Explosive ordnance (EO) puts one in two people in Syria at risk of death and injury and impedes the delivery of crucial humanitarian assistance. However, the extent of EO in Syria and its devastating impact is not sufficiently known or discussed among donors and humanitarian actors. International humanitarian mine action (HMA) actors operating in Syria for over ten years have come together to address this gap, sharing data and insight from their work on the ground. They produced a report to highlight the extent of EO contamination in Syria; its devastating impact on people, vital infrastructure and provision of humanitarian assistance; the crucial activities performed by humanitarian mine action (HMA) actors; and the action required to address this issue
Purpose: To determine the prevalence and severity of manual wheelchair rear wheel misalignment in community-dwelling manual wheelchair users and estimate the associated increases in rolling resistance (RR) and risk of repetitive strain injuries (RSIs).
Materials and Methods: Data were collected in an outpatient rehabilitation clinic, a university research laboratory, and at adaptive sporting events in the United States. Two hundred active, self-propelling man- ual wheelchair users were recruited. Angular misalignment (referred to as toe angle) while the wheelchair was loaded with the user, and the difference between the maximum and minimum toe angle (referred to as slop) with the wheelchair unloaded.
Results: Average results for toe angle and slop (movement in the rear wheels) were 0.92 and 0.61 degrees, respectively. Using a lab-based testing method, we quantified the impact of increased RR forces due to misalignment in increased RR forces. Our results indicate that the average toe angle while under load and slop, without loading, measured in the community increase required propulsion force by 3.0 N. Combined toe angle and slop (i.e., the worst-case scenario) added increased propulsion force by 3.9 N. Conclusions: We found that rear-wheel misalignment was prevalent and severe enough that it may increase the risk for RSIs and decrease participation. To mitigate this issue, future work should focus on reducing misalignment through improved maintenance interventions and increased manufacturing qual- ity through more stringent standards.
Road crashes endanger the lives and livelihoods of millions of road users globally and in India. The risk of a road crash in low-income countries is three times higher than compared to that in high-income countries. Not only does it lead to untold and unaccounted for suffering and loss for victims and their families, but also, it drains the GDP of countries by claiming millions of economically productive young lives6. While it is recognized that RTIs affect the developed and developing world in different ways, it also impacts poor households and disadvantaged sections of the population within developing countries differently. World Bank commissioned a survey-based assessment study in association with the Save LIFE Foundation (SLF) to determine such differential impacts more objectively in India. This study aims to capture the socioeconomic realities and nuances of road crashes at the sub-national level in India. It seeks to document inter-linkages between poverty, inequalities, road users, and road crash outcomes by analyzing data from four States in India, i.e., Uttar Pradesh, Bihar ,Tamil Nadu and Maharashtra. The four states have been selected on the basis of several criteria including demographic and geographical representation, magnitude of fatality burden and socio-economic parameters such as economic growth, poverty rate and social welfare.
This report outlines findings on how children are uniquely affected by explosive weapons and how the aftercare that children receive is frequently inadequate or non-existent.
This is the 22nd annual Landmine Monitor report. Landmine Monitor 2020 provides a global overview of the landmine situation. Chapters on developments in specific countries and other areas are available in online Country Profiles at www.the-monitor.org/cp. Landmine Monitor covers mine ban policy, use, production, trade, and stockpiling; includes information on developments and challenges in assessing and addressing the impact of mine contamination and casualties through clearance, risk education, and victim assistance; and documents international and national support for mine action. This report focuses on calendar year 2019, with information included up to October 2020 where possible.
The victim assistance coordination section covers the following topics: Participation of victims and their representative organizations; A relevant government agency to coordinate victim assistance; Multi-sectoral efforts in line with the CRPD; National referral mechanisms; Centralized database with needs and challenges
this report provides a 10-year review of developments in addressing the global cluster munitions problem, with information included up to September 2020. Profiles published online provide additional country-specific findings on these topics. Thematic maps are also published in the report and available online.
As well as a 10-year review, Cluster Munition Monitor 2020 covers cluster munition ban policy, use, production, transfers, and stockpiling globally, and also contains information on the impact of cluster munition contamination and casualties, as well as developments and challenges in addressing such impact through clearance, risk education and victim assistance.
