Prevalence of Posttraumatic Stress Disorder and Depression Among Internally Displaced Persons In Mogadishu

Background Nearly three decades of conflict and frequent droughts and environmental hardships, have left 2.6 million of Somalis in displacement camps. Even though psychological impact of war and natural disasters are well documented, little is known about the unseen scars of psychological trauma in Internally displaced persons in Somalia. The purpose of the study was to determine the prevalence of post-traumatic stress disorder (PTSD) and depression amongst internally displaced persons (IDPs), and examine association between displacement and these psychiatric conditions. Methodology A cross-sectional quantitative study was conducted among 406 IDPs in Mogadishu. Harvard Trauma Questionnaire was used to determine levels of trauma exposure and PTSD, and Hopkins Symptom Checklist-25 was used to estimate prevalence of depression. Multivariate and bivariate analysis was conducted to analyze the association of demographic and displacement variables on the outcomes of PTSD and depression. Results More than half (59%) of participants met the symptom criteria of depression, and nearly one third (32%) of respondents met the symptom criteria for PTSD. The most prevalent traumatic event was lack of food or water (80.2%). Important predictive factors in development of psychiatric morbidity were unemployment, cumulative traumatic exposure, frequency and duration of displacement. Conclusion The study revealed high levels of Depressive disorder and Post-Traumatic Stress Disorder among internally displaced persons in Mogadishu. Furthermore, this study provided evidence to IDPs’ susceptibility to trauma exposure and lack of essential services and goods. Study also highlighted the importance of provision of Mental Health and Psychosocial Support (MHPSS) service in IDP camps.

Gerontological aspects of improving the quality of medical and social assistance to older displaced persons in the context of the COVID-19 pandemic in Ukraine

Исследование посвящено вопросам организации медицинского и социального обслуживания переселенцев пожилого возраста на уровне первичной медико-санитарной помощи (ПМСП) на Украине, определению основных задач и особенностей организации и предоставления им паллиативной и хосписной помощи (ПХП) в условиях пандемии COVID-19. По результатам социологического исследования с использованием методов опроса, экспертных оценок были проанализированы социально-психологические характеристики переселенцев пожилого возраста, особенностей их социальной адаптации, финансирования и медико-социального обслуживания. Были определены пути улучшения организации амбулаторной помощи переселенцам старшего возраста на уровне ПМСП, включающие структурную модернизацию и оптимизацию организационного обеспечения. Внедрение доступных и экономически обоснованных подходов позволяет усилить взаимодействие специалистов учреждений здравоохранения и социальной защиты, оптимизировать соблюдение стандартов и принципов медицинской помощи. В рамках организации ПХП базовыми являются европейские подходы формирования стратегии непрерывности предоставления паллиативной помощи в условиях пандемии COVID-19. Внедрение предлагаемых подходов в организации медицинской и социальной помощи на уровне амбулаторий ПМСП и обеспечение доступной ПХП являются актуальными для переселенцев пожилого возраста, находящихся в группе повышенного риска при пандемии COVID-19. This work aimed to study the organization of medical-social services for the elderly internally displaced persons at the level of primary medico-sanitary aid (PMSA) in Ukraine, assessment of the main tasks and specifics of organization and provision of palliative and hospice care (PHC) under COVID-19 conditions. As a result of the sociological investigation, using the questionnaire methods and experts’ evaluations, we have analyzed the socio-psychological characteristics of the elderly internally displaced persons, the specifics of their social adaptation, financing and medico-social servicing at the level PMSA, including structural modernization and optimization of organizational provision. The introduction of an affordable and economically viable system allows for the interaction of specialists from health care and social protection institutions, and optimizes compliance with the standards and principles of medical care. Within the framework of the PНC, we use the European approaches of formation of the strategy of palliative care expansion under COVID-19 pandemic. One of the main tasks is the provision of constant PHC. Introduction of the organization-structural system of the medical-social care at the PMSA level and provision of accessible and highly qualitative constant PHC are actual for the elderly displaced people, who are in the group of high risk COVID-19 death group.

The Sexual and Reproductive Health Context of an Internally Displaced Persons' Camp in Northeastern Nigeria: Narratives of Girls and Young Women

In humanitarian settings, ~35 million girls and young women of reproductive age (15–24) are in urgent need of sexual and reproductive health (SRH) information and services. Young women and girls in humanitarian contexts are particularly vulnerable to unwanted pregnancies, unsafe abortion, gender-based violence, and early and forced marriage. We sought to understand girls' and young women's experiences with unwanted pregnancy, abortion, contraception, sexually transmitted infections (STIs), gender-based violence (GBV), and forced marriage in an IDP camp in Northeastern Nigeria. We conducted 25 in-depth interviews with girls aged 15–19 (N = 13; 8 single and 5 married) and young women aged 20–24 (N = 12; 3 single and 9 married). All interviews were audiotaped, transcribed, translated, computer recorded and coded for analysis. The participants in our study fled from and witnessed violence to arrive in the IDP camp with little material support. Lack of necessities, especially food, has driven many to sex in exchange for goods or into forced marriages. This, in turn, leads to increased unwanted pregnancies and unsafe abortions. Participants had limited knowledge about contraception, and some information about SRH services available in the camp, but overall, knowledge and utilization of SRH services was low.

