BACKGROUND: In conflict settings, as it is the case in Syria, it is crucial to enhance health information management to facilitate an effective and sustainable approach to strengthening health systems in such contexts. In this study, we aim to provide a baseline understanding of the present state of health information management in Northwest Syria (NWS) to better plan for strengthening the health information system of the area that is transitioning to an early-recovery stage.
METHODS: A combination of questionnaires and subsequent interviews was used for data collection. Purposive sampling was used to select twenty-one respondents directly involved in managing and directing different domains of health information in the NWS who worked with local NGOs, INGOs, UN-agencies, or part of the Health Working Group. A scoring system for each public health domain was constructed based on the number and quality of the available datasets for these domains, which were established by Checci and others.
CONCLUSIONS: Reliable and aggregate health information in the NWS is limited, despite some improvements made over the past decade. The conflict restricted and challenged efforts to establish a concentrated and harmonized HIS in the NWS, which led to a lack of leadership, poor coordination, and duplication of key activities. Although the UN established the EWARN and HeRAMS as common data collection systems in the NWS, they are directed toward advocacy and managed by external experts with little participation or access from local stakeholders to these datasets.
CONCLUSIONS: There is a need for participatory approaches and the empowerment of local actors and local NGOs, cooperation between local and international stakeholders to increase access to data, and a central domain for planning, organization, and harmonizing the process. To enhance the humanitarian health response in Syria and other crisis areas, it is imperative to invest in data collection and utilisation, mHealth and eHealth technologies, capacity building, and robust technical and autonomous leadership.

Wider healthcare-strengthening interventions are recommended in cholera hotspots and could benefit other types of diarrhoeal diseases which contribute to greater mortality than cholera.
Describe facility capacity and provider knowledge for case management of diarrhoea and cholera surveillance in cholera hotspots in the Democratic Republic of Congo (DRC) among health facilities, drug shops, and traditional health practitioners.
We conducted a sequential exploratory mixed-method study, using focus group discussions, facility audits, and provider knowledge questionnaires during September and October 2022 in North Kivu and Tanganyika provinces, Eastern DRC. Content analysis was used for qualitative data. Quantitative data were summarised by facility level and healthcare provider type. Audit and knowledge scores (range 0-100) were generated. Multivariable linear regression estimated association between scores and explanatory factors. Qualitative and quantitative data were triangulated during interpretation.
Overall, 244 facilities and 308 providers were included. The mean audit score for health facilities was 51/100 (SD: 17). Private facilities had an -11.6 (95% CI, -16.7 to -6.6) lower adjusted mean score compared to public. Mean knowledge score was 59/100 (95% CI, 57 to 60) for health facility personnel, 46/100 (95% CI, 43 to 48) for drug shop vendors and 37/100 (95% CI, 34 to 39) for traditional health practitioners. Providers had particularly low knowledge concerning when to check for low blood sugar, use of nasogastric tubes, and dosing schedules. Knowledge about case definitions for cholera was similar between groups (range 41-58%) except for traditional health practitioners for the definition during an outbreak 15/73 (21%).
Increasing awareness of cholera case definitions in this context could help improve cholera surveillance and control. Increased support and supervision, especially for private providers, could help ensure facilities are equipped to provide safe care. More nuanced aspects of case management should be emphasised in provider training.

Mental health expenditure accounts for just 2.1% of total domestic governmental health expenditure per capita. There is an economic, as well as moral, imperative to invest more in mental health given the long-term adverse impacts of mental disorders. This paper focuses on how economic evidence can be used to support the case for action on global mental health, focusing on refugees and people displaced due to conflict. Refugees present almost unique challenges as some policy makers may be reluctant to divert scarce resources away from the domestic population to these population groups. A rapid systematic scoping review was also undertaken to identify economic evaluations of mental health-related interventions for refugees and displaced people and to look at how this evidence base can be strengthened. Only 11 economic evaluations focused on the mental health of refugees, asylum seekers and other displaced people were identified. All but two of these intervention studies potentially could be cost-effective, but only five studies reported cost per quality-adjusted life year gained, a metric allowing the economic case for investment in refugee mental health to be compared with any other health-focused intervention. There is a need for more consistent collection of data on quality of life and the longer-term impacts of intervention. The perspective adopted in economic evaluations may also need broadening to include intersectoral benefits beyond health, as well as identifying complementary benefits to host communities. More use can be also made of modelling, drawing on existing evidence on the effectiveness and resource requirements of interventions delivered in comparable settings to expand the current evidence base. The budgetary impact of any proposed strategy should be considered; modelling could also be used to look at how implementation might be adapted to contain costs and take account of local contextual factors.

