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Due to the war in Ukraine and the treatment of patients with war wounds in the hospitals of the TraumaNetworks of the German Society for Trauma Surgery (TraumaNetzwerke DGU®), injuries from life-threatening mission situations (LebEL), terrorism, violence and war have become a matter of daily professional life. Furthermore, the societal and global feeling of security has fundamentally changed. The much-cited term "turning point in history", the reorientation of the Armed Forces and the investigation of the resilience of the healthcare system with respect to the "fitness for war", approximate to the description of the current challenges for trauma surgery (UCH) in Germany. Based on the developments following the terrorist attacks in Paris in 2015 and in Brussels in 2016, a clarification is given as to which adaptations have already been successful and how quickly an improvement could successfully be achieved. In this context, the concept of tactical care and the course on Terror and Disaster Surgical Care (TDSC), for example, have been game changing. The main challenge currently lies in overcoming the structural alterations in the German healthcare system and professionally in the treatment of war wounded personnel from Ukraine. The knowledge gained from these two national tasks must be analyzed for the future development and adaptation of established treatment structures, e.g., of the TraumaNetzwerke DGU®, under the requirements of the increased resilience against war, terrorism and violence. The aim is to name that which has already been achieved with respect to the national challenges for UCH and at the same time to outline or discuss further necessities for improvements and elimination of possible gaps in capabilities.

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This article considers aspects of a development aid that provides medical support to strengthen pediatric orthopedics in Rwanda. We present part of the Afriquia foundation work, a nonprofit foundation from Poland involved in supporting the medical sector in Rwanda as a sign of global solidarity and the human right to health. The main foundation's activity is the treatment of orthopedic problems among Rwandan citizens. We present a case study of two children under the care of the Afiquia foundation. 11-year-old Seraphine treated due to the consequences of right tibia osteomyelitis and 11-year-old Lavi suffering from osteogenesis imperfecta. Both children were treated surgically in Poland due to Rwanda's lack of treatment possibilities. After the applied treatment, Seraphine walks correctly without crutches and can attend school and thrive among her peers. Lavi has not sustained any fragility fracture since the surgery in Poland. He is healthy and constantly ongoing his rehabilitation including gait training. The described cases initiated development aid in Rwanda, supplying hospitals with orthopedic implants and training medical staff. The growing number of humanitarian crises across the globe and the people affected requires increasing organizations involved in providing relief. The emphasis should be on global education, aiming to make the recipients reflect and prepare them to face humanitarian crises.

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The ongoing conflict in Palestine has exacerbated an already dire healthcare situation for children, with hospitals and medical facilities struggling to function amidst targeted attacks and limited resources. This editorial highlights the urgent need for improved healthcare infrastructure and access to medical services for Palestinian children, who face disproportionate suffering and trauma. The blockade and restrictions on Gaza further compound the crisis, hindering access to specialized care and essential medications. The international community must prioritize humanitarian aid and support to address these challenges, safeguarding the health and well-being of Palestinian children amid conflict. Long-term solutions are imperative to build a sustainable healthcare system that ensures the rights of all children to access quality healthcare services, irrespective of geopolitical circumstances.

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Community reaction to refugees and asylum-seekers is often gauged by attitude surveys that are not designed to overcome built-in bias. Questionnaires that do not account for context and background consequently yield results that misrepresent community attitudes and offer predictably negative responses to immigrant groups. Such surveys can alter public perception, fuel anti-refugee sentiment, and affect policy simply because of how they are constructed. This model survey among humanitarian aid-workers from nine Greek non-governmental organizations uses specific techniques designed to overcome these challenges by applying sample familiarity, non-inflammatory hypothesis-testing, educational question stems, intentional ordering of questions, and direct questioning rather than surrogate measures like statistical approximation. Respondents working in the refugee crisis in Greece demonstrate how empathy, education, and exposure to refugees serve to overcome the harmful stereotypes of outsiders as contributors to crime, terror, and social burden.