Shielding individuals at high risk of COVID-19: a micro-simulation study

Background One of the proposed interventions for mitigating COVID-19 epidemics, particularly in low-income and crisis-affected settings, is to physically isolate individuals known to be at high risk of severe disease and death due to age or co-morbidities. This intervention, known as 'shielding', could be implemented in various ways. If shielded people are grouped together in residences and isolation is imperfect, any introduction of infections within the shielding group could cause substantial mortality and thus negate the intervention's benefits. We explored the effectiveness of shielding under various modalities of implementation and considered mitigation measures to reduce its possible harms. Methods We used an individual-based mathematical model to simulate the evolution of a COVID-19 epidemic in a population of which a fraction above a given age cut-off are relocated to shielding residences, in which they have variable levels of contacts with their original household, the outside world and fellow shielding residents. We set our simulation with the context of an internally displaced persons' camp in Somaliland, for which we had recently collected data on household demographics and social mixing patterns. We compared an unmitigated epidemic with a shielding intervention accompanied by various measures to reduce the risk of virus introduction and spread within the shielding residences. We did sensitivity analyses to explore parameters such as residence size, reduction in contacts, basic reproduction number, and prior immunity in the population. Results Shielded residences are likely to be breached with infection during the outbreak. Nonetheless, shielding can be effective in preventing COVID-19 infections in the shielded population. The effectiveness of shielding is mostly affected by the size of the shielded residence, and by the degree by which contacts between shielded and unshielded individuals are reduced. Reductions in contacts between shielded individuals could further increase the effectiveness of shielding, but is only effective in larger shielded residences. Large shielded residences increase the risk of infection, unless very large reductions in contacts can be achieved. In epidemics with a lower reproduction number, the effectiveness of shielding could be negative effectiveness. Discussion Shielding could be an effective method to protect the most at-risk individuals. It should be considered where other measures cannot easily be implemented, but with attention to the epidemiological situation. Shielding should only be implemented through small to medium-sized shielding residences, with appropriate mitigation measures such as reduced contact intensity between shielded individuals and self-isolation of cases to prevent subsequent spread.

South Sudan: The SDF and “Protection of Civilians”

The Japan Engineering Groups (JEG) deployment to the United Nations Mission in South Sudan (UNMISS) from 2012 to 2017 exhibited consecutive aspects of “integration” and “robustness.” During the first two years, Japan’s method of “integration,” or the “All Japan” approach, fit well with UNMISS’s focus on statebuilding. It yielded various outcomes, not only in the restoration of facilities and infrastructure (e.g., road construction) but also in the nonengineering support provided to the locals (e.g., job training). With the outbreak of de facto civil war in December 2013, however, UNMISS’s top priority moved from statebuilding to Protection of Civilians (PoC), thereby intensifying inclinations toward “robustness.” Afterward, the JEG mostly focused on the construction of a PoC site, that is, a shelter for evacuated locals and internally displaced people. While security in South Sudan continued to deteriorate, the amendment to the Peacekeeping Operations (PKO) Act as part of the 2015 Peace and Security Legislation enabled the Government of Japan (GoJ) to assign the JEG to partial security missions, such as the “coming-to-aid” duty. In the end, however, the GoJ abruptly withdrew the JEG in May 2017, thereby discontinuing the series of SDF deployments to United Nations Peacekeeping Operations since 1992.

Structural Violence among Internally Displaced Persons (IDPS) Within Idp Settlements in Mogadishu Somalia

Background: Gender based violence (GBV) remains a public health concern. Internally displaced persons (IDPs) and refugees have been shown to be at the highest risk of gender based violence. Somalia has been without a stable government for 26 years resulting in weak community and formal protection structures hence disproportionately increasing the vulnerability of females to gender based violence. Continued displacement of community members in South Central Somalia due to war, inters clan conflicts and the ongoing drought has resulted in more IDPs living in settlements along major urban areas. These IDPs continue to face violations such as forced evictions, discrimination and gender based violence. Objective: This study was aimed at investigating the past and present forms of structural violence faced by IDPs in Mogadishu as well as their knowledge and perceptions regarding the same. Methods: A descriptive cross sectional design was used in this study, in the month of May 2017. The study population for this survey was 320 IDPs in 10 IDP settlements in KM-11 and KM-13 regions of Mogadishu, South Central Somalia. Results: The study established a 91.7% prevalence rate of female genital mutilation among the female respondents. World Health Organization (W.H.O.) type III was the most common form of FGM that female respondents in the two IDP settlements (38.9%) had faced, followed by W.HO. type 4 (23.1%) and W.H.O. type I and II (15.9%). The mean age at which FGM was carried out among this group was 7 years while forced and early marriages (mean of 16 years) are common among this population group. Sexual assault and rape were singled out as the most common forms of violence faced by females in the two IDP settlements with the risk factors for this violence being described as displacement, overcrowding in IDP settlements, poor lighting in the IDP settlements at night, unaccompanied females in the IDP settlements and female headed households. Respondents expressed their overwhelming preference for community protection structures in averting GBV and customary law in arbitrating gender based violence cases. There was low awareness on services available for GBV survivors and so was the knowledge on the urgency to seek medical services within the 72 hours window period following rape. Conclusion: The study has established that structural violence is common among IDPs living in Mogadishu and it is constraining them from achieving the quality of life that would have otherwise been possible if they were not displaced. There is need to strengthen both community and formal protection units as well as raise awareness regarding the effects of the various forms of violence facing female IDPs, create awareness regarding services available for GBV survivors and ensure that these services are available and accessible to the IDPs