Developing a conceptual framework for the health protection of United Nations peacekeepers against the COVID-19 pandemic from global health perspectives.

The coronavirus disease 2019 (COVID-19) pandemic has posed particular health risks to United Nations peacekeepers, which require prompt responses and global attention. Since the health protection of United Nations peacekeepers against the COVID-19 pandemic is a typical global health problem, strategies from global health perspectives may help address it. From global health perspectives, and referring to the successful health protection of the Chinese Anti-Ebola medical team in Liberia, a conceptual framework was developed for the health protection of United Nations peacekeepers against the COVID-19 pandemic. Within this framework, the features include multiple cross-borders (cross-border risk factors, impact, and actions); multiple risk factors (Social Determinants of Health), multiple disciplines (public health, medicine, politics, diplomacy, and others), and extensive interdepartmental cooperation. These strategies include multiple phases (before-deployment, during-deployment, and post-deployment), multi-level cooperation networks (the United Nations, host countries, troop-contributing countries, the United Nations peacekeeping team, and United Nations peacekeepers), and concerted efforts from various dimensions (medical, psychological, and social).

Did Covid-19 lockdown positively affect the urban environment and UN- Sustainable Development Goals?

This work quantifies the impact of pre-, during- and post-lockdown periods of 2020 and 2019 imposed due to COVID-19, with regards to a set of satellite-based environmental parameters (greenness using Normalized Difference Vegetation and water indices, land surface temperature, night-time light, and energy consumption) in five alpha cities (Kuala Lumpur, Mexico, greater Mumbai, Sao Paulo, Toronto). We have inferenced our results with an extensive questionnaire-based survey of expert opinions about the environment-related UN Sustainable Development Goals (SDGs). Results showed considerable variation due to the lockdown on environment-related SDGs. The growth in the urban environmental variables during lockdown phase 2020 relative to a similar period in 2019 varied from 13.92% for Toronto to 13.76% for greater Mumbai to 21.55% for Kuala Lumpur; it dropped to -10.56% for Mexico and -1.23% for Sao Paulo city. The total lockdown was more effective in revitalizing the urban environment than partial lockdown. Our results also indicated that Greater Mumbai and Toronto, which were under a total lockdown, had observed positive influence on cumulative urban environment. While in other cities (Mexico City, Sao Paulo) where partial lockdown was implemented, cumulative lockdown effects were found to be in deficit for a similar period in 2019, mainly due to partial restrictions on transportation and shopping activities. The only exception was Kuala Lumpur which observed surplus growth while having partial lockdown because the restrictions were only partial during the festival of Ramadan. Cumulatively, COVID-19 lockdown has contributed significantly towards actions to reduce degradation of natural habitat (fulfilling SDG-15, target 15.5), increment in available water content in Sao Paulo urban area(SDG-6, target 6.6), reduction in NTL resulting in reducied per capita energy consumption (SDG-13, target 13.3).

Strengthening the primary care workforce to deliver high-quality care for non-communicable diseases in refugee settings: lessons learnt from a UNHCR partnership.

Non-communicable disease (NCD) prevention and care in humanitarian contexts has been a long-neglected issue. Healthcare systems in humanitarian settings have focused heavily on communicable diseases and immediate life-saving health needs. NCDs are a significant cause of morbidity and mortality in refugee settings, however, in many situations NCD care is not well integrated into primary healthcare services. Increased risk of poorer outcomes from COVID-19 for people living with NCDs has heightened the urgency of responding to NCDs and shone a spotlight on their relative neglect in these settings. Partnering with the United Nations Refugee Agency (UNHCR) since 2014, Primary Care International has provided clinical guidance and Training of Trainer (ToT) courses on NCDs to 649 health professionals working in primary care in refugee settings in 13 countries. Approximately 2300 healthcare workers (HCW) have been reached through cascade trainings over the last 6 years. Our experience has shown that, despite fragile health services, high staff turnover and competing clinical priorities, it is possible to improve NCD knowledge, skills and practice. ToT programmes are a feasible and practical format to deliver NCD training to mixed groups of HCW (doctors, nurses, technical officers, pharmacy technicians and community health workers). Clinical guidance must be adapted to local settings while co-creating an enabling environment for health workers is essential to deliver accessible, high-quality continuity of care for NCDs. On-going support for non-clinical systems change is equally critical for sustained impact. A shared responsibility for cascade training-and commitment from local health partners-is necessary to raise NCD awareness, influence local and national policy and to meet the UNHCR's objective of facilitating access to integrated prevention and control of NCDs.

