Rafael Castro Delgado

The Lebanese-Syrian crisis: impact of influx of Syrian refugees to an already weak state.

Background Lebanon, a small Middle Eastern country facing constant political and national unity challenges with a population of approximately 300,000 Palestinian and Iraqi refugees, has welcomed more than 1.2 million Office of the United Nations Commissioner for Refugees (UNHCR)-registered Syrian refugees since 2012. The Government of Lebanon considers individuals who crossed Lebanese–Syrian borders since 2011 as “displaced”, emphasizing its long-standing position that Lebanon is not a state for refugees, refusing to establish camps, and adopting a policy paper to reduce their numbers in October 2014. Humanitarian response to the Syrian influx to Lebanon has been constantly assembling with the UNHCR as the main acting body and the Lebanon Crisis Response Plan as the latest plan for 2016. Methods Review of secondary data from gray literature and reports focusing on the influx of Syrian refugees to Lebanon by visiting databases covering humanitarian response in complex emergencies. Limitations include obtaining majority of the data from gray literature and changing statistics due to the instability of the situation. Results The influx of Syrian refugees to Lebanon, an already weak and vulnerable state, has negatively impacted life in Lebanon on different levels including increasing demographics, regressing economy, exhausting social services, complicating politics, and decreasing security as well as worsened the life of displaced Syrians themselves. Conclusion Displaced Syrians and Lebanese people share aggravating hardships of a mutual and precarious crisis resulting from the Syrian influx to Lebanon. Although a lot of response has been initiated, both populations still lack much of their basic needs due to lack of funding and nonsustainable program initiatives. The two major recommendations for future interventions are to ensure continuous and effective monitoring and sustainability in order to alleviate current and future suffering in Lebanon.

Desastres y salud pública: un abordaje desde el marco teórico de la epidemiología

Durante la decada 1990-2000 los desastres (catastrofes) causaron cada ano una media de 75.000 muertes, afectaron a una media anual de 256 millones de personas y causaron perdidas economicas por valor de mas de 650.000 millones de euros. La magnitud del problema, su impacto sobre la salud publica y sobre el nivel de desarrollo de las poblaciones afectadas es de tal importancia que se justifica un particular interes desde el punto de vista de la salud publica, especialmente con la aparicion de las denominadas emergencias complejas. El objetivo de este trabajo es revisar las definiciones, los conceptos fundamentales y las caracteristicas basicas de la epidemiologia de los desastres. Se analizan tambien los factores de riesgo de los desastres, los efectos sobre la salud publica de los principales tipos de desastres y las principales estrategias preventivas en funcion de las diferentes fases del ciclo de un desastre.

The Perceived Barriers of Access to Health Care Among a Group of Non-camp Syrian Refugees in Jordan:

The aims of this study were to identify the most needed health care services, accessibility of various health care services, and barriers to access as perceived by a group of Syrian refugees living in non-camp settings in Jordan and to compare accessibility among different groups. The study was conducted in the Amman, Irbid, Karak, and Maan governorates of Jordan. This is a cross-sectional, analytical, observational study using convenience and snowball sampling for data collection. A structured questionnaire was included in an ongoing needs assessment of a Jordanian nongovernment organization in April 2014, with a total of 196 surveys conducted. In addition to the prevalent acute and communicable diseases, chronic diseases and dental problems were common. Preventive and primary health care were more accessible than advanced services. Structural and financial barriers hindered access. The specific survey location and governorate were associated with a difference in reported access. Registration status, health provider, duration, and out-of-pocket payment did not affect accessibility. The capacities of health facilities at different levels should be increased. Enhanced information sharing among health providers can improve identification of needs and gaps.

Mortalidad y morbilidad por desastres en España

Objetivo: Este estudio analiza los episodios de desastres ocurridos en Espana entre 1950 y 2005, para conocer su distribucion y estimar su impacto en la mortalidad y la morbilidad. Metodos: Estudio observacional retrospectivo en el que se ha utilizado la definicion de Naciones Unidas y se ha considerado desastre al episodio, natural o tecnologico, con mas de 15 muertos y/o mas de 50 heridos, excluidos los desastres medioambientales y los fenomenos epidemicos. Resultados: La frecuencia de desastres en Espana ha aumentado durante el periodo estudiado, especialmente en las ultimas 4 decadas, y son el doble en el segundo semestre del ano, con una gran variabilidad geografica. Espana tiene un perfil de desastre mixto, con predominio de los desastres tecnologicos, que son 4,5 veces mas frecuentes que los naturales. El desastre natural mas frecuente en nuestro pais es la inundacion y el tecnologico, el accidente de transito.