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BACKGROUND: Disasters affect human health and well-being globally. Nursing plays a vital role in disaster preparedness and response, ensuring efficient early care coordination and delivering effective field treatment. AIM: This study investigates the challenges an Israeli humanitarian delegation encountered during their response to major earthquakes in Turkey in 2023. It explicitly focuses on difficulties in preparation, operations, and collaboration with local teams. The study further analyzes the findings and extracts valuable lessons from the mission. METHODS: Using a qualitative descriptive design, 22 out of 32 nurses involved in delegation participated in three focus group discussions within two months of returning to Israel. The discussions were recorded, transcribed verbatim, and analyzed thematically. The study followed the COREQ guidelines, ensuring comprehensive reporting and methodological rigor in qualitative research. FINDINGS: The study's main findings spanned predeparture preparation, mission challenges in the disaster zone, and postmission lessons, each highlighted by subthemes and participant quotations. A strong sense of mission was evident among the participants, along with frustration at inefficient time management prior to deployment. Many participants noted additional challenges, related to the difficulty of working in multiple languages and across cultures, and the opportunities for resolution. Finally, participants called for better psychological support following the mission. CONCLUSION: Nurses in disaster zones offer valuable insights to enhance preparation, cross-cultural communication, and postmission implementation. NURSING AND HEALTH POLICY IMPLICATIONS: Nurse managers and healthcare policymakers can utilize this study's findings to develop future nursing training programs in disaster-related skills. Additionally, it can help foster collaboration among international healthcare teams.

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BACKGROUND: Humanitarian aid workers are exposed to deployment-related health threats. Identifying subgroups at a higher risk of infection in this diverse population could help optimize prevention. METHODS: We carried out a retrospective study based on anonymized data of humanitarian aid workers that visited our clinic for a post-deployment visit between 1 January 2018 and 31 December 2021. We conducted a descriptive analysis of basic demographic data, self-reported risk exposure and health problems encountered during deployment extracted from a standard questionnaire. RESULTS: The questionnaire was administered to 1238 aid workers during 1529 post-deployment medical consultations. The median age was 37.2 years (IQR 31.7-44.3), and 718/1529 (47.0%) were female aid workers. The median duration of deployment was 6 months (IQR 3-12 months). Most deployments (1321/1529 (86.4%)) were for a medical organization and in Sub-Saharan Africa (73.2%). The most common risk exposures were contact with freshwater in schistosomiasis endemic regions (187/1308 (14.3%)), unprotected sexual contact with a person other than a regular partner (138/1529 (9.0%)), suspected rabies exposure (56/1529 (3.7%)) and accidental exposure to blood (44/1529 (2.9%)). Gastrointestinal problems (487/1529 (31.9%)), malaria (237/1529 (15.5%)) and respiratory tract infections (94/1529 (6,2%)) were the most encountered health problems. Fifteen volunteers (1%) were hospitalized during deployment and 19 (1.2%) repatriated due to health problems. Adherence to malaria chemoprophylaxis was poor, only taken according to the prescription in 355 out of 1225 (29.0%) of aid workers for whom prophylaxis was indicated. CONCLUSION: Humanitarian aid workers deployed abroad encounter significant rates of health problems and report a high level of risk exposure during their deployment, with the risks being greatest among younger people, those deployed to rural areas, and those working for non-medical organizations. These findings help guide future pre-deployment consultations, to increase awareness and reduce risk behaviour during deployment, as well as focus on adherence to medical advice such as malaria chemoprophylaxis.

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Generosity and selflessness from the host community in Cox's Bazar were deemed to be instrumental in supporting Rohingyas who sought refuge in Bangladesh in 2017. Thousands of Rohingyas had to flee from their own country to save lives due to state-supported military violence. Initially, Bangladeshi media and civil society were largely supportive of the Rohingyas. However, the initial sympathy later withered away and may have turned into frustration and hostility. Based on 39 in-depth interviews with hot community members and humanitarian professionals, this paper argues that protraction of the crisis, inability to access natural resources due to the refugee camps, some Rohingyas' involvement in various unlawful activities, a perceived sense of neglect from the international community, and disruption in local labour market/trade affecting cost of living conditions for low-income people seem to have played important roles in creating widespread tensions between the host community and Rohingya refugees. We contend that findings of this study will add to the critical scholarship of humanitarian development in deepening the understanding of host and refugee communities' relationships. This paper will also have a positive impact on future policies toward harmonious coexistence between host communities and displaced refugees and potential sustainable solutions to the crisis.

