Background: The combination of global demographic changes and a growing number of humanitarian cr... more Background: The combination of global demographic changes and a growing number of humanitarian crises in middle-income countries that have a higher life expectancy has led to an increase in the number of older populations affected by humanitarian crises. The aim of this review was to systematically examine evidence on the health needs of older populations in humanitarian crises, including both armed conflicts and natural disasters, in low-and middle-income countries (LMICs).
Methods: A systematic review methodology was used. The search strategy used terms related to older populations and humanitarian crises in LMICs. Five bibliographic databases were used, along with relevant grey literature sources. Descriptive analysis was used, and a quality assessment conducted using the Newcastle-Ottawa Scale and CASP instruments.
Results: A total of 36 studies were eligible for review. The majority of the studies were cross-sectional, three were cohort studies, and four used qualitative methodologies. The main health outcomes were mental health, physical health, functioning, and nutrition. Vulnerability factors included older age, female gender, being widowed, increased exposure to traumatic events, prior mental health problems, low income and education, and rural residency. Ten studies addressed the responsiveness of health systems and access to such services. The quality of the included studies was generally low.
Conclusions: There is an urgent need to strengthen the evidence base on the health needs of older populations in humanitarian crises.
Recognition of the need for evidence-based interventions to help to improve the effectiveness and... more Recognition of the need for evidence-based interventions to help to improve the effectiveness and efficiency of humanitarian responses has been increasing. However, little is known about the breadth and quality of evidence on health interventions in humanitarian crises. We describe the findings of a systematic review with the aim of examining the quantity and quality of evidence on public health interventions in humanitarian crises to identify key research gaps. We identified 345 studies published between 1980 and 2014 that met our inclusion criteria. The quantity of evidence varied substantially by health topic, from communicable diseases (n=131), nutrition (n=77), to non-communicable diseases (n=8), and water, sanitation, and hygiene (n=6). We observed common study design and weaknesses in the methods, which substantially reduced the ability to determine causation and attribution of the interventions. Considering the major increase in health-related humanitarian activities in the past three decades and calls for a stronger evidence base, this paper highlights the limited quantity and quality of health intervention research in humanitarian contexts and supports calls to scale up this research.
On Saturday, 3 December 2016, ~2000 activists, including women who had previously been detained i... more On Saturday, 3 December 2016, ~2000 activists, including women who had previously been detained in UK immigration facilities, gathered to protest against the continued imprisonment of individuals in the Yarl’s Wood ‘Immigration Removal Centre’, and to speak out against the broader network of 11 detention facilities, multiple holding rooms and supporting state apparatus that exists to control, contain and curtail the movement of those people deemed undesirable by the UK government.
We challenge the assertion made by Govind Persad and Ezekiel Emanuel (Aug 27, p 932) that “expand... more We challenge the assertion made by Govind Persad and Ezekiel Emanuel (Aug 27, p 932) that “expanding access to less effective or more toxic [antiretroviral] treatments rather than requiring the worldwide best treatment in all settings” is ethically justifiable.
Six months prior to the publication of Saving Lives and Staying Alive, 24 patients, 4 caretakers ... more Six months prior to the publication of Saving Lives and Staying Alive, 24 patients, 4 caretakers and 14 MSF staff members were killed during a sustained US airstrike on the Kunduz Trauma Hospital in north-eastern Afghanistan. This attack represented the single greatest loss of life from an aerial bombardment for Médecins Sans Frontières/Doctors Without Borders (MSF) in the organization’s 44-year history.
The recent London School of Hygiene & Tropical Medicine (LSHTM) Global Health Lab—”The US electio... more The recent London School of Hygiene & Tropical Medicine (LSHTM) Global Health Lab—”The US elections: what are the implications for global health?”—and Richard Horton’s subsequent summary of the event (Dec 3, p 2726), raise questions not only of post-election enquiry but also of our shared understanding of contemporary global health.
