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On this page from Medecins Sans Frontieres, you can find resources intended for educational and training purposes on various subjects: inclusive language, healthcare disparities, sexual orientation and gender identity, and more.

In this blog, Dr Ahmed Khalafalla looks at the war in Sudan and its disastrous consequences for the health system. He outlines his observations about the impacts of war and conflict on patient safety, from shortages of medical equipment to disruptions to vital primary care services. War is the worst thing a person can experience. The history of the civil war in Sudan goes back to the birth of the modern, post-colonial nation. Its sparks erupted in the year 1955 in southern Sudan, with demands for political and human rights in the southern region. Since that date, the country has experienced many internal wars, including the outbreak of this last war on 15 April 2023 in the Sudanese capital, Khartoum. This latest fighting has been fuelled by vertical and horizontal divisions in the Sudanese Armed Forces and paramilitary groups, which have been the tool of this chronic war. As a result of the war, the institutions of the country have gradually abandoned their functional role, and this is seen especially with regard to the provision of healthcare services. During this latest war, many of the health service’s institutions have gone out of service, either due to the lack of equipment and the loss and shortage of healthcare professionals, or because of direct targeting by both sides of the conflict. This targeting is a clear violation of all local and international norms and laws, and means the Sudanese healthcare system faces tragic conditions. It has lost its ability to adapt to bear the burdens of this war throughout the country, and the war has exposed medical teams, first aid teams and emergency committees to many risks related to their own safety. And because patient safety relies on the safety of medical teams, the provision of safe medical services has been disrupted. I have been observing the impact on the health system throughout this latest war, and can see that from the top of the health system management hierarchy, there has been an absence of management. Government institutions lack adequate plans to manage this disaster. Some of the biases and limitations that are associated with power have also had an impact on how the health system has fared. But there is hope. In spite of these challenges, the Sudan Medical Association—represented by its executive committee, its branches in the states, its general assembly and its emergency groups— has displayed leadership and provided a practical alternative that has contributed to the management of healthcare during the conflict. It has been able to organise and direct the healthcare system to adapt to the disaster of the war. According to the latest report of the Sudan Medical Association and its Preliminary Committee, which was issued on 1 June 2023: 66% of hospitals adjacent to war zones are out of service out of (89) basic hospitals in the capital and the states, there are (59) suspended hospitals and (30) hospitals that are fully or partially functioning (some of them provide first aid only. many hospitals are threatened with closure due to the lack of medical staff, medical supplies, water and electricity, According to another report dated 12 June 2023, the number of civilian deaths reached 958, in addition to about 1,000 other deaths in Western Sudan that are not included in the report, and the number of casualties is 4,746. These numbers do not include deaths and injuries among soldiers on both sides of the war. Here are my observations about the impact of war on patient safety: The collapse of leadership, administrative systems and communication management systems has a direct impact on case management, which impacts patient safety. War makes it more difficult for the population to find and access medical and health services. Often, patients cannot be safely and appropriately transported to healthcare facilities. During a war, the quality of healthcare services deteriorates, for example in areas such as infection control and patient falls. Communication between medical teams becomes more difficult. Identifying injured patients and those who have died is very challenging and large numbers remain unidentified. The accumulation of bodies in the roads leads to environmental risks. The collapse of the primary healthcare sector and related services increases patient safety risks for key groups of patients. It becomes harder to follow-up with pregnant women and people with chronic diseases and disabilities. Immunisation services and childhood vaccinations are interrupted and infectious disease and environmental health services cannot fully function, which may lead to emergence of epidemic outbreaks. Lack of availability of medicines, diagnostic and therapeutic medical devices increases the risks to patient safety. Medical staff shortages become much worse. In Sudan there is an acute shortage of medical staff in areas including orthopaedics, general surgery and emergency doctors. Further blogs from Dr Ahmed Khalafalla: Spotlight on Sudan: How can we improve healthcare services during war?

In this article in the New Yorker, Lucy Easthope, who has worked on major emergencies since 9/11, says that small interventions can make a significant difference.

This new report from the British Red Cross describes how asylum seekers struggle to access the internet and lack digital tools. The British Red Cross explained that the report aims to improve understanding of the experiences of digital exclusion among people seeking asylum, and how these experiences may impact access to, and experience of, healthcare. Researchers conducted interviews with 30 people currently seeking asylum across England for the report. The researchers themselves also had lived experience of seeking asylum.

