Delivery of emergency care services in post-conflict or conflict-affected settings
Citation: Werner K, Kak M, Herbst CH, et al. Emergency care in post-conflict settings: a systematic literature review. BMC Emergency Medicine. 2023;23:37.
Language: Abstract and full text available in EN.
Free to view: Yes.
Funding sources: World Bank Group.
What is this? In this systematic review, the authors searched for studies that assessed the delivery of emergency care services in post-conflict or conflict-affected settings. They restricted their searches to articles published after 1 January 2000 in English, French or Spanish. They did the search in September 2021 and included 26 studies, from 18 countries.
What was found: Four barriers impacted the delivery of emergency care systems in post-conflict settings: (1) poor infrastructure, (2) social distrust, (3) scarcity of emergency care training, and (4) lack of available resources and supplies.
The destruction of infrastructure (such as damaged roads) hindered the delivery of emergency care systems during and after conflict periods.
Lingering social distrust in conflict settings may be difficult to repair between opposing groups, and these social cohesion challenges can extend into health service and delivery.
Inadequate training and expertise of healthcare workers, in particular in emergency care principles, may lead to higher morbidity and mortality.
Resource-related difficulties were widespread in different settings, restricting the ability to develop or enhance emergency care services.
Implications: The authors of the review concluded that emergency care systems are important in achieving universal health coverage and that aligning them with global health priorities might help to save hundreds of thousands of lives every year. They also stated future research should focus on the effective delivery of emergency care interventions that have been employed in settings with limited available resources, specifically in the context of post-conflict settings.
Other considerations: The authors of the review discussed their findings in the context of place of residence, occupation, education, and time-dependent relationships (during and after conflict).
This summary was prepared by Yasmeen Saeed, checked by Cristián Mansilla and Ana Pizarro, and finalized by Mike Clarke.
Evidence Gaps: This review identified two main gaps:
| Evidence gap | Classification | Population/setting identified | Study type |
|
‘’Future research should endeavour to corroborate the effectiveness of emergency care interventions that have been demonstrated to be effective in low-resource settings, in the context of post-conflict settings. To start, interventions to consider include implementing triage systems training healthcare providers in basic emergency care skills, and conducting first-aid responder training’’ “Quantitative analyses that can provide evidence of the effectiveness of interventions for improving emergency care in these settings are lacking’’ |
More research with higher external validity | Post-conflict settings | N/A |
| ‘’Few studies used any form of quantitative means to assess interventions aimed at improving the delivery of emergency care’’ | More high-quality research is needed | Post-conflict settings | Quantitative |
These gaps were identified up to September 2021 with no geographical restrictions. An updated search was conducted on 28 August 2023 to check if new studies have filled this gap, finding:
- No more recent systematic review addressing the same or a broader question.
- No primary study that could contribute to fill the gap.
This evidence gap was identified, extracted, and classified by Ana Beatriz Pizarro and Jawaria Karim. Updated searches were carried out by Jane McHugh. Ana Beatriz Pizarro assessed the search results to address the gaps, and the findings were checked and finalized by Cristián Mansilla. The methodology we used to assess each gap can be found here.