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UNASSIGNED: Yemen is regarded as one of the Middle East\'s poorest countries. Decades of political, economic, and social difficulties have culminated in the current protracted conflict. As a result, the globe experienced its worst humanitarian catastrophe. The ongoing war has affected several public services, notably the health sector, which is operating at less than half its capacity. This study aims to examine Yemen\'s health system at the governorate level (Al Hodeida) amidst the current conflict. It analyzes current challenges and produces suggestions for enhancement.
UNASSIGNED: The study used qualitative research methods such as Key Informant Interviews (KIIs) and document analysis. The study used WHO\'s health systems framework to measure health system performance. Twelve KIIs were conducted via Skype with several health stakeholders. In addition, documents were analyzed to inform the subject guide, generate themes, and aid in the triangulation of results.
UNASSIGNED: According to the study findings, the governorate health system managed to offer a minimum level of healthcare services while making some advances in outbreak control jointly with other partners. One of the main difficulties confronting the governorate\'s health system is a severe lack of financial resources forcing it to rely entirely on external aid. Furthermore, other significant deficiencies include inadequate health system organogram, low reporting capacities, insufficient funding, and scarcity of health professionals.
UNASSIGNED: Yemen\'s frail health system has been weakened by almost eight years of insecurity and conflict. If the current scenario continues, most of Yemen\'s health system\'s operations and indicators will likely deteriorate. On the other hand, progress in some areas, such as primary healthcare (PHC) services and disease management, is remarkable. However, for better performance, Yemen\'s health system leadership and stakeholders should seek a holistic strategy to improve the entire dimensions of the health system.

A health system has three key stakeholders, the State-at national and subnational levels-the health service providers and the citizens. In most settings and especially in peacetime, these stakeholders are typically well-defined. In contrast, during conflict and crisis as well as during ceasefire and post-conflict peacebuilding, stakeholders in the health system are often more diverse and contested. Health systems in such settings tend to be more decentralised, de facto-often in addition to de jure decentralisation. Despite much debate on the potential benefits of decentralisation, assessing its impact on health system performance remains difficult and its effect is open to dispute in the literature. This narrative synthesis aims to support efforts to assess and make sense of how decentralisation impacts health system performance in fragile and post-conflict countries-by synthesising evidence on the impact of decentralisation on health system performance from six country case studies: Papua New Guinea, the Philippines, Indonesia, Pakistan, Myanmar and Nepal. The impact of decentralisation on health system performance is optimised when combining centralisation (e.g., the benefits of central coordination in improving efficiency) with decentralisation (e.g., the benefits of local decision making in improving equity and resilience). The findings may inform efforts to think through what to centralise or decentralise, the impacts of those choices, and how the impact may change over time as countries go through and emerge from conflict-and as they go through and recover from the Covid-19 pandemic and prepare for future pandemics.

BACKGROUND: Thalassaemia affects many families in Northeast Syria, an area devastated by over a decade of conflict which has significantly impacted their health system. People with thalassaemia require holistic multidisciplinary care for the clinical complications of thalassaemia. The risks of thalassaemia treatment include blood-borne viral infections secondary to unsafe transfusion, increased vulnerability to serious bacterial infection following splenectomy, and complications of both iron overload and iron chelation therapy. Médecins Sans Frontières (MSF) provided outpatient thalassaemia care programmes in northeast Syria between April 2017 October 2019 in a complex conflict context challenged by population displacement, the destruction of medical facilities, and periods of insecurity.
METHODS: We performed a secondary descriptive analysis of the thalassaemia cohort data to describe basic clinical and demographic characteristics of the patient population. A desk review of internal and publicly available documents was supplemented by informal interviews with MSF staff to describe and analyse the programmatic approach.
METHODS: MSF delivered programmes with thalassaemia investigations, provision of blood transfusion, iron chelation therapy, and psychosocial support. Thalassemia programmes were novel for the organisation and operational learning took place alongside service implementation. Lessons were identified on equipment procurement and the requirements for the implementation of vital investigations (including ferritin testing), to inform clinical decision making. Lessons included the importance of supply planning for sufficient blood products to meet diverse clinical needs in a conflict area, so those with thalassaemia have continued access to blood products among the competing priorities. Iron chelation therapy met a large need in this cohort. Adapted protocols were implemented to balance social factors, hygiene considerations, toxicity, tolerability, and adherence to therapy. Wider service needs included considerations for family planning advice and services, continuity of care and patient access through decentralised services or laboratory access, psychosocial support, and improved data collection including quality of life measurements to understand the full impact of such programmes.
CONCLUSIONS: Although this type of programming was not \"routine\" for the organisation, MSF demonstrated that life-sustaining thalassaemia care can be provided in complex conflict settings. International non-governmental organisations can consider this care possible in similar contexts.

