The research, led by Dina Farran of Embrace, the organization that runs Lebanon’s National Lifeline, together with colleagues from the Lebanese Ministry of Public Health’s National Mental Health Programme, Vrije Universiteit Amsterdam, and other institutions, examined burnout among the hotline’s operators during the conflict period spanning September 2024 until the ceasefire. Burnout is not a vague feeling of tiredness; in occupational health research it is measured along three distinct dimensions captured by the Maslach Burnout Inventory-Human Services Survey: emotional exhaustion, the depletion of emotional resources; depersonalization, the development of detached, cynical responses toward the people one serves; and personal accomplishment, the sense of competence and meaningful achievement in one’s work, which tends to erode as burnout deepens.

The study design was a cross-sectional online survey conducted in February 2025, after the ceasefire had taken hold but while memories of the crisis period were fresh. All 96 operators who had been trained and remained active throughout the conflict were invited to participate, and 51 completed the survey, a response rate of 53.1 percent. That sample size is modest, and the authors are candid that the findings are exploratory, but the setting is extraordinarily rare: a national crisis line operating continuously while its country is under active bombardment, staffed largely by people who were themselves living through the same war as the callers they served.

The headline numbers are, in one sense, reassuring. Only nine of the 51 participants, or 17.6 percent, met criteria for burnout. Across the three dimensions, operators reported moderate levels of emotional exhaustion and moderate depersonalization, while their sense of personal accomplishment remained relatively preserved. For a workforce answering distress calls during airstrikes and mass displacement, that profile suggests a degree of resilience that the researchers attribute in part to the structures wrapped around the role. Yet moderate is not negligible, and the study’s real value lies in what predicted who fared worse and who fared better.

One individual-level factor stood out in the adjusted logistic regression models: concurrent employment. Operators who held an additional job alongside their Lifeline role showed higher emotional exhaustion. In Lebanon’s protracted economic crisis, where salaries in many sectors have collapsed, moonlighting is often a necessity rather than a choice, and the finding hints at a structural vulnerability. A crisis line operator who spends the day at another job and the night absorbing other people’s despair has little capacity left for recovery, and the exhaustion dimension of burnout is precisely the one most tightly linked to workload and insufficient recovery time.

More striking, the protective factors were overwhelmingly organizational and relational rather than personal. Satisfaction with the role itself, perceived organizational support, access to supervision, clear communication within the service, and opportunities for professional development were all associated with more favourable burnout indicators. In other words, the operators who weathered the war best were not necessarily those with unusual personal fortitude; they were those embedded in a system that supported them, communicated clearly, and invested in their growth. This aligns with a broad body of occupational health psychology research showing that organizational resources, often described under the umbrella of job demands-resources theory, buffer the strain of emotionally demanding work more reliably than individual coping strategies alone.

Supervision deserves particular attention. In crisis line practice, supervision is not a luxury; it is the mechanism through which operators process the emotional residue of difficult calls, receive feedback on their technique, and rehearse responses to situations they may face again. During the 2024 conflict, Lebanese operators were handling calls from people who were displaced, bereaved, or suicidal while rockets fell, and the study suggests that having a structured space to decompress and reflect was linked to better outcomes on the burnout measures. Perceived organizational support, the belief that the institution values one’s contribution and cares about one’s wellbeing, has repeatedly been shown in the literature to attenuate the link between job demands and exhaustion, and this study extends that evidence into the extreme context of armed conflict.

The authors were careful with their statistics. Because burnout was relatively uncommon in the sample, they ran sensitivity analyses using alternative burnout classifications and Firth penalized logistic regression, a technique designed to produce more stable estimates when outcome events are sparse and conventional maximum-likelihood models risk biased or inflated coefficients. The overall pattern of findings held up reasonably well, though some associations shifted depending on how burnout was operationally defined, a reminder that in small cross-sectional studies the details of measurement matter. The cross-sectional design itself imposes a further limit: the survey captured a single moment in time, so it cannot establish whether organizational support caused lower burnout or whether less burned-out operators simply perceived their organization more positively.

Even with those caveats, the implications for hotline practice are concrete. The study points to supervision, organizational support, communication processes, professional development opportunities, and operational flexibility as levers that crisis services can actually pull, particularly in low-resource and conflict-affected settings where the mental health workforce is thin and turnover would be catastrophic. Lebanon’s National Lifeline, launched under the National Mental Health Programme, has become a model for suicide prevention infrastructure in the region, and its operators’ experience during the war offers a template: protect the workforce with the same seriousness that the workforce protects the public. The authors call for longitudinal and intervention studies to test these associations directly, which would mean following hotline staff over time and evaluating whether strengthening supervision and support genuinely reduces burnout rather than merely correlating with it.

The broader resonance of the study lies in its timing and its setting. Suicide rates and psychological distress typically surge during armed conflict and humanitarian emergencies, which means crisis lines are often busiest exactly when their operators are most personally endangered and most personally distressed. The Lebanese findings suggest that the answer to that paradox is not to recruit tougher people but to build tougher systems: services that treat operator wellbeing as a core operational parameter rather than an afterthought. As conflicts and climate disasters multiply the demand for remote psychological crisis support worldwide, the quiet data from a Beirut hotline in February 2025 may prove to be a blueprint for keeping the people who answer the phone from burning out themselves.

Subject of Research: Burnout among suicide prevention hotline operators during the 2024 war in Lebanon

Article Title: Burnout indicators among operators of Lebanon’s national suicide prevention lifeline during the 2024 war: organizational correlates and implications for hotline practice

Article References: Farran, D., Haj, M. E., Chiha, G., Fouani, R. E., Ramia, J. A., Noun, P., Zeinoun, L., Atoui, M., & El Chammay, R. (2026). Burnout indicators among operators of Lebanon’s national suicide prevention lifeline during the 2024 war: organizational correlates and implications for hotline practice. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08591-z

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08591-z

Keywords: burnout, suicide prevention, crisis hotline, Lebanon, armed conflict, occupational health, mental health workforce, emotional exhaustion, organizational support, supervision, Maslach Burnout Inventory, BMC Psychiatry

The study, a cross-sectional survey published in BMC Nursing, recruited 465 novice nurses from six Middle Eastern countries: Iraq, Syria, Yemen, Palestine, Saudi Arabia, and Lebanon. The researchers defined novice narrowly, including only nursing interns and nurses with under twelve months of clinical experience, a deliberate choice that targets the exact population most likely to be deployed to the front lines of patient contact without specialized training. Participants completed a knowledge and competency questionnaire adapted from the World Health Organization’s Psychological First Aid Facilitator’s Manual for Orienting Field Workers, the standard international reference for teaching the technique. Psychological first aid is not psychotherapy; it is a structured, non-intrusive approach built on supportive communication, grief support, and trauma-informed care, designed to reduce acute distress and connect people to practical help in the immediate aftermath of crisis.

The headline result is stark. On a knowledge test scored from 0 to 15, the overall mean was 7.61, with a standard deviation of 1.75. In other words, the average novice nurse in the sample answered roughly half of the psychological first aid knowledge items correctly. Self-perceived competence told a different and more encouraging story: on a scale from 1 to 5, participants rated their own ability to deliver psychological first aid at a mean of 3.52. That mismatch, moderate confidence paired with roughly fifty percent knowledge, is the study’s central tension, and it is a familiar pattern in emergency care research. Confidence without corresponding knowledge can be dangerous in a crisis, because a clinician who believes they are helping may not recognize when their approach drifts into harmful territory, such as forcing a survivor to talk about traumatic events before they are ready.

Geography mattered. Self-perceived competence differed significantly across the six countries, with the analysis producing an F statistic of 7.083 and a p-value below .001, an effect size of eta squared equal to 0.072. Nurses in Palestine reported the highest competence, averaging 3.83 out of 5, followed closely by Syria at 3.76. At the other end, Lebanon averaged 3.26 and Saudi Arabia 3.18. Knowledge scores also differed across countries in the omnibus analysis, with an F of 2.850 and p equal to .018, though the effect was smaller at eta squared of 0.037. Palestine again led with a mean knowledge score of 8.25, while Saudi Arabia recorded the lowest at 7.00. The pattern is intuitively compelling: the countries where armed conflict is a lived, daily reality produced the most confident novices, suggesting that exposure to crisis conditions, whether through formal training or sheer necessity, shapes how ready these young nurses feel.

