Introduction: The ongoing war in Ukraine has triggered a large-scale humanitarian crisis, significantly affecting the mental health and psychosocial well-being of the population. In this context, Mental Health and Psychosocial Support (MHPSS) has become a vital component of humanitarian response, requiring coordinated and integrated systems aligned with global standards, such as the Inter-Agency Standing Committee (IASC) framework. Purpose: This research explores how MHPSS coordination mechanisms operate in wartime Ukraine, identifies key actors and systemic barriers, and evaluates the impact of coordinated approaches on access, resilience, and psychosocial well-being. Approach: The study employs a desk-based narrative synthesis methodology, drawing on peer-reviewed literature, humanitarian reports, and policy documents, including the Ukrainian government’s Concept for the Development of Mental Health Care until 2030. Analytical lenses include the IASC MHPSS intervention pyramid and localization theory. The study also proposes visual tools to analyze coordination structures and service delivery pathways. Results: The study finds that Ukraine’s MHPSS coordination system demonstrates notable adaptability and well-developed structures. Core activities such as 4W mapping, non-specialist training programs, and policy alignment initiatives have expanded access, particularly to community-based care. However, challenges including stigma, provider burnout, insufficient funding, and limited rural access continue to constrain effectiveness. Innovative strategies like telehealth platforms and mobile clinics reflect adaptive resilience. Overlapping mandates and data fragmentation further complicate service alignment. Nonetheless, coordinated efforts have reached over 1.2 million individuals in 2023, with early evidence suggesting reductions in psychological distress among internally displaced populations. These findings underscore the critical role of context-sensitive, decentralized approaches in building sustainable MHPSS systems in conflict-affected settings. Conclusions: Ukraine’s MHPSS coordination system demonstrates adaptability and effectiveness in crisis settings, but enduring structural challenges remain. Future priorities should include strengthening local leadership, ensuring long-term financing, and integrating services to ensure sustainable support in crisis contexts.
Rihab Imam Mukhtar Elsharief, Magda Elhadi Ahmed Yousif, Abeer Abd ELrhman ELnour ELtilib
Background: Armed conflict has catastrophic effect on public health and overall wellbeing including causalities during war, long lasting physical and psychological effects, the reduction in human and financial resources which available to meet social needs and creation of setting in which violence is primary domain this issues clearly appeared in Sudan since conflict between Sudan army force and Rapid response force in 15th of April 2023. Methodology: This review aimed to reflect the effect of armed conflict on public health especially vulnerable groups and create plan for reform of collapsed health system during and after war in Sudan. Comprehensive review for previous related article using Pub –med, Google scholar Lancet and records from Federal and Local Ministry of Health in Sudan was done. Also SWOT analysis for current complexes was done to detect problems and achieve solutions. Results: The study reflects the effect of armed conflict on public health in countries suffered from war. The vulnerable populations those sufferings during war are elderly, children, neonates and women. SWOT analysis for current situation in Sudan reflects devastating effect of war in healthcare system. The study also offering a plan for strengthening of healthcare system which build on decentralization policy, Innovation related to community healthcare workers (CHWs) adoption and health-financing system strengthens. Conclusion: Strengthening of healthcare systems after disasters is an urgent concern, especially in countries that have experienced armed conflict due to great impact on public health. However, since few studies have been conducted concerning this topic in Sudan, further research is recommended.
This Note addresses the implementation of health insurance reform in Yemen. As a result of a system of user fees and a lack of health insurance, the current regime poses serious barriers to health care access for Yemen's uninsured citizens. When the dust settles from the ongoing conflict with Houthi rebels, the time will be ripe for replacing Yemen's health financing system. In order to rebuild trust and curb abuse in the public health system, legal reforms are required to implement health insurance through decentralized decision-making and accountability measures. The Welfare Regime Framework accommodates these general reforms through policies that reflect the particular circumstances of Yemen. The implementation of health insurance reform will require policy reforms that bring together local, national, and international stakeholders to finance and develop management capacity for community-based health insurance in Yemen.
