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Concept: Peacekeeping

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Introduction of Vibrio cholerae to Haiti during the deployment of United Nations (UN) peacekeepers in 2010 resulted in one of the largest cholera epidemics of the modern era. Following the outbreak, a UN-commissioned independent panel recommended three pre-deployment intervention strategies to minimize the risk of cholera introduction in future peacekeeping operations: screening for V. cholerae carriage, administering prophylactic antimicrobial chemotherapies, or immunizing with oral cholera vaccines. However, uncertainty regarding the effectiveness of these approaches has forestalled their implementation by the UN. We assessed how the interventions would have impacted the likelihood of the Haiti cholera epidemic.

Concepts: Epidemiology, Microbiology, Vibrio cholerae, United Nations, Cholera, Vibrio, Peacekeeping, United Nations Security Council

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Media reports of leukaemia and other cancers among European United Nations (UN) peacekeepers who served in the Balkans, and a scientific finding of excess Hodgkin lymphoma among Italian UN peacekeepers who served in Bosnia, suggested a link between cancer incidence and depleted uranium (DU) exposure. This spurred several studies on cancer risk among UN peacekeepers who served in the Balkans. Although these studies turned out to be negative, the debate about possible cancers and other health risks caused by DU exposure continues. The aim of the present study was to investigate cancer incidence and all-cause mortality in a cohort of 6076 (4.4% women) Norwegian military UN peacekeepers deployed to Kosovo between 1999 and 2011.

Concepts: Epidemiology, Cancer, European Union, Serbia, NATO, Kosovo, Montenegro, Peacekeeping

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Stan Houston and Adam Houston highlight how deployment of UN peacekeepers has the potential to introduce artemisinin-resistant malaria into Africa.

Concepts: Introduction, Steve Morse, Peacekeeping

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Sexual violence is highly prevalent in armed conflict and other humanitarian crises and attracting increasing policy and practice attention. This systematic review aimed to canvas the extent and impact of initiatives to reduce incidence, risk and harm from sexual violence in conflict, post-conflict and other humanitarian crises, in low and middle income countries. Twenty three bibliographic databases and 26 websites were searched, covering publications from 1990 to September 2011 using database-specific keywords for sexual violence and conflict or humanitarian crisis. The 40 included studies reported on seven strategy types: i) survivor care; ii) livelihood initiatives; iii) community mobilisation; iv) personnel initiatives; v) systems and security responses; vi) legal interventions and vii) multiple component interventions. Conducted in 26 countries, the majority of interventions were offered in African countries. Despite the extensive literature on sexual violence by combatants, most interventions addressed opportunistic forms of sexual violence committed in post-conflict settings. Only one study specifically addressed the disaster setting. Actual implementation of initiatives appeared to be limited as was the quality of outcome studies. No studies prospectively measured incidence of sexual violence, although three studies provided some evidence of reductions in association with firewood distribution to reduce women’s exposure, as did one program to prevent sexual exploitation and abuse by peacekeeping forces. Apparent increases to risk resulted from lack of protection, stigma and retaliation associated with interventions. Multiple-component interventions and sensitive community engagement appeared to contribute to positive outcomes. Significant obstacles prevent women seeking help following sexual violence, pointing to the need to protect anonymity and preventive strategies. This review contributes a conceptual framework for understanding the forms, settings, and interventions for conflict and crisis-related sexual violence. It points to the need for thorough implementation of initiatives that build on local capacity, while avoiding increased risk and re-traumatisation to survivors of sexual violence.

Concepts: Game theory, Incidence, Humanitarian aid, Disasters, Peacekeeping, Humanitarian crisis

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In April, 2017, the United Nations (UN) announced that it will withdraw peacekeeping soldiers from Haiti after 13 years there.(1) Known by its French acronym MINUSTAH, the mission has been controversial in security terms, but in terms of public health, it is not controversial to state that peacekeepers will be leaving a heavy mark on the health of Haitians. The UN has acknowledged that peacekeeping soldiers were responsible for both the introduction of cholera (which sparked a nationwide epidemic) and the sexual abuse and exploitation of Haitians, including minors. Despite these acknowledgments, there has been insufficient action to result in justice for either the victims of cholera or the victims of sexual abuse. On July 13, 2017, the UN General Assembly passed a resolution asking the UN member states to consider contributing $40 million in leftover funds from MINUSTAH to the control of cholera in the country, and the member states have 60 days to act.