Yet the researchers are careful about how far that interpretation can be pushed. When they applied Bonferroni corrections to the pairwise comparisons between countries, no individual country difference remained statistically significant in the adjusted model. The omnibus tests flagged real variation, but the study cannot say with confidence that Palestinian nurses know more than Saudi nurses, or that Syrian nurses feel more competent than Lebanese ones, once the statistical penalty for multiple comparisons is paid. This is a common and often misunderstood feature of multi-group survey research: an overall test can detect that the groups are not identical while the corrected pairwise tests, with their stricter thresholds, cannot pinpoint exactly which pairs differ. The honest reading is that country-level variation exists in self-perceived competence, but its precise boundaries remain unresolved.

There is a second methodological caution, and the authors flag it prominently. The knowledge scale’s reliability, measured by the KR-20 coefficient, was low. KR-20 is a measure of internal consistency for dichotomous test items, analogous to Cronbach’s alpha, and a low value means the individual items on the test are not measuring a single coherent underlying construct with precision. Because of this, the researchers interpreted their knowledge findings primarily at the item level rather than leaning on the aggregate score. That decision matters for anyone hoping to use the 7.61 figure as a precise benchmark. What the study can credibly support is the identification of specific item-level knowledge gaps, particular concepts or procedures within psychological first aid that novice nurses across all six countries consistently got wrong, and those gaps become concrete targets for curriculum design.

The practical implications reach beyond the region. Psychological first aid has become a cornerstone of international emergency response, endorsed by the WHO and embedded in disaster-preparedness frameworks worldwide, yet capacity in many conflict-affected countries remains limited. Nurses are often the main providers of this support in crisis settings, not by design but by arithmetic: they outnumber mental health specialists by orders of magnitude, and they are physically present when survivors arrive. If the newest members of the nursing workforce, those most likely to be staffing emergency departments and field hospitals, hold only partial command of the technique, then the first psychological contact a war survivor receives may rest on an uneven foundation. The study’s authors argue that their findings support the further development and evaluation of psychological first aid education specifically tailored to novice nurses in conflict-affected settings.

The survey’s design carries its own trade-offs, which shape how the results should be used. It relied on convenience sampling, meaning participants were recruited by accessibility rather than drawn randomly from national registries of novice nurses, so the sample may overrepresent certain hospitals, cities, or training backgrounds within each country. The cross-sectional design captures a single moment in time; it cannot show whether competence grows with experience, whether confidence precedes knowledge or follows it, or whether the country differences reflect training systems, cultural norms around expressing confidence, or the intensity of local conflict exposure. Self-perceived competence, moreover, is a subjective measure. A nurse who rates themselves 4 out of 5 may be genuinely skilled or simply unaware of what skilled looks like, which is precisely why the knowledge test, despite its reliability limitation, is the more objective half of the instrument.

The ethics of conducting such research across active conflict zones deserve note. The multicountry protocol received institutional review board approval from Vision Colleges in Saudi Arabia, Taiz University in Yemen, Tishreen University in Syria, and the American University of Beirut in Lebanon, with the central approval explicitly covering Iraq and Palestine as participating sites where local co-investigators confirmed no additional review was required under their institutions’ procedures. All participants gave electronic informed consent, no personal identifiers were collected, and the study adhered to the Declaration of Helsinki. Running a coordinated survey across six countries, several of them in or recovering from armed conflict, is itself a logistical achievement, and the transparency of the ethical documentation strengthens confidence in the data’s provenance.

What remains is the gap the study exposes. Half of fifteen is not a passing grade for the psychological frontline of war, and 3.52 out of 5 confidence does not close it. The researchers did not receive external funding for the work, and they frame their contribution as diagnostic rather than curative: a baseline measurement of where novice nurses stand, with item-level knowledge gaps identified and country-level variation in self-perceived competence documented. The next step they point toward is concrete, developing and evaluating psychological first aid education built for this specific population, then measuring whether knowledge and confidence converge at a level the situation demands. Until that happens, the young nurses of Iraq, Syria, Yemen, Palestine, Saudi Arabia, and Lebanon will keep doing the work, improvising half of it, and hoping the half they know is the half that matters.

Subject of Research: Psychological first aid preparedness among novice nurses in conflict-affected Middle Eastern countries

Article Title: Novice nurses’ preparedness for psychological first aid in conflict-affected Middle Eastern Countries: a cross-sectional survey

Article References: Innab, A., Taleb, F., Altaheri, A. T. A., Noureddine, S., Elfayoumy, R., Adra, M., Massouh, A., Avedissian, T., Shurafi, S. O., Albakour, E. J., Hallaj, F. A., Hermis, A. H., Jumaa, Z. Y., & Mani, Z. A. (2026). Novice nurses’ preparedness for psychological first aid in conflict-affected Middle Eastern Countries: a cross-sectional survey. BMC Nursing. https://doi.org/10.1186/s12912-026-05331-2

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05331-2

Keywords: psychological first aid, novice nurses, armed conflict, Middle East, cross-sectional survey, WHO, nursing education, trauma-informed care, competence, BMC Nursing, Iraq, Syria

The research, led by Hiba Abdelmunim Suliman Elsheikh of the National University and Almughtarbeen University in Khartoum, together with colleagues across Sudan and Saudi Arabia, surveyed 384 adult cancer patients between June and August 2025 at two oncology centers in River Nile State. All participants had been diagnosed before April 2023, meaning every person in the cohort was already navigating cancer treatment when the fighting between the Sudanese Armed Forces and the Rapid Support Forces began. Just over half of the respondents, 203 patients or 52.9 percent, were internally displaced by the time they were surveyed, and 233 patients, or 60.7 percent, were female.

The technical design of the study matters for interpreting its results. The team used convenience sampling and a validated questionnaire, then analyzed the data with descriptive statistics and chi-square or Fisher’s exact tests in SPSS version 27, applying a conventional significance threshold of p ≤ 0.05. To untangle which factors independently predicted psychological harm, the researchers turned to multivariable ordinal logistic regression, a statistical approach suited to outcomes ordered from none through mild and moderate to severe. This allowed them to estimate the strength of association between specific war-related exposures and escalating levels of psychological impact, while controlling for other variables in the model.

The headline numbers are grim. Difficulty accessing cancer treatment because of the war was reported by 263 patients, or 68.5 percent of the cohort. When the researchers probed why, the barriers clustered into four dominant categories: financial constraints, cited by 190 patients or 72.2 percent of those reporting access problems; medication shortages, cited by 175 or 66.5 percent; travel difficulties or insecurity, cited by 163 or 62.0 percent; and limited availability of healthcare professionals, cited by 129 or 49.0 percent. Treatment interruptions, the clinical consequence of these barriers, were reported by 161 patients, or 41.9 percent. In oncology, where radiotherapy and chemotherapy schedules are calibrated to tumor biology and cell-cycle kinetics, interruptions of even a few weeks can compromise local control and survival, making this figure a proxy for measurable clinical risk rather than mere inconvenience.

The psychological toll was equally severe. A total of 138 patients, or 35.9 percent, reported severe psychological impacts, with additional patients experiencing moderate or mild levels. The regression analysis revealed which exposures independently drove this escalation. Difficulty accessing treatment carried a coefficient of B = 0.961 (95% CI: 0.385–1.536, p = 0.001), meaning patients facing access barriers were significantly more likely to slide toward severe psychological outcomes. Skipping or postponing treatment sessions was similarly predictive, with B = 1.035 (95% CI: 0.258–1.811, p = 0.009). Exposure to security threats independently predicted psychological harm as well, with B = 0.610 (95% CI: 0.093–1.128, p = 0.021).