In fragile, conflict-affected and vulnerable settings there is an urgent need for action on quality of healthcare, given the significant health needs of the populations in these environments and the increasing numbers of people for whom such settings are home. The Quality of care in fragile, conflict-affected and vulnerable settings: tools and resources compendium represents a curated, pragmatic and non-prescriptive collection of tools and resources to support the implementation of interventions to improve quality of care in such contexts. Relevant tools and resources are listed under five areas: ensuring access and basic infrastructure for quality shaping the system environment reducing harm improving clinical care engaging and empowering patients, families and communities. Cross-cutting products are also signposted. The compendium is a companion to the World Health Organization resource Quality of care in fragile, conflict-affected and vulnerable settings: taking action.

Fragile, conflict-affected and vulnerable (FCV) settings is a broad term describing a range of situations including humanitarian crises, protracted emergencies and armed conflicts. In FCV settings delivery of quality health services faces significant challenges, including disruption of routine health service organization and delivery systems, increased health needs, complex and unpredictable resourcing issues, and vulnerability to multiple public health crises. Despite the difficulty of addressing quality in FCV settings, the need is acute, given the significant health needs of the populations in such environments and the increasing numbers of people for whom FCV settings are home.   WHO is working with Member States, the Global Health Cluster, and technical and academic partners to support action to address quality in FCV settings. Building on the foundations of the WHO National quality policy and strategy initiative, WHO has developed a technical document, “Quality of care in fragile, conflict-affected and vulnerable settings: taking action”. The document outlines a practical approach to action planning and implementation of quality interventions in FCV settings and is accompanied by a curated compendium of tools.

Nurses often express a desire to serve others as a volunteer. They volunteer within their communities and across borders in global settings. While nurses considering participation or serving as a volunteer express altruistic intention, their actions may result in unintended adverse consequences to the host community. The purpose of this position statement is to promote ethically responsible volunteer efforts classified as short-term (six months or less) practice experiences in local and global healthcare and public health.

This paper, published in Tropical Diseases, Travel Medicine and Vaccines, aims to present contemporary criticism of medical volunteering. A range of ethical concerns are identified and possible ways of alleviation suggested. 

Save The Children are further strengthening their policy and regulatory frameworks to assure medical safety, while promoting a culture of learning to minimise medical incidents and maximise patient safety across their programmes. This article discusses why reduction of avoidable harm within healthcare is so important, and why more can be done within the international development sector.

Months before Hurricane Helene would devastate the Southeast, the Institute for Healthcare Improvement was launching its Chief Quality Officer Network. The group was to serve as a forum for best practices on quality and safety for executives around the world. Hospital leaders discuss how they navigated the healthcare challenges caused by Hurricane Helene, including working together through the CQO Network to share solutions.  

This article in The Lancet examines the role of national public health institutes (NPHIs) in dealing with health emergencies in the Eastern Mediterranean region. NPHIs are science-based organisations or networks concerned with public health functions in countries. The Covid-19 pandemic highlighted the importance of NPHIs and their potential in future emergency preparedness and response (EPR). A 2022 global review acknowledged the contribution of more than 13 NPHIs in the Eastern Mediterranean region during the pandemic and called for more clarity on the future role of NPHIs in EPR. These NPHIs have different governance models, organisational mandates, capacities and links within national and global systems—and this complexity raises questions about how they should best be engaged in EPR.

This article in The Lancet looks at the need to prioritise palliative care and medications during armed conflict. The authors argue that the Israel–Hamas conflict amplifies the dire need for access to morphine and other essential palliative care medicines included on WHO's Model Lists of Essential Medicines in order to alleviate serious health-related suffering during humanitarian crises. They outline calls that the global palliative care community has made to the World Health Organization (WHO) and other aid organisations to: add adequate oral and injectable morphine and other pain-relieving medicines in humanitarian aid response packages ensure adequate essential medicine supplies for surgery and anaesthesia provide guidelines on the safe use of essential medicines and their distribution to all aid and health workers collaborate with receiving authorities to prevent removal of controlled medicines from emergency kits include paediatric essential medicine formulations for children. They argue that opioids and other essential palliative care medicines equip health workers with the means to relieve serious health-related suffering across clinical scenarios when curative or life-saving interventions are unavailable.