Concepts: Epidemiology, Human rights, United Nations, United Nations General Assembly, Terrorism, Haiti, Peacekeeping, United Nations Security Council

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This article takes stock of some of the important contributions to the study of peacekeeping (PK). Two key topics stand out: peacekeeping burden sharing and mission effectiveness. For burden sharing, the theoretical foundation is the private provision of public goods and joint products. Implications for burden sharing differ whether financial or troop contributions are being shared, with the latter driven by jointly produced country-specific benefits. Financial burden sharing can also differ between United Nations (UN)-led and non-UN-led peacekeeping operations, wherein country-specific benefits are especially important for the latter. Many articles gauge peacekeeping effectiveness by the mission’s ability to maintain the peace or to protect lives for a set time period. More recently, multiple criteria are raised for evaluating peacekeeping in today’s world of multifaceted peacebuilding operations.

Concepts: United Nations, Periodization, Kosovo, Peace, Peacekeeping, United Nations Security Council, Department of Peacekeeping Operations, Srebrenica massacre

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More than five years after a United Nations peacekeeping battalion introduced cholera to Haiti, over 150,000 peacekeepers continue to be deployed annually from cholera endemic countries. The United Nations has thus far declined to provide antimicrobial chemoprophylaxis to peacekeepers, a policy based largely on concerns that the risks of drug resistance generation and spread would outweigh the potential benefits of preventing future cholera importations. In this study, we sought to better understand the relative benefits and risks of cholera chemoprophylaxis for peacekeepers in terms of antibiotic resistance.Using a stochastic model to quantify the potential impact of chemoprophylaxis on importation and transmission of drug-resistant and drug-sensitive V. cholerae, we found that chemoprophylaxis would decrease the probability of cholera importation, but would increase the expected number of drug-resistant infections if an importation event were to occur. Despite this potential increase, we found that least 10 drug-sensitive infections would likely be averted per excess drug-resistant infection under a wide range of assumptions about the underlying prevalence of drug resistance and risk of acquired resistance.Given these findings, policymakers should reconsider whether the potential resistance risks of providing antimicrobial chemoprophylaxis to peacekeepers are sufficient to outweigh the anticipated benefits.

Concepts: Antibiotic resistance, Probability, United Nations, Cholera, Drug resistance, Peacekeeping, United Nations Security Council, Srebrenica massacre

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To estimate total and cause-specific mortality after international peacekeeping deployments among the Finnish military peacekeeping personnel in comparison to the general population of similar age and sex.

Concepts: Cohort study, Cohort, European Union, Demography, Population, United Nations, Peacekeeping, Department of Peacekeeping Operations

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A large number of studies have shown that hardiness and cohesion are associated with mental health in a military context. However, most of them are presented without controlling for baseline mental health symptoms, which is their most significant source of error. The present study investigates the combined effect of hardiness and cohesion in a prospective design, controlling for baseline levels of symptoms among Norwegian personnel serving in a peacekeeping operation in Kosovo. Multivariate regression analyses were performed in which self-reported mental health complaints were regressed on our explanatory variables. Our findings suggest that both cohesion and hardiness contributed to increased stress resiliency, as measured by a lower level of reported mental health complaints. Our baseline measure of mental health accounted for a larger proportion of the variance than our other predictors. A significant interaction between cohesion and hardiness suggested a combined effect, over and above the individual contributions of the predictors. For individuals who scored high on hardiness, cohesion levels did not influence levels of mental health complaints. Individuals who scored low on hardiness, on the other hand, reported lower levels of mental health complaints when cohesion levels were high.

Concepts: Regression analysis, Linear regression, European Union, Measurement, United Nations, Kosovo, Peacekeeping, Kosovo Force

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Post-Cold War United Nations Peace Keeping Operations (UN PKOs) have been increasingly involved in dangerous areas with ill-defined boundaries, harsh and remote geographies, simmering internecine armed conflict and disregard on the part of some local parties for peacekeepers' security and role. In the interest of ‘force protection’ and optimising operations, a key component of UN PKOs is healthcare and medical treatment. The expectation is that UN PKO medical support will conform to the general intent and structure of UN PKOs. To do so requires effective policies and planning informed by a review of medical aspects crucial to UN PKOs. The intent of this article is to report on a review of principal medical aspects practical to post-Cold War UN PKOs.

Concepts: United Nations, Peace, Peacekeeping, Department of Peacekeeping Operations, Multinational Force and Observers, Military operations other than war