Publications
122 results found
Abbara A, Rao B, Titanji BK, et al., 2022, The monkeypox outbreak must amplify hidden voices in the global discourse (vol 400, pg 23, 2022), LANCET, Vol: 400, Pages: 160-160, ISSN: 0140-6736
Abbara A, Rao B, Titanji BK, et al., 2022, The monkeypox outbreak must amplify hidden voices in the global discourse (vol 400, pg 23, 2022), LANCET, Vol: 400, Pages: 160-160, ISSN: 0140-6736
Zumla A, Traore T, Amao L, et al., 2022, Reducing the threat of epidemic-prone infections at mass gathering religious events, LANCET, Vol: 400, Pages: 80-82, ISSN: 0140-6736
- Author Web Link
- Cite
- Citations: 5
Abbara A, Rao B, Titanji BK, et al., 2022, The monkeypox outbreak must amplify hidden voices in the global discourse, LANCET, Vol: 400, Pages: 23-23, ISSN: 0140-6736
- Author Web Link
- Cite
- Citations: 4
Castro KG, Ditiu L, Sahu S, et al., 2022, Optimising tuberculosis care for refugees affected by armed conflicts Comment, LANCET RESPIRATORY MEDICINE, Vol: 10, Pages: 533-536, ISSN: 2213-2600
- Author Web Link
- Cite
- Citations: 2
Karah N, Antypas K, Al-toutanji A, et al., 2022, An Innovative Approach to Providing Web-Enabled Diagnostic Laboratory Services in Syria, AMERICAN JOURNAL OF CLINICAL PATHOLOGY, Vol: 157, Pages: 554-560, ISSN: 0002-9173
- Author Web Link
- Cite
- Citations: 4
Marzouk M, Alhiraki OA, Aguas R, et al., 2022, SARS-CoV-2 transmission in opposition-controlled Northwest Syria: modeling pandemic responses during political conflict, INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES, Vol: 117, Pages: 103-115, ISSN: 1201-9712
- Author Web Link
- Cite
- Citations: 4
Desai AN, Mohareb AM, Hauser N, et al., 2022, Antimicrobial Resistance and Human Mobility, INFECTION AND DRUG RESISTANCE, Vol: 15, Pages: 127-133, ISSN: 1178-6973
- Author Web Link
- Cite
- Citations: 5
Abbara A, Rayes D, Ekzayez A, et al., 2022, The health of internally displaced people in Syria: are current systems fit for purpose?, JOURNAL OF MIGRATION AND HEALTH, Vol: 6, ISSN: 2666-6235
- Author Web Link
- Cite
- Citations: 1
Sbaiti M, Streule M, Alhaffar M, et al., 2021, Whose voices should shape global health education? Curriculum codesign and codelivery by people with direct expertise and lived experience, BMJ Global Health, Vol: 6, ISSN: 2059-7908
There are contrasting opinions of what Global Health (GH) curricula should contain and limited discussion on whose voices should shape it. In GH education, those with first-hand expertise of living and working in the contexts discussed in GH classrooms are often absent when designing curricula. To address this, we developed a new model of curriculum co-design called Virtual Roundtable for Collaborative Education Design (ViRCoED). This paper describes the rationale and outputs of the ViRCoED approach in designing a new section of the Global Health BSc curriculum at Imperial College London, with a focus on healthcare in the Syrian conflict. The team, importantly, involved partners with lived and/or professional experience of the conflict as well as alumni of the course, and educators in all stages of design and delivery through to marking and project evaluation. The project experimented with disrupting power dynamics and extending ownership of the curriculum beyond traditional faculty by co-designing and co-delivering module contents together with colleagues with direct expertise and experience of the Syrian context. An authentic approach was applied to assessment design using real-time syndromic healthcare data from the Aleppo and Idlib Governorates. We discuss the challenges involved in our collaborative partnership and describe how it may have enhanced the validity of our curriculum with students engaging in a richer representation of key health issues in the conflict. We observed an enhanced self-reflexivity in the students’ approach to quantitative data and its complex interpretation. The dialogic nature of this collaborative design was also a formative process for partners and an opportunity for GH educators to reflect on their own positionality. The project aims to challenge current standards and structures in GH curriculum development and gesture towards a GH education sector eventually led by those with lived experience and expertise to significantly