On Oct 10, 2015, Médecins Sans Frontières (MSF) rejected Pfizer's proposed donation of 1 million ... more On Oct 10, 2015, Médecins Sans Frontières (MSF) rejected Pfizer's proposed donation of 1 million doses of its branded pneumococcal conjugate vaccine (PCV). The news caused a stir in the global health community; after all, free essential health goods might be considered something to be celebrated.
Palliative care interventions have historically been neglected in the practice of humanitarian me... more Palliative care interventions have historically been neglected in the practice of humanitarian medicine. This may come as a surprise, since it is a sombre reality that medical practitioners are frequently witness to death and dying in their response to humanitarian crises.
At the UK premiere of Ken Loach's latest film, I, Daniel Blake, a group of people with disabiliti... more At the UK premiere of Ken Loach's latest film, I, Daniel Blake, a group of people with disabilities and their supporters gathered to protest against the benefits system, asserting that “we are Daniel Blake every single day”.
2016 will already be remembered as a year of great setbacks in the pursuit of global health and w... more 2016 will already be remembered as a year of great setbacks in the pursuit of global health and wellbeing; mass social upheaval in the Middle East and north Africa, driven by conflict and a legacy of persistent structural violence, continues to challenge the notion of our shared humanity, while the end of the world's worst Ebola virus outbreak in west Africa has prompted sombre reflection and fierce critique of systemic failures in global outbreak response.
The International Organisation for Migration (IOM) estimates that more than 909,000 people crosse... more The International Organisation for Migration (IOM) estimates that more than 909,000 people crossed into Europe by sea in 2015 (IOM 2015). Driven by violence and conflict, political instability, and economic insecurity, hundreds of thousands of migrants and exiles now seek supposed safety in Europe’s southern states and neighbouring countries.
The movement of people has featured throughout human history; so substantial is the legacy of mig... more The movement of people has featured throughout human history; so substantial is the legacy of migration that the freedom of movement within and across borders was enshrined in article 13 of the UN Universal Declaration of Human Rights in 1948.
The suffering endured by refugees and other exiles in the northern port town of Calais, France, h... more The suffering endured by refugees and other exiles in the northern port town of Calais, France, has been the subject of significant media attention in recent months. Renewed interest in the plight of Calais’ encamped population began to peak in April 2015, at the same time that the French authorities forcibly closed the largest settlement, situated in woodland adjacent to an active titanium oxide factory. Residents of this settlement were relocated to a nearby segment of sandy grassland that was once both a waste disposal site and a local shooting range.
Painting pickups pink has become an operational imperative for certain humanitarian agencies work... more Painting pickups pink has become an operational imperative for certain humanitarian agencies working in conflict and other unstable contexts.
Humanitarian crises continue to pose a significant threat to health. In 2012, the United Nations ... more Humanitarian crises continue to pose a significant threat to health. In 2012, the United Nations identified 144 million people directly affected by conflict or environmental disasters (OCHA 2013). During the acute phase of most humanitarian crises, the provision of surgical support remains a priority (Sphere Project 2011). A surge in the number of traumatic injuries in the acute phase can overwhelm pre-existing health services; for example, over a 10-week period following the 2010 Haiti earthquake, Medecins sans Frontieres/Doctors without Borders (MSF) alone performed more than 4000 surgical procedures (Chu et al. 2011). At the same time, there is often a need to supplement routine surgical activities in the wake of widespread infrastructural damage and disruption to the local medical human resource pool. Rehabilitation interventions play an equally important role as efforts are made to support patients during their longer term recovery.