Conflicts and wars contribute substantially to the development and spread of antimicrobial resistance (AMR). War-related factors that contribute to AMR include restricted resources, high casualties, suboptimal infection prevention control, and environmental pollution from infrastructure destruction and heavy metals release from explosives. This article in The Lancet looks at the impact of the war in Gaza on AMR. It highlights that access to essential antibiotics, primarily through donations, has been a continuous challenge due to the blockade of Gaza and that Gaza's already restricted national surveillance system for AMR adds to the challenges.

To overcome this preventable disease we need to invest in failing infrastructure and tackle humanitarian crises at cholera’s roots, says Petra Khoury in this BMJ article. Once thought to be close to eradication, cholera is back—dehydrating and killing people within hours and ravaging communities across six continents. Despite the alarming numbers of cases and deaths over the past year, decision makers are averting their eyes, leaving people to die from a preventable and treatable disease. The healthcare community should sound the alarm for immediate actions. A strong and global emergency response is urgently needed, but it is only a first step. More than ever the world must invest in water and sanitation systems and prepare communities before outbreaks occur.

This literature review in the Journal of Patient Safety aimed to assess lessons learned on patient safety in Organization for Economic Cooperation and Development (OECD) countries, and to assess whether they can be applied to humanitarian medicine. The authors concluded that safety culture and strategies will need to be adapted to address different intervention contexts and to respond to the concerns and expectations of humanitarian staff. As there is no overarching authority for the sector, medical humanitarian organisations, have a major responsibility in the development of a general patient safety policy in all their operations.

Despite widespread condemnation of the UK's asylum partnership arrangement with Rwanda, the Home Office appears to be going ahead with its plans to relocate to east Africa people who it deems to have arrived illegally and who are therefore not eligible for asylum in the UK. The policy, formed in response to increasing arrivals of migrants in small boats (28 500 arrived to the UK in 2021), has been hailed by Prime Minister Boris Johnson as the “morally right thing to do”, and is designed to deter refugees from entering the country through “illegal, dangerous or unnecessary methods”. Faith leaders, charities, civil servants, and members of parliament in the UK have denounced the plan as unethical, wrong, racist, and callous—sentiments echoed by the UN Refugee Agency (UNHCR), Human Rights Watch, and Amnesty International. The agreement is unfair and shameful. It might be illegal and is certainly immoral. It is also undoubtedly bad for health.

In 2020, 82 million people worldwide were forcibly displaced. In the same year, the UK received applications for asylum for over 37,500 people. Over 40% of those were women and children, and 8% were children who had arrived in the UK alone without a parent or guardian. This information produced by the Royal College of Psychiatry aims to support health and social care professionals in the UK coming into contact with displaced people. It provides information, guidance and support to ensure timely, high-quality care. This resource provides information on the following subjects: Experiences of mental illness in asylum seekers and refugees Distress and common mental illnesses in displaced people Approaches and principles Need for triage Barriers to accessing healthcare Safeguarding

A large proportion of avoidable harm and adverse events occur in fragile, conflict-affected and vulnerable (FCV) settings. This article in the BMJ Open outlines the online Delphi study approach that will be taken to generate a consensus on the most relevant patient safety interventions for FCV settings. The results of this study will create a list of the most relevant patient safety interventions, based on the consensus reached among a range of experts including frontline clinicians and administrators, non-governmental organisations, policymakers and researchers. The study aims to increase awareness of the issues in this area, and identify priority interventions as well as areas for further evaluation and research.

This article in the Journal of Global Health aimed to consider which patient safety interventions are the most effective and appropriate in fragile, conflict-affected, and vulnerable (FCV) settings. The authors examined available literature published between 2003 and 2020, using an evidence-scanning approach. They found that the existing literature is dominated by infection prevention and control interventions for multiple reasons, including strength of evidence, acceptability, feasibility and impact on patient and healthcare worker wellbeing. They identified an urgent need to further develop the evidence base, specialist knowledge and field guidance on a range of other patient safety interventions such as education and training, patient identification, subject specific safety actions and risk management.