Hartley A, El-Sayed A, Abbara A, et al., 2021, Restricted use of echocardiography in suspected endocarditis during COVID-19 lockdown: a multidisciplinary team approach, Cardiology Research and Practice, Vol: 2021, Pages: 1-4, ISSN: 2090-0597
Background:Infective endocarditis (IE) is challenging to manage in the COVID-19 lockdown climate, in part given its reliance on echocardiography for diagnosis and management, and the associated virus transmission risks to patients and healthcare workers. This study assesses utilisation of the endocarditis team (ET) in limiting routine echocardiography, especially transoesophageal echocardiography (TOE), in patients with suspected IE, and explores the effect on clinical outcomes.Methods:All patients discussed at the ET meeting at Imperial College Healthcare NHS Trust during the first lockdown in the UK (23rd March – 8th July 2020) were prospectively included and analysed in this observational study.Results:In total, 38 patients were referred for ET review (71% male, median age 54 [interquartile range 48, 65.5] years). At the time of ET discussion, 21% had no echo imaging, 16% had point-of-care ultrasound only and 63% had formal TTE. In total, only 16% underwent TOE. The ability of echocardiography, in those where it was performed, to affect IE diagnosis according to the Modified Duke Criteria was significant (p=0.0099), however, sensitivity was not affected. All-cause mortality was 17% at 30-days and 25% at 12-months from ET discussion in those with confirmed IE.Conclusion:Limiting echocardiography in patients with a low pre-test probability (not probable or definite IE according to the Modified Duke Criteria) did not affect the diagnostic ability of the Modified Duke Criteria to rule out IE in this small study. Moreover, restricting non-essential echocardiography, and importantly TOE, in patients with suspected IE through use of the ET did not impact all-cause mortality.
Abbara A, Zakieh O, Rayes D, et al., 2021, Weaponizing water as an instrument of war in Syria: impact on diarrhoeal disease in Idlib and Aleppo governorates, 2011-2019, International Journal of Infectious Diseases, Vol: 108, Pages: 202-208, ISSN: 1201-9712
Objectives:Investigate the weaponization of water during the Syrian conflict and the correlation of attacks on water, sanitation, and hygiene (WASH) infrastructure in Idlib and Aleppo governorates with trends in waterborne diseases reported by Early Warning and Response surveillance systems.Methods:We reviewed literature and databases to obtain information on attacks on WASH in Aleppo and Idlib governorates between 2011 and 2019. We plotted weekly trends in waterborne diseases from two surveillance systems operational in Aleppo and Idlib governorates between 2015 and early 2020.Results:The literature review noted several attacks on water and related infrastructure in both governorates, suggesting that WASH infrastructure was weaponized by state and non-state actors. Most interference with WASH in the Aleppo governorate occurred before 2019 and in the Idlib governorate in the summer of 2020. Other acute diarrhea represented >90% of cases of diarrhea; children under 5 years contributed 50% of cases. There was substantial evidence (p < 0.001) of an overall upward trend in cases of diarrheal disease.Conclusions:Though no direct correlation can be drawn between the weaponization of WASH and the burden of waterborne infections due to multiple confounders, this research introduces important concepts on attacks on WASH and their potential impacts on waterborne diseases.