11th Annual edition
On 1st September 2020, the UN adopted a new Resolution on Road Safety to extend until 2030 the global commitments to improve road safety and launched the Second Decade of Action for Road Safety (2021-2030), thus encouraging greater efforts worldwide. This builds on the Ministerial Declaration adopted in Stockholm in February 2020 and integrates the joint key asks of the many civil society organisations that have been advocating, over the past years, for stronger global leadership on road safety.
The Global Alliance of NGOs for Road Safety, of which Humanity & Inclusion (HI) is a member, has convened and leveraged the diverse voices of road users, road crashes victims’ associations, local organisations and international NGOs. This Resolution represents a great achievement for the global road safety community.
Purpose: To explore the experiences of being a family with one member suffering from severe traumatic brain injury (STBI) up to 7 years earlier through narrative family interviews.
Methods: There are few studies where a family as a unit, including persons with STBI, are interviewed together. This study used a family systems research approach following a qualitative interpretative design. Therefore, 21 families with a total of 47 family members were interviewed. Qualitative content analysis was used to reveal categories with sub-categories and a theme.
Results: “From surviving STBI towards stability, through the unknown, into a new everyday life and a new future as a family” characterized the implicit message. The results revealed two categories both with three subcategories. The first category characterized the rapid change from a normal everyday life to one of uncertainty and finally to one of stability, and the second category described how it is to adapt as a family after STBI.
Conclusions: Long-term experiences of STBI show the importance for the whole family of belonging to a context, having a job, and having something to belong to as a way to achieve stability. Families` feelings of loneliness and lack of treatment and support are challenges for professionals when trying to involve families in care and rehabilitation.
In recent years, more than 120 million people each year have needed urgent humanitarian assistance and protection. Armed conflict has profoundly negative consequences in communities. Destruction of civilian infrastructure impacts access to basic health services and complicates widespread emergency responses. The number of conflicts occurring is increasing, lasting longer and affecting more people today than a decade ago. The number of children living in conflict zones has been steadily increasing since the year 2000, increasing the need for health services and resources. This review systematically synthesised the indexed and grey literature reporting on the delivery of trauma and rehabilitation interventions for conflict-affected populations.
A systematic search of literature published from 1 January 1990 to 31 March 2018 was conducted across several databases. Eligible publications reported on women and children in low and middle-income countries. Included publications provided information on the delivery of interventions for trauma, sustained injuries or rehabilitation in conflict-affected populations. A total of 81 publications met the inclusion criteria, and were included in the review.
BMJ Global Health 2020;5:e001980
Purpose: Translating the Neck Disability Index (NDI) into the Malay language (NDI-M); evaluation of psychometric properties in patients with neck pain.
Methods: The NDI-M was translated according to established guidelines. In the first visit, 120 participants completed the NDI-M, visual analogue scale (VAS) for pain and demographic details. 98 participants returned to complete similar questionnaires and the Global Rating of Change (GRoC) scale. The NDI-M was evaluated for internal consistency, test-retest reliability, content validity, construct validity and responsiveness.
Results: The NDI-M demonstrated excellent internal consistency (Cronbach’s α = 0.84) and good test-retest reliability (ICC2,1 = 0.79). Content validity was confirmed with no floor or ceiling effects. Construct validity was established revealing three-factor subscales explaining 68% of the total variance. The NDI-M showed a moderate correlation with VAS (Rp = 0.49, p < 0.001). Regarding responsiveness, a moderate correlation between NDI-M change scores and VAS change scores was found (Rp = 0.40, p < 0.001). However, there was no significant correlation between NDI-M with GRoC (Rs = 0.11, p = 0.27).
Conclusions: The NDI-M is a reliable and valid tool to measure functional outcomes in patients with neck pain. It is responsive in detecting changes in pain intensity during a patient’s rehabilitation journey.