Disaster risk profile and existing legal framework of Nepal: floods and landslides

Nepal has a complicated geophysical structure that is prone to various kinds of disasters. Nepal ranks the most disaster-prone country in the world and has experienced several natural calamities, causing high property and life losses. Disasters are caused by natural processes, but may be increased by human activities. The overall objective of this paper is to analyze the disaster risk profile and existing legal framework of Nepal. The paper is based on secondary data sources. Major causative factors for floods and landslides are heavy and continuous rainfall, outburst floods, infrastructure failure, and deforestation. Historical data of natural disasters in Nepal show that water-induced disasters have killed hundreds of people and affected thousands every year. Likewise, properties worth millions of US dollars have been damaged. There is an increasing trend toward landslides and floods, which will likely continue to rise if proper intervention is not taken. A positive correlation between water-induced disasters and deaths has been observed. Nepal has a poor Index for Risk Management (INFORM). There are fluctuations in the recording of death data caused by flood and landslides. The Government of Nepal focuses more on the response phase than on the preparedness phase of disasters. The existing disaster management act seems to be weak and outdated. There is a gap in current legal procedure, so the country is in dire need of a comprehensive legal framework. The new proposed act seems to take a much broader approach to disaster management. With a long-term vision of managing disaster risk in the country, the Government of Nepal has begun the Nepal Risk Reduction Consortium (NRRC) in collaboration with development and humanitarian partners. In order to improve the vulnerability of Nepal, an early warning system, mainstreaming disasters with development, research activities, community participation and awareness, and a rainfall monitoring system must all be a focus.

Conocimientos en soporte vital básico y desfribilador externo automático de los monitores de centros deportivos de una zona geográfica del Principado de Asturias

OBJECTIVE A study was conducted to determine the level of knowledge about cardiopulmonary resuscitation and automated external defibrillation (AED) in sport instructors working in public sport centers in Asturias. METHODS A cross-sectional study was conducted on sports instructors in May 2014, by completing a self-administered questionnaire on cardiopulmonary resuscitation and use of AED, with 25 items and four possible answers, only one valid, divided into five categories (emergency medical system in Asturias, initial assessment, circulation,airway and use of AED). Age, gender, work experience as sports instructor, previous training courses, education and training and employment contract were studied as epidemiological variables. RESULTS A total 26 questionnaires (52%) were collected in public sports centers, and 84% of total responses were correct. It should be emphasized that among the wrong answers, 42.30% did not know what was the first action in a cardiac arrest, and 36.62% did not know how to perform a complete cardiopulmonary resuscitation if the person affected had a perioral injury, with 46.15% not knowing how to respond to a cardiac arrest due to drowning. CONCLUSIONS It is recommended to include the management of cardiac arrest in their workplace in the training plans and the continuing education of sports instructors, at least every two years, according to national laws and laws from Asturias, including also training on the use and management of AED.

Terrorismo, salud pública y sistemas sanitarios

Today the terrorism is a problem of global distribution and increasing interest for the international public health. The terrorism related violence affects the public health and the health care services in an important way and in different scopes, among them, increase mortality, morbidity and disability, generates a context of fear and anxiety that makes the psychopathological diseases very frequent, seriously alters the operation of the health care services and produces important social, political and economic damages. These effects are, in addition, especially intense when the phenomenon takes place on a chronic way in a community. The objective of this paper is to examine the relation between terrorism and public health, focusing on its effects on public health and the health care services, as well as to examine the possible frames to face the terrorism as a public health concern, with special reference to the situation in Spain. To face this problem, both the public health systems and the health care services, would have to especially adapt their approaches and operational methods in six high-priority areas related to: (1) the coordination between the different health and non health emergency response agencies; (2) the reinforcement of the epidemiological surveillance systems; (3) the improvement of the capacities of the public health laboratories and response emergency care systems to specific types of terrorism as the chemical or biological terrorism; (3) the mental health services; (4) the planning and coordination of the emergency response of the health services; (5) the relations with the population and mass media and, finally; (6) a greater transparency in the diffusion of the information and a greater degree of analysis of the carried out health actions in the scope of the emergency response.

