Patel, S. S., Zvinchuk, O., & Erickson, T. B. (2020). The Conflict in East Ukraine: A Growing Need for Addiction Research and Substance Use Intervention for Vulnerable Populations. Forensic science & addiction research , 5 (3), 406-408. Publisher's VersionAbstract
Security and trauma challenges in Ukraine have been constantly evolving since the 2014 Russian military incursion of Crimea and War in Donbass. One long-term consequence of the conflict in East Ukraine is the toll of substance and alcohol use and addictions that may have been triggered by the conflict among the veterans, internally displaced peoples, and civilian survivors. Further funding and research on substance and alcohol addiction with these vulnerable populations affected by the ongoing Ukrainian conflict should be examined. Are people from fragile states and conflict zones more susceptible to co-morbidity with substance abuse and addiction?
Patel, S. S., Zvinchuck, O., Sukhovii, O., Neylan, J. H., & Erickson, T. B. (2021). Converging Impact of the Ongoing Conflict and COVID-19 Pandemic on Mental Health and Substance Use Disorders in Ukraine. Journal of Emergency Management , 19 (9), 63-68. Publisher's VersionAbstract
Since the Russian annexation of the Autonomous Republic of Crimea and the subsequent occupation of parts of the Donetsk and Luhansk regions, Ukraine has been facing increasing security and healthcare challenges. The seven-year war in East Ukraine has led to a rise in substance and alcohol use and increasing addiction rates among veterans, internally displaced persons, and civilian survivors. This article examines the combined impact of the ongoing Russo–Ukrainian conflict and COVID-19 pandemic on substance use in Ukraine. It also gives an overview of the institutions in place to monitor and improve mental health in the country. The article highlights the urgent need for further funding and research on substance and alcohol addiction, with vulnerable populations affected by the conflict during the COVID-19 pandemic. Frontline healthcare workers in this region should anticipate an increased burden of patients suffering from substance use disorders who are in need of emergency management intervention and proper behavioral health referrals.
Patel, S. S., McCaul, B., Cáceres, G., Peters, L. E. R., Patel, R. B., & Clark-Ginsberg, A. (2021). Delivering the promise of the Sendai Framework for Disaster Risk Reduction in fragile and conflict-affected contexts (FCAC): A case study of the NGO GOAL's response to the Syria conflict. Progress in Disaster Science , 10 (April 2021), 100172. Publisher's VersionAbstract
The Sendai Framework for Disaster Risk Reduction (SFDRR) has helped to reduce global disaster risk, but there has been a lack of progress in disaster risk reduction (DRR) for people living in fragile and conflict affected contexts (FCAC). Given the mounting evidence that DRR cannot be implemented through conventional approaches in FCAC, serious efforts must be made to understand how to meet SFDRR's goals. This paper offers a case study of international non-governmental organization GOAL's programming that responds to the protracted crisis in Syria, with a critical discussion on SFDRR and how to adapt humanitarian relief and disaster resilience.
Patel, S. S., Grace, R. M., Chellew, P., Prodanchuk, M., Romaniuk, O., Skrebets, Y., Ryzhenko, S. A., et al. (2020). Emerging technologies and medical countermeasures to chemical, biological, radiological, and nuclear (CBRN) agents in East Ukraine. Conflict and health , 14 (1), 1-4. Publisher's VersionAbstract
Since 2014, Ukraine has been beset by an armed conflict with international and internal dimensions. The nature of this conflict is multidimensional, and disaster preparedness and response in this context must be as well. Health experts from Ukraine, the United States of America, United Kingdom, Czech Republic, and Norway convened for an educational event in Dnipro, East Ukraine on November 11-15, 2019. At the event, “Emerging Technologies and Countermeasures to CBRN Agents: Advanced Training Response to Conflict and Security Challenges in East Ukraine,” over 1,000 participants participated in panel discussions, didactic lectures, and an advanced training on various dimensions of disaster response. This report provides an overview of the key discussions and outcomes of the event.
Mathews, C., Lombard, C., Puren, A., Cheyip, M., Ayalew, K., Jonas, K. N., Kuo, C., et al. (2020). Evaluation of a South African Combination HIV Prevention Programme for Adolescent Girls and Young Women: HERStory Study . South African Medical Research Council & Centers for Disease Control and Prevention. Publisher's VersionAbstract
The HERStory Study is an evaluation of this intervention, conducted by the South African Medical Research Council (SAMRC) and partners. The primary objective of the HERStory Study is to determine the intervention impact on HIV incidence over a two-year period. Secondary objectives include assessing the intervention impact on the prevention of behaviours that put AGYW at risk of HIV and other sexually transmitted infections (STIs), and the impact of the intervention on the cognitions and social environments of AGYW. The HERStory Study quantitative evaluation study design includes two consecutive cross-sectional household surveys conducted two years apart, to detect changes in HIV incidence using a laboratory testing algorithm comprising the bio-assays for determining recent infections, the Limiting Antigen Avidity Enzyme Immunosorbent Assay (LAg Avidity EIA). A sample of 14000 AGYW aged 15 to 24 years per survey was planned, which gives 80% power to detect a 33% reduction in HIV incidence from 3% to 2% over two years. The study design also includes qualitative research to complement the quantitative evaluation, to provide an in-depth understanding of changes in risk and protective factors related to HIV acquisition among AGYW and to identify gaps and challenges in the intervention components and their implementation as well as ways to revise and improve the intervention and its implementation. This report only includes results of the first survey, conducted in 2017 to 2018. The qualitative findings and second survey results will be reported separately.
Kivlehan, S., Allen, A., Viun, O., Makarov, D., Schnorr, D., Patel, S. S., Ryzhenko, S. A., et al. (2022). Evaluation of change in emergency care knowledge and skills among front-line healthcare providers in Ukraine with the Basic Emergency Care course: a pretest/post-test study. BMJ open , 12. Publisher's VersionAbstract


