In 2023 Alkhathami and colleagues from the Prince Sultan Military College of Health Sciences highlighted the Kingdom of Saudi Arabia\'s transformative upgrades across various sectors, notably including enhancements to the healthcare system, and called for action to extend these upgrades to the military healthcare field. Prompted by this call to action, the leadership of the military healthcare system swiftly commenced initiatives, acting in less than three months from this pivotal appeal. In January 2023 the first author ordered a decree via the General Directorate of Armed Forces Medical Services of Saudi Arabia, in collaboration with US central Command and international partners, to host the 3rd International Conference of Military Medicine. The event graciously welcoming more than 1000 military representatives from 20 participating nations. The Military Medical Conference, fostering a global military community dialogue on the necessity to explore collective capacities to endure and overcome humanitarian challenges, thereby sustaining health, promoting well-being, and nurturing life through strategies that align with the insights of Alkhathami et al. (2023). The response and the need underlined by the original article are discussed by the Major General, staff of the Saudi Military Medical Services and academics from the University of Sharjah.

Energy and humanitarian action have long been uneasy bedfellows. In the field, many humanitarian practitioners lack the time or remit to engage with a complex issue such as energy, and the topic to date has received relatively little attention from the private, development and academic sectors. This paper hopes to provide more clarity on energy in forced displacement settings by analysing how energy is interwoven with the humanitarian cluster system. This paper has two aims: (1) to assess existing evidence in the sector and explain the links between energy and each of the humanitarian clusters and (2) to provide recommendations on how humanitarian response efforts can transition from informal action to a comprehensive response on sustainable energy provision. This paper is the first to investigate the role of energy using the cluster system as a framework and contributes to a rapidly evolving field of research and practice on energy in humanitarian contexts. Our analysis demonstrates that energy is not fully integrated within humanitarian programme planning. Further, it highlights pathways for improving humanitarian outcomes enabled by improved energy practices. We identify ten ways clusters can integrate action on energy to support crisis-affected communities.

UNASSIGNED: Conflicts, akin to other crises, disrupt lives and healthcare infrastructure, disproportionately affecting vulnerable individuals. The ongoing Sudanese conflict, initiated on April 15, 2023, between the Sudanese Armed Forces (SAF) and the Rapid Support Force (RSF), triggers significant population displacement, healthcare facility closures, and a scarcity of medical resources. Amid the intense conflict in Khartoum, reports of deceased individuals in the streets heighten concerns about public health, emphasizing the gravity of the situation. This crisis compounds the challenges faced by Sudan\'s already fragile healthcare system, impacting over 5 million displaced individuals, including those reliant on life-saving hemodialysis sessions. This commentary aims to illuminate the challenges confronting kidney dialysis patients in war-torn Sudan, emphasizing the impact on the Al-Goled hemodialysis center.
UNASSIGNED: This commentary relies on reports from the American Society of Nephrology (ASN), European Renal Association (ERA), and The International Society of Nephrology (ISN), along with recent journal articles discussing the consequences of ongoing conflicts. Personal observations in Al-Goled contribute to the insights, and data from the Al-Goled hemodialysis center in Sudan illuminate the struggles faced by kidney dialysis patients during the conflict, presented as a case study.
UNASSIGNED: Kidney dialysis patients, crucial for regular hemodialysis sessions, confront severe challenges due to the overwhelming conflict. With an estimated 8000 kidney failure patients in Sudan, disruptions in healthcare services, targeted attacks on medical staff, and a shortage of resources exacerbate their plight. The Al-Goled hemodialysis center, initially designed for 30 daily sessions, experiences a surge in demand, accommodating 85 patients daily-an alarming 183% increase. Limited resources, machine malfunctions, and a shortage of medications contribute to the loss of 13 patients\' lives.
UNASSIGNED: The conflict in Sudan disproportionately impacts kidney dialysis patients, causing disruptions in essential healthcare services. The surge in demand at the Al-Goled center underscores the broader impact on healthcare institutions nationwide. Local efforts to source medical supplies face bureaucratic hurdles and complex exportation procedures, impeding support for kidney patients. Patients, once receiving 3 weekly sessions, now struggle to secure even one, jeopardizing their well-being. Urgent international intervention is needed to cease the conflict and ensure the safety of healthcare facilities, especially for vulnerable populations like kidney dialysis patients.

