Development of a World Health Organization Programme for School Mental Health in the Eastern Mediterranean Region

Background: Schools provide an exceptional opportunity for mental health promotion and intervention. Aims: To describe the development of a World Health Organization (WHO) School Mental Health Program (SMHP) in the Eastern Mediterranean Region. Methods: Two tenets guided development of the SMHP: (1) it used a multitiered system of support framework including 3 tiers of interventions (universal, early and targeted); and (2) interventions must be feasible for implementation by non-mental health professionals. Results: The WHO SMHP is organized into a background section, followed by 3 modules: Social–Emotional Childhood Development; Mental Health Promoting Schools (Promotion and Prevention); and Addressing Student Mental Health Problems in Your Classroom, including specific classroom strategies and case examples. Conclusion: Developing an appropriate curriculum sensitive to the needs of individual countries requires involvement of those familiar with schooling in those countries, with mental health priorities and practices that promote mental health, and to coalesce school staff, parents and community members in the service of their children.

Impact of noncommunicable diseases on direct medical costs and worker productivity, Saudi Arabia

Background: The prevalence of noncommunicable diseases (NCDs) has been increasing in Saudi Arabia. Aim: Our objective was to estimate the effect of NCDs on direct medical costs and workforce productivity in Saudi Arabia. Methods: To estimate direct medical costs, we estimated the unit cost of treating 10 NCDs, then multiplied the unit cost by disease prevalence and summed across diseases. To estimate workforce productivity losses, we multiplied gross domestic product per person in the labour force by the loss in productivity from each NCD and the prevalence in the labour force of each NCD. Results: We estimated annual direct medical costs of 11.8 billion international dollars (Int$) for the 10 NCDs assessed (13.6% of total annual health expenditure). We estimated workforce productivity losses of Int$ 75.7 billion (4.5% of gross domestic product). Conclusion: The economic burden of NCDs in Saudi Arabia – particularly the effect on worker productivity – is substantial.

COVID-19 financing strategies for refugees and migrants in the Eastern Mediterranean Region

Background: The COVID-19 pandemic has had devastating consequences on health care systems worldwide. While the world was slowly moving towards achieving health for all, the pandemic destroyed progress made over the past 25 years and exposed the vulnerability of health care systems and health insurance schemes as well as their lack of resilience. Heath care systems failed to respond in a timely and efficient manner, lives have been, and continue to be, lost and vulnerable populations, especially refugees and migrants, are more at risk than ever as many are left out of country vaccination programmes. Aims: The Eastern Mediterranean region hosts 13 million internally displaced persons and 12 million refugees as of 2018. Thus, adopting inclusive health financing mechanisms is crucial to addressing the crisis and protecting indigenous and displaced populations. Methods: By looking at regional best practices and the response of the United Nations, we outline possible financing tools for including refugees and migrants in health insurance schemes for COVID 19 and introduce novel solutions for addressing gaps in funding. Results: Among the suggested solutions are the inclusion of refugees and migrants in national health care systems, setting up community-based health insurance for migrant and refugee populations, as well as introducing a catastrophe bond financing scheme. Conclusions: While COVID-19 is far from over, many countries in the EMR have included migrants in their COVID-19 vaccine rollout plans. While this is not the first instance of inclusion in some countries, many others are unable or do not prioritize migrants in their health systems, to the detriment of the entire country. This paper, therefore, tackles the possible health financing measures which curb or prevent migrants from accessing such systems and presents possible solutions to change the status quo.

Distribution and cost of Syrian refugees operated on in Southeastern Anatolia, Turkey

Background: As a result of the Syrian civil war, > 5 million Syrian citizens have fled to neighbouring countries, particularly Turkey, under refugee status. Aims: To analyse the cost and justification for surgery of Syrian refugees treated in a secondary care hospital in Sanliurfa, Southeastern Turkey, close to the Syrian border. Methods: We enrolled 1458 Syrian refugees who were operated upon between 2012 and 2015. The data were obtained through a retrospective search of the hospital information system. Patients were divided into traumatic and nontraumatic cases. Injured body regions, anaesthetic technique, duration of operation, length of hospital stay, sociodemographic features and treatment cost were recorded and analysed. Results: Length of the hospital stay was 7.66 (0.31) days for all 1458 patients. The most common operations were orthopaedic, urological and cranial surgery. The total healthcare costs while patients stayed in hospital was ~US$ 2 million, and cost per patient was US$ 1400. Conclusions: The number of trauma operations performed has declined between 2012 and 2015. Health spending on refugees is an indicator of the economic burden on the country

