Archives of Iranian Medicine
Volume:23 Issue: 4, Apr 2020

Violence is a challenging modern epidemic worldwide. Less evidence is available on the populations most affected by violence in recent decades. The aim of the study was to ecologically investigate temporal trends of the global burden of violence according to gender, age group, and socio-demographic development.

Data on the age- and gender-specific rates of country-level disability adjusted life years (DALYs) attributable to different types of violence i.e. interpersonal violence (IV), and collective violence (CV) and legal interventions were retrieved from online database provided by the global burden of diseases project. Countries were categorized according to their socio-demographic index (SDI). Incidence rate ratio (IRR) per one year was estimated according to age groups, genders and SDI categories applying Poisson regression modeling.

The highest decrease of the DALYs attributable to IV was observed for the under-five-years age group and then for 5–14-years in both genders, globally. Considering the CV, estimated IRRs were significant only for the under-five-years age group, which was at 1.30 (95% CI: 1.20, 1.40, per 10 years) for girls and 1.29 (95% CI: 1.21, 1.39, per 10 years) for boys.

The rate of DALYs due to IV has been more decreasing among women and children during the recent decades. By the next 10 years, the attributed DALYs to CV would increase up to 120%. Children, adolescents and women are highly affected by CV in countries with middle-low and middle social development in the recent decades.

Childhood trauma exerts a significant effect on psychological life of people. It is a ubiquitous phenomenon. We face a social epidemic with serious consequences that shatter the life of survivors. Victimization in early years of life entraps the individuals in the victim-rescuer-abuser triangle. Many perpetrators and criminals have had history of childhood abuse. The main objective of this study was the assessment of patients with a history of child abuse who behaved in abusive manner in adulthood.

By reviewing the files of 3694 patients referred to my outpatient private clinic, I tried to gather data to answer the questions related to this study including history of abuse, victimization, substance abuse, and the percent of patients who were involved in abusive behaviors in adulthood.

In total, 1075 patients reported a history of some abuse during childhood (29.10%). Of them, 19.44% (total = 209, 78 men and 131 women) behaved as an abuser for most of their life. The prevalence of substance abuse in people with history of abuse was 36.6% compared to 28.36% in those without. The prevalence of acting as an abuser and perpetrator in adult life was 27.5%, 19.5%, 18.4% and 11.11% among the divorced, married, single and widowed respectively.

This preliminary study showed that a significant number of patients with history of childhood abuse involved in abusive behavior and victimization of others in adulthood. Paying attention to this issue by mental health practitioners and policy makers can prevent the intergenerational transmission of abuse and development of a more peaceful society.

To describe the utilization and out-of-pocket (OOP) payments of war survivors receiving health care services and its determinants.

A cross-sectional study was carried out by systematic random sampling at national level (n = 3079) on healthcare utilization in war survivors on their last received services. A validated questionnaire was used to gather the information of inpatient and outpatient healthcare services and OOP payment. The data were analyzed to indicate the determinants of health utilization and expenses.

Health care utilization was reported in 91.6% (n = 2822). The majority (82.5%) received one or two services in their last visits, mostly related to physician visits and medications (65.97%). Health care utilization was higher than general population annually, especially in physician visit (6.6 versus 4.89), medication (5.1 versus 3.6), and hospitalization (0.78 versus 0.15). About 20.2% (n = 599) of the study population paid out of their pocket for their last medical care services. The frequency of OOP payment was greater for physician visit and medication. Payment for hospitalization, imaging, and lab tests were more significantly associated with proceeding to reimburse the expenses (P < 0.001). The median OOP payment was US$10.8 (interquartile range US$20.6). Gender (P = 0.003), area of residence (P = 0.01) and being war victims (P = 0.005) were the significant determinants for both OOP payments and reclaiming the expenditure. Higher amount of payments (P < 0.001) and more received health services (P = 0.002) were also important factors in reclaiming the expenditure.