UNASSIGNED: Although multiple prognostic models exist for Ebola virus disease mortality, few incorporate biomarkers, and none has used longitudinal point-of-care serum testing throughout Ebola treatment center care.
UNASSIGNED: This retrospective study evaluated adult patients with Ebola virus disease during the 10th outbreak in the Democratic Republic of Congo. Ebola virus cycle threshold (Ct; based on reverse transcriptase polymerase chain reaction) and point-of-care serum biomarker values were collected throughout Ebola treatment center care. Four iterative machine learning models were created for prognosis of mortality. The base model used age and admission Ct as predictors. Ct and biomarkers from treatment days 1 and 2, days 3 and 4, and days 5 and 6 associated with mortality were iteratively added to the model to yield mortality risk estimates. Receiver operating characteristic curves for each iteration provided period-specific areas under curve with 95% CIs.
UNASSIGNED: Of 310 cases positive for Ebola virus disease, mortality occurred in 46.5%. Biomarkers predictive of mortality were elevated creatinine kinase, aspartate aminotransferase, blood urea nitrogen (BUN), alanine aminotransferase, and potassium; low albumin during days 1 and 2; elevated C-reactive protein, BUN, and potassium during days 3 and 4; and elevated C-reactive protein and BUN during days 5 and 6. The area under curve substantially improved with each iteration: base model, 0.74 (95% CI, .69-.80); days 1 and 2, 0.84 (95% CI, .73-.94); days 3 and 4, 0.94 (95% CI, .88-1.0); and days 5 and 6, 0.96 (95% CI, .90-1.0).
UNASSIGNED: This is the first study to utilize iterative point-of-care biomarkers to derive dynamic prognostic mortality models. This novel approach demonstrates that utilizing biomarkers drastically improved prognostication up to 6 days into patient care.

OBJECTIVE: Using a model-based analysis, we calculated the total costs associated with the exclusive breast-feeding (EBF) and breast milk substitute (BMS) usage for one infant for six months within select humanitarian contexts to (a) determine if there is a notable difference in costs and (b) use these results to inform future creation of data-informed humanitarian response standard operating procedures.
METHODS: The inputs and costing data were drawn from a mixture of local e-commerce vendors, peer-reviewed literature and personal communications with field-based humanitarian responders. To account for cost fluctuations, each input\'s costs along with low and high parameters are presented. All costs are presented in 2021 United States Dollars.
METHODS: Humanitarian responses within Indonesia and Jordan.
METHODS: Not applicable.
RESULTS: There was a notable difference in the total cost of care in both selected locations across the study arms (Indonesia: $542; Jordan: $892).
CONCLUSIONS: Given the reality of limited funding for comprehensive humanitarian response around the world and the necessity of prioritising certain interventions, humanitarian response organisations should consider the notable cost difference between EBF and BMS usage (along with the proven health benefits of EBF). This difference should play a role in informing the future creation of standard operating procedures while also ensuring that all infants within a humanitarian crisis receive appropriate feeding.

Humanitarian crises are unpredictable and complex environments, in which access to basic services and infrastructures is not adequately available. Computing in a humanitarian crisis environment is different from any other environment. In humanitarian environments the accessibility to electricity, internet, and qualified human resources is usually limited. Hence, advanced computing technologies in such an environment are hard to deploy and implement. Moreover, time and resources in those environments are also limited and devoted for life-saving activities, which makes computing technologies among the lowest priorities for those who operate there. In humanitarian crises, interests and preferences of decision-makers are driven by their original languages, cultures, education, religions, and political affiliations. Hence, decision-making in such environments is usually hard and slow because it solely depends on human capacity in absence of proper computing techniques. In this research, we are interested in overcoming the above challenges by involving machines in humanitarian response. This work proposes and evaluates a text classification and embedding technique to transform historical humanitarian records from human-oriented into a machine-oriented structure (in a vector space). This technique allows machines to extract humanitarian knowledge and use it to answer questions and classify documents. Having machines involved in those tasks helps decision-makers in speeding up humanitarian response, reducing its cost, saving lives, and easing human suffering.
UNASSIGNED: The online version contains supplementary material available at 10.1186/s41018-023-00135-4.

To respond to the unintended consequences of prevention measures to reduce COVID-19 transmission, individuals and groups, including religious leaders, have collaborated to provide care to those negatively impacted by these measures. Amid these various efforts and interventions, there is a need to deepen our understanding of diverse expressions of care across various geographical and social contexts. To address this need, the objective of this study was to investigate how religious leaders in the Philippines practiced care for their communities by meeting emergency food needs amid the COVID-19 pandemic. Guided by an ethics of care theoretical orientation, we conducted 25 remote semi-structured interviews with Filipino religious leaders who partnered with a Philippines-based non-governmental organization (NGO) to mobilize essential food aid to their local communities. Through defining the efforts and activities of these religious leaders as care work, we found that religious leader experiences revolved around navigating care responsibilities, caring alongside others, and engaging holistically with the care work. Additionally, we observed how contextual factors such as the humanitarian settings where religious leaders worked, the partnership with an NGO, and the positionality of local religious leaders within their communities, fundamentally shaped the care work. This study expands our understanding of how care is practiced and experienced and also brings greater visibility to the experiences and efforts of local religious leaders in responding to humanitarian emergencies.