Morgan C, Barrett J, Brown A, et al., 2021, Respiratory samples to diagnose tuberculosis in the absence of chest x-ray abnormalities, RESPIRATORY MEDICINE, Vol: 185, ISSN: 0954-6111
Rayes D, Meiqari L, Yamout R, et al., 2021, Policies on return and reintegration of displaced healthcare workers towards rebuilding conflict-affected health systems: a review for The Lancet-AUB Commission on Syria., Confl Health, Vol: 15, Pages: 1-12, ISSN: 1752-1505
BACKGROUND: War and armed conflicts severely disrupt all health system components, including the healthcare workforce. Although data is limited on the scale of health care worker (HCW) displacement in conflict zones, it is widely acknowledged that conflict conditions result in the displacement of a significant portion of qualified HCWs from their country of origin. While voluntary HCW return is integral to health system rebuilding in conflict-affected and post-conflict settings, there has been little exploration of the nature of national or international policies which encourage HCW return and reintegration to their home countries in the post-conflict period. METHODS: We conducted a systematic review to identify policies and policy recommendations intended to facilitate the return of displaced HCWs to their home countries and acknowledge their contribution to rebuilding the post-conflict health system. We searched three bibliographic databases and a range of organisational and national health agency websites to identify peer-reviewed articles and grey literature published in English or Arabic between 1 January 1990 to 24 January 2021, and extracted relevant information. We classified policies and policy recommendations using an adapted version of the UNHCR 4Rs Framework. RESULTS: We identified nine peer-review articles and four grey literature reports that fit our inclusion criteria, all of which were published in English. These covered issues of repatriation (n = 3), reintegration (n = 2), health system rehabilitation and reconstruction (n = 2); six documents covered several of these themes. Information was available for nine conflict contexts: Afghanistan, Iraq, Kosovo, Lebanon, Namibia, Northern Uganda, South Sudan, Timor Leste, and Zimbabwe. Findings demonstrate that health system rebuilding and rehabilitation serve as precursors and reinforcers of the successful return, repatriati
Abbara A, Ekzayez A, 2021, Healthcare leadership in Syria during armed conflict and the pandemic, BMJ Global Health, Vol: 6, ISSN: 2059-7908
Syria’s protracted conflict has driven an exodus of healthcare workers through the weaponisation of healthcare, leaving a diminished pool from which medical and healthcare leaders can arise. Prior to the conflict, a lack of transparency, poor accountability and nepotism have influenced appointments to positions of power and influence in Syria, weakening such structures. Despite this, there has been some evidence of strong leadership in key organisations that are responding to the COVID-19 pandemic in Syria, though decades of poor investment in leadership among healthcare workers have taken their toll. Regional or international institutions with established medical and healthcare leadership programmes must build links to support the development of context-relevant programmes for Syria and other conflict-affected contexts.
Almhawish N, Karah N, Elferruh Y, et al., 2021, Protecting healthcare workers in conflict zones during the COVID-19 pandemic: Northwest Syria, JOURNAL OF INFECTION, Vol: 82, Pages: 216-217, ISSN: 0163-4453
- Author Web Link
- Cite
- Citations: 3
Yarwood V, Gunst M, Chen CY-T, et al., 2021, A retrospective review of specialist referrals for refugees into Greece's health system: A humanitarian organization's perspective., Avicenna J Med, Vol: 11, Pages: 84-92, ISSN: 2231-0770
Aim: Refugee arrivals to Europe have numbered more than one million since 2015 with the majority arriving through Greece. The healthcare needs of refugees have placed strains on Greece's healthcare system which has already been affected by its ongoing economic crisis. At the peak of arrivals during 2016, primary healthcare was primarily provided by humanitarian organizations with specialist referrals into the Greek healthcare system. There is little published literature on the type and impacts of specialist referrals for refugees in Greece. The aim of this retrospective review is to identify the type and impacts of specialist referrals for refugees into Greece's health system. Methods: This retrospective study reviewed the number and type of specialty referrals from one humanitarian organization providing primary healthcare for refugees in Greece. All consultations during an 8-month period (December 1, 2016-July 31, 2017) were reviewed. Results: Of 4168 consultations, 42% were patients aged 17 years or younger, 52% were male, and 90% were Syrian. Two hundred and thirty-three patients (11%) required a specialist referral; 25% were for dental (provided by another humanitarian organization), 10% each for obstetrics and gynecology and pediatrics, and 8% for ophthalmology. Respiratory complaints were most frequently seen, and these were more predominant in the winter months. Pediatric consultations varied according to month, likely due to population movements. Conclusion: Dentistry was noted to be a gap in humanitarian response programming and accounted for the greatest need for specialist input with referrals for women and children accounting for a large proportion of referrals.