In the summer of 2014, at the height of the Israeli Defence Force’s ‘Operation Protective Edge’, ... more In the summer of 2014, at the height of the Israeli Defence Force’s ‘Operation Protective Edge’, The Lancet published ‘An open letter for the people in Gaza’ signed by Paola Manduca, Iain Chalmers, Derek Summerfield, Mads Gilbert and Swee Ang, on behalf of 24 signatories. The letter denounced what it called ‘the aggression of Gaza by Israel’ and condemned the humanitarian impact of the incursion and of other Israeli actions such as the blockade on Gaza (Manduca et al. 2014a). The publication of the letter stimulated vigorous debate with a further 20 published responses equally divided either in support of, or opposition to, the original letter (Lancet 2014). The letter was branded ‘anti-Jewish bigotry, pure and simple’ by some (Marmor and Spirt 2014), while others claimed that the authors had failed to declare ‘conflicts of interest’ (Stall et al. 2014; Wolf, Brown, and Aharony 2014).
In July 1944, hundreds of politicians, leading economists and diplomats from the Allied nations g... more In July 1944, hundreds of politicians, leading economists and diplomats from the Allied nations gathered in Bretton Woods, New Hampshire, to deliberate over a blueprint for a post-war global order. Proponents of an emerging school of thought maintained that market-driven service provision, and minimal state interference in the market, was the key to healthy economic growth and subsequent political stability. This approach became a defining feature of neoliberalism, which in turn would become the dominant political and economic philosophy of the twentieth century.
Background: The combination of global demographic changes and a growing number of humanitarian cr... more Background: The combination of global demographic changes and a growing number of humanitarian crises in middle-income countries that have a higher life expectancy has led to an increase in the number of older populations affected by humanitarian crises. The aim of this review was to systematically examine evidence on the health needs of older populations in humanitarian crises, including both armed conflicts and natural disasters, in low-and middle-income countries (LMICs).
Methods: A systematic review methodology was used. The search strategy used terms related to older populations and humanitarian crises in LMICs. Five bibliographic databases were used, along with relevant grey literature sources. Descriptive analysis was used, and a quality assessment conducted using the Newcastle-Ottawa Scale and CASP instruments.
Results: A total of 36 studies were eligible for review. The majority of the studies were cross-sectional, three were cohort studies, and four used qualitative methodologies. The main health outcomes were mental health, physical health, functioning, and nutrition. Vulnerability factors included older age, female gender, being widowed, increased exposure to traumatic events, prior mental health problems, low income and education, and rural residency. Ten studies addressed the responsiveness of health systems and access to such services. The quality of the included studies was generally low.
Conclusions: There is an urgent need to strengthen the evidence base on the health needs of older populations in humanitarian crises.
Recognition of the need for evidence-based interventions to help to improve the effectiveness and... more Recognition of the need for evidence-based interventions to help to improve the effectiveness and efficiency of humanitarian responses has been increasing. However, little is known about the breadth and quality of evidence on health interventions in humanitarian crises. We describe the findings of a systematic review with the aim of examining the quantity and quality of evidence on public health interventions in humanitarian crises to identify key research gaps. We identified 345 studies published between 1980 and 2014 that met our inclusion criteria. The quantity of evidence varied substantially by health topic, from communicable diseases (n=131), nutrition (n=77), to non-communicable diseases (n=8), and water, sanitation, and hygiene (n=6). We observed common study design and weaknesses in the methods, which substantially reduced the ability to determine causation and attribution of the interventions. Considering the major increase in health-related humanitarian activities in the past three decades and calls for a stronger evidence base, this paper highlights the limited quantity and quality of health intervention research in humanitarian contexts and supports calls to scale up this research.
On Saturday, 3 December 2016, ~2000 activists, including women who had previously been detained i... more On Saturday, 3 December 2016, ~2000 activists, including women who had previously been detained in UK immigration facilities, gathered to protest against the continued imprisonment of individuals in the Yarl’s Wood ‘Immigration Removal Centre’, and to speak out against the broader network of 11 detention facilities, multiple holding rooms and supporting state apparatus that exists to control, contain and curtail the movement of those people deemed undesirable by the UK government.