But the strongest signal in the entire model belonged to family economic difficulty. Patients whose families faced moderate economic strain showed a coefficient of B = 2.283 (95% CI: 1.425–3.142, p < 0.001), and those facing severe economic hardship showed B = 3.666 (95% CI: 2.768–4.564, p < 0.001). In practical terms, financial collapse within a household was the single most powerful predictor of psychological deterioration among Sudanese cancer patients in the study, outstripping even direct exposure to violence. This finding reframes the crisis: the war’s most corrosive effect on mental health in this population may operate through economic destruction rather than through the sound of gunfire alone.

The study’s authors identified limited access to health professionals and security-related travel barriers as the most important challenges overall, a ranking that reflects the structural anatomy of a health system in freefall. Sudan’s oncology infrastructure was already thin before the conflict; the National Cancer Institute in Wad Medani, referenced in the study’s abbreviations, was among the facilities affected as fighting spread. When oncologists, pharmacists, and radiotherapy technicians flee or are displaced, and when supply chains for cytotoxic drugs and supportive medications fracture, the remaining patients face a cascade: no professional to prescribe, no pharmacy to dispense, no road safe enough to travel.

What makes this research particularly valuable is its timing and its specificity. Empirical evidence on cancer care during armed conflict in low- and middle-income countries remains scarce, and most of what exists is anecdotal or drawn from facility-level reports. By surveying patients directly and applying formal statistical modeling, the Sudanese team converted lived experience into quantifiable associations. The convenience sampling design and the restriction to two centers in River Nile State, a relatively accessible region that absorbed large numbers of displaced people, do impose limits on generalizability, and the authors acknowledge that the findings describe patients who managed to reach care at all. The true population-level picture is likely worse, since patients unable to reach any facility were by definition excluded from the sample.

The clinical implications extend beyond Sudan. Cancer care depends on continuity in a way few other medical specialties do: a surgical resection cannot be postponed indefinitely, a radiotherapy course cannot be paused without consequence, and a chemotherapy protocol cannot be improvised from whatever drugs happen to be available. The study’s conclusion calls for urgent implementation of conflict-adapted strategies, including safe and flexible care delivery, maintenance of treatment continuity, and essential psychosocial support in resource-limited settings. Translated into practice, this could mean decentralized chemotherapy administration, telemedicine consultations for patients in insecure areas, buffer stocks of essential cytotoxic agents, and routine psychological screening embedded within oncology follow-up.

For the 384 patients who participated, the study is a documentation of a catastrophe in progress. For the global health community, it is a warning about what happens when cancer care is left out of humanitarian planning. The war in Sudan has severely disrupted oncology services, limited access to treatment, interrupted continuity of care, and worsened psychological and economic burdens, and the associations identified in this research, between financial hardship, medication shortages, insecurity, and poorer mental health outcomes, offer a roadmap for intervention. Whether that roadmap is followed before more patients lose both their treatment and their psychological resilience remains an open question, one that the answers to this study can no longer defer.

Subject of Research: Health & Medicine

Article Title: Cancer care in a fragile health system: effects of armed conflict on access, continuity, and mental health in Sudan

Article References: Elsheikh, H. A. S., Hamadalneel, Y. B., Hamed, M. M. O., Taha, L. G. M., Suliman, Y. A., Hamid, A., Taifor, T. A., Mohamed, R. M. A., & Al Zamel, A. M. (2026). Cancer care in a fragile health system: effects of armed conflict on access, continuity, and mental health in Sudan. BMC Cancer. https://doi.org/10.1186/s12885-026-17189-3

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17189-3

Keywords: Sudan, armed conflict, cancer care, oncology, treatment disruption, psychological impact, healthcare access, BMC Cancer, global health, humanitarian crisis, Cancer, care

The research, led by Ana Maria Chamorro Coneo of Universidad del Norte in Barranquilla together with colleagues at Durham University, focused on pupils aged 10 to 17 in communities affected by armed conflict and severe deprivation. Populations with these characteristics remain markedly under-represented in the bullying literature, even though roughly one in three students worldwide experiences bullying and its psychological consequences can extend well into adulthood. In regions where violence has been a normalised feature of social life, the researchers argue, the way children conceptualise peer aggression matters enormously for how interventions are designed and received.

The study used a convergent mixed-methods design, combining quantitative and qualitative strands conducted in parallel. In the quantitative strand, 202 pupils completed a free-word-association task, generating a total of 1,737 evoked words: 928 in response to the prompt of bullying and 809 in response to cyberbullying. This technique, rooted in social representations theory, asks participants to produce the first words that come to mind, revealing the spontaneous cognitive landscape surrounding a concept rather than their agreement with researcher-imposed definitions.

The researchers then grouped the evoked terms into conceptually related categories and examined how those distributions varied by age group and gender. Because each pupil generated multiple associations, the data were clustered within individuals, and the team handled this methodological challenge with participant-level permutation tests, a non-parametric approach that preserves the grouping of responses within pupils rather than treating every word as an independent observation. This statistical care matters: naive comparisons of word frequencies can produce misleading significance when responses from the same child are correlated.

The quantitative results showed that canonical elements of bullying and cyberbullying, such as aggression, harm and intent, dominated the associative space. Yet the composition of responses shifted modestly but measurably across age groups, with a permutation p-value of .016. Among 10-to-12-year-olds, violence- and aggression-related terms accounted for 65.0 percent of responses, compared with 55.2 percent among 13-to-14-year-olds and 58.8 percent among 15-to-17-year-olds. Meanwhile, terms related to discrimination and exclusion rose from just 2.7 percent in the youngest group to 9.7 percent in the middle group and 7.1 percent in the oldest. In other words, as children grow older, their mental model of bullying appears to expand beyond raw physical aggression to encompass relational and prejudicial harm. No evidence of gender differences emerged, with a permutation p-value of .894, suggesting that boys and girls in these communities draw on broadly similar conceptual frameworks.

The qualitative strand added depth and texture to these patterns. The researchers conducted five focus groups with a total of 43 participants, using a codebook approach to Thematic Analysis in which coding decisions are anchored to a predefined and iteratively refined framework, enhancing transparency and reliability. During the discussions, pupils described physical, verbal, sexual and online peer aggression in vivid, sometimes unsettling detail. One phrase that gave the study its title captured a chilling social dynamic: another person’s suffering framed as a source of joy, a reminder of how cruelty can become entertainment within peer groups.

Yet the qualitative data also revealed conceptual slippage with practical consequences. Participants did not always reference repetition, one of the three defining criteria of bullying in most academic definitions, alongside intent and power imbalance, when describing what bullying means. Some used the terms bullying and school violence interchangeably, blurring the boundary between a targeted, repeated pattern of victimisation and more generalised peer conflict. The power imbalance dimension, when it did appear, was most often framed as unfair treatment tied to appearance, gender, race or social class, rather than as an abstract structural feature of a relationship.

These findings do not mean the pupils misunderstood bullying. The researchers emphasise that participants demonstrated an overall grasp of the core elements of bullying and cyberbullying, even where the edges of those categories occasionally blurred. But the blurring itself is diagnostic. In communities where everyday violence is familiar, distinguishing a one-off fight from a sustained campaign of victimisation may carry less intuitive weight than it does in the calm corridors of a well-resourced school. Prevention programmes that assume children arrive with a shared, textbook definition of bullying may therefore misfire, teaching distinctions that pupils do not yet recognise or failing to engage with the categories they actually use.

The authors draw two main implications for intervention. First, programmes in similar settings should explicitly target the distinctions between bullying, cyberbullying and broader school violence, particularly among younger pupils, and should tailor content to pupils’ own definitions and lived experiences rather than importing generic materials. Second, programmes should integrate components addressing prejudice and power imbalances, since the discrimination and exclusion themes that emerged in both strands of the study point to appearance, gender, race and social class as the fault lines along which victimisation is organised. Strengthening detection and prevention, the study suggests, requires engaging directly with the social hierarchies children already perceive.

Methodologically, the study also offers a template for research in hard-to-reach settings. The combination of free-word association with permutation-based inference and codebook thematic analysis allowed the team to quantify collective representations while preserving the voice of individual pupils, all under ethical procedures approved by the Institutional Review Board of Universidad del Norte, with written informed consent from parents or guardians and written assent from every child. Conducted without external funding, the work underscores how locally grounded research can illuminate the psychology of populations that global bullying scholarship has too often overlooked, and it suggests that the path to safer schools in conflict-affected regions begins with listening to how children themselves name the harm they see.