Objective Evaluate the change in participant emergency care knowledge and skill confidence after implementation of the WHO-International Committee of the Red Cross (ICRC) Basic Emergency Care (BEC) course.

Design Pretest/post-test quasi-experimental study.

Setting Mechnikov Hospital in Dnipro, Ukraine.

Participants Seventy-nine participants engaged in the course, of whom 50 (63.3%) completed all assessment tools. The course was open to healthcare providers of any level who assess and treat emergency conditions as part of their practice. The most common participant profession was resident physician (24%), followed by health educator (18%) and prehospital provider (14%).

Interventions The 5-day WHO-ICRC BEC course.

Primary and secondary outcome measures Change in pre-course and post-course knowledge and skill confidence assessments. Open-ended written feedback was collected upon course completion and analysed for common themes.

Results Participant knowledge assessment scores improved from 19 (IQR 15–20) to 22 (IQR 19–23) on a 25-point scale (p<0.001). Participant skill confidence self-assessment scores improved from 2.5 (IQR 2.1–2.8) to 2.9 (IQR 2.5–3.3) on a 4-point scale (p<0.001). The most common positive feedback themes were high-quality teaching and useful skill sessions. The most common constructive feedback themes were translation challenges and request for additional skill session time.

Conclusions This first implementation of the WHO-ICRC BEC course for front-line healthcare providers in Ukraine was successful and well received by participants. This is also the first report of a BEC implementation outside of Africa and suggests that the course is also effective in the European context, particularly in humanitarian crisis and conflict settings. Future research should evaluate long-term knowledge retention and the impact on patient outcomes. Further iterations should emphasise local language translation and consider expanding clinical skills sessions.