Interprofessional team conflict amplifies division and impedes patient care. Normal differences of opinion escalate to frank conflicts when members respond with indignation or resentment. These behaviors engender a workplace culture that degrades collaborative clinical management and patient safety. We describe the impacts of dysfunctional team culture along with interventions that can lead to more productive teams. In our case study, an interprofessional group of critical care clinicians recognized that their interactions impaired collaborative care and requested support. Two experts, a nurse and a physician, facilitated two 2-h workshops with 18 critical care physicians, nurses, and fellows to begin transforming their dysfunctional unit culture. After establishing psychological safety, facilitators introduced the learning pathways grid to explore (1) how faulty assumptions lead to dysfunctional interactions and suboptimal results and (2) how new assumptions informed by new insights enable teams to redesign their interactions. Through reflection and analysis, clinicians concluded that understanding other clinicians\' goals and perspectives benefits patients and families, helps clinicians feel valued, and fosters mutual trust. This exercise supports interprofessional teams to transform dysfunctional interactions by helping team members to develop a mindset of humility and inquiry and to remind themselves about the good intentions in others. To address conflict, we offer a conversational approach grounded in curiosity, respect, and transparency. Ultimately, the most important communication strategy for effective critical care is caring about the perspectives and experiences of other members of the interprofessional team.

UNASSIGNED: Social assistance, humanitarian relief, and disaster response increasingly overlap, especially where recurrent crises and persistent conflicts prevail. In such situations, distinctions between risk and uncertainty become especially important. It is critical for policy and practice to shift from focusing on risk assessment and management to embracing uncertainty.
UNASSIGNED: The article assesses the appropriateness of two approaches to social assistance and humanitarian relief where crises recur and conflicts persist: risk assessment and management; and embracing uncertainty and ignorance.
UNASSIGNED: The article reviews different approaches to social assistance, humanitarian relief, and disaster response, and asks how they are framed. It draws on experiences from programmes offering social assistance, humanitarian relief, and disaster response, highlighting the professional, bureaucratic, and institutional features that influence programme design and functioning. These are compared with \"high-reliability\" approaches deployed in other critical infrastructure-such as water and energy supply.
UNASSIGNED: Mainstream approaches focus on risk assessment and management, assuming predictability and stability. This is problematic, especially in settings of crisis and conflict where there may be no functioning delivery system for social assistance and relief. The article highlights alternatives to the mainstream risk-focused approaches, which emphasize learning, collaboration, adaptation, and flexibility. Such approaches must build on embedded practices of moral economy, collective action, and mutual care and be supported through professional and institutional capacities that generate reliability.
UNASSIGNED: The article suggests a new agenda for the intersection of social assistance, humanitarian relief, and disaster response, which makes uncertainty the focus for rethinking responses at scale, especially in settings affected by crisis and conflict.

The co-parenting relationship matters for postdivorce parental adjustment. This study explores the relative impact of different forms of co-parenting behaviors, coupled with an individual\'s psychological resources, in explaining parent mental health in recently divorced or separated parents (n = 355). A latent variable structural equation model was fit to examine pathways between dimensions of co-parenting (support, overt conflict, self-controlled covert conflict, and externally controlled covert conflict), various psychological resources (satisfaction with the divorce decree, perceived competence of the co-parent, and self-efficacy), and adverse mental health symptomology. Significant direct pathways were identified between overt co-parenting conflict and adverse mental health. Indicators of co-parenting quality were tied differentially to various resources. Indirect effects were found for both self-controlled covert conflict and overt conflict on adverse mental health symptomology through self-efficacy. Leverage points and considerations for health professionals and practitioners working with divorcing parents are discussed.