We challenge the assertion made by Govind Persad and Ezekiel Emanuel (Aug 27, p 932) that “expand... more We challenge the assertion made by Govind Persad and Ezekiel Emanuel (Aug 27, p 932) that “expanding access to less effective or more toxic [antiretroviral] treatments rather than requiring the worldwide best treatment in all settings” is ethically justifiable.
Six months prior to the publication of Saving Lives and Staying Alive, 24 patients, 4 caretakers ... more Six months prior to the publication of Saving Lives and Staying Alive, 24 patients, 4 caretakers and 14 MSF staff members were killed during a sustained US airstrike on the Kunduz Trauma Hospital in north-eastern Afghanistan. This attack represented the single greatest loss of life from an aerial bombardment for Médecins Sans Frontières/Doctors Without Borders (MSF) in the organization’s 44-year history.
The recent London School of Hygiene & Tropical Medicine (LSHTM) Global Health Lab—”The US electio... more The recent London School of Hygiene & Tropical Medicine (LSHTM) Global Health Lab—”The US elections: what are the implications for global health?”—and Richard Horton’s subsequent summary of the event (Dec 3, p 2726), raise questions not only of post-election enquiry but also of our shared understanding of contemporary global health.
On Oct 10, 2015, Médecins Sans Frontières (MSF) rejected Pfizer's proposed donation of 1 million ... more On Oct 10, 2015, Médecins Sans Frontières (MSF) rejected Pfizer's proposed donation of 1 million doses of its branded pneumococcal conjugate vaccine (PCV). The news caused a stir in the global health community; after all, free essential health goods might be considered something to be celebrated.
Palliative care interventions have historically been neglected in the practice of humanitarian me... more Palliative care interventions have historically been neglected in the practice of humanitarian medicine. This may come as a surprise, since it is a sombre reality that medical practitioners are frequently witness to death and dying in their response to humanitarian crises.
At the UK premiere of Ken Loach's latest film, I, Daniel Blake, a group of people with disabiliti... more At the UK premiere of Ken Loach's latest film, I, Daniel Blake, a group of people with disabilities and their supporters gathered to protest against the benefits system, asserting that “we are Daniel Blake every single day”.
2016 will already be remembered as a year of great setbacks in the pursuit of global health and w... more 2016 will already be remembered as a year of great setbacks in the pursuit of global health and wellbeing; mass social upheaval in the Middle East and north Africa, driven by conflict and a legacy of persistent structural violence, continues to challenge the notion of our shared humanity, while the end of the world's worst Ebola virus outbreak in west Africa has prompted sombre reflection and fierce critique of systemic failures in global outbreak response.
The International Organisation for Migration (IOM) estimates that more than 909,000 people crosse... more The International Organisation for Migration (IOM) estimates that more than 909,000 people crossed into Europe by sea in 2015 (IOM 2015). Driven by violence and conflict, political instability, and economic insecurity, hundreds of thousands of migrants and exiles now seek supposed safety in Europe’s southern states and neighbouring countries.
The movement of people has featured throughout human history; so substantial is the legacy of mig... more The movement of people has featured throughout human history; so substantial is the legacy of migration that the freedom of movement within and across borders was enshrined in article 13 of the UN Universal Declaration of Human Rights in 1948.
The suffering endured by refugees and other exiles in the northern port town of Calais, France, h... more The suffering endured by refugees and other exiles in the northern port town of Calais, France, has been the subject of significant media attention in recent months. Renewed interest in the plight of Calais’ encamped population began to peak in April 2015, at the same time that the French authorities forcibly closed the largest settlement, situated in woodland adjacent to an active titanium oxide factory. Residents of this settlement were relocated to a nearby segment of sandy grassland that was once both a waste disposal site and a local shooting range.
Painting pickups pink has become an operational imperative for certain humanitarian agencies work... more Painting pickups pink has become an operational imperative for certain humanitarian agencies working in conflict and other unstable contexts.