UNASSIGNED: Jordan hosts one of the highest numbers of refugees per capita in the world, with the Syrian crisis leading to an influx of displaced persons to the already vulnerable population. However, limited resources and a lack of cancer-care strategies have made it difficult for refugees in Jordan to access quality cancer care. The King Hussein Cancer Center (KHCC) and Foundation (KHCF) have played a pivotal role in providing financial and medical support for displaced children with cancer, treating 968 non-Jordanian children with cancer between 2011-2022, with a median age of 6 years. Of these, 84% were fully funded by KHCF, and nationalities included Syrians (29%), Palestinians (26%), Iraqis (23%), and Yemenis (17%). Cancer diagnoses included solid tumors (44%), leukemia (23%), lymphoma (13%), bone sarcomas (9.5%), and retinoblastoma (9.1%). The median cost of treatment was JOD 18,000 (USD 25,352), with a total estimated cost of JOD 23.8 million (USD 33.5 million). More recently, in partnership with St. Jude Children\'s Research Hospital (SJCRH), two successive humanitarian funds (HF) were established to optimize cancer care for displaced children in Jordan.
UNASSIGNED: Between February 2018 and September 2022, 51 children were fully treated on KHCC-SJCRH-HF, with a median age of 6 years and nationalities including Syrians (80%), Iraqis (6%), and Yemenis (8%). The most common cancer diagnoses were leukemia (41%), lymphoma (25%), solid tumors (24%), retinoblastoma (6%), and brain tumors (4%). Of these, 94% are alive and 51% are still receiving coverage. The median coverage for patients was JOD 21,808 (USD 30,715), and the total cost of treatment on KHCC/KHCF-SJCRH/American Lebanese Syrian-Associated Charities HF1 and HF2 was JOD 1.44 million (USD 1.97 million) and JOD 1.18 million (USD 1.67 million), respectively.
UNASSIGNED: This experience highlights the high burden of displaced children with cancer in Jordan, and the importance of local foundations like KHCC/KHCF and partnerships with international partners like SJCRH in providing lifesaving humanitarian initiatives and quality cancer care. Innovative cancer-care delivery models and sustainable financing are essential to ensure continuous coverage and access to cancer care for displaced persons in Jordan.

Natural language processing (NLP) is a rapidly evolving field at the intersection of linguistics, computer science, and artificial intelligence, which is concerned with developing methods to process and generate language at scale. Modern NLP tools have the potential to support humanitarian action at multiple stages of the humanitarian response cycle. Both internal reports, secondary text data (e.g., social media data, news media articles, or interviews with affected individuals), and external-facing documents like Humanitarian Needs Overviews (HNOs) encode information relevant to monitoring, anticipating, or responding to humanitarian crises. Yet, lack of awareness of the concrete opportunities offered by state-of-the-art techniques, as well as constraints posed by resource scarcity, limit adoption of NLP tools in the humanitarian sector. This paper provides a pragmatically-minded primer to the emerging field of humanitarian NLP, reviewing existing initiatives in the space of humanitarian NLP, highlighting potentially impactful applications of NLP in the humanitarian sector, and describing criteria, challenges, and potential solutions for large-scale adoption. In addition, as one of the main bottlenecks is the lack of data and standards for this domain, we present recent initiatives (the DEEP and HumSet) which are directly aimed at addressing these gaps. With this work, we hope to motivate humanitarians and NLP experts to create long-term impact-driven synergies and to co-develop an ambitious roadmap for the field.

Improving handwashing with soap (HWWS) among children in humanitarian emergencies has the potential to reduce the transmission of several important infectious diseases. However, there is limited evidence on which approaches are effective in increasing HWWS among children in humanitarian settings. One recent innovation - the \"Surprise Soap\" intervention - was shown to be successful in a small-scale efficacy trial in a humanitarian setting in Iraq. This intervention includes soap with embedded toys delivered through a short household session comprising a glitter game, instruction of how and when to wash hands, and HWWS practice. Whilst promising, this approach has not been evaluated at programmatic scale in a complex humanitarian setting.
We conducted a cluster-randomised controlled equivalence trial of the Surprise Soap intervention in IDP camps in Kahda district, Somalia. Proportionate stratified random sampling was employed to recruit 200 households, with at least one child aged 5-12, across the camps. Eligible households were randomly allocated to receive the Surprise Soap intervention (n = 100) or an active comparator handwashing intervention in which plain soap was delivered in a short household session comprising standard health-based messaging and instruction of how and when to wash hands (n = 100). The primary outcome was the proportion of pre-specified occasions when HWWS was practiced by children aged 5-12 years, measured at baseline, 4-weeks, 12 weeks, and 16 weeks post invention delivery.
HWWS increased in both groups (by 48 percentage points in the intervention group and 51 percentage points in the control group, at the 4-week follow up), however, there was no evidence of a difference in HWWS between the groups at the 4-week (adjusted RR (aRR) = 1.0, 95% CI 0.9-1.1), 12-week (aRR = 1.1, 95% CI 0.9-1.3), or 16-week (aRR = 1.0, 95% CI 0.9-1.2) follow-up.
In this complex humanitarian setting, where soap availability and past exposure to handwashing promotion was low, it appears that well-designed, household-level targeted handwashing interventions that include soap provision can increase child HWWS and potentially reduce disease risk, but the Surprise Soap intervention offers no marginal benefit over a standard intervention that would justify the additional costs.