This article analyzes the process through which WHO was established on the basis of the experience of the League of Nations Health Organization (LNHO). The article particularly focuses on the LNHO technocrats. Through their prewar experiences, technocrats realized that international health governance could promote international cooperation, while it could be utilized by various national representatives as one of their diplomatic strategies. Technocrats tried to alleviate this vulnerability by balancing big powers with smaller powers, national representatives with specialists, and centralization with decentralization. Their efforts and the development of international security in which economic and social cooperation were evaluated as a means towards international security resulted in the international health governance's autonomous establishment under the UN system, which can be termed as the origin of “human security.” The development of social cooperation in the postwar period can be considered to be an extension of their efforts in the League of Nations.
BACKGROUND: The Ministry of Defense budget constitutes 16% of the state budget. The budget for the Ministry of Health and for civilian health care is derived from the state budget. The health care funds receive their budgets from several sources. The capitation formula, which is determined by law, is the main factor that affects the size of the budget each fund receives. OBJECTIVE: The objective of this study is to describe the manner of planning, managing, monitoring, and controlling the budget allocated to medical services, which is a public budget for soldiers. METHODS: Several parameters are suggested for comparison, including the interface with the civilian health system, the method for budgeting a health care system, possible results of managing a medically centered budget, and the possibilities for monitoring the provided services. We also examine the potential for decentralization of authority. CONCLUSIONS: Managing the budget and locating appropriate alternatives, as well as the availability and accessibility of medical services, are important for procurement and for forming contracts with both military and civilian systems. Turnover based on updated information might serve to improve future health services.
At first thought, there would appear to be little or no obvious connection between Landmarks in Hepatology and the essay recently published in the New England Journal of Medicine by 1986 Nobel Peace Prize Laureate Elie Wiesel.1 In 40 articles published over the past 4 years, the Landmarks series has not only documented the background of numerous discoveries in hepatology that have resulted from observation and experimentation, but it has also celebrated the physicians and investigators who brought us these new hepatological insights, investigations, and therapies. The Landmarks essays have been embellished with play on words and other attempts at humor, biography, history, politics, and the arts, and have presented for the readership abstruse facts and historical trivia to enhance the appreciation and enjoyment of the science and clinical innovation of hepatology. In contrast, Professor Wiesel's essay reminded us of one of the saddest eras in medical experimentation that serves as an archetype for inhumanity perpetrated by physicians, often but not always in the name of science, on hapless human subjects who had no choice but to participate in the most cruel and brutal experiments. It goes without saying that there was no semblance of informed consent. Wiesel refers, of course, to the medical experiments carried out by Nazi physicians and their henchmen and lackeys during the Dark Age known as the Third Reich. Out of this sordid experience, portrayed in the accounts of survivors and eyewitnesses, historical documents, and in the testimonies of those physicians who faced the Nuremberg Tribunal, ethical rules for experimentation on patients and volunteers were codified2 (Fig. 1). Surely, however, there is no connection between the celebration of hepatological discovery and the perversion of Nazi medical brutality—but there is. And because there is we have the opportunity, justification, and, in fact, the duty to confront the memory of these events so as to reinforce our vigilance and determination to uphold the highest ethical standards in hepatology and, indeed, in all of medicine, be it experimental science or routine clinical practice. This connection between discovery in hepatology and cruel experimentation was personified by one of the most prestigious and prodigious investigators in liver disease in the 1920s and 1930s; namely, Hans Eppinger. Observant and perceptive readers of Landmarks in Hepatology will surely have noticed that until now there has been no mention of Hans Eppinger nor any reference to his many contributions in the field. This purposeful exclusion came about, rightly or wrongly, because I felt unable to honor this physician-scientist for his early discoveries, knowing full well about his later utterly ethically unacceptable activities as a medical leader, physician-scientist, and human being. This month's