Viewpoint

Health-care needs of people affected by conflict: future trends and changing frameworks

The number of refugees and asylum seekers worldwide is increasing, and these populations often experience significant mental health challenges due to their difficult life experiences. This study aims to explore the perspectives of refugees and asylum seekers regarding their behavior when seeking mental healthcare. We conducted a meta-synthesis of thirteen articles published between January 2000 and January 2023. The study identified four main themes: understanding of mental health, utilization of health services, the role of society, and necessary interventions. Based on our findings, we provided recommendations for healthcare providers, governments, and researchers to improve the mental healthcare-seeking behavior of these populations in the future.

Conflicts are increasing and becoming more prolonged, causing some of the highest numbers of forcibly displaced persons in a generation. The relationship between conflict and displacement and morbidity is complex and intersects with political, social, military, economic, and demographic factors. Excess morbidity and mortality in conflict and displacement settings are primarily driven by indirect causes, while direct war-related injuries and mortality usually represent a small proportion of the overall negative consequences of conflict on the health status of the affected population. The main causes of death during conflict and displacement tend to remain similar as in pre-crisis situations, with communicable diseases predominating in low-income countries and non-communicable diseases occurring more frequently in adults in middle-income countries. Conflict and displacement have multi-dimensional effects on the functioning of the health system that adversely affects access to and provision of healthcare. Attacks on health facilities, shortages of human, material and financial resources, reduced access to health facilities, limited availability of data as well as insufficient coordination and leadership are a few of the challenges that exist.

Sexting is increasing among adolescents globally and may be an indicator of sexual activity. Yet researchers know little about sexting patterns of forcibly displaced urban adolescents. We sought to identify patterns of sexting among these adolescents and to determine how sexting patterns differed by adolescents’ digital technology use, support of equitable gender norms, and sexual health practices. Using data from a community-based sample, we identified three groups: non-sexters, or individuals who did not sext (n = 205; 84.7%); moderate sexters, or individuals who received sexually explicit texts and nude pictures, but only sent texts (n = 13; 5.4%); and poly-sexters, or individuals who sent and received both texts and nude pictures (n = 24; 9.9%). We observed differences between sexting patterns and digital technology use, gender norms, and sexual health practices. Understanding these sexting patterns may inform the development and implementation of digital sexual health interventions for forcibly displaced adolescents. This study highlights potential positive outcomes associated with sexting (i.e., condom efficacy and use) as well as its concerning correlated factors (e.g., less access to sexual and reproductive health services) among refugee adolescents. Based on these findings, we offer recommendations for future digital sexual health interventions.

Worldwide there are over 80 million refugees and forcibly displaced people, who are at risk of exposure to repeated potentially traumatic events and ongoing stressors during their resettlement. This article reviews the current knowledge about the prevalence, risk factors, and nature of mental health conditions in refugees. It also addresses the evidence regarding treatment of mental health problems in refugees as well as the major challenges for delivering better mental health care to this population. The article also highlights issues that clinicians need to be sensitive to when assessing and treating refugees with mental health conditions.

Aging is rapidly accelerating worldwide; by 2050, the number of people aged 65 and older will have more than doubled to reach 1.5 billion and represent 16% of the global population. In this chapter, we offer an overview of this demographic trend at the global scale. Beyond the global figures, demographic aging is characterized by many spatial variations across and within countries depending upon fertility levels, quality of health-care provision, socioeconomic development, social conditions, and population policies. We then examine how health and well-being in later life are related to the physical, social, and cultural environments in which older adults are embedded. We finally discuss how contemporary trends exert pressures on older adults, challenge their coping capacities, and pose real equity issues. In particular, four stressors are highlighted: (1) the prominence of neoliberalism and the welfare state retrenchment; (2) climate change; (3) the sharp increase in migration, both national and international; and (4) discriminations.