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Aid workers offer important perspectives for understanding better the most pervasive challenges that arise when implementing emergency response programming in humanitarian settings. This large sample study provides a global review of these perspectives, derived from 4,679 applications to the National NGO Program on Humanitarian Leadership, in which aid workers were asked to respond to the following question: 'What do you consider to be the biggest challenges in the implementation of emergency response programming in today's humanitarian settings?'. Through a qualitative coding process, the research team identified 14 major challenges that were prevalent across the applicants' responses and cross-tabulated these with their demographics. Coordination (30 per cent) and operating environment (29.5 per cent) were the most frequently reported. The study found a significant association between challenges identified and certain demographic variables. The results supplement a body of literature that is largely composed of small-scale, context-specific studies in which disaggre-gation of data by demographics is not possible.

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Humanitarian organisations are increasingly utilising biometric data. However, we know little about the extent and scope of this practice, as its benefits and risks have attracted all the attention so far. This paper explores the biometric practices of the United Nations Refugee Agency, the United Nations World Food Programme, the International Committee of the Red Cross, Médecins Sans Frontières, and World Vision International. The study analysed relevant documents published over the past two decades and 17 semi-structured interviews with humanitarian workers conducted between June 2021 and June 2022. The findings reveal that humanitarian organisations use diverse types and functions of biometric data for different services, collaborate with many actors, and employ various data protection measures. Ultimately, challenging the straightforward generalisations about the use of such data, the paper argues that variational applications of biometrics in the humanitarian context require case-by-case analysis, as each instance will likely produce a different outcome.

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Objective: Leader humility has been linked to many positive outcomes but not examined in humanitarian aid work. Three studies examined the multilevel correlates, contributions, and consequences of leader humility in Medair-a large, multinational, faith-based aid organization. Study 1 examined correlates of leader humility in a sample of 308 workers and 167 leaders. Study 2 explored multilevel contributions of leader humility in 96 teams comprised of 189 workers. Study 3 utilized a subsample (50 workers, 34 leaders) to explore consequences of Time 1 leader and team humility on outcomes 6 months later. Method: Participants completed measures of humility (general, relational, team), leader and team attributions (e.g., effectiveness, cohesion, and growth-mindedness), organizational outcomes (e.g., job engagement and satisfaction; worker and team performance), and psychological outcomes (e.g., depression, anxiety, compassion satisfaction, and flourishing). Results: Leader and team humility contributed to multilevel positive attributions about leaders (as effective and impactful), teams (as cohesive, psychologically safe, and growth-minded), and oneself (as humble), and those attributions contributed to organizational and psychological outcomes. Teams' shared attributions of their leader's humility contributed to higher worker job satisfaction and team performance. Longitudinally, for workers and leaders, leader and team humility were associated with some positive organizational and psychological outcomes over time. Conclusion: In humanitarian organizations, leader humility seems to act as an attributional and motivational social contagion that affects aid personnel's positive attributions about their leaders, teams, and themselves. In turn, these multilevel positive attributions contribute to several positive team, organizational, and psychological outcomes among workers and leaders.

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BACKGROUND: Essential workers carry a higher risk of SARS-CoV-2 infection and COVID-19 mortality than individuals working in non-essential activities. Scientific studies on COVID-19 risk factors and clinical courses for humanitarian aid workers (HAW) specifically are lacking. The nature of their work brings HAW in proximity to various populations, therefore potentially exposing them to the virus. The objective of this study is to assess severity degrees of COVID-19 in relation to multiple risk factors in a cohort of HAW. METHODS: Retrospective cohort study of data collected by the Staff Health Unit of the International Committee of the Red Cross, over 12 months (February 2021 - January 2022). Prevalence of demographic and health risk factors and outcome events were calculated. Factors associated with disease severity were explored in univariable and multivariable logistic regression models. Resulting OR were reported with 95%CI and p-values from Wald Test. P-values < 0.05 were considered significant. RESULTS: We included 2377 patients. The mean age was 39.5y.o. Two thirds of the patients were males, and 3/4 were national staff. Most cases (3/4) were reported by three regions (Africa, Asia and Middle East). Over 95% of patients were either asymptomatic or presented mild symptoms, 9 died (CFR 0.38%). Fifty-two patients were hospitalised and 7 needed a medical evacuation outside the country of assignment. A minority (14.76%) of patients had at least one risk factor for severe disease; the most recorded one was high blood pressure (4.6%). Over 55% of cases occurred during the predominance of Delta Variant of Concern. All pre-existing risk factors were significantly associated with a moderate or higher severity of the disease (except pregnancy and immunosuppression). CONCLUSIONS: We found strong epidemiological evidence of associations between comorbidities, old age, and the severity of COVID-19. Increased occupational risks of moderate to severe forms of COVID-19 do not only depend on workplace safety but also on social contacts and context.