Subject of Research: Bullying and cyberbullying perceptions among children and adolescents in rural, conflict-affected communities of Northern Colombia

Article Title: “Another person’s suffering is my joy”: A mixed-methods study of bullying and cyberbullying in rural, conflict-affected communities of Northern Colombia

Article References: Chamorro Coneo, A. M., Hoyos de los Rios, O., Canchila, E., & Andres, F. E. (2026). “Another person’s suffering is my joy”: A mixed-methods study of bullying and cyberbullying in rural, conflict-affected communities of Northern Colombia. BMC Psychology. https://doi.org/10.1186/s40359-026-05646-4

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05646-4

Keywords: bullying, cyberbullying, school violence, armed conflict, Colombia, children and adolescents, mixed methods, free word association, thematic analysis, social representations, power imbalance, school psychology

The research team, led by Amani N. Alansari of Hamad Medical Corporation in Doha, followed PRISMA guidelines and registered the review prospectively. They searched PubMed, EMBASE, Web of Science, and SCOPUS from database inception through January 2026, initially retrieving 7,902 records. After removing 1,885 duplicates and screening 6,017 titles and abstracts, nineteen full-text reports were assessed for eligibility. Twelve were excluded for reasons including lack of a comparison group, irrelevance to war, or conference abstract status. Seven studies ultimately made the cut, spanning retrospective cohorts, historical cohorts, cross-sectional comparisons, and national registry analyses. Sample sizes ranged from a mere 39 participants in a small Kharkiv hospital comparison to over 500,000 live births in Ukrainian national registry data.

The methodological machinery behind the findings is worth understanding. Dichotomous outcomes such as preterm birth, stillbirth, and neonatal death were pooled as odds ratios using Review Manager 5.4 software, while continuous measures like birth weight, birth length, and head circumference were pooled as mean differences. The researchers started with fixed-effects models and switched to random-effects models when heterogeneity, quantified by the I² statistic, proved substantial. For preterm birth, the initial fixed-effects estimate across four studies was essentially null (OR 0.96, 95% CI 0.83–1.10), but heterogeneity was extreme at 85%. After switching to a random-effects model and excluding one influential study, heterogeneity dropped to a moderate 46% and the pooled estimate remained non-significant at OR 0.80 (95% CI 0.61–1.05).

Stillbirth told a similar story. The fixed-effects model across four studies yielded an odds ratio of 1.00 (95% CI 0.94–1.07) with 80% heterogeneity. After applying random effects and removing the Polish World War II study by Liczbinska and colleagues, heterogeneity vanished entirely (I² = 0%) and the estimate stayed flat at OR 0.98 (95% CI 0.93–1.05). Neonatal mortality followed the same pattern: the fixed-effects model initially suggested a significant 22% reduction in death among conflict-exposed infants (OR 0.78, 95% CI 0.71–0.85), but with 89% heterogeneity that finding dissolved under random-effects modeling into a non-significant OR of 1.07 (95% CI 0.73–1.56). In other words, what looked like protection was statistical noise.

Then came the anthropometric paradox. Pooling two studies, the random-effects model showed that conflict-exposed neonates had significantly higher birth weight, with a mean difference of 1.56 kg (95% CI 0.55–2.56), though heterogeneity was severe at 92%. Head circumference also came out significantly larger in exposed infants, with a mean difference of 0.60 cm (95% CI 0.47–0.74) and only modest heterogeneity at 35%. Birth length showed no significant difference. These are not small effects; a 1.56 kg mean difference in birth weight is enormous by any clinical standard, and the authors themselves flag it as biologically implausible as a true protective effect of war.

So what explains it? The researchers propose three mechanisms. First, survival bias: infants who survive to delivery in conflict zones may represent hardier pregnancies, while compromised fetuses may end in early pregnancy losses or stillbirths that go unrecorded in settings with collapsed surveillance systems. Second, displacement patterns may concentrate healthier, wealthier families near functioning hospitals, while those unable to flee face outcomes invisible to facility-based data collection. Third, the included studies varied enormously in how they defined exposure, timed it, and selected comparison groups, from the 1999 Belgrade bombing cohort to Ukrainian national registry trends comparing 2012 with 2022. The cross-sectional Kharkiv study comparing residents with internally displaced persons, rated only fair quality, reported shorter birth length and lower Apgar scores among displaced infants, hinting at what facility-based data may be missing.

The findings clash sharply with prior literature. Le and Nguyen’s analysis of 53 developing countries over three decades found that intrauterine conflict exposure reduced birth weight by 2.8% and raised low birth weight incidence by 3.2 percentage points. Mansour and Rees documented increased low birth weight risk among Palestinian infants during the al-Aqsa Intifada. Keasley and colleagues’ systematic review identified consistent evidence of increased low birth weight across nine studies from Libya, Bosnia, Palestine, and Afghanistan. Jawad and colleagues, analyzing 181 countries from 2000 to 2019, found that wars increased maternal and infant mortality, though notably not neonatal mortality, a result consistent with the current review. Behboudi-Gandevani and colleagues found increased odds of small-for-gestational-age infants and neonatal mortality among immigrants from conflict zones, suggesting that war’s effects travel with displaced populations long after the guns fall silent.

The authors are emphatic that the absence of adverse associations should not be read as evidence of protection. Most included studies relied on hospital-based data, systematically undercounting the most vulnerable women who cannot reach healthcare at all. Several studies scored only moderate quality on the Newcastle-Ottawa Scale, primarily because they lacked multivariable adjustment for maternal age, parity, socioeconomic status, and pre-existing conditions. The review also could not examine long-running conflicts in Syria, Yemen, Sudan, or Palestine, and the authors note that outcomes in these settings are entangled with economic collapse, food insecurity, and healthcare disruption, making it nearly impossible to isolate war’s direct effects. Exposure to hazardous munitions, including reported use of incendiary substances in populated areas, adds another layer of risk that routine hospital datasets cannot capture.

The practical implications are stark. The authors call for community-based prospective cohorts with proper adjustment for nutrition, socioeconomic indicators, and healthcare access, alongside mobile health initiatives and parallel surveillance systems operating outside hospital walls. Clinicians caring for conflict-affected populations should maintain heightened vigilance regardless of what pooled estimates suggest, and humanitarian organizations should invest in data collection mechanisms that reach women delivering at home, in shelters, or in transit. The paradoxical heavier babies in this meta-analysis are, in effect, a statistical signature of everything the data cannot see. As the authors conclude, the most effective intervention for protecting maternal and neonatal health globally remains the prevention of armed conflict itself, a reminder that some public health problems cannot be solved within the health system at all.

Subject of Research: The association between armed conflict exposure and neonatal outcomes including preterm birth, stillbirth, mortality, and anthropometric measures

Article Title: The impact of armed conflict exposure on preterm birth, stillbirth, and neonatal anthropometric measures: a systematic review and meta-analysis

Article References: Alansari, A. N., Sabbah, A. F., Salim, A., Varghese, B., Singh, K., & Elshanbary, A. A. (2026). The impact of armed conflict exposure on preterm birth, stillbirth, and neonatal anthropometric measures: a systematic review and meta-analysis. International Journal of Public Health, 71, Article 1609784. https://doi.org/10.3389/ijph.2026.1609784

Image Credits: AI Generated

DOI: 10.3389/ijph.2026.1609784

Keywords: armed conflict, neonatal outcomes, preterm birth, stillbirth, birth weight, meta-analysis, systematic review, survival bias, humanitarian health, Ukraine, maternal health, public health

The research team, led by Farah Elbayoumi of Al-Azhar University Gaza with colleagues from the Islamic University of Gaza, Israa University and Abou Bekr Belkaid University in Algeria, recruited 248 adults attending three governmental dermatology clinics across the Gaza Strip between 15 March and 15 June 2025, in the midst of the 2023 to 2025 Gaza war. Skin diagnoses were established by the attending physician at the point of care, and a trained data collector then administered the questionnaire as a structured interview. Participants completed two widely used psychiatric instruments: the DASS-21, which quantifies depression, anxiety and stress, and the PCL-5, a checklist that screens for probable post-traumatic stress disorder with a conventional positivity threshold of 33 points.