article will therefore redress the balance with respect to both components of that man's extraordinary career, which ended ignominiously in self-destruction. My decision to revisit those tragic events was not taken lightly; it is also in full keeping with the commitment expressed in the first paragraph of the very first article in this series,3 which promised enlightenment in order to avoid repetition of past mistakes. Whereas it is hard to believe that anything as terrible as occurred under the auspices of Nazi medicine could happen now or in the future, we can never be reminded too often of the needs for obtaining true informed consent, for full disclosure in explaining the likely outcome of our actions as physicians, and of partnering with rather than patronizing our patients and study volunteers. Physicians have an abiding responsibility toward their patients and experimental subjects, whose rights must be protected and championed even when the good of the community, of the state, and of humankind appears to be at stake. It is timely to address this issue now in the closing days of the year that simultaneously commemorated the 60th anniversary of the liberation of the Nazi extermination camps at the end of the Second World War and saw the wide distribution and acclaim of the movie Hotel Rwanda, which poignantly and painfully chronicled a recent modern genocide so graphically. We have yet to learn the full extent of physician participation and complicity in the abuse and torture of detainees at Abu Ghraib.4, 5 To paraphrase Elie Wiesel in his interview with Professor Georg Klein6 on December 10, 2004, in connection with the Nobel Peace Prize that he was awarded for his work on genocide and for his message of peace, atonement, and human dignity, "It was not hatred that perished at Auschwitz….only the victims died." Hans Eppinger was born in Prague in 1879 supposedly into a part-Jewish family of so-called "Privileged Jews"7-10 who, thus entitled by the Emperor, enjoyed social, civil, and professional liberties that were out of reach to their less favored co-religionists. It may appear paradoxical that Eppinger was also apparently accredited years later as an "Official Aryan" by the National Socialist authorities, a designation that was clearly linked to his joining the Nationalsozialistische Deutsche Arbeiter-Partei (NSDAP); i.e., the National Socialist German Workers' Party, nicknamed the Nazi Party. Yet it was not uncommon that exemptions to the 1935 Nuremberg Racial Laws were granted to certain Mischlinge; i.e., Jewish half-breeds, and incongruously many Deutschblütigkeitserklärüngen (Certificates of German Blood) were actually signed by Adolf Hitler himself, thereby officially classifying the recipients as Aryans when such outright hypocrisy suited the Führer and his kind.11 An astounding number of these Mischlinge were promoted to high rank in the German Armed Forces, and some even prospered politically.11 It should be noted, however, that the truth about Eppinger's ethnicity is still not known, and more discovery about it is needed. In 1902, more than 30 years before these grotesque events transpired, Eppinger was awarded his Doctorate in Medicine in Graz, where 20 years earlier his father, Hans Eppinger senior, had been appointed Professor of Pathological Anatomy. After staying for a few years, Eppinger moved to the famed Allgemeine Krankenhaus (General Hospital) in Vienna, where he rose to become First Assistant in the First Medical Clinic, which was headed by the internationally acclaimed cardiologist Karel Frederik Wenckebach. Later, when he was a full Professor of Medicine, Eppinger accepted the position of Chair of Medicine in Freiburg im Breisgau, after turning down offers from Strassburg, Halle, Königsberg, Leipzig, Frankfurt, and even Berlin. He left for Cologne in 1930, but it was there that in April 1933—ironically, probably because of his part-Jewish heritage—he fell foul of the Brown Shirts, Hitler's Sturmabteilung (SA or Storm Division). He hurriedly returned to Vienna to head the First Clinic but, importantly, because of his tussle with the German Reich, this appointment was permitted only after the intervention of Kurt von Schuschnigg, the Austrian Education Minister, who was to succeed Engelbert Dollfuss as Chancellor when the latter was assassinated in July 1934. Eppinger's professional interests and expertise ran the gamut of internal medicine and pathology, and he published extensively on topics as diverse as bundle branch block, diaphragmatic defects, cardiac asthma, circulatory dysfunction, nephrosis, hemolytic anemia, the inflammatory reaction, parathyroid disease, and many more besides.7 He was a fanatical and overzealous experimenter and at the same time a much sought-after clinical consultant for monarchs, heads of state, and other notables, including Josef Stalin and the Dowager Queen Marie of Rumania. It was rumored that he had also attended Adolf Hitler, but this possibility was dismissed by the late Fritz Redlich (1910-2004) in his biography of the German dictator,12 on the grounds that Hitler did not like famous and overbearing academic physicians and was