Stegomyia indices of Aedes aquatic stages in El Geneina town, Western Sudan

Background: Darfur in Western Sudan has the most volatile camps of internally displaced persons (IDPs) and has experienced several outbreaks of dengue, chikungunya and yellow fever. Aims: To determine the prevalence and Stegomyia indices of Aedes aquatic stages in El Geneina town, Western Darfur. Methods: Cross-sectional entomological surveys of immature stages of Aedes were carried out during August–November 2019 in 4 sites with IDP camps and a residential area with no camp. Results: We searched 17 730 houses, IDP camps and buildings of governmental corporations for Aedes larvae, and 6809 (38.4%) were positive for Aedes aquatic stages. Both Aedes aegypti and Aedes vittatus larvae were found. However, A. aegypti constituted > 90% of the larvae. Six positive water containers were recorded: tyres, clay pots, barrels, plastic water tanks, flower vases and old cars: 26% of 92 tyres contained Aedes larvae compared to 23.8% of 21 old cars and 17.1% of 44 198 clay pots. This suggested that clay pots were the main source of Aedes. The results showed high infestation of El Geneina town with Aedes immature stages in all study sites including public buildings and residential areas with no IDP camps. Stegomyia indices varied among study sites, and were more elevated in sites with IDP camps. For all sites, House index = 38.40, Container Index = 11.40, Breateu index = 13.60 and Pupa Index = 27. Conclusion: Multisectoral response coupled with community participation are urgently needed to reduce the burden of Aedes-borne diseases in the unstable El Geneina town.

Health system considerations related to voluntary and forced displacement in the Eastern Mediterranean Region: a critical analysis of the available literature

Background: The WHO Region for the Eastern Mediterranean has had a history of complex migration patterns, with high levels of migration to, from and within the Region, overlaid by massive recent forced displacement. Relatively little is known about the health system response to this large-scale mobility. Aims: To review the literature on the Region critically, identify gaps and suggest areas needing research and policy attention. Method: A search of the published literature using MEDLINE and POPLINE was conducted on health and migration focusing on the WHO health system building blocks with no date or language limitations. Results: Out of 4679 retrieved articles published between 1964 and January 2019, 140 met our inclusion criteria; 45 additional articles were included in a December 2020 update. Most publications focused on refugees and on the delivery of services. Conclusions: Few studies explored the responsiveness of health system to refugees and migrants compared with those for host communities, or assessed the quality of services or refugees’/migrants’ perceptions of available health services. Few suggested new approaches to financing health care access for these populations or new governance arrangements.

Behavioural and emotional symptoms among schoolchildren: a comparison between Jordanians and Syrian refugees

Background: There is a high prevalence of mental illness, including depression, anxiety, nicotine dependence, and sleep disorders among Jordanian adolescents and schoolchildren. There are many young Syrian refugees in Jordan, who have an increased risk of physical and psychological illnesses. Aim: To assess the behavioural and emotional symptoms among Syrian schoolchildren refugees in Jordan and their Jordanian counterparts. Methods: A cross-sectional, descriptive study was conducted from October to December 2018 on Syrian and Jordanian schoolchildren, aged 12–17 years, attending the same schools in 4 cities with the highest density of Syrian refugees. A self-reported questionnaire was used to collect information about sociodemographic characteristics. The Strengths and Difficulties Questionnaire was used to measure behavioural and emotional symptoms. Results: This study included 1877 Jordanian schoolchildren and 1768 Syrian schoolchildren refugees. The Syrian children’s parents were significantly less educated and had significantly lower incomes and larger families than Jordanian parents had. The total difficulties and peer relationship problems were abnormally high in more than half of children. Compared to Jordanians, Syrian schoolchildren had more total difficulties (58.2% vs 52.5%), and peer relationship (55.5 vs 53.6%), conduct (47.6% vs 44.8%), and emotional problems (32.0% vs 30.8%), but they had fewer hyperactivity/inattention problems (35.5% vs 36.9%), and prosocial behaviour problems (42.5% vs 43.0%). In binary logistic regression, Syrian were more likely than Jordanian schoolchildren to experience overall difficulties and emotional symptoms. Conclusion: There were significant but unspoken behavioural and emotional symptoms and mental health needs among Syrian and Jordanian schoolchildren. They are all in need of urgent psychosocial support.