The headline numbers are stark. Overall, 86.3 percent of participants had extremely severe anxiety on the DASS-21. Severe or extremely severe depression affected 76.6 percent of the sample, severe or extremely severe stress affected 76.2 percent, and 74.2 percent screened positive for probable PTSD. For context, in peacetime community surveys, prevalence figures for these conditions typically run to a small fraction of such levels. The authors emphasize that these are clinic attendees rather than a general population sample, so the burden reflects people unwell enough to seek dermatological care during a war, but even with that caveat the scale of distress is exceptional.

The study’s central analytical finding is that skin and psyche moved together. Skin disease severity correlated significantly with poorer scores across all psychiatric domains, with Spearman correlation coefficients ranging from 0.21 to 0.32 and all p-values below 0.001. In regression models adjusted for other factors, severe skin disease independently doubled the odds of severe or extremely severe depression, with an odds ratio of 2.05 and a 95 percent confidence interval of 1.10 to 3.80, and independently doubled the odds of severe or extremely severe stress, with an odds ratio of 2.05 and a confidence interval of 1.09 to 3.86. The mechanism the researchers invoke is a feedback loop long described in psychodermatology: sustained conflict stress dysregulates immune and inflammatory pathways that drive skin disease, while visible, itchy or painful skin lesions in turn amplify psychological distress, each condition feeding the other in a continuous cycle.

Diagnostic category mattered as well. Participants with dermatitis, a group of 17 people in the sample, reported the highest unadjusted psychiatric symptom scores across all DASS-21 and PCL-5 domains. After the authors applied false-discovery-rate correction to their bivariate disease-type comparisons, only the depression and PCL-5 differences remained statistically significant, with corrected p-values of 0.041 and 0.028 respectively. The anxiety and stress differences did not survive correction, with corrected p-values of 0.13 and 0.11, and the authors flag them as exploratory. Separately, fungal infection emerged as an independent predictor of severe stress, carrying an odds ratio of 5.65 with a confidence interval of 1.60 to 19.98, a wide interval that reflects the small number of cases but a signal consistent with the idea that chronic, treatment-resistant infections impose a distinctive psychological toll.

Perhaps the most socially revealing finding concerns visibility. Participants were asked how much they worried about others noticing their skin symptoms on a five-point scale, and each one-point increase in that worry independently raised the odds of probable PTSD by 24 percent, with an odds ratio of 1.24 and a confidence interval of 1.00 to 1.52. Sixty-one percent of participants reported concealing their skin condition from others. Intriguingly, concealment itself was not significantly associated with any psychiatric outcome, suggesting that the burden lies less in the act of hiding than in the anticipatory fear of being seen, a form of appearance-related stigma that operates even in a population facing existential threats on every side.

Methodologically, the team took deliberate steps to guard against over-interpretation in a difficult research environment. Bivariate comparisons across disease types were corrected for the false discovery rate, a statistical safeguard against treating chance findings as real when many comparisons are made. The regression models were checked for internal consistency using Cronbach’s alpha and for multicollinearity using variance inflation factors, diagnostics that confirm the predictor variables carried distinct information rather than redundant signals. Non-parametric tests were used for the skewed symptom scores, an appropriate choice for data that do not follow a normal distribution. Ethical approval was granted by the Health Research Committee at Al-Israa University on 5 March 2025, before recruitment began, and electronic informed consent was obtained from all participants, with participation having no bearing on clinical care.

The authors are candid about the limits of their evidence. The study used a convenience sample of clinic attendees rather than a random population sample, and the final 248 participants fell below the pre-specified target sample size. Cross-sectional design means the data capture a single moment and cannot establish whether skin disease drives psychiatric symptoms, psychiatric symptoms exacerbate skin disease, or, most likely in a war zone, both directions operate simultaneously through shared stress and immune pathways. The authors also note that the article was shared early as a peer-reviewed, accepted version of record in progress, citable with a permanent DOI but subject to further edits.

Even with those caveats, the implications reach beyond Gaza. The authors argue that their findings highlight the potential value of integrated psychodermatology approaches in conflict-affected humanitarian settings, including mental health screening embedded in dermatology clinics, stigma-sensitive counselling, and appropriate referral pathways, all of which they frame as candidates for further evaluation rather than established interventions. The logic is practical as much as scientific: in a health system under siege, dermatology clinics may be one of the few clinical touchpoints still functioning, and a patient presenting with an inflamed skin condition may in fact be carrying an untreated psychiatric emergency that no one has measured.

The study also contributes to a growing scientific literature on how armed conflict disrupts health through sustained stress and immune-related pathways. Chronic psychological stress alters hypothalamic-pituitary-adrenal axis activity and sympathetic output, which in turn modulate inflammatory cytokines, skin barrier function and itch signaling, providing a plausible biological substrate for the correlations observed here. What this study adds is documentation from inside an active war zone, where such evidence has long been scarce, and a demonstration that even in extremis, the old clinical observation holds: the skin and the mind are not separate organs of suffering. For the 248 patients counted in this study, and for the many they represent, treating one without the other may mean treating neither.

Subject of Research: Psychiatric symptom burden among dermatology patients in the Gaza conflict

Article Title: Psychological symptom burden among dermatology clinic attendees during the Gaza conflict: a cross-sectional psychodermatology study

Article References: Elbayoumi, F., Alshaer, N., Aljahish, A., Hassanien, M., Alkhaldey, E., Albelbeisi, A. H., & Benhamed, N. K. (2026). Psychological symptom burden among dermatology clinic attendees during the Gaza conflict: a cross-sectional psychodermatology study. BMC Public Health. https://doi.org/10.1186/s12889-026-29885-7

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29885-7

Keywords: psychodermatology, Gaza Strip, armed conflict, mental health, PTSD, depression, anxiety, skin disease, DASS-21, PCL-5, stigma, public health

The scale of the result is difficult to overstate. A prevalence of 81.4 percent for self-reported psychological distress means that roughly five out of every six students in the sample were struggling with war-related emotional strain at the time of the survey. For comparison, the researchers had based their sample size calculation on an assumed prevalence of about 45 percent, a figure drawn from earlier studies. The observed rate turned out to be far higher than that planning assumption, suggesting that the psychological toll of conflict on this population had been substantially underestimated.

Armed conflict can push students toward psychological distress through several intertwined pathways. The study’s authors point to forced displacement, disruption of education, direct exposure to violence, worry about personal and family safety, bereavement, economic instability, and the erosion of social support networks. University students occupy a particularly vulnerable position in this landscape: they are old enough to be directly involved in or targeted by conflict, yet their studies depend on a stability that war destroys. Many also carry responsibility for supporting families whose livelihoods have been shattered.

Methodologically, the study stands out for its use of Bayesian logistic regression, a statistical approach that differs from the classical frequentist methods more common in public health research. Instead of producing a single point estimate and a p-value, Bayesian analysis yields a posterior probability distribution for each effect, summarized here as odds ratios with 95 percent credible intervals. A credible interval has a more direct interpretation than a confidence interval: given the data and the model, there is a 95 percent probability that the true effect lies within that range. This framing is especially useful in settings like conflict research, where prior knowledge from earlier studies can be formally incorporated and where uncertainty is often large.

Before fitting the Bayesian model, the researchers used descriptive statistics and chi-square tests to screen for associations between distress and a set of candidate factors: gender, region, war zone exposure, family death, physical injury, direct participation in the war, and family support roles. Several of these survived into the multivariable analysis with strong effects. Students who had been physically injured in the conflict faced the steepest odds, at 5.13 times those of uninjured peers (95 percent credible interval: 2.26 to 11.29). Physical injury, the data suggest, is one of the most powerful markers of lasting psychological harm in this population.

