Challenges to conducting epidemiology research in chronic conflict areas: examples from PURE- Palestine

Rasha Khatib, Rita Giacaman, Umaiyeh Khammash, Salim Yusuf, Rasha Khatib, Rita Giacaman, Umaiyeh Khammash, Salim Yusuf

Abstract

Little has been written on the challenges of conducting research in regions or countries with chronic conflict and strife. In this paper we share our experiences in conducting a population based study of chronic diseases in the occupied Palestinian territory and describe the challenges faced, some of which were unique to a conflict zone area, while others were common to low- and middle- income countries. After a short description of the situation in the occupied Palestinian territory at the time of data collection, and a brief overview of the design of the study, the challenges encountered in working within a fragmented health care system are discussed. These challenges include difficulties in planning for data collection in a fragmented healthcare system, standardizing data collection when resources are limited, working in communities with access restricted by the military, and considerations related to the study setting. Ways of overcoming these challenges are discussed. Conducting epidemiological research can be very difficult in some parts of our turbulent world, but data collected from such regions may contrast with those solely from politically and economically more stable regions. Therefore, special efforts to collect epidemiologic data from regions engulfed by strife, while challenging are essential.

Keywords: Cardiovascular disease; Conflict zone; Epidemiology; Low- and middle- income countries; Occupied Palestinian territory.

Figures

Fig. 1
Fig. 1
Map of the West Bank indicating communities included in PURE Palestine

References

    1. Husseini A, Abu-Rmeileh NM, Mikki N, et al. Cardiovascular diseases, diabetes mellitus, and cancer in the occupied Palestinian territory. Lancet. 2009;373(9668):1041–9. doi: 10.1016/S0140-6736(09)60109-4.
    1. Ministry of Health . Annual health report, 2009. 2010.
    1. Abdul-Rahim HF, Husseini A, Giacaman R, Jervell J, Bjertness E. Diabetes mellitus in an urban Palestinian population: prevalence and associated factors. East Mediterr Health J. 2001;7(1–2):67–78.
    1. Abdul-Rahim HF, Holmboe-Ottesen G, Stene LC, et al. Obesity in a rural and an urban Palestinian west bank population. Int J Obes Relat Metab Disord. 2003;27(1):140–6. doi: 10.1038/sj.ijo.0802160.
    1. Batniji R, Rabaia Y, Nguyen-Gillham V, et al. Health as human security in the occupied Palestinian territory. Lancet. 2009;373(9669):1133–43. doi: 10.1016/S0140-6736(09)60110-0.
    1. Rabaia Y, Giacaman R, Nguyen-Gillham V. Violence and adolescent mental health in the occupied Palestinian territory: a contextual approach. Asia Pac J Public Health. 2010;22(3 Suppl):216S–21. doi: 10.1177/1010539510373028.
    1. Giacaman R, Rabaia Y, Nguyen-Gillham V, Batniji R, Punamaki RL, Summerfield D. Mental health, social distress and political oppression: the case of the occupied Palestinian territory. Glob Public Health. 2011;6(5):547–59. doi: 10.1080/17441692.2010.528443.
    1. Abu-Rmeileh NM, Hammoudeh W, Mataria A, et al. Health-related quality of life of Gaza Palestinians in the aftermath of the winter 2008–09 Israeli attack on the strip. Eur J Public Health. 2012;22(5):732–7. doi: 10.1093/eurpub/ckr131.
    1. Teo K, Chow CK, Vaz M, Rangarajan S, Yusuf S, PURE Investigators-Writing Group The prospective urban rural epidemiology (PURE) study: Examining the impact of societal influences on chronic noncommunicable diseases in low-, middle-, and high-income countries. Am Heart J. 2009;158(1):1–7.e1. doi: 10.1016/j.ahj.2009.04.019.
    1. OCHA . West bank movement and access update. united nations office for the coordination of humanitarian affairs occupied Palestinian territory; 2012. 2012.
    1. Soliman AS, Schairer C. Considerations in setting up and conducting epidemiologic studies of cancer in middle- and low-income countries: the experience of a case–control study of inflammatory breast cancer in North Africa in the past 10 years. Cancer Med. 2012;1(3):338–49. doi: 10.1002/cam4.36.
    1. Khader A, Farajallah L, Shahin Y, et al. Cohort monitoring of persons with hypertension: an illustrated example from a primary healthcare clinic for Palestine refugees in Jordan. Trop Med Int Health. 2012;17(9):1163–70. doi: 10.1111/j.1365-3156.2012.03048.x.
    1. Sousa C, Hagopian A. Conflict, health care and professional perseverance: a qualitative study in the west bank. Glob Public Health. 2011;6(5):520–33. doi: 10.1080/17441692.2011.574146.
    1. D'Souza C, Sadana R. Why do case studies on national health research systems matter?: Identifying common challenges in low- and middle-income countries. Soc Sci Med. 2006;62(8):2072–8. doi: 10.1016/j.socscimed.2005.08.022.

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