Patel, S. S., & Clark-Ginsberg, A. (2020). Incorporating Issues of Elderly Loneliness into the Coronavirus Disease–2019 Public Health Response. Disaster Medicine and Public Health Preparedness , 14 (3), E13-E14. Publisher's VersionAbstract
As the systems that people depend on are increasingly strained by the coronavirus disease–2019 (COVID-19) outbreak, public health impacts are manifesting in different ways beyond morbidity and mortality for elderly populations. Loneliness is already a chief public health concern that is being made worse by COVID-19. Agencies should recognize the prevalence of loneliness among elderly populations and the impacts that their interventions have on loneliness. This letter describes several ways that loneliness can be addressed to build resilience for elderly populations as part of the public health response to COVID-19.
Patel, S. S., Moncayo, O. E., Conroy, K. M., Jordan, D., & Erickson, T. B. (2020). The Landscape of Disinformation on Health Crisis Communication During the COVID-19 Pandemic in Ukraine: Hybrid Warfare Tactics, Fake Media News and Review of Evidence. Journal of Science Communication , 19 (05), A02. Publisher's VersionAbstract
The COVID-19 pandemic has impacted the world in ways not seen since the 1918–1920 Spanish Flu. Disinformation campaigns targeting health crisis communication during this pandemic seek to cripple the medical response to the novel coronavirus and instrumentalize the pandemic for political purposes. Propaganda from Russia and other factions is increasingly infiltrating public and social media in Ukraine. Still, scientific literature has only a limited amount of evidence of hybrid attacks and disinformation campaigns focusing on COVID-19 in Ukraine. We conducted a review to retrospectively examine reports of disinformation surrounding health crisis communication in Ukraine during the COVID-19 response. Based on the themes that emerged in the literature, our recommendations are twofold: 1) increase transparency with verified health crisis messaging and, 2) address the leadership gap in reliable regional information about COVID-19 resources and support in Ukraine.
Clark-Ginsberg, A., McCaul, B., Bremaud, I., Cáceres, G., Mpanje, D., Patel, S. S., & Patel, R. B. (2020). Practitioner approaches to measuring community resilience: The analysis of the resilience of communities to disasters toolkit. International Journal of Disaster Risk Reduction , 50 (November 2020), 101714. Publisher's VersionAbstract
To be useful for operational programs, measures of resilience must not just be valid, but be easy to use and useful. Unfortunately, while resilience measurement techniques have progressed tremendously over the past decade, most progress has been on improving validity rather than utility and ease of use. In this article we present a new tool for measuring community resilience that incorporates issues of utility and ease of use, the Analysis of Resilience of Communities to Disasters (ARC-D) toolkit. The toolkit was developed over the course of ten years by the international humanitarian and development organization GOAL to enable aid organizations to measure community resilience in a way that supports resilience building interventions. It offers an approach to measurement that is cognizant of the resilience policy landscape, including the Sendai Framework, and approaches to data collection and measurement relevant to aid agencies. We first present the core tenants of community resilience measurement before describing the toolkit, which consists of 30 measures, a guidebook, and an online platform. To illustrate its use, we provide a case study of a resilience building program in Tegucigalpa, Honduras. By developing one of the first resilience toolkits focused beyond validity and providing a description of how such an assessment works, this article has implications for resilience researchers and practitioners.
Patel, S. S., & Samet, J. M. (2011). The psychological and welfare consequences of the Chernobyl disaster: a systematic literature review, focus group findings, and future directions (pp. 1-125) . USC Institute for Global Health. Publisher's VersionAbstract

On April 26, 1986, a nuclear disaster occurred at the Chernobyl Nuclear Power Plant, contaminating areas of what are now modern-day Belarus, Moldova, Russia, and Ukraine. Beyond radiation exposure and cancer risks, the disaster led to the imposition of diverse acute and chronic stressors on the people living around the site. Principal among these health effects are psychological consequences, including ongoing psychological stress, post- traumatic stress disorder, and diminished well-being.