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BACKGROUND: To help promote the effective delivery of drug donations, the World Health Organization (WHO) developed the Guidelines for Medicine Donations. The need for revisions is timely given the large-scale influx of medicine donations since the start of the COVID-19 pandemic. This study analyses current policies of donors and recipients that are commensurate with the recommendations in the Guidelines and examines current practices, challenges, and revision suggestions. RESULTS: A search for medicine donation policies of donors and recipients was conducted in May/June 2022 and repeated in January 2023. Potential donor countries were identified from the high-income countries on the United Nation's (UN) List of G20 Countries. Potential pharmaceutical company donors were selected from those with 2021 revenue of $30 billion or greater. Potential non-government organization donors came from the WHO list of non-governmental organizations (NGOs) and two other sources. Potential recipient countries were those on the UN List of Least Developed Countries. These four lists were supplemented with actual donors and recipients identified from the literature. All policies retrieved were screened to identify which of the 12 recommendations from the WHO Guidelines were incorporated. We identified 38 policies from 1 donor country, 6 brand-name multinational pharmaceutical companies, 6 NGOs and 25 recipient countries. Most policies incorporated all 12 recommendations. Twenty-five of the 38 policies were developed in 2010 or later. The majority of actual donors and recipients did not have policies that were publicly available. A rapid literature review for publications from 2010 onwards identified challenges in implementing the WHO Guidelines and suggested for revisions. Challenges included: (1) information management; (2) medication presentation; (3) influence from the pharmaceutical industry; (4) donation sustainability; and (5) the belief that donations are inherently good. CONCLUSIONS: Our findings suggest that both donors and recipients could further align their policies with the existing Guidelines and both groups should be consulted on any revisions to ensure that their experiences are reflected and their needs are addressed. While the current WHO Guidelines for Medicine Donations are a solid base for medical humanitarian efforts, evidence points to the need for an update to meet current challenges.

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BACKGROUND: Syria has been in continuous conflict since 2011, resulting in more than 874,000 deaths and 13.7 million internally displaced people (IDPs) and refugees. The health and humanitarian sectors have been severely affected by the protracted, complex conflict and have relied heavily on donor aid in the last decade. This study examines the extent and implications of health aid displacement in Syria during acute humanitarian health crises from 2011 to 2019. METHODS: We conducted a trend analysis on data related to humanitarian and health aid for Syria between 2011 and 2019 from the OECD's Creditor Reporting System. We linked the data obtained for health aid displacement to four key dimensions of the Syrian conflict. The data were compared with other fragile states. We conducted a workshop in Turkey and key informants with experts, policy makers and aid practitioners involved in the humanitarian and health response in Syria between August and October 2021 to corroborate the quantitative data obtained by analysing aid repository data. RESULTS: The findings suggest that there was health aid displacement in Syria during key periods of crisis by a few key donors, such as the EU, Germany, Norway and Canada supporting responses to certain humanitarian crises. However, considering that the value of humanitarian aid is 50 times that of health aid, this displacement cannot be considered as critical. Also, there was insufficient evidence of health displacement across all donors. The results also showed that the value of health aid as a proportion of aggregate health and humanitarian aid is only 2% in Syria, compared to 22% for the combined average of fragile states, which further indicates the predominance of humanitarian aid over health aid in the Syrian crisis context. CONCLUSION: This study highlights that in very complex conflict-affected contexts such as Syria, it is difficult to suggest the use of health aid displacement as an effective tool for aid-effectiveness for donors as it does not reflect domestic needs and priorities. Yet there seems to be evidence of slight displacement for individual donors. However, we can suggest that donors vastly prefer to focus their investment in the humanitarian sector rather than the health sector in conflict-affected areas. There is an urgent need to increase donors' focus on Syria's health development aid and adopt the humanitarian-development-peace nexus to improve aid effectiveness that aligns with the increasing health needs of local communities, including IDPs, in this protracted conflict.