When emergencies strike, there is a huge surge in the need for Early Rehabilitation. Early Rehabilitation for patients with traumatic injuries in conflicts and disasters is now recognised as being an integral part of a patient’s recovery. However, the majority of rehabilitation professionals in countries that experience such emergencies do not have all the skills needed to treat all of the injuries. HI, in collaboration with leading organisations (ICRC, MSF-France, CBM, Livability & the WHO), has created this educational resource package to fill this gap
Each chapter of this handbook has been written by experts in their field. It includes pictures and evidence based treatment protocols to help rehabilitation professionals around the world to delivery high quality early rehabilitation intervention. Chapters included are:
- Key Challenges in Delivering Early Rehabilitation in Conflicts and Disasters
- Early Rehabilitation Patient Assessment and Treatment - the Basics
- Early Rehabilitation of Fractures
- Early Rehabilitation of Peripheral Nerve Injuries
- Early Rehabilitation of Amputees
- Early Rehabilitation of Acquired Brain Injuries
- Early Rehabilitation of Spinal Cord Injuries
- Early Rehabilitation of Burns
Videos accompany each of the chapters. The handbook contents are directly linked to modules taught on disasterready.org where there are additional accompanying resources designed to be used in conflict and disasters settings
Background: People with spinal cord injury (SCI) often have great need for healthcare services, but they report access challenges. Primary care access to people with SCI has not been explored in Botswana.
Objective: This study aimed to identify barriers and facilitators that users with spinal cord injuries experience in accessing primary care services in the greater Gaborone area, Botswana.
Methods: A quantitative, cross-sectional, observational study was conducted. Data were collected with a structured questionnaire from 57 participants with traumatic and non-traumatic SCI. Descriptive and inferential analysis was performed.
Results: The male to female ratio was 2.8:1. The mean age of participants was 40 years (standard deviation 9.59). Road traffic crashes caused 85% of the injuries. Most participants visited primary care facilities between 2 and 10 times in the 6 months before the study. Participants were satisfied with the services (63%) and felt that facilities were clean (95%) and well maintained (73.5%). Preferential treatment, respect, short waiting times and convenient hours facilitated satisfaction with services. Availability was hampered by insufficient provider knowledge on SCI as indicated by 71.9% of participants, and shortage of consumables (80.7%). Structural challenges (42.1% could not enter the facility by themselves and 56.5% could not use the bathroom) and lack of height-adjustable examining couches (66.7%) impeded accessibility. Cost was incurred when participants (64.9%) utilised private health services where public services failed to address their needs.
Conclusion: Primary care services were mostly affordable and adequate. Availability, acceptability and accessibility aspects created barriers.
African Journal of Disability, Vol 8, 2019
Objective: To explore the presence of pain, how pain was addressed by physicians and parents, and how pain affected everyday life in young children with cerebral palsy (CP).
Methods: Children with CP, aged 5–10 years, participated in this cross-sectional study. Data were collected from medical records spanning a period of two years and by a standardized parental interview that included six structured questions and the Pain Interference Index.
Results: A total of 118 children, with a mean age of 7.4 years (SD 1.5), participated in the study. The parents of 81% of these children were interviewed. Pain was reported in 52% of the children, and pain was present at all severity levels. The prescription of analgesics was documented in 25% of these children’s medical records. Fifty-nine percent of the children with pain received analgesics from their parents. Pain restricted the children’s everyday lives particularly concerning sleep, school work and being with friends.
Conclusions: Half of this group of young children with CP were reported to have pain. Pain restricted the children's everyday lives and seemed to be under-treated. If pain can be addressed early, the children's everyday lives are likely to be improved.
Cluster Munition Monitor covers cluster munition ban policy, use, production, transfers, and stockpiling in every country in the world, and also contains information on cluster munition contamination and clearance activities, as well as casualties and victim assistance. Its principal frame of reference is the Convention on Cluster Munitions, although other relevant international law is reviewed, including the Convention on the Rights of Persons with Disabilities. The report focuses on calendar year 2018, with information included into August 2019 where possible. Sections are: cluster munition ban policy; contamination and clearance; casualties; victim assistance; and status of the convention
Background: The development of secondary health conditions (SHCs) after spinal cord injury (SCI) is common and can affect an individual’s emotional well-being, and his or her health-related quality of life (QOL). Little is known about relationships between performing health-benefiting behaviours and the presence (or absence) of SHCs and QOL, particularly in South Africa.