Substantial time has now passed since the disaster occurred and the possibility of health effects other than cancer has not been sufficiently addressed. This report assesses the research conducted on these health effects, particularly quality of life, functioning, and neuropsychological status among the victims of the disaster. Through a systematic review approach, this report documents the range of studies that have been carried out—largely cross-sectional surveys with several cohort (follow-up) studies. This report includes 50 publications; their results have been considered within the outcomes of anxiety, depression, post-traumatic stress disorder, well-being, and cognition.

Based on this systematic review, we find that there is evidence for adverse psychological and welfare consequences of the Chernobyl disaster. The extent of the available research, however, was limited and the various Chernobyl-affected groups have not been systematically investigated. In research subsequent to the disaster, emphasis has been given to cancer risk, as a result of the widespread radiation exposure to workers and the population. Nonetheless, the studies conducted show consistent indication that exposure to the Chernobyl disaster, broadly construed, has led to adverse psychological consequences. They point to a range of adverse effects that might be mitigated through evidence-based interventions. However, the available data are again limited in their coverage of affected populations and they fail to provide a picture of ongoing challenges to well-being faced by the populations in the area affected by the accident.

As one step in exploring future research directions on the neuropsychological consequences of the Chernobyl disaster, we arranged for focus groups to learn the most critical concerns of residents in Kiev (Kyiv), Ukraine today. In general, the focus group discussions gave useful insights regarding people’s perceptions, concerns, and attitudes towards their health and the current state of health care in Kiev. For most respondents, health was considered one of the most important values in their lives; however, few reported about the medical services used in cases of illness. Among the main concerns on the future health consequences of the Chernobyl disaster, many respondents said that children need to have more detailed investigation of their health, including physical and mental health. The following emerged with consensus as key issues: dissatisfaction with the quality of the medical care, the use of non evidence-based diagnostics and treatments, lack of knowledge in the population about the signs of both physical and mental disorders, concerns about children’s health, and the potential impact of environmental factors including the Chernobyl disaster.

In this report, we have considered two sources of evidence on the long- term neuropsychological consequences of the Chernobyl disaster: the published research evidence available in the accessible literature and the findings of focus groups conducted in Kiev in March, 2011. The broad findings from these two sources are convergent and clear: twenty-five years after the Chernobyl disaster, the populations affected at the time, whether by being displaced or exposed to radiation, have sustained neuropsychological consequences and these consequences remain of public health and medical significance.

At the 25th anniversary year of the disaster, it would be timely to give greater discussion to the topic of long-term neuropsychological consequences. Our recommendations address this need. They broadly cover future research, potential interventions, and networking in Ukraine, Belarus, Russia, and Moldova. In addition, we recommend the need for further understanding on how evidence on the neuropsychological consequences of the disaster and related support could make a difference to motivate action by policymakers. We also recommend
a comprehensive cataloguing of ongoing research and an evaluation of opportunities for expanding studies to cover neuropsychological outcomes.


Brooks, S. K., & Patel, S. S. (2021). Psychological Consequences of the Flint Water Crisis: A Scoping Review. Disaster Medicine and Public Health Preparedness , 1-11. Publisher's VersionAbstract

Objective: To summarize existing literature on the mental health impact of the Flint Water Crisis.

Methods: In March 2020, we searched 5 databases for literature exploring the psychological consequences of the crisis. Main findings were extracted.

Results: 132 citations were screened and 11 included in the review. Results suggest a negative psychological effect caused by the water crisis, including anxiety and health worries, exacerbated by lowered trust in public health officials, uncertainty about the long-term impacts of the crisis, financial hardships, stigma, and difficulties seeking help. There was evidence that concerns about tap water continued even after the state of emergency was lifted.

Conclusions: With a possible compound effect to residents of Flint with the recent COVID-19 pandemic, the results highlight the need for more resources for psychological health interventions in Flint as well as a need for local governments and health authorities to regain the trust of those affected by the Flint Water Crisis.

Keywords: flint water crisis; literature review; mental health; psychological warfare; public health.

