflict-affected. Midwives face many challenges that impact their workforce participation and retention, and these challenges are often compounded in conflict settings. Somalia ranks among the countries with the highest maternal mortality rate, with an estimated shortage of 20,000 midwives compared to the WHO recommended standard. Yet, limited research has explored the lived experience of midwives in conflict. This qualitative study seeks to explore the experiences, plans, and aspirations of midwifery students and recent graduates from nine midwifery schools in Somalia and to understand how the safety and security situation impacts their educational experience and willingness to join the profession.

More than 650 million women alive today were married as children. Relative to efforts to prevent child marriage, efforts to support child brides have received much less attention. This review set out to map and describe interventions that support child brides. We performed a scoping review using seven electronic databases coupled with a grey literature search in January 2022. Data were extracted using a piloted extraction tool and findings were reported in narrative synthesis. A total of 34 projects were included in our review. Most projects focused on improving sexual and reproductive health (SRH) knowledge and behaviours among child brides, which was often achieved through a combination of SRH education, counselling and information provision, along with linkages to SRH services. Some interventions were health facility-based and aimed at improving responsiveness of health service providers to the needs of child brides. Very few described economic interventions as one component of a broader health intervention, and only three interventions focused on improving girls' educational outcomes. We also note the paucity of media-based interventions, despite their popularity among adolescents. Over time, interventions addressing the needs of child brides have increased, but the preponderance of evidence has focused on SRH interventions, with interventions that couple education with adolescent-friendly health services demonstrating promise. Interventions addressing other areas of health and social wellbeing of this group, such as mental health, sexual health, and economic independence, have been overlooked in comparison. The review highlights the need for additional empirical evidence on what works to support child brides.

In 2020, COVID-19 modeling studies predicted rapid epidemic growth and quickly overwhelmed health systems in humanitarian and fragile settings due to preexisting vulnerabilities and limited resources. Despite the growing evidence from Bangladesh, no study has examined the epidemiology of COVID-19 in out-of-camp settings in Cox’s Bazar during the first year of the pandemic (March 2020-March 2021). This paper aims to fill this gap.

Female genital mutilation (FGM), defined as any procedure altering or removing external female genitalia without medical justification, is a serious human rights violation affecting women, particularly across several African and Middle Eastern countries, where it also poses a significant public health challenge.¹ The consequences of FGM are extensive, impacting both mental and reproductive health and contributing to complications like hypertensive disorders during pregnancy, such as eclampsia.¹

Introduction: Yemen has one of the highest rates of child marriage in the Middle East and North Africa region and is home to one of the world's worst humanitarian crises. How the conflict and resulting displacement have impacted family formation patterns is not entirely clear. In this study, we investigate the impact of displacement on child marriage and early childbearing by comparing time-to-first-marriage and time-to-first-birth among displaced and non-displaced girls.

On Sept 13, 2024, WHO announced the prequalification of the first mpox vaccine, MVA-BN.¹ WHO's Strategic Advisory Group of Experts (SAGE) on Immunization recommended this vaccine for people at high risk of mpox exposure in the current outbreak, stating that “this vaccine may be used ‘off-label’ in infants, children and adolescents, and in pregnant and immunocompromised people”. ¹ Missing from these recommendations are breastfeeding mothers. In 2022, WHO had stated that the MVA-BN vaccine could be used in breastfeeding women.² However, WHO's new 2024 guidance, which replaced the 2022 recommendations, simply states, “MVA-BN safety and efficacy has not been evaluated in breastfeeding women. Data are not available to assess…the safety of MVA-BN in breastfed infants.”³

MVA-BN contains a weakened, non-replicating virus that cannot cause mpox. Currently, some countries recommend its use in people who are breastfeeding,⁴ whereas others prefer not to make this recommendation.⁵ This contradiction has, understandably, led to confusion among health-care workers.

There has been tremendous progress in building and promoting evidence-based practice around parenting programming in low- and middle-income countries. However, there remains a dearth of evidence specifically examining gender transformative programming designed to address gender-based violence in humanitarian settings. To inform this gap, we examine how existing gender transformative programmatic material addresses the unique circumstances of parenting in humanitarian settings. Incorporating lessons from the field, we inform considerations of how to adapt future content to address gender-based violence in humanitarian settings. We reviewed two gender transformative programs in humanitarian settings: Safe at Home and Sibling Support for Adolescent Girls in Emergencies. Four thematic recommendations emerged for gender-transformative parenting programming in humanitarian settings to address gender-based violence, specifically intimate partner violence and violence against children. These recommendations include: 1) Recognize the diversity of families in humanitarian settings, 2) Prioritize participatory approaches from the start, 3) Set realistic parameters and goals for the specific humanitarian context, and 4) Ensure pathways to scale and sustainability within the initial program design. We advocate for broader application of these principals to support gender-transformative parenting programming that is tailored to address gender-based violence in humanitarian settings and that will continue to build the respective evidence base.

This study investigates the association between forced displacement and the experience of menstrual shame, highlighting age and current displacement as influential factors of menstrual wellbeing amidst humanitarian crises.

Violence and threats against health facilities and workers, both in peacetime and during armed conflict, and the criminalisation of medical care, such as abortion care, limit access to health services and result in worse health outcomes for millions of people around the world.^1,2 Combatants', governments', and the international community's abdication of responsibility to protect health workers and facilities subjects physicians, nurses, and other health personnel to verbal and physical attack and leads to needless patient deaths. As leaders of medical and nursing organisations and researchers in the field, we share the conviction that attacks against health personnel anywhere should be a matter of concern for health professionals everywhere.