Both outpatient services and hospital admission are more frequent among war survivors compared to the general Iranian population. Future studies should attempt to explore the reasons.

War causes more death and disability than many major diseases. There are few studies in the context of the deleterious impact of war on fertility potential; therefore, in this study, we tried to review articles about the adverse effects of war on male/ female fertility potential

In this study, a total of 183 articles related to the effects of war on fertility potential were examined by a systematic search using known international medical databases.

Among these studies, there were limited studies on the effects of war on female infertility and most studies examined the effects of war on sperm parameters and male infertility. The physical and psychological trauma of war can increase the risk of infertility in men and women. Presence of reproductive system toxins in weapons, stressful periods of war and direct damage to the reproductive system can impair the fertility of men and women. The way war affects male fertility is not clear, but the higher degree of stress during wartime seems to play an important role. Using reproductive toxicants during the war also increases the risk of impairment in reproductive function in men. Some studies have shown the harmful effects of Sulfur mustard as a war chemical toxin especially on sperm quality and male infertility. Oxidative stress induced by free radicals is a major mechanism for the direct effects of Sulfur mustard on male infertility.

The study of past research suggests that exposure to war may be an independent risk factor for reproductive disorders and infertility in men. For female infertility, war leads to menstrual dysfunction.

As two essential human rights, as well as pillars of sustainable development, health and peace are closely interrelated. Further, health and well-being are the focus of Sustainable Development Goal (SDG) 3, while peace lies at the heart of SDG 16. This paper investigates the relationship between the three concepts of health, peace and sustainable development in the relevant literature.

This is a qualitative study. Following the establishment of the construct of peace and health through consultation with three key informants (one health sociologists, one high-ranking diplomat, and one health policy maker), we conducted a scoping review of the literature, followed by purposefully obtained grey literature, i.e. UN and country reports. As a result, 30 documents, including journal articles, were identified. We used content analysis to extract themes and categorize them in line with the relevant SDGs.

Lack of peace has direct and indirect impact on health, as well as health workers, the civil society, and the whole community who have in turn a critical role in creating peace. Strong and resilient health systems are essential in reaching out to citizens during war, while achieving SDGs would be impossible if SDG 16 is compromised. Health and peace are interchangeable, and achieving either is impossible without the other.

Physicians and other human resources for health are the key actors in peaceful environment to attain health for all. In the absence of peace, the resilience of health system will be threatened and the hope for sustainable development may fade.

The number of deaths and disabilities due to all types of violence has increased; violence and especially war heavily affect public and individual health and all sectors, including the health sector, are responsible for making attempts to take part in mitigation of war effects. However, “peace through health” has not been so far included globally in the curriculum of basic medical schools. The study aims to prepare data on responsibilities that could be devolved to health sector, and the importance and role of education for those health workers who are willing to participate in the peace field

A systematic search in Web of Science, PubMed, Scopus and ERIC was conducted looking for relevant documents following combination of the key terms: peace, health and education.

Health professionals consider war as a serious contagious disease that needs to be prevented like any other diseases. Prevention maneuvers at the primordial, primary, secondary and tertiary stages are important tasks that can be carried out by health professionals; there is an increasing demand for establishment of some courses; the roles and the manner of performing these tasks are not part of medical curriculum and for better execution of these roles, peace through health courses should be developed and then integrated to the current curriculum of health-related universities.

The work of developing peace through health courses has been started before and it will continue until it completely becomes an accepted global course.

Limited studies have reported epidemiologic data on the impact of Iran-Iraq war. This study examines the war casualties for both combatants and civilians on Iranians at national level.

Databases of Veterans and Martyrs Affair Foundation (VMAF), Janbazan Medical and Engineering Research Center (JMERC) and Ministry of Health were used to collect the data. The prevalence of injuries for both civilians and combatants was presented. Casualties were studied based on conventional and unconventional weapons attacks (1980–2018), separately.