Patel, S. S., Webster, R. K., Greenberg, N., Weston, D., & Brooks, S. K. (2020). Research fatigue in COVID-19 pandemic and post-disaster research: causes, consequences and recommendations. Disaster Prevention and Management , 29 (4), 445-455. Publisher's VersionAbstract

Research fatigue occurs when an individual or population of interest tires of engaging with research, consequently avoiding further participation. This paper considers research fatigue in the context of the current COVID-19 pandemic, to identify contributory factors and possible solutions for future post-disaster research.

The authors draw on examples from the literature and their own observations from the recruitment and data collection phases of qualitative and quantitative studies, to provide an overview of possible research fatigue in the current COVID-19 pandemic, with implications for future post-disaster research.

People affected by disasters sometimes receive multiple requests for study participation by separate teams who may not necessarily be coordinating their work. Not keeping participants informed of the research process or outcomes can lead to disillusionment. Being overburdened with too many research requests and failing to see any subsequent changes following participation may cause individuals to experience research fatigue.

Guidelines for researchers wishing to reduce the occurrence of research fatigue include ensuring greater transparency within research; sharing of results and using oversight or gatekeeper bodies to aid coordination. Failure to restrict the number of times that people are asked to participate in studies risks poor participation rates. This can subsequently affect the quality of information with which to inform policy-makers and protect the health of the public during the COVID-19 pandemic or other public health disasters/emergencies.

Sanderson, D., Patel, S. S., Loosemore, M., Sharma, A., Greenwald, K., & Patel, R. B. (In Press). A review of peer-reviewed published research on corruption and disasters in the built environment. Disasters. Publisher's VersionAbstract
This paper presents the findings of a review of academic literature concerning the degree to which corruption worsens naturally-triggered disasters in the built environment. The research employed a ‘systematic literature review’ methodology to analyse leading academic databases, resulting in a detailed analysis of 59 peer-reviewed, published papers. It was found that while much of the literature focuses on earthquakes (relating to building and infrastructure collapse), the quality of governance and the drivers of corruption, there is presently limited scholarship concerning the general scope, reach and scale of how disasters are worsened by corruption.
Samet, J. M., & Patel, S. S. (2013). Selected Health Consequences of the Chernobyl Disaster: A Further Systematic Literature Review (pp. 1-91) . USC Institute for Global Health.Abstract

In a previous report (Samet and Patel 2011), we provided a systematic review of the evidence on neuropsychological consequences of the Chernobyl disaster along with findings of focus groups conducted in Kiev, Ukraine. The report’s overall conclusion on the long-term neuropsychological consequences was “the broad findings from these two sources are convergent and clear: twenty-five years after the Chernobyl disaster, the populations affected at the time, whether by being displaces or exposed to radiation, have sustained neuropsychological consequences and these consequences remain of public health and medical significance” (Samet and Patel 2011).

In this report, we extend the earlier research on neuropsychological consequences of the disaster. We add findings from further focus groups conducted in Bila Tserkva, Ukraine, and extend the literature review to cover suicide, reproductive health, immune system and blood disorders, respiratory diseases, and cardiovascular diseases. These are outcomes that may be plausibly affected by the stress associated with the disaster and its aftermath.

Neylan, J. H., Patel, S. S., & Erickson, T. B. (2021). Strategies to counter disinformation for healthcare practitioners and policymakers. World Medical & Health Policy , 1-9. Publisher's VersionAbstract


Medical disinformation has interfered with healthcare workers' ability to communicate with the general population in a wide variety of public health contexts globally. This has limited the effectiveness of evidence-based medicine and healthcare capacity. Disinformation campaigns often try to integrate or co-opt healthcare workers in their practices which hinders effective health communication. We describe a critical overview of issues health practitioners and communicators have experienced when dealing with medical disinformation online and offline as well as best practices to overcome these issues when disseminating health information. This article lists disinformation techniques that have yet to be used against the medical community but need to be considered in future communication planning as they may be highly effective. We also present broad policy recommendations and considerations designed to mitigate the effectiveness of medical disinformation campaigns.



  • Medical practitioners must