Knipper M, Sedas AC, Keshavjee S, et al., 2021, The need for protecting and enhancing TB health policies and services for forcibly displaced and migrant populations during the ongoing COVID-19 pandemic, International Journal of Infectious Diseases, Vol: 113, ISSN: 1201-9712
Disruption of health services due to the COVID-19 pandemic threatens to derail progress being made in tuberculosis control efforts. Forcibly displaced people and migrant populations face particular vulnerabilities as a result of the COVID-19 pandemic, which leaves them at further risk of developing TB. They inhabit environments where measures such as "physical distancing" are impossible to realize and where facilities like camps and informal temporary settlements can easily become sites of rapid disease transmission. In this viewpoint we utilize three case studies-from Peru, South Africa, and Syria-to illustrate the lived experience of forced migration and mobile populations, and the impact of COVID-19 on TB among these populations. We discuss the dual pandemics of TB and COVID-19 in the context of migration through a syndemic lens, to systematically address the upstream social, economic, structural and political factors that - in often deleterious dynamics - foster increased vulnerabilities and risk. Addressing TB, COVID-19 and migration from a syndemic perspective, not only draws systematic attention to comorbidity and the relevance of social and structural context, but also helps to find solutions: the true reality of syndemic interactions can only be fully understood by considering a particular population and bio- social context, and ensuring that they receive the comprehensive care that they need. It also provides avenues for strengthening and expanding the existing infrastructure for TB care to tackle both COVID-19 and TB in migrants and refugees in an integrated and synergistic manner.
Abbara A, Karim T, Attal B, 2021, Armed conflict alone does not explain the devastation of Yemen’s health system, BMJ Global Health, Vol: 6, ISSN: 2059-7908
Patterson B, Abbara A, Collin S, et al., 2021, Predicting drug-induced liver injury from anti-tuberculous medications by early monitoring of liver tests, JOURNAL OF INFECTION, Vol: 82, Pages: 240-244, ISSN: 0163-4453
- Author Web Link
- Cite
- Citations: 3
Tarnas MC, Desai AN, Lassmann B, et al., 2021, Increase in Vector-Borne Disease reporting affecting humans and animals in Syria and neighboring countries before and after the onset of conflict: A ProMED analysis 2003-2018, International Journal of Infectious Diseases, Vol: 102, Pages: 103-109, ISSN: 1201-9712
OBJECTIVES: The protracted and violent conflict in Syria has resulted in large-scale displacement of people and destruction of health and sanitation infrastructure. The aim of this study was to examine epidemiological trends in vector-borne disease (VBD) outbreaks before and following the onset of the Syrian conflict (2011). METHODS: ProMED, a digital disease surveillance tool, was queried for VBD outbreak reports affecting humans and animals in Syria and select bordering countries between 2003-2018. Data were normalized by dividing the number of unique VBD events by the total number of unique outbreak events reported by ProMED for each year. Suspected and confirmed case counts and deaths were manually extracted. RESULTS: Reports on VBDs increased from a mean of 2.9/year pre-2011 to 12.8/year post-2011, a 343.5% (p < 0.05) increase. After normalization, reports increased by 485.5% (p < 0.05) over the time periods. Post-2011, the most commonly reported VBDs were leishmaniasis, Crimean-Congo hemorrhagic fever and lumpy skin disease. Reported numbers of suspected and confirmed cases and deaths increased during the conflict period. CONCLUSIONS: VBD outbreak events in ProMED increased in Syria and select bordering countries after the onset of the Syrian conflict in 2011. Enhanced disease surveillance is critical to detect and manage outbreaks in conflict settings.