El riesgo de desastre químico como cuestión de salud pública

This revision is aimed at providing health care personnel, particularly those who may be involved in planning and/or responding to a chemical accident, with an overview of the subject of major industrial accidents. In the introduction, a brief presentation is made of some data concerning the main industrial disasters which have occurred in the past in addition to some accidents which have occurred in our area that could have evolved into a major accident. A review is also provided of Spanish and European laws currently in effect regarding this matter, in addition to summarizing the main consequences which may result from explosions, phenomena of a thermal type and the leakage of hazardous substances, particularly stressing the third of these three cases. A brief summary is also given of the main steps to be taken for a correct risk analysis in a given geographical area. Lastly, the overall organization of the Chemical Industry Emergency Plans and the functions of the different groups taking part therein, including the main functions of the medical team, is provided. Planning and responding to an industrial disaster is markedly multi-disciplinary endeavor, and this document is aimed at providing health care professionals with an overview of the main aspects involved in order to thus contribute to a more in-depth knowledge of a subject which we consider to be of importance for health care personnel and a better-integrated response, given that were an industrial disaster to occur, we would have to deal with a serious public health care problem on the spot.

The Effect of Armed Conflict on the Utilization of Maternal Health Services in Uganda: A Population-based Study.

Introduction: Maternal mortality rates can be adversely affected by armed conflict, implying a greater level of vulnerability among women, and is often linked to the lack of or limited access to maternal healthcare during conflict. Previous research in Uganda has shown that armed conflict negatively impacts women’s utilization of maternal healthcare services for a multitude of reasons at the individual, health-system and political levels. Methods: This study compared aggregated Demographic and Health Surveys data from 13 districts in Northern Uganda, a conflict-affected region, with data from the rest of the country, for the use of maternal healthcare services for the years 1988, 1995, 2000, 2006 and 2011, using statistical analyses and logistic regression. Specific indicators for maternal healthcare utilization included contraceptive use, antenatal care, skilled assistance at birth and institutional delivery. Results: Use of contraception and institutional deliveries among women in Northern Uganda was significantly lower compared to the rest of the country. However, skilled assistance at birth among women in Northern Uganda was significantly higher. Conclusions: The findings in this study show that armed conflict can have a negative impact on aspects of maternal healthcare such as contraceptive use and institutional deliveries; however, other indicators such as skilled assistance at birth were seen to be better among conflict-affected populations. This reiterates the complex nature of armed conflict and the interplay of different factors such as conflict intensity, existing health systems and services, and humanitarian interventions that could influence maternal healthcare utilization. Key words: Armed conflict, maternal health utilization, Northern Uganda, contraception, skilled assistance at birth, antenatal care, institutional delivery

Disaster management and primary health care: implications for medical education

Natural and manmade disasters often result in the breakdown of social system and services with pronounced effects on human development and economy. They also cause illhealth and deaths either directly or through the disruption of health systems, leaving the affected communities without access to healthcare in times of emergency. Empirical evidence shows that these negative effects are disproportionally concentrated in the developing countries which accounts for 68.2% of globally reported disaster mortalities in 2012.1 The geophysical risks, urbanization, population growth and climate changes further increase the vulnerability to natural disasters, particularly, in developing countries. The increased scale, frequency, and impact of natural and manmade disasters underpin the need for adaptation of context-specific, multi-sectoral and multidisciplinary disaster management interventions and plan. The plan shall encompass the coordination and integration of activities necessary to build, sustain and improve the capability to prepare for, protect against, respond to, and recover from any emergency. Moreover, it is essential to maintain a surge capacity at a local and national level to respond immediately when a health emergency or disaster struck. To this end, high-income countries have established efficient and effective emergency medical care systems, namely, Rescue 112. This system has played a crucial role in responding immediately and successfully managing medical emergencies such as injuries, trauma and other life-threatening conditions. However, establishing such a robust emergency medical care system in low-income countries is not possible due to substantial financial, human and material resources required to maintain and operate such services.2 Instead the primary health care exits in lowincome countries that provides an opportunity to integrate and mainstream disaster response services. The integration of the disaster management within the primary health care can be proved instrumental in the provision of optimal and low-cost emergency medical assistance by utilizing the existing primary health care network (physical infrastructure and human/financial capital). Additionally, the integration will pave a way in preparing households, communities and health systems in managing disaster related risks and hazards.3 Despite the need for adapting integrated approaches, primary healthcare and emergency medical assistance within the broader domain of disaster management have been portrayed and perceived as two separate entities with arguments in favour for and against each.4 These arguments revolve around the conceptual definitions whereas primary health care and emergency medical assistance are considered as developmental and emergency response intervention respectively. Considering the need for access to and availability of emergency medical assistance in the resource-poor settings, this paper discusses the implications for medical education with regard to: a) integration of disaster management in primary health care, and b) minimum disaster management competencies and skills required for physician/general practitioners working in the primary health care facilities.