Humanitarian crises continue to pose a significant threat to health. In 2012, the United Nations ... more Humanitarian crises continue to pose a significant threat to health. In 2012, the United Nations identified 144 million people directly affected by conflict or environmental disasters (OCHA 2013). During the acute phase of most humanitarian crises, the provision of surgical support remains a priority (Sphere Project 2011). A surge in the number of traumatic injuries in the acute phase can overwhelm pre-existing health services; for example, over a 10-week period following the 2010 Haiti earthquake, Medecins sans Frontieres/Doctors without Borders (MSF) alone performed more than 4000 surgical procedures (Chu et al. 2011). At the same time, there is often a need to supplement routine surgical activities in the wake of widespread infrastructural damage and disruption to the local medical human resource pool. Rehabilitation interventions play an equally important role as efforts are made to support patients during their longer term recovery.
In the summer of 2014, at the height of the Israeli Defence Force’s ‘Operation Protective Edge’, ... more In the summer of 2014, at the height of the Israeli Defence Force’s ‘Operation Protective Edge’, The Lancet published ‘An open letter for the people in Gaza’ signed by Paola Manduca, Iain Chalmers, Derek Summerfield, Mads Gilbert and Swee Ang, on behalf of 24 signatories. The letter denounced what it called ‘the aggression of Gaza by Israel’ and condemned the humanitarian impact of the incursion and of other Israeli actions such as the blockade on Gaza (Manduca et al. 2014a). The publication of the letter stimulated vigorous debate with a further 20 published responses equally divided either in support of, or opposition to, the original letter (Lancet 2014). The letter was branded ‘anti-Jewish bigotry, pure and simple’ by some (Marmor and Spirt 2014), while others claimed that the authors had failed to declare ‘conflicts of interest’ (Stall et al. 2014; Wolf, Brown, and Aharony 2014).
In July 1944, hundreds of politicians, leading economists and diplomats from the Allied nations g... more In July 1944, hundreds of politicians, leading economists and diplomats from the Allied nations gathered in Bretton Woods, New Hampshire, to deliberate over a blueprint for a post-war global order. Proponents of an emerging school of thought maintained that market-driven service provision, and minimal state interference in the market, was the key to healthy economic growth and subsequent political stability. This approach became a defining feature of neoliberalism, which in turn would become the dominant political and economic philosophy of the twentieth century.
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Papers by James Smith
Methods: A systematic review methodology was used. The search strategy used terms related to older populations and humanitarian crises in LMICs. Five bibliographic databases were used, along with relevant grey literature sources. Descriptive analysis was used, and a quality assessment conducted using the Newcastle-Ottawa Scale and CASP instruments.
Results: A total of 36 studies were eligible for review. The majority of the studies were cross-sectional, three were cohort studies, and four used qualitative methodologies. The main health outcomes were mental health, physical health, functioning, and nutrition. Vulnerability factors included older age, female gender, being widowed, increased exposure to traumatic events, prior mental health problems, low income and education, and rural residency. Ten studies addressed the responsiveness of health systems and access to such services. The quality of the included studies was generally low.
Conclusions: There is an urgent need to strengthen the evidence base on the health needs of older populations in humanitarian crises.
Methods: A systematic review methodology was used. The search strategy used terms related to older populations and humanitarian crises in LMICs. Five bibliographic databases were used, along with relevant grey literature sources. Descriptive analysis was used, and a quality assessment conducted using the Newcastle-Ottawa Scale and CASP instruments.
Results: A total of 36 studies were eligible for review. The majority of the studies were cross-sectional, three were cohort studies, and four used qualitative methodologies. The main health outcomes were mental health, physical health, functioning, and nutrition. Vulnerability factors included older age, female gender, being widowed, increased exposure to traumatic events, prior mental health problems, low income and education, and rural residency. Ten studies addressed the responsiveness of health systems and access to such services. The quality of the included studies was generally low.
Conclusions: There is an urgent need to strengthen the evidence base on the health needs of older populations in humanitarian crises.