Indirect participation in the war carried an odds ratio of 4.43 (credible interval: 2.70 to 7.18), while direct participation was associated with an odds ratio of 2.03 (credible interval: 1.06 to 4.17). The finding that indirect involvement predicted distress more strongly than direct involvement may seem counterintuitive, but the authors do not overinterpret the mechanism; both forms of exposure clearly elevated risk. Losing a family member to the war nearly tripled the odds of distress (odds ratio 3.03, credible interval: 1.59 to 5.56), and having spent time in a war zone more than doubled them (odds ratio 2.66, credible interval: 1.64 to 4.41). Loss of family property raised the odds by a smaller but still meaningful margin (odds ratio 1.68, credible interval: 1.02 to 2.81).

Two further factors emerged as significant. Female students had roughly twice the odds of distress compared with male students (odds ratio 2.06, credible interval: 1.23 to 3.56), a pattern consistent with broader literature on gender differences in the psychological consequences of conflict and displacement. Students’ work status was also associated with distress, with an odds ratio of 2.73 (credible interval: 1.23 to 7.18), although the wide credible interval here reflects considerable uncertainty, likely because relatively few students fell into the relevant category. Taken together, the model indicates that distress in this population is not randomly distributed but concentrated among students with specific, identifiable war exposures.

The practical implications are direct. The authors recommend that universities in conflict-affected settings strengthen mental health screening so that students at highest risk, including those who were injured, bereaved, displaced, or exposed to war zones, can be identified early. They also call for accessible psychosocial support services and functioning referral systems that can connect students to appropriate care. With more than four-fifths of students reporting distress, the need is not marginal; it touches nearly the entire student body, and campus counseling capacity in such settings is typically far below what the numbers demand.

The study does have limitations that shape how its findings should be read. The authors themselves note that further research using validated mental health instruments is needed to assess the severity of psychological distress, since the current survey relied on self-reported measures rather than clinical diagnostic tools. The cross-sectional design captures a single moment in time and cannot establish that war exposures caused the distress, even though the temporal logic of the exposures makes the association highly plausible. The sample comes from a single university, so generalization to other conflict-affected regions requires caution, although the study’s focus on students from conflict-affected areas gives it particular relevance for northern Ethiopia.

Even with those caveats, the study contributes something the field has lacked: a quantified, statistically rigorous estimate of psychological distress among university students in an Ethiopian conflict zone, along with a ranked set of risk factors that intervention programs can act on. The Bayesian framework adds transparency about uncertainty, giving decision-makers not just best guesses but plausible ranges for every effect. As conflicts continue to disrupt higher education in various parts of the world, the message from Debre Markos is clear: the mental health of students in war-affected regions is a large-scale, measurable problem, and the first step toward addressing it is systematic screening backed by services that can respond to what screening finds.

Subject of Research: Prevalence and risk factors of war-related psychological distress among university students in conflict-affected Ethiopia

Article Title: Psychological distress due to war and associated factors among university students in a conflict-affected region of Ethiopia: a Bayesian logistic analysis

Article References: Gebrie, Y. F., & Cherie, K. T. (2026). Psychological distress due to war and associated factors among university students in a conflict-affected region of Ethiopia: a Bayesian logistic analysis. BMC Psychology. https://doi.org/10.1186/s40359-026-05777-8

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05777-8

Keywords: psychological distress, war exposure, Ethiopia, university students, Bayesian logistic regression, mental health, armed conflict, cross-sectional study, physical injury, bereavement, Debre Markos University, odds ratio

The argument lands twelve years after the Lancet-Oslo University Commission on Global Governance for Health concluded that the political origins of health inequity demanded institutional reform. In the view of lead author Ellen Beer of Karolinska Institutet and her colleagues, that reform has not materialised. Global governance frameworks for protecting health in conflict are still managed in silos, divided between humanitarian agencies, security councils and diplomatic fora, while routine public health governance rarely engages with the upstream political decisions that expose populations to violence, deprivation and displacement in the first place. The team contends that governance for health must explicitly govern the political, commercial, environmental and epistemic determinants of health at an institutional level, and that protecting life in conflict should become part of everyday public health discourse rather than an emergency afterthought.

The technical backbone of the argument rests on international humanitarian law, the body of rules codified in the 1949 Geneva Conventions and their additional protocols, which restricts the methods of warfare in order to protect civilians, health systems and the environment. Attacks on hospitals, restrictions on humanitarian aid and the destruction of civilian infrastructure mark, in the authors’ framing, the point at which political and commercial determinants of health produce their most system-destroying consequences. Political determinants, meaning the decisions of governments and armed actors, shape whether populations are exposed to violence. Commercial and regulatory decisions shape the circulation of resources, including weapons. When those decisions fail, the result is the collapse of the very systems that public health depends upon: supply chains, electricity, water treatment, cold chains for vaccines and the trained workforce that operates them.

The commercial dimension is where the authors draw their most provocative parallel. Public health has built binding regulation around other harmful industries, from tobacco marketing restrictions to conflict-of-interest safeguards that limit industry influence on policy, and has established norms requiring disclosure and management of tobacco industry links across publications, funding and employment. Yet outside international arms trade treaties, everyday policies governing institutional relationships with the arms sector are far less ubiquitous, despite the sector’s documented relationship to mortality, displacement and environmental harm. The authors ask a pointed question: if public health has decided that institutional entanglement with the tobacco industry must be disclosed and managed, should comparable norms not apply to institutional relationships with the arms industry? They argue that the arms sector, as a structural and upstream driver of violations of humanitarian law, warrants similar governance standards.

Environmental harm in conflict supplies some of the most durable evidence for the case. Armed conflict contaminates agricultural land, water systems and air, threatening health through chronic disease, malnutrition and intergenerational trauma. Attacks on water infrastructure contribute directly to cholera outbreaks, a mechanism epidemiologists understand well: destruction of treatment and distribution systems forces populations onto contaminated sources, and Vibrio cholerae follows. The carbon footprint of modern warfare is also enormous. Recent analyses cited by the authors estimate that carbon emissions from military operations can exceed the annual emissions of entire countries, folding war into the planetary health agenda alongside climate change and biodiversity loss.

The historical record shows how long these consequences can persist. The health effects of Agent Orange, the herbicide sprayed over Vietnam, remain measurable decades later, and unexploded ordnance still maims civilians in Laos and Cambodia. Such events prompted the international community to adopt Additional Protocol I, which prohibits methods of warfare intended or expected to cause widespread, long-term and severe damage to the natural environment, and later treaties such as the 2008 Convention on Cluster Munitions. But the authors stress a critical structural weakness: only signatory states are obliged to comply. Governing the environmental determinants of conflict through commercial and political routes, they argue, must therefore become a priority within planetary health rather than being left to treaty law alone.

There is also a distributional argument running through the piece. Failure to govern conflict-related determinants of health falls hardest on populations already structurally marginalised within health systems. Women, children, Indigenous peoples, gender-diverse people, older adults, people with chronic conditions and disabilities, and displaced people experience the most severe consequences of armed conflict and of violations of humanitarian law. Advocacy for the health of marginalised populations, the authors conclude, is therefore inseparable from advocacy for the evolution of governance itself. A public health field that documents inequity without engaging the political machinery that produces it, they suggest, is abdicating part of its mandate.

The team adds a decolonial critique to this structural analysis. Scholarship on decolonising global health has documented how power asymmetries persist in agenda-setting, funding allocation, authorship, representation and control over knowledge production, and in deciding which determinants and which commercial sectors get governed at all. The devaluation of local knowledge, lived experience and political analysis, the authors argue, constitutes a form of epistemic violence, and it helps enable selective recognition of humanitarian law violations. In conflict-affected settings, these asymmetries shape whose suffering is recognised, whose security is prioritised, which crises attract diplomacy and whose knowledge is considered authoritative in humanitarian research, advocacy and policy. Decolonising public health, on this reading, requires examining how coloniality persists through governance structures and determines who is protected.

What elevates the piece beyond diagnosis is its proposed mechanism: health diplomacy. Once dismissed as soft power, health diplomacy has evolved, the authors write, into a practical instrument for managing crises, fostering trust and negotiating cooperative action under hostile conditions. It offers a channel for engaging the political determinants that lie upstream of humanitarian law violations, and a nominally neutral platform that can unblock traditional political channels by refocusing negotiations on shared health interests. Concrete applications include cross-border coordination on water and energy security, vector control and the protection of health systems in fragile contexts. Crucially, the authors frame health diplomacy as both a response tool and a preventive one: by reducing risk and building trust before crises escalate, it can support more resilient recovery pathways after them. Given its growing role in international security, they argue, public health governance actors need training in governance, negotiation and conflict-aware health policy so that a health lens can be integrated into international conflict dialogues and negotiations.