pathologically as secretive about his health as he was over other details of his personal life and history. By coincidence, Redlich, who was Chair of Psychiatry (1950-1967) and Dean of the Medial School (1967-1972) at Yale University, had been a medical student and resident in Vienna when Eppinger was Chair of Medicine, before he emigrated to the United States in 1938. There are several associations between Eppinger and modern hepatology. First, of course, was his fascination with liver disease, in which he undertook many studies. Arguably his most important—one could say "Landmark"—contribution was in helping to dispel the myth that jaundice in hepatitis, so-called "catarrhal jaundice," is due to biliary obstruction caused by ascending duodenal inflammation, swelling of the ostium of the bile duct, and mucus biliary plugging, as Gabriel Andral and his many followers maintained.13, 14 Eppinger reasoned instead that toxins absorbed from the intestines injured the endothelium in the liver ("capillaritis"), causing intralobular edema and allowing serum to escape from the blood and deposit in the space of Disse.15 Eppinger's monograph on liver pathology and therapy, in which this hypothesis of "serous hepatitis" is also discussed,16 was, in its time, the handbook or bible for anyone interested in liver disease. The second link between Eppinger and modern hepatology was his mentorship of and complex relationship with the late Hans Popper (1903-1988), the undisputed father of hepatology in the latter part of the 20th Century.8-10, 17 Hans Popper worked in Eppinger's laboratory both in Vienna as a medical student and later in Freiburg in 1928.9, 10 When Eppinger returned to Vienna in 1933, he persuaded Popper to transfer from the Institute of Pathology to the First Medical Clinic as an Assistant Physician. Next, Eppinger appointed Popper and Hans Kaunitz (who, like Popper, was Jewish) to supervise a new ward that he opened. During all of his activities, Eppinger's brilliance and achievements were indelibly stained by defects of personality and character, which were well recognized by all who knew him and of him. Notwithstanding Popper's admiration for him as a scientist and his profound debt to him as a mentor and supporter, these flaws alone were grave enough to mar Eppinger as a role model for young scientists and physicians. As John Cornwell points out in the opening of his book on Hitler's scientists,18 quoting François Rabelais,19 "Science without conscience is the ruin of the soul" — Science sans conscience n'est que ruine de l'âme — a warning that might have been written with Eppinger in mind. Eppinger had no scruples10; he stole case histories from other physicians and had to be supervised while watching operations in case he stole instruments as well. He was banned from the University library after being caught cutting pages out of books and bound journals. He stole gallbladders from Wenckebach's laboratory and later, using these specimens without due acknowledgment, he published the phenomenon of gallbladder edema in patients who died of beriberi. Eppinger's callous handling of his patients was no less dishonorable or overt. In his autobiography, the esteemed German theologian Helmut Thielicke described the cruel, dangerous, and demeaning treatment he received from Eppinger, whose advice he had sought for severe tetany following inadvertent parathyroid injury.20 Otto Fleming, who had been a medical student in the 1930s in Vienna and who later was a general practitioner in south Yorkshire, UK, recalled how he and all his fellow students were shocked by Eppinger's brutality when he reduced a patient to tears by explaining to those present in the lecture theater that this man with nephritis was in the "final act of the tragedy" of his disease.21 Apparently even those in NSDAP circles in Vienna complained about, among other criticisms, Eppinger's brutality to his patients and his reckless driving.22 Werner Creutzfeldt, Professor Emeritus and former Chair of Medicine at the University of Göttingen for 28 years, recalled Hans Popper inferring that Eppinger had a hole in his brain where other people have a conscience. Creutzfeldt also related to me that even almost a score of years after Eppinger's departure from Freiburg, senior nurses still in practice there vividly remembered Eppinger's heartless attitude towards his patients, a contrast to the warmth of their nostalgia for Siegfried Thannhauser, who succeeded him briefly. There is no doubt that Eppinger was an ardent Nazi, as Redlich described him,12 and played a key role in the dastardly Sea Water Experiments in the Dachau concentration camp.22-24 However, these signature activities in his curriculum vitae are either glossed over euphemistically or omitted completely from the many available, albeit brief, biographical accounts of Eppinger's life.7-10, 25, 26 Eppinger was dismissed from his position in the University of Vienna after the war, in June 1945, because he had been a member of the then-illegal Nazi Party in Austria before the Anschluss; i.e., the annexation of Austria by Germany.27 He had also been a clandestine member of the nationalistic