Newborns and Under-5 Mortality in Ethiopia: The Necessity to Revitalize Partnership in Post-COVID-19 Era to Meet the SDG Targets.

The Sustainable Development Goals (SDGs) were adopted during the United Nations meeting in 2015 to succeed Millennium Development Goals. Among the health targets, SDG 3.2 is to end preventable deaths of newborns and children under 5 years of age by 2030. These 2 targets aim to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births. Ethiopia is demonstrating a great reduction in child mortality since 2000. In the 2019 child mortality estimation which is nearly 5 years after SDGs adoption, Ethiopia's progress toward reducing the newborns and under-5 mortality lie at 27 and 50.7 per 1000 live births, respectively. The generous financial and technical support from the global partners have helped to achieve such a significant reduction. Nevertheless, the SDG targets for newborns and under-5 mortality reduction are neither attained yet nor met the national plan to achieve by the end of 2019/2020. The partnership dynamics during COVID-19 crisis and the pandemic itself may also be taken as an opportunity to draw lessons and spur efforts to achieve SDG targets. This urges the need to reaffirm a comprehensive partnership and realignment with other interconnected development goals. Therefore, collective efforts with strong partnerships are required to improve the determinants of child health and achieving SDG target reduction until 2030.

Trends in classifying vaccine hesitancy reasons reported in the WHO/UNICEF Joint Reporting Form, 2014-2017: Use and comparability of the Vaccine Hesitancy Matrix.

Since 2014, the World Health Organization (WHO) member states have been annually reporting vaccine hesitancy reasons, using the WHO/UNICEF Joint Reporting Form (JRF). The Vaccine Hesitancy Matrix (VHM), developed by a WHO strategic advisory group of experts, can serve as an important tool to categorize vaccine hesitancy reasons reported in the JRF. We aimed to describe the reasons for vaccine hesitancy reported globally from 2014 to 2017 to ascertain trends over time and understand the comparability of using the VHM to classify hesitancy reasons from 2014 to 2016 based on previously published literature. We conducted a quantitative content analysis to code and categorize vaccine hesitancy reasons reported in the JRF from 2014 to 2017. Vaccine hesitancy trends were consistent from 2014 to 2017, where vaccine hesitancy reasons were mainly related to "individual and group level influences" (59%) followed by "contextual influences" (25%), and "vaccine- or vaccination-specific issues" (16%). Comparability of our approach to categorize vaccine hesitancy to the previously published JRF data showed that results were mostly but not entirely consistent. Major differences in categorizing vaccine hesitancy were noted between two specific reasons - "experience with past vaccination" (under "individual and group influences") and "risk/benefit- scientific evidence" (under "vaccine and vaccination-specific issues"); this was usually due to lack of clear definitions in some sub-categories and generic responses reported in the JRF. The JRF hesitancy module may benefit from modifications to improve the data quality. Understanding global vaccine hesitancy is crucial and JRF can serve as an important tool, especially with the potential introduction of a COVID-19 vaccine.

Violation of the Global Ceasefire in Nagorno-Karabagh: A Viral Amplification of Aggression.