The authors close with a proposition that reframes the entire field. Violations of international humanitarian law, they argue, should be understood as failures in the governance of political, commercial, environmental and epistemic determinants of health, and preventing the disproportionate health and health-system impacts of conflict requires stronger governance of those determinants as part of broader global governance for health. That, in turn, requires confronting power asymmetries in agenda-setting, knowledge production and decision making. The message to the public health community is blunt: as one cited commentary puts it, public health has always been about politics informed by evidence, and its practitioners are agents of change working in the political arena. With attacks on health care at record levels and rising year on year, the authors argue that the era of treating war as someone else’s governance problem is over. The tools exist; what is missing, they contend, is the institutional will to connect them.

Subject of Research: Governance of the determinants of health in armed conflict, international humanitarian law violations, and health diplomacy

Article Title: The governance gap: Determinants of health, international humanitarian law violations, and the case for health diplomacy

Article References: Beer, E., Chen-Xu, J., Yuen, R., Planatscher, A., Gilmour, R., Ahmed, Z., Santamaria-Plaza, C., Zotti, N., Vasic, M., Hachem, M., Rosiello, F., & Shellah, D. (2026). The governance gap: Determinants of health, international humanitarian law violations, and the case for health diplomacy. PLOS Global Public Health, 6(10), e0007482. https://doi.org/10.1371/journal.pgph.0007482

Image Credits: AI Generated

DOI: 10.1371/journal.pgph.0007482

Keywords: global health governance, international humanitarian law, health diplomacy, attacks on health care, social determinants of health, armed conflict, planetary health, commercial determinants, decolonising global health, Geneva Conventions, health systems, PLOS Global Public Health

The historical backdrop is essential to understanding why such institutions emerged at all. Colombia’s internal armed conflict has raged since the 1960s, pitting the national army against guerrilla groups, paramilitary forces, and a shifting cast of other combatants. According to the National Centre for Historical Memory, more than six million people were forcibly displaced from central regions by 2015, many of them resettling precariously along the ‘agricultural frontier’ – the advancing edge of colonization where forest is cleared and new land incorporated into production. These displaced settlers, or colonos, often occupied land without formal titles, sometimes on parcels granted by the state, sometimes simply on territory considered unoccupied. From the 1980s and 1990s onward, the state offered specific perimeters for settlement: resguardos for indigenous populations, collective councils for Afro-descendant communities, and Peasant Reserve Zones for farming families. Yet the application of Plan Colombia, the US-backed counter-narcotics and counter-insurgency program, and the expansion of paramilitary groups controlling commodity and illicit-crop trade pushed the mobile guerrillas back into their historical strongholds, intensifying pressure on the very communities trying to put down roots.

The study traces the genealogy of peasant mobilization to the mid-1980s, during a truce between the FARC and the government. An inquiry led by sociologists including the celebrated chronicler Alfredo Molano among colonos in the Macarena mountains and the Caguán region produced a proposal addressed to the government: grant settlers property rights on land within what would later become a national natural park, provide technical assistance, and in exchange the producers would commit to managing the forest, wildlife, and soils. This proposal prefigured the ZRC model, formally recognized by Law 160 of 1994. Protest marches in 1985 and 1987 toward departmental capitals such as San José del Guaviare, led by peasant families, coca-leaf pickers, and traders, demanded recognition of populations who had occupied their lands for some thirty years since the period of La Violencia. When structural adjustment policies swept through Latin America in the mid-1990s, liberalizing markets and withdrawing the state, the Ministry of Agriculture estimated that at least one million peasants suffered income losses by 1994 – a grievance that fueled renewed mobilization and the demand for reserve zones where families could cultivate land.

The trajectory was brutally interrupted. The Patriotic Union political party, created after the 1984 accord between the FARC, the colonos, and the government in the department of Meta, saw thousands of its members – elected officials, mayors, and two presidential candidates in 1989 – assassinated by paramilitary groups between 1985 and 1990. The collapse of the El Caguán peace process in 2002 and the post-September 11 international context produced Plan Colombia, which strengthened paramilitaries defending large landholdings. Their scorched-earth policy included massacres such as Mapiripán in the department of Meta in 1997, a municipality that had hosted meetings about a pilot Peasant Reserve Zone project and had drawn virulent opposition from large landowners practicing extensive cattle ranching. In this crucible of violence, the researchers show, armed actors themselves became governance providers: guerrillas with deep local roots, particularly the FARC, played mediation roles and could constitute what geographer Robert McColl termed an ‘insurgent state,’ establishing territorial control through refuge spaces and population protection while simultaneously demonstrating the government’s inefficacy.

Against this turbulent canvas, the JAC represent the oldest thread of local self-organization. Created by Law 19 of 1958 as part of a public administration reorganization, they began as urban neighborhood associations and were adapted in rural areas by displaced colonos as forms of intermediation with the state. The first JAC along the Caguán River in Caquetá date to 1972, before the FARC even established themselves there; by 1975, two already held legal personhood and functioned regularly. Theoretically apolitical, these committees of neighbors can receive delegated functions of control, oversight, and management of public services from municipal councils, departmental assemblies, or the national government. In rural areas they rest on the veredas – subdivisions of rural municipalities – and on shared identity and belonging. A former national director of the JAC system claimed the committees contributed to building 30 percent of the nation’s infrastructure: rural roads, community halls, chapels, schools, and markets. During the Caguán negotiations, the JAC even served as mediation spaces between guerrillas and government delegates, and in zones of guerrilla or even paramilitary influence they often became the sole representation of civilian power.

The ZRC, by contrast, are a land-access instrument born of agrarian struggle. Defined by Law 160 of 1994 as geographic zones selected by the general council of the Colombian Institute for Agrarian Reform according to agro-ecological and socioeconomic characteristics, they were regulated nationally by Decree 1777 of 1996, which allowed their creation in all regions rather than only in colonization zones. The first six ZRC emerged from a pilot plan co-financed by the World Bank from 1997. The study focuses on two contrasting cases in the Andean axis: the Pato-Balsillas ZRC in Caquetá, officially recognized in 1997, and the North Cauca ZRC, whose recognition by the National Land Agency remained pending as of 2024 despite years of requests. Pato-Balsillas, a transition zone between Andean and Amazonian systems on the eastern flank of the Eastern Cordillera, experienced four waves of colonization identified by researcher J. González – from quinine and rubber extraction through 1920, early colonization to 1950, ‘colonization by violence’ between 1950 and 1965, and finally flight following army bombardments, after which families returned in a homecoming commemorated annually since 1984 with a festival of ‘the return.’

Today the Pato-Balsillas ZRC spans roughly 74,000 hectares with about 6,250 inhabitants, organized into three towns and 26 vereda committees. It is managed by the Municipal Association of Colonos of the Pato River, AMCOP, whose board includes representatives of every vereda junta and of colonos’ cooperatives producing bananas, milk, and coffee. A social fund, fed by one percent of each agricultural sale by member producers, reallocates resources to members in need. Specialized committees handle conflict resolution, women’s affairs, and youth. The association’s regulatory reach is tangible: residents described to interviewers how suspected thieves are detained, the police called, and outsiders who commit serious offenses collectively expelled after news is spread across every vereda so that no one gives them work. AMCOP also links the community into wider networks – the UNIOS union of social, agrarian, environmental, human rights, peasant, and indigenous organizations, and the departmental coordination COORDOSAC in Caquetá. Crucially, AMCOP protects a buffer zone between the ZRC perimeter and Los Picachos National Natural Park, an arrangement the regional environmental authority CORPOAMAZONIA formally recognizes, following a 1997 agreement that redefined park boundaries and relocated some of the roughly 200 colonist families living inside the park through a mini land-reform program distributing parcels from a large estate.

