Evidence map›Paper›PMID 41392142›Full record

ArticlePopulation health metrics2025

Attacks on healthcare in conflict-affected countries: a comparison of temporal trends in ongoing conflicts in Lebanon, Myanmar, occupied Palestinian territory, Sudan and Ukraine using WHO SSA and SHCC data, 2018-2024.

Jayra Usmany, Dennis G Barten, Krzysztof Goniewicz, Fredrik Granholm, Danielle N Poole, Derrick Tin, Frits H M van Osch

Abstract readComparative Study
In one paragraph

Article in Population health metrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Health service disruptions under economic sanctions: evidence from Iran.International journal for equity in health · 2026
    Article
  2. Article
  3. Liver disease care amid wars and conflicts.Nature reviews. Gastroenterology & hepatology · 2026
    Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Jayra Usmany *Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands.
Dennis G Barten *Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands. Dbarten@viecuri.nl.
Krzysztof GoniewiczDepartment of Security, Polish Air Force University, Deblin, Poland.
Fredrik GranholmDepartment of Anaesthesia and Intensive Care, Sundsvall County Hospital, Sundsvall, Sweden.
Danielle N PooleYale School of Public Health, New Haven, CT, USA.
Derrick TinDepartment of Critical Care, University of Melbourne, Melbourne, Australia.
Frits H M van OschDepartment of Clinical Epidemiology, VieCuri Medical Center, Venlo, the Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe Geneva Conventions form the core of International Humanitarian Law (IHL), safeguarding healthcare and protecting civilians from the brutality of war. Unfortunately, these conventions are often disregarded. Attacks on healthcare have devastating effects on healthcare systems, and it is therefore vital to document such attacks and detect possible temporal patterns. This study aims to assess temporal trends in attacks on healthcare in five conflict-affected countries: Lebanon, Myanmar, occupied Palestinian territory (oPt), Sudan and Ukraine.

methodsThis study used two publicly available databases: the World Health Organization Surveillance System for Attacks on Health Care (WHO SSA) and the Insecurity Insight Safeguarding Health in Conflict Coalition (SHCC). Start dates and key events were determined for each conflict based on grey literature searches. From the start dates onward, data on attacks on healthcare were collected. The data collection ended on December 31, 2024. Statistical analysis entailed chi-square tests for temporal trends.

resultsThe WHO SSA and SHCC database reported a total of 4,289 and 5,454 attacks, respectively, in the five investigated conflict-affected countries. For all conflict-affected countries except Lebanon, there were significant differences between the databases regarding the reported number of attacks. Temporal trend analyses revealed that, in Myanmar, oPt, Sudan and Ukraine, the highest number of attacks occurred during the 0-2 month period. In Lebanon, the highest number of attacks was observed in the 9-11-month period. All peaks in the number of attacks were associated with either the immediate or early phase of the conflict or with major conflict escalations.

conclusionsTemporal trend analyses of five ongoing armed conflicts revealed that spikes in attacks on healthcare were either associated with the immediate or early phases of the conflict or with major conflict escalations. Although major differences exist between the WHO SSA and SHCC database, particularly regarding the reported number of attacks, the observed patterns were largely similar.

Indexed as

Armed ConflictsDelivery of Health CareDatabases, FactualHumansLebanonMyanmarSudanUkraineWorld Health OrganizationArmed conflictsAttacks on healthcareTemporal trends

Identifiers

PMID41392142
PMCPMC12822187

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.