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The Horn of Africa faces an ongoing multi-year drought due to five consecutive failed rainy seasons, a novel climatic event with unpreceded impacts. Beyond the starvation of millions of livestock, close to 23 million individuals in the region are currently facing high food insecurity in Kenya, Somalia and Ethiopia alone. The severity of these impacts calls for the urgent upscaling and optimisation of early action for droughts. However, drought research focuses mainly on meteorological and hydrological forecasting, while early action triggered by forecasts is seldom addressed. This study investigates the potential for early action for droughts by using seasonal forecasts from the European Centre for Medium-Range Weather Forecasts (ECMWF) SEAS5 system for the March-April-May (MAM) and October-November-December (OND) rainy seasons. We show that these seasonal rainfall forecasts reflect major on-the-ground impacts, which we identify from drought surveillance data from 21 counties in Kenya. Subsequently, we show that the SEAS5 drought forecasts with short lead times have substantial potential economic value (PEV) when used to trigger action before the OND season across the region (PEVmax = 0.43). Increasing lead time to one or two months ahead of the season decreases PEV, but the benefits persist (PEVmax = 0.2). Outside of Kenya, MAM forecasts have limited value. The existence of opportunities for early action during the OND season in Kenya and Somalia is demonstrated by high PEV values, with some regions recording PEVmax values close to 0.8. To illustrate the practical value of this research, we point to a dilemma that a pastoralist in the Kenyan drylands faces when deciding whether to adopt early livestock destocking. This study underscores the importance to determine the value of early actions for forecast users with different action characteristics, and to disseminate this value alongside the standard forecasts themselves. This allows users to trigger effective actions before drought impacts develop.

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•Initiated in 2019, Humanitarian neurosurgery in Cote d'Ivoire is entirely supported by national non-governmental entities.•Free neurosurgical care is made possible through fundraising campaigns operated via social networking platforms.•Humanitarian neurosurgical activities in Cote d'Ivoire target children with hydrocephalus and neural tube defects.

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The spatiotemporal variation of the death and tested positive cases is poorly understood during the respiratory coronavirus disease 2019 (COVID-19) pandemic. On the other hand, COVID-19's spread was not significantly slowed by pandemic maps. The aim of this study is to investigate the connection between COVID-19 distribution and airborne PM2.5 (particulate matter with an aerodynamic diameter less than 2.5 µm). Long-term exposure to high levels of PM2.5 is significantly connected to respiratory diseases in addition to being a potential carrier of viruses. Between April 2020 and March 2021, data on COVID-19-related cases were gathered for all prefectures in Japan. There were 9159, 109,078, and 451,913 cases of COVID-19 that resulted in death, severe illness, and positive tests, respectively. Additionally, we gathered information on PM2.5 from 1119 air quality monitoring stations that were deployed across the 47 prefectures. By using the statistical analysis tools in the Geographical Information System (GIS) software, it was found that the residents of prefectures with high PM2.5 concentrations were the most susceptible to COVID-19. Additionally, the World Health Organization-Air Quality Guidelines (WHO-AQG) relative risk (RR) of 1.04 (95% CI: 1.01-1.08), which was used to compute the PM2.5-caused deaths, was employed as well. Approximately 1716 (95% CI: 429-3,432) cases of PM2.5-related deaths were thought to have occurred throughout the study period. Despite the possibility that the actual numbers of both COVID19 and PM2.5-caused deaths are higher, humanitarian actors could use PM2.5 data to localize the efforts to minimize the spread of COVID-19.