The North Cauca case shows a different pathway: governance functioning without official recognition. In the fertile Cauca River valley, where sugar-cane expansion from the 1940s concentrated land in large estates and indigenous movements led by Manuel Quintín Lame had long reclaimed ancestral territories, three associations – ASTRACAL, ASTRAZONAC, and ASPROZONAC – carry the ZRC project forward with elected boards registered at the chamber of commerce. Connected to the national agricultural federation FENSUAGRO through the PUPSOC popular unity process, they coordinate recognition of long-established settlers, form ‘peasant territories’ even where families lack titles, and negotiate land acquisition for new arrivals. After the 2013 national agrarian strike, which blocked the Pan-American Highway in Cauca for three months, PUPSOC and the CIMA organization established a permanent dialogue roundtable with the government, strengthening their recognition and securing progress in parcel allocation. Land occupation itself, shared as a strategy by indigenous, Afro-descendant, and peasant organizations alike, remains a lever of spatial appropriation confined largely to the cordillera slopes, with almost no access to valley floor land.

Perhaps the most striking finding concerns environmental governance. The Pato-Balsillas communities maintain a manual of coexistence whose ecological rules are explicit: each junta names an ecological committee to safeguard forest, streams, fauna, and flora; commercial hunting is absolutely prohibited; felling trees or primary and secondary forest older than eight years is banned; violations incur up to fifty days of communal labor or reforestation of the affected zone. The result, documented with reference to FAO and National Land Agency data, is a deforestation rate below one percent within and around the ZRC – a remarkable figure given that its jurisdiction, San Vicente del Caguán, ranked for years among the country’s deforestation hotspots. A parallel experiment in the Cimitarra River valley, the ‘yellow line,’ has marked trees since 1983 to delimit some 70,000 hectares of biodiverse, water-rich territory, later ratified by the peasant association, backed by technical soil studies, and ultimately rewarded with a forest reserve designation and a mining moratorium. The authors conclude that these deep spatial knowledges – of paths, rain cycles, flora, and fauna – combined with learned appropriation of state instruments, give rural organizations local legitimacy and real intermediation power. In a country where the 2016 peace agreement has not ended confrontation with holdout armed groups, they argue, the future of rural territories depends on better interaction between these bottom-up practices and national decision-making – a reconfiguration of the state that, remarkably, is being built from below.

Subject of Research: Bottom-up local governance and collective action by peasant communities in Colombia's armed conflict

Article Title: Action collective et formes locales de gouvernance en contexte de conflit armé en Colombie

Article References: Lopez Galvis, A. F., & Guibert, M. (2026). Action collective et formes locales de gouvernance en contexte de conflit armé en Colombie. Geographica Helvetica, 81(4), 589-601. https://doi.org/10.5194/gh-81-589-2026

Image Credits: AI Generated

DOI: 10.5194/gh-81-589-2026

Keywords: Colombia, armed conflict, peasant governance, Community Action Committees, Peasant Reserve Zones, land reform, FARC, collective action, rural development, deforestation, bottom-up governance, displacement

In an article published in Population and Development Review, Michael Zaslavsky of the University of Wisconsin-Madison and Aliakbar Akbaritabar of the Max Planck Institute for Demographic Research and the University of Rostock set out to test the assumption of free scholarly mobility under conditions of armed conflict. Their conclusion is pointed. The full-scale invasion certainly made the displacement of Ukrainian researchers visible to the world, but the data show that researchers were already leaving conflict-affected regions for other parts of Ukraine and for destinations abroad after Russia illegally annexed Crimea and fighting erupted in the Donbas in 2014. Scholarly mobility during war, the authors argue, cannot simply be understood as a matter of individual choice.

The methodological core of the study is as elegant as it is ambitious. Rather than relying on surveys or administrative records, which are difficult to collect in wartime and often unavailable at fine geographic resolution, the researchers turned to one of the richest digital trails that scholars leave behind: their scientific publications. Every paper records the institutional affiliations of its authors — the universities, research institutes, and other organizations to which they are professionally connected. By examining affiliation data for tens of thousands of researchers, region by region, and tracking how those affiliations changed between 2009 and 2022, the authors were able to estimate scholarly mobility across more than a decade at an unusually fine geographical level.

This bibliometric approach has real technical advantages. Publication records are continuously produced, publicly available, and timestamped, which means they capture movements as they happen rather than retrospectively. They also cover researchers who might never appear in migration statistics, including those who move between institutions within a country without ever crossing a border. The trade-off, which the authors acknowledge, is that publication histories reveal when and where a scholar’s institutional base changed, but not why any individual moved. Still, aggregated across tens of thousands of careers, the affiliation trail offers a powerful lens on how a national research system reorganizes itself under the pressure of war.

The results reveal a redrawing of Ukraine’s scholarly map after 2014 — but not a single uniform pattern. Between 2015 and 2017, Donetsk and Luhansk, the two main regions of the Donbas, were losing researchers on balance to other parts of Ukraine. For every 1,000 actively publishing scholars, roughly 54 more researchers were leaving than arriving in Donetsk, and about 46 more in Luhansk. These are substantial net losses for regions that historically anchored significant parts of the country’s research capacity, and they occurred while armed conflict was actively disrupting the institutions those researchers depended on.

When the authors examined mobility across national borders, Crimea stood out most sharply. International migration there produced a net loss of approximately 117 researchers per 1,000 actively publishing scholars. Donetsk also recorded a substantial international loss, at about 66 per 1,000. Behind these headline figures, however, different dynamics were at work. In some regions, the imbalance arose because more researchers left for institutions abroad; in others, it reflected fewer arrivals from other countries. Even so, the overall direction was consistent: more scholars left than arrived in the east of the country, and the changes were not confined to the territories directly touched by fighting.

That last finding may be the study’s most consequential. War, the data suggest, was associated not only with researchers leaving Ukraine but also with changes in how those who remained were distributed within the country. Internal relocation — from contested or destabilized regions toward other Ukrainian regions — operated alongside international emigration, meaning that the geography of Ukrainian science was being reorganized from within even as the country lost researchers abroad. Any account that reduces the phenomenon to brain drain, the authors argue, misses this internal dimension entirely. Scholars did not simply exit; they moved between regions, and those movements redistributed expertise in ways that will shape regional research capacity for years to come.

One result genuinely surprised the research team. The expectation going in was that more developed regions would retain their own researchers and attract new ones, functioning as safe havens of academic activity. Instead, the authors found that these regions could also be places from which scholars were better able to relocate. Zaslavsky offers a possible explanation: researchers based in better-connected, more developed regions tend to have stronger links to other research institutions, and therefore more opportunities to move when crisis hits. In other words, the very resources that make a region academically strong may also make its scholars more mobile — a finding that complicates any simple mapping of conflict impact onto regional disadvantage.

The study’s implications extend well beyond Ukraine. Because researchers carry knowledge, professional networks, and opportunities for collaboration with them, where they move matters for both the places they leave and the places that receive them. Qualifications and international connections, the authors emphasize, do not necessarily protect researchers from forced displacement — nor do they guarantee that those who want to leave can actually do so. Wartime scholarly migration, on this evidence, is shaped by constraint as much as by opportunity, and treating it as a free market of talent misrepresents the reality on the ground.

There is also a practical lesson for how the research community monitors and responds to crises. Publicly available bibliometric data, the authors argue, can complement surveys, administrative records, and qualitative research, helping to track where research systems are losing scholars and where those researchers are relocating while a crisis is still unfolding. Such knowledge is not merely descriptive. When countries eventually face the task of rebuilding research communities and institutions after conflict, knowing which regions lost scholars, which absorbed them, and which lost them across borders becomes essential groundwork for reconstruction. For Ukraine, a country whose scholarly map has now been redrawn twice — after 2014 and again after 2022 — that groundwork has already begun.

Subject of Research: Internal and international migration of researchers in Ukraine during armed conflict, 2009 to 2022

Article Title: Tracking researchers in Ukraine through war and armed conflict:

Article References: Tracking researchers in Ukraine through war and armed conflict:. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: Ukraine, scholarly mobility, armed conflict, bibliometrics, brain drain, Donbas, Crimea, research migration, demography, Population and Development Review, displacement, research systems