On March 23, 2020, the United Nations (UN) made an "Appeal for a Global Ceasefire following the Outbreak of Coronavirus." Despite this appeal, the Nagorno-Karabagh war was instigated on September 27, 2020. This Guest Editorial frames the conflict in the context of the UN appeal and by introducing a figure that plots seven-day average coronavirus disease 2019 (COVID-19) cases overlaid with key inflection points to illustrate the clear impact that conflict has had on pandemic spread in Armenia. The conflict in Nagorno-Karabagh provides a timely, concise, and illustrative example of conflict and its impact on health. Finally, an argument is made that the ability to enforce the UN "Appeal for a Global Ceasefire" is essential to ensure global health and security.

ESCAP CovCAP survey of heads of academic departments to assess the perceived initial (April/May 2020) impact of the COVID-19 pandemic on child and adolescent psychiatry services.

In April 2020, the European Society for Child and Adolescent Psychiatry (ESCAP) Research Academy and the ESCAP Board launched the first of three scheduled surveys to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on child and adolescent psychiatry (CAP) services in Europe and to assess the abilities of CAP centers to meet the new challenges brought on by the crisis. The survey was a self-report questionnaire, using a multistage process, which was sent to 168 heads of academic CAP services in 24 European countries. Eighty-two responses (56 complete) from 20 countries, representing the subjective judgement of heads of CAP centers, were received between mid-April and mid-May 2020. Most respondents judged the impact of the crisis on the mental health of their patients as medium (52%) or strong (33%). A large majority of CAP services reported no COVID-19 positive cases among their inpatients and most respondents declared no or limited sick leaves in their team due to COVID-19. Outpatient, daycare, and inpatient units experienced closures or reductions in the number of treated patients throughout Europe. In addition, a lower referral rate was observed in most countries. Respondents considered that they were well equipped to handle COVID-19 patients despite a lack of protective equipment. Telemedicine was adopted by almost every team despite its sparse use prior to the crisis. Overall, these first results were surprisingly homogeneous, showing a substantially reduced patient load and a moderate effect of the COVID-19 crisis on psychopathology. The effect on the organization of CAP services appears profound. COVID-19 crisis has accelerated the adoption of new technologies, including telepsychiatry.

Efforts to mitigate the economic impact of the COVID-19 pandemic: potential entry points for neglected tropical diseases.

BACKGROUND: The damage inflicted by the coronavirus diseases 2019 (COVID-19) pandemic upon humanity is and will continue to be considerable. Unprecedented progress made in global health over the past 20 years has reverted and economic growth has already evaporated, giving rise to a global recession, the likes of which we may not have experienced since the Second World War. Our aim is to draw the attention of the neglected tropical disease (NTD) community towards some of the major emerging economic opportunities which are quickly appearing on the horizon as a result of COVID-19. MAIN TEXT: This scoping review relied on a literature search comprised of a sample of articles, statements, and press releases on initiatives aimed at mitigating the impact of COVID-19, while supporting economic recovery. Of note, the donor scenario and economic development agendas are highly dynamic and expected to change rapidly as the COVID-19 pandemic unfolds, as are donor and lender priorities. CONCLUSIONS: The NTD community, particularly in low- and middle-income countries (LMICs), will need to work quickly, diligently, and in close collaboration with decision-makers and key stakeholders, across sectors at national and international level to secure its position. Doing so might enhance the odds of grasping potential opportunities to access some of the massive resources that are now available in the form of contributions from corporate foundations, trust funds, loans, debt relieve schemes, and other financial mechanisms, as part of the ongoing and future economic development agendas and public health priorities driven by the COVID-19 pandemic. This paper should serve as a starting point for the NTD community to seek much needed financial support in order to sustain and revitalize control and elimination efforts pertaining to NTDs in LMICs.

'Health for All by All' during a pandemic: 'Protect Everyone' and 'Keep the Promise' of Universal Health Coverage in the Eastern Mediterranean Region.