Cantor D, Swartz J, Roberts B, et al., 2021, Understanding the health needs of internally displaced persons: A scoping review, JOURNAL OF MIGRATION AND HEALTH, Vol: 4, ISSN: 2666-6235
- Author Web Link
- Cite
- Citations: 13
Tarnas M, Lassmann B, Desai A, et al., 2020, Impact of the Syrian conflict on vector-borne disease trends in Syria and neighboring countries: A one health ProMED analysis between 2003 to 2018, Publisher: ELSEVIER SCI LTD, Pages: 210-210, ISSN: 1201-9712
Abou Fayad A, El Diwachi O, Haraoui LP, et al., 2020, War, antimicrobial resistance, and <i>Acinetobacter baumannii</i> (WAMRA), Publisher: ELSEVIER SCI LTD, Pages: 87-88, ISSN: 1201-9712
- Author Web Link
- Cite
- Citations: 1
Abbara A, Ekzayez A, Tarakji A, et al., 2020, Sanctions on Syria., The Lancet Global Health, Vol: 8, Pages: e1369-e1369, ISSN: 2214-109X
Karah N, Rafei R, Elamin W, et al., 2020, Guideline for Urine Culture and Biochemical Identification of Bacterial Urinary Pathogens in Low-Resource Settings., Diagnostics, Vol: 10, ISSN: 2075-4418
Medical diagnosis in low-resource settings is confronted by the lack of suitable guidelines, protocols and checklists. Online-accessible procedural documents are difficult to find, might be mistranslated or interpreted and usually do not address the needs of developing countries. Urinalysis, one of the most frequently performed diagnostic examinations worldwide, involves a series of tests aiming to detect particular disorders, such as urinary tract infections, kidney disease and diabetes. In this guideline, we present an alternative approach for clinical laboratories with limited resources to identify common bacterial uropathogens. We propose dividing the identification plan into two levels. The implicated pathogen will first be assigned into a bacterial group, basic identification, against which a suitable panel of antimicrobial agents shall be selected for the antimicrobial susceptibility testing (AST). Characterization of the pathogen to the genus or species level, advanced identification, will then be performed to ensure correct reading of the AST results and determine the epidemiology of clinically significant pathogens. Most of the proposed steps in our guideline are tailored to meet the needs of clinical laboratories in low-resource settings. Such guidelines are needed to strengthen the capacity of regional pathology laboratories and to enhance international initiatives on antimicrobial resistance and health equity.
García-Mingo A, Abbara A, Roy RB, 2020, "You said the hospital can't be bombed"., The Lancet Child and Adolescent Health, ISSN: 2352-4642
Karamya ZA, Youssef A, Adra A, et al., 2020, High rates of antimicrobial resistance among clinical isolates from microbiology laboratories in Syria, Journal of Infection, Vol: 82, Pages: e8-e10, ISSN: 0163-4453
Abbara A, Joseph L, Ismail S, et al., 2020, A qualitative research study which explores humanitarian stakeholders’ views on healthcare access for refugees in Greece, International Journal of Environmental Research and Public Health, Vol: 17, ISSN: 1660-4601
Introduction: As of January 2020, 115,600 refugees remain in Greece; most are Afghani, Iraqi or Syrian nationals. This qualitative research study explores the views of key stakeholders providing healthcare for refugees in Greece between 2015 and 2018. The focus was on identifying key barriers and facilitators to healthcare access for refugees in Greece. Methods: 16 interviewees from humanitarian and international organisations operating in Greece were identified through purposive and snowball sampling. Semi-structured interviews were conducted between March and April 2018. Data were analysed using the Framework Method. Results: Key themes affecting healthcare access included the influence of socio-cultural factors (healthcare expectations, language, gender) and the ability of the Greek health system to respond to existing and evolving demands; these included Greece’s ongoing economic crisis, human resource shortages, weak primary healthcare system, legal barriers and logistics. The evolution of the humanitarian response from emergency to sustained changes to EU funding, coordination and comprehensiveness of services affected healthcare access for refugees. Conclusion: The most noted barriers cited by humanitarian stakeholders to healthcare access for refugees in Greece were socio-cultural and language differences between refugees and healthcare providers and poor coordination among stakeholders. Policies and interventions which address these could improve healthcare access for refugees in Greece with coordination led by the EU.
Moqeem U, Mukhtar O, Abbara A, et al., 2020, Experiences of healthcare workers displaced by conflict: lessons from past conflicts and implications, Publisher: OXFORD UNIV PRESS, Pages: V114-V114, ISSN: 1101-1262
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.