The Iran-Iraq war led to 183 623 lost lives, 554 990 injured and 40 240 captured. The mean length of captivity was 45.7 months (1 month-19 years) and 2.7% (n = 575) died in captivity. There were 1 439 180 war related injuries recorded in databanks, mostly affecting men (98.4%). About 1 439 180 injuries were recorded, most of them related to conventional weapons (938 928 [65.24%]). Remaining artillery and mortar fragmentation in the body (39.5%, n = 371 236), psychological disorders (15.9%, n = 228 944), and exposure to chemical weapons (11%, n = 158 817) were the most prevalent war-related injuries.

Human casualties of the Iran-Iraq war on the Iranian side and the health care system are huge even after more than three decades.

Epidemiology can be considered as a responsible public health science the aim of which is to control health problems. One of the most important public health problems is “war”. The aim of the present paper, therefore, is threefold: firstly, to determine to what extent war has been investigated from an epidemiological point of view; secondly, what the definition and scope of “war epidemiology” would be; and thirdly, if it would be possible to introduce a new branch of epidemiology entitled “peace epidemiology”. In the present study, I have tried to fulfill the aims of the study based on my experiences in war and peace epidemiology and also by reviewing the most relevant websites, documents and papers. Evidence suggests that enough epidemiological studies have not been carried out to determine the sheer public health consequences of war. “War epidemiology” can be defined as “the study of the distribution and determinants of war-related events in specified populations, and the application of this study to the control of war”. “Peace epidemiology” is a new branch of epidemiology which “highlights how peace could positively shape our world”. Epidemiologists need to produce more scientific evidence about the negative public health consequences of wars and also the positive public health consequences of peace. The ultimate aim of “war epidemiology” is to control war, usually by secondary and tertiary prevention activities. However, the ultimate aim of “peace epidemiology” is to reinforce peace by primary and/or primordial prevention activities.

According to the purposes for the formation of the United Nations, sophistication of institutions like the Security Council must be evaluated based on the provision of peace and how they guarantee human rights. Therefore, in case Security Council does not follow these two mentioned factors, its function would be itself a threat to the international peace and security. This analytical research is based on collecting library theoretical data related to different field studies which investigated the effects of sanctions issued by the Security Council, the United States and the European Union on citizens’ health and tried to assess both their efficiency and legitimacy. The right to health is connected with the right of living. In case enough drugs, appropriate treatment and medical equipment are not provided at the proper time, both physical and mental health might be threatened and this can cause death of a large number of people. Considering the Security Council as an institution which is expected to take into account the citizens’ basic rights and not to ignore its own initial objective, the present paper was an attempt to provide explanations for the above concepts and their relationships and to analyze the findings of previous field studies. The paper concluded that sanctions issued by the Security Council and the United States are potentially functioning as threats to the international peace and so these sanctions are violating the citizens’ right to health. Keywords

The discussions held by the congress panels can be boiled down to the following convictions. Health professionals, especially those who are working in the Middle East region, have to promote peace as part of their professional responsibility. Moving towards this objective can be realized through a number of measures. It is both necessary and feasible to increase research to identify the causes and consequences of war and violence; and to appropriately translate the findings to politicians, health professionals and masses of people. These can be achieved by means of boosting cooperation between international organizations and of bolstering the position of non-governmental organizations (NGOs) on a global scale. Showing respect to other societies and civilizations, encouraging cultural interactions between societies, and elevating public intellectuality and general demand for reduction of violence can be effective in decreasing the latter and the effects thereof. Of the engagements that health professionals must seriously take on is employing health diplomacy and curbing the accumulation of unrestricted power and unilateralism through enforcing international treaties. Finally, it is essential to make health systems more resilient to complex emergencies caused by wars so that they can survive such conditions.

This report describes an experience of the first international health for peace conference held in November 2018 in Shiraz University of Medical Sciences. This paper discusses the panel on peace education in medical and paramedical schools and the way for the future.