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BACKGROUND: Warzone humanitarian medical aid missions are infrequent and applying lessons from these missions is vital to ensuring preparedness for future crises. Between 2013-2018, the Israel Defense Forces Medical Corps (IDF-MC) provided humanitarian medical aid to individuals injured in the Syrian Civil War who chose to seek medical assistance at the Israeli-Syrian border. Patients requiring care surgical or advanced care were transferred to civilian medical centers within Israel. This study aims to describe the injury characteristics and management of hospitalized Syrian Civil War trauma patients over a five-year period. METHODS: Retrospective cohort analysis cross-referencing data from the IDF trauma registry, documenting prehospital care, and the Israel National Trauma Registry, documenting in-hospital care, between 2013 and 2018. Syrian trauma patients hospitalized in Israeli hospitals were cross-referenced between the two registries. Multivariable logistic regression was applied to identify independent factors associated with in-hospital mortality. RESULTS: Overall, 856 hospitalized trauma patients were included following definitive cross-matching. The median age was 23 years, and 93.3% were males. Blast (n = 532; 62.1%) and gunshot (n = 241; 28.2%) were the most common injury mechanisms. Injury Severity Score was ≥25 for 28.8% of patients and most common body regions with severe injury (Abbreviated Injury Scale≥3) were the head (30.7%) and thorax (25.0%). Intensive care unit admission was required for 40.1% of patients, and the median hospital stay was 13 days. In-hospital mortality was recorded for 73 (8.5%). Signs of shock upon emergency department admission and severe head injury were significantly associated with mortality in the adjusted model whereas age of <18 years was associated with decreased odds for in-hospital mortality. CONCLUSIONS: Trauma patients hospitalized in Israel following injuries sustained in the Syrian Civil War were characterized by a high prevalence of blast injuries with concomitant involvement of several body regions. Future missions should ensure preparedness for complex multi-trauma, often involving the head, and ensure high intensive care and surgical capacities.

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INTRODUCTION: Disaster Medicine (DM) requires skills, knowledge, and prior experience that are rarely put to test by health care providers. Pediatric DM presents unique challenges in terms of both knowledge and practice. METHODS: An anonymous survey consisting of demographic and five-point Likert scale questions was administered to physicians, nurses, and other medical personnel from Israel's major medical emergency teams who were deployed to respond to the refugee crisis in Ukraine. This included teams from the Hadassah and Tel Aviv Sourasky Medical Centers and the Israel Ministry of Health. RESULTS: Of the 171 members of the medical teams deployed on the Ukraine border, a total of 105 responses were obtained (61.4%) from 61 physicians, 50 nurses, and 12 other health care providers. The teams were composed of pediatricians (31.6%), internal medicine physicians (21.6%), Emergency Medicine and intensive care physicians (18.0%), and 31.0% other specialties.For 60% of the participants, this was their first deployment, and 78% had received no training in DM. Members rated the need for DM training at 4/5 (IQR 3-5). Forty-nine (49) members (46.6%) were not briefed on situational awareness and 97 members (89.5%) were not trained in the recognition of acute stress reactions. The responders also rated their concerns about providing medical aid to children at 2/5 (IQR 1-3). A medical clown was part of the teams 42.8% of the time; the presence of clowns was rated at a median of 4/5 (IQR 4-5). The team members underscored the need for more targeted training in DM at 5/5 (IQR 3-5). CONCLUSION: The findings highlight the need for the formulation of a disaster education model that includes pediatric DM.

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BACKGROUND: Germany has a statutory health insurance system. However, a substantial part of the population still suffers from limited access to regular health services. While humanitarian organizations are partially filling this gap, people with limited access show a high prevalence of mental disorders. This study investigates the prevalence, and social determinants of mental disorders in patients attending the clinics of a humanitarian health network in three major cities in Germany, as well as perceived barriers to healthcare access in this population. METHODS: We performed a descriptive, retrospective study of individuals attending the outpatient clinics of the humanitarian organization Ärzte der Welt, in Berlin, Hamburg and Munich, in 2021. Medico-administrative data was collected using a digital questionnaire at first presentation to the clinics. We report the prevalence of both perceived altered mental health and diagnosed mental disorders, as well as the perceived barriers to healthcare access in this population. We performed a logistic regression analysis to identify the socio-demographic factors associated with mental disorders. RESULTS: Our study population consisted of 1,071 first presenters to the clinics in 2021. The median age at presentation was 32 years and 57.2% of the population were male. 81.8% experienced a form of homelessness, 40% originated from non-EU countries and only 12.4% had regular statutory health insurance. 101 (9.4%) patients had a diagnosed mental disorder. In addition, 128 (11.9%) patients reported feeling depressed, 99 (9.2%) reported a lack of interest in daily activities, and 134 (12.5%) lacked emotional support in situations of need on most days. The most reported barrier to accessing health services was high health expenses, reported by 61.3% of patients.In the bivariate logistic regression analysis age, insurance status and region of origin were significantly associated with mental disorders. In the multivariable analysis, only age groups 20-39 and 40-59 years remained significant. CONCLUSIONS: People with limited access to regular health services have a high need for mental health services. As a chronic condition, this is even more difficult to manage outside of regular services, where humanitarian clinics are only filling the gap in serving basic health needs.

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