Few implementation science (IS) measures have been evaluated for validity, reliability and utility – the latter referring to whether a measure captures meaningful aspects of implementation contexts. We present a real-world case study of rigorous measure development in IS that assesses Barriers and Facilitators in Implementation of Task-Sharing in Mental Health services (BeFITS-MH), with the objective of offering lessons-learned and a framework to enhance measurement utility.

The eastern Democratic Republic of Congo (DRC) has faced dual burdens of poor mental health and heightened levels of violence against women and children within the home. Interventions addressing family violence prevention may offer a path to mitigate mental distress within the eastern DRC. This exploratory analysis uses data from a pilot cluster randomized controlled trial conducted in North Kivu, DRC, assessing the impact of Safe at Home, a violence prevention intervention. Mental health was assessed at endline using the Patient Health Questionnaire-4. Statistical analyses employed multilevel linear regression.

Assuming successful randomization, impact of the Safe at Home intervention on mental health differed by participant gender. Women enrolled in the Safe at Home intervention reported statistically significant decreases in mental distress symptoms [β (95%CI) = −1.01 (−1.85, −0.17)], whereas men enrolled in Safe at Home had similar scores in mental distress to the control group [β (95%CI) = −0.12 (−1.32, 1.06)].

Ultimately, this exploratory analysis provides evidence of the potential for a family violence prevention model to improve women’s mental health in a low-resource, conflict-affected setting, although further research is needed to understand the impact on men’s mental health.

On Aug 14, 2024, WHO declared mpox a Public Health Emergency of International Concern.¹ The Democratic Republic of the Congo is particularly affected. The importance of exclusive breastfeeding for infant survival has been widely shown, and is of particular relevance in the Democratic Republic of the Congo, where new mpox cases are increasing, including among breastfeeding women.

During outbreaks of viral pathogens, whether breastmilk or breastfeeding can transmit the relevant virus is often questioned (ie, during the COVID-19 pandemic and Ebola outbreaks). A priori, guidelines often state that breastmilk should be withheld from infants without evidence of transmission. A 2021 study estimated that many newborns separated from their mothers who were infected with SARS-CoV-2 probably had higher mortality from being denied breastmilk than from contracting the virus from mothers who were infected.²

Background Throughout the Syrian conflict, the Syrian government has intentionally attacked health facilities, violating International Humanitarian Law. Previous studies have qualitatively described health system disruptions following attacks on healthcare or established associations between armed conflict and health service utilisation, but there are no quantitative studies exploring the effects of health facility attacks. Our unprecedented study addresses this gap by quantifying the effects of health facility attacks on health service use during the Syrian conflict.

Methods This retrospective observational study uses 18 537 reports capturing 2 826 627 consultations from 18 health facilities in northwest Syria and 69 attacks on these facilities. The novel study applies case time series design with a generalised non-linear model and stratification by facility type, attack mechanism and corroboration status.

In introducing the new CHH–Lancet Commission on Health, Conflict, and Forced Displacement, Paul B Spiegel and colleagues argue that the humanitarian system to date requires systemic change.¹ We agree, but believe that the Commission's efforts will fall short without a fundamental rejection of apolitical humanitarianism. Historical and contemporary crises, such as the ongoing genocide in Gaza, illustrate that apolitical humanitarianism undermines the field's effectiveness and its ability to respond to those most affected. Avoiding engagement with politics in humanitarian action maintains a broken system that prioritises powerful interests over the needs of individuals in humanitarian crises.

The principle of apolitical humanitarianism—rooted in neutrality, impartiality, and independence—has long been a foundational concept in the humanitarian response. However, the idea of transcending political affiliation as a strength of the field was challenged in the late 20th century, particularly during the Rwandan genocide and other conflicts in which humanitarians found their aid targeted and instrumentalised.² At the time of writing this, we witness this in Gaza, where those accused of indiscriminate attacks on civilians also control the humanitarian response,^3,4 raising questions about the effectiveness of apolitical humanitarianism.

How can palliative care framings advance humanitarian discourse? The imperative for palliative care in humanitarian settings is increasingly urgent. Recent efforts by health and humanitarian organizations demonstrate increasing attention to the issue. Yet palliative care is still not adequately formally considered or enacted by humanitarian agencies in rhetoric, policy, research, or practice. Even where it is considered in humanitarian action, palliative care is often assumed to be a novel intervention, rather than a caring practice that has existed from time immemorial, including in humanitarian situations. The generation of ideas in this paper has followed a dynamic, iterative, and reflexive process through engagement with key literature, critical thinking, conversations with colleagues across both sectors, primary data, and debate amongst the authors. The paper argues that the current dominant frame of a new, specialized, professionalized, and medicalized palliative care in the humanitarian sector would perpetuate existing challenges. It contends that viewing both fields through a “new-old” lens, where historical and traditional caring practices intertwine with progressive discourse for a more just and appropriate public health response, can further humanitarianism. It posits that the humanitarian-development nexus, decoloniality, and localization thought can benefit from palliative care practice through critical interaction with a broad range of literature.

On 6 February 2023, an Mw 7.8 earthquake struck southern and central Türkiye and north-western Syria, affecting the lives of 4.6 and 2.5 million children, respectively. In such crises, infants who are dependent on commercial milk formula (CMF) face increased vulnerability to diseases and malnutrition as safe preparation of CMF becomes difficult and sometimes impossible. The Operational Guidance on Infant and Young Child Feeding in Emergencies (OG-IFE) provides guidance on protecting and supporting recommended infant and young child feeding and minimizing the risks that come with CMF feeding. In addition, the International Code of Marketing of Breastmilk Substitutes (the Code) ensures adequate nutrition for infants by protecting and promoting breastfeeding and ensuring the proper usage of CMF. This study aims to document violations of the Code and the OG-IFE during the earthquake relief efforts to help strengthen infant and young child feeding emergency responses and inform future disaster relief policies.