Deutschen Klub, to which he had paid dues since November 1937.22 He stood idly by when 153 of the 197 medical faculty in Vienna were sacked within weeks of the Anschluss, mostly for being Jewish.28 Eppinger may not have been driven by extreme racist views per se—after all, he had appointed several Jews like Popper and Kaunitz to high positions in his Clinic. Rather, Eppinger fervently believed that the goals of the Third Reich offered the best future for Germans everywhere. Whether this was the main philosophy of so many other physicians, who it must be remembered represented the highest enrollment (45%) in the NSDAP of any professional group,29 is far from clear. Also, by joining forces with the NSDAP he sought to further his own megalomania for research opportunities and material support. Whatever his motivation, Eppinger did abet the militantly prejudiced, recently appointed Dean, Eduard Pernkopf, in ruthlessly promoting the Nazi medical ethos in the Vienna school. Hans Eppinger even celebrated the first anniversary of the "cleansing" of the faculty by authoring an upbeat newspaper article in the Neues Wiener Tagblatt, in which he declared, "Now that all disease (my italics) has been eradicated, the Viennese School of Medicine can in future dedicate itself to its great task without inhibition."28 Pernkopf, incidentally, rose to become the Rector of the University in 1943; after spending 2 years imprisoned by the Allies after the war, he was free to complete his notorious "Atlas of Topographical and Applied Human Anatomy," for which the bodies of almost 1,400 people executed by the Gestapo, mostly for "political" reasons, served as artists' models.30 To Eppinger, who threw in his lot wholeheartedly with the philosophy, doctrines, policies, and hierarchy of the Third Reich, it was but a small step to invest his medical research expertise in the planning and conduct of human studies for the benefit of the German military effort. Although Eppinger's other activities have not yet been exhaustively researched, there has been no evidence presented thus far that he also participated medically in the sickening racial hygiene work that aimed to perfect techniques of mass extermination and sterilization, nor in studies that sought to document and preserve the anatomical characteristics of inferior racial groups, those people referred to as Untermenschen, or "subhumans," considered to have Lebensunwertes Leben, i.e., lives unworthy to be lived, and other individuals, such as the enfeebled, retarded, and those with neurological or physical defects. Neither did he seem to engage in futile sadistic experiments, such as excruciatingly painful attempts at muscle, bone, and even whole limb transplantation. In this context, it is chilling to point out that numerous German physicians had already played key practical roles in forcible sterilizations (some 300,000 to 400,000 victims) and in legalized killings, mostly by gassing and cremation, of individuals with mental or physical handicaps. Therein was the prototype for the extermination process of the Final Solution of the Jews, which physicians not an of the German physicians to the Nazi the and the or and were of using their medical such as the early of the so-called of and have been The of how to and and in the for of time the and military The to in and studies were to this end on both of the military To a at the German over the of the of with an so-called which some already was true with an Eppinger and from that a be to the of and with that of or complete for to to the best of health and even may be by the Eppinger also that his recently promoted in Vienna, conduct the which had to be at the Dachau concentration because the of volunteers at the medical were so late in the The experiments were in the of but the of including the of a liver without not to mention that the experimental subjects of would and other in attempts to some The of and including between the of the Medical of the and Reich of the and Reich of the it that Eppinger was no but was instead a key the offered on was the that there was no of during the of the the that the physicians were only following the of their or the of the the that the Allies and other had experiments the that the victims were to and the that there were no or for human experimentation that could The also that to as would the of medical and it that their among some of the and on the Although it is true that human experiments have been in almost even after the Nuremberg was have the and human of the Third Reich. act of not Also, or not the no with or or the this responsibility has been expressed in all over the Also, the was recognized in where for human experimentation also had been before During his to with his was and his that there had been any of the that had and Eppinger's to that on his was to years of the other physicians and in the were of were to by 5 to life 2 to for years, and to 10 were Eppinger was not but he was to appear before the However, on the of 25, one before the of the was he and it not for the extraordinary events that occurred almost 40 years later, the of Hans Eppinger may well have with