Objectives: This research study was conducted in order to determine the associations between health behaviour, SHCs and QOL in people with SCI (PWSCI).
Method: This cross-sectional study included 36 PWSCI discharged from a private rehabilitation facility in Pretoria, South Africa. The PWSCI completed questionnaires pertaining to lifestyle, independence, presence of SHCs, social support and QOL. Data were analysed using descriptive and inferential statistics such as correlation tests and chi-square test of independence (x2) using the SPSS v25. Moderate, moderately high and high correlations are reported (Pearson r ≥ 0.4). Results were significant if p < 0.05.
Results: Participation in health-benefiting behaviour was associated with increased QOL (r = 0.457, p < 0.01) and increased social support from family and friends (r = 0.425, p < 0.01), which was associated with increased QOL (r = 0.671, p < 0.001). Not participating in specific neuromusculoskeletal health behaviours was found to be associated with the overall presence of SHCs (r = -0.426, p < 0.01).
Conclusions: Participating in health-benefiting behaviour can reduce the development of SHCs and subsequently increase QOL in PWSCI. Health professionals must focus on minimising the development of SHCs by providing specific education on good health-benefiting behaviour.
African Journal of Disability, Vol 8, 2019
The present report is submitted pursuant to the request contained in the statement by the President of the Security Council of 21 September 2018 (S/PRST/2018/18). It also responds to the Council’s requests for reporting on the protection of medical care and on conflict and food insecurity, contained in resolutions 2286 (2016) and 2417 (2018), respectively. Section II provides a summary of achievements and challenges to the United Nations work on protecting civilians over the past 20 years. Section III reviews the current state of the protection of civilians and emphasizes the enduring relevance of the protection agenda 20 years on. Section IV focuses on the central challenge of enhancing respect for the law – the first of three protection priorities identified in the report of 2017 (S/2017/414) and discussed in the report of 2018 (S/2018/462) – with a particular focus on the conduct of hostilities. Section V discusses how the Council and Member States can rise to meet this challenge and, moreover, strengthen the practical impact of the protection agenda in the years ahead.
The specific goals of this publication are first, to conduct an analysis of 1 year of conflict related trauma in Gaza; second, to highlight the role of the Health Cluster partners, including the World Health Organization (WHO) as the cluster lead agency, in supporting the local health system; and third, to document success stories, challenges and lessons learnt
This report looks at the challenges linked to the use of explosive weapons in the Syrian context for the provision of adequate immediate assistance and to plan for mid- to long-term assistance to the victims of explosive violence, to ensure their full recovery and inclusion into society. It is based on data and testimonies collected from humanitarian agencies, actors and patients across all areas of control in Syria. The testimony of Farah, a Syrian girl injured during the bombing of her school, and of her mother, is shared throughout the report to illustrate the challenges faced by victims.
This report was compiled from June to August 2019 and relies on multiple sources, including review of both gray and academic literature, published and unpublished data from INGOs working in Syria response, firsthand interviews with patients and Syrian humanitarians working both inside Syria and from cross-border locations, and expatriate staff from INGOs and UN agencies. Interviews were conducted at a distance during June and July 2019 with 12 individuals, among which: 2 patients; 3 mine action operators; 4 medical staff, and 3 humanitarian workers
This report covers children's exposure to blasts, children's unique vulnerability to blast injury (head, torso, burns and long term effects) and why children are exposed to blast.
Across five of the deadliest conflicts for children in 2017, an estimated 72% of child casualties were due to blasts. Using UN data for Afghanistan, Yemen, Syria, Nigeria and Iraq we can see that of the 7,364 children killed or maimed in conflict in 2017, at least 5,322 were linked to blasts.
The Field Manual has been created to provide technical guidance for those with medical training. It enables the user to adapt their knowledge to the treatment of severely injured children. It has paediatric-specific sections on:
- Pre-hospital care and transport
- Damage control resuscitation, surgery and intensive care
- Surgery (thoraco-abdominal, limb, burns)
- Neurological injury
- Ward care
- Psychosocial support
- Ethics and safeguarding
The Manual is also intended for use by anyone who is required to plan for the treatment of severely injured children, so they can see the resources, training and equipment that is required in a medical facility likely to receive blast injured children.
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