The Universal Health Coverage (UHC) Day has been commemorated on 12 December every year since 2017. In 2019, the theme of the day was "Keep the Promise", referring to the Political Declaration on UHC endorsed by Heads of States at the United Nations General Assembly High-Level Meeting on 23 September 2019. In 2020, the theme is "Protect Everyone", emphasizing global and individual health security in the context of the COVID-19 pandemic, attributed to SARS-CoV 2 - a virus that infected more than 4 million people in the Eastern Mediterranean Region (EMR) and left over 100 000 dead in less than 12 months (6.6% and 7.1% of the global toll, respectively). Keeping the promise of UHC, while ensuring health security, is becoming a priority agenda of policy-makers and practitioners in the EMR in order to save lives, advance health and protect livelihoods.

Coping with COVID-19 in United Nations peacekeeping field hospitals: increased workload and mental stress for military healthcare providers.

INTRODUCTION: This study aimed to explore the impact of COVID-19 on the United Nations peacekeeping field hospitals where medical supply and manpower are extremely insufficient. METHODS: A level II hospital was deployed in Wau, South Sudan, as the regional referral centre of the United Nations Mission in South Sudan (UNMISS). It had a total strength of 63 personnel with 47 medical staff (average age 38.3±8.0 years, 33 men). A new 'appointment-triage-disinfection' work pattern was adopted to cope with the COVID-19 outbreak in the mission. Data on medical service statistics and workload before/after the outbreak were collected and compared. The mental health of staff was analysed from the quarterly psychological survey, including Perceived Stress Scale (PSS)-10, Generalised Anxiety Disorder (GAD)-7 and Patient Health Questionnaire (PHQ)-9. RESULTS: The number of outpatients decreased slightly after the COVID-19 outbreak (41.9±11.9 to 37.6±11.8 per week, p=0.49), whereas the weekly hospital length of stay of inpatients increased significantly (0.4±1.0 to 3.1±3.9 days, p=0.02). Total weekly working hours increased from 1884.9±34.1 to 2023.5±67.3 hours (p<0.001). Elevated mental stress (PSS-10: 4.3±2.4 in February to 7.5±3.9 in May, p<0.001; GAD-7: 4.0±2.3 to 9.4±4.0, p<0.001; PHQ-9: 2.1±1.2 to 3.2±2.4, p<0.001) was documented among healthcare providers after the outbreak. The threat of COVID-19 infection, delay in rotation and family-related concerns constituted the main stressors. CONCLUSION: COVID-19 imposes a huge pressure on peacekeeping field hospitals. Increased workload and mental stress among frontline healthcare providers deserve the attention of UNMISS officials. Facilitating the rotation of the medical staff might potentially improve the operational readiness of the hospital by bringing in well-trained personnel and sufficient medical supplies.

Exploring anti-corruption, transparency, and accountability in the World Health Organization, the United Nations Development Programme, the World Bank Group, and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Corruption is recognized by the global community as a threat to development generally and to achieving health goals, such as the United Nations Sustainable Development Goal # 3: ensuring healthy lives and promoting well-being for all. As such, international organizations such as the World Health Organizations and the United Nations Development Program are creating an evidence base on how best to address corruption in health systems. At present, the risk of corruption is even more apparent, given the need for quick and nimble responses to the COVID-19 pandemic, which may include a relaxation of standards and the rapid mobilization of large funds. As international organizations and governments attempt to respond to the ever-changing demands of this pandemic, there is a need to acknowledge and address the increased opportunity for corruption.In order to explore how such risks of corruption are addressed in international organizations, this paper focuses on the question: How are international organizations implementing measures to promote accountability and transparency, and anti-corruption, in their own operations? The following international organizations were selected as the focus of this paper given their current involvement in anti-corruption, transparency, and accountability in the health sector: the World Health Organization, the United Nations Development Program, the World Bank Group, and the Global Fund to Fight Aids, Tuberculosis and Malaria. Our findings demonstrate that there has been a clear increase in the volume and scope of anti-corruption, accountability, and transparency measures implemented by these international organizations in recent years. However, the efficacy of these measures remains unclear. Further research is needed to determine how these measures are achieving their transparency, accountability, and anti-corruption goals.