him. However, in the late the and of the that he in Freiburg in and the of many and in liver research that and to a for and in liver studies. he to his Hans Popper, the father of hepatology of the for advice on a for the and Popper the name of Eppinger. Werner Creutzfeldt, for was at the in the of Eppinger's and from other than Hans Popper himself, and so he Popper the Popper was on of his for Eppinger as a liver scientist and his to After all, when Popper Vienna in under the of the Gestapo, among the he with him were his his his and a signed of that he later to that of his own the it must be that it was and that Popper knew of Eppinger's role in and did as he his for The must be however, that Popper's was At the very he should have his mentor more knowing well of his and the that he had on in Vienna in the medical even when its faculty had been by The Eppinger which Popper to a Nobel Prize of was awarded first to in but he nor recipients were likely to have had any as to Eppinger's name In the early Professor of Medicine at Yale University and of the for in Medicine at the Yale University School of Medicine, of the and it with the Eppinger whose he had as a medical student and about he had later in the of The case was taken by the and Eppinger's name was from the but only after the on the of the New on November The New article caused great to who were the of the for the of in that very Armed with few facts at that time, were and between those who of the and those who were and that was The the years of Hans Popper's as he was of his earlier of but he no over the of the As he me while on a to he knew that when he to work for Eppinger in he had a with the years later, the for for the same to the name of Eppinger from a that had received its designation by the in on the anniversary of its latter and, we the between Hans Eppinger and modern us full to the at the of this namely, how to with the flaws of the when these are related to the conduct of the science itself and human and life are In this can be considered under the of which often to from studies that were or like the at who recently published that no from experiments should be by in the that experiments by such are likely to be as well as being there was evidence that even in Dachau the were this is not a since some and investigations, like the Nazi and for the link between and were even were on the same racial hygiene that to and have that the benefit of the research is of such that it more lives than were the and the could not or would not have been in any other without such human we should and the and at the same time the highest and to the time the are This the however, of on the and by our we their To between these is too a to As might be by such the to medicine would be for This was to the in the when the of the New England Journal of Medicine to the of Nazi studies that were to be in In the case of Eppinger, the decision is an of his earlier work is clearly it can be to have been and ethically yet at the same time and at one should him and for the he did and one should never his name to be as an for or as a role The more by however, and one that is both more and more to is so many physicians the and in so many have the their of and a commitment to Yet for all Wiesel still in us as a I in that medicine is still a he the highest ethical the still for And for us all, We to him. in of this the was of Professor that there was no evidence that Eppinger had any Jewish It was a that Eppinger's was of from the on both of Jewish of of the of The with and by and with and and with Werner Creutzfeldt and Elie Wiesel The also the for his and in the of this essay in Whereas the and of these the his a of and documents, the are his
Israel's ongoing health reform provides lessons regarding attempts to combine universal coverage under national health insurance with a version of managed competition. Based on principles of 'justice, equality and mutual aid," Israel's National Health Insurance Law, 1994 guarantees access to a broad basket of basic services to be provided by four competing sick funds, and the availability of resources adequate to finance the basket. The new rights of citizens to universal coverage and to move freely among sick funds constituted a major policy breakthrough. However, successive amendments to the Law reflect continuing controversy over the amount of resources required to finance the basic basket. Despite the intention to base the system on decentralization and competition, successive amendments have placed more control over health system finance and sick fund management in the hands of the Ministries of Finance and Health. Updating the basic basket to take account of new technologies and drugs has raised unresolved dilemmas. In the Israeli case the dialectic of management vs. competition and of government vs. market, obscures fundamental issues related to the right of citizens to health services. The process set in motion by adoption of The National Health Insurance Law, 1994 calls on public managers and politicians to design institutions which can set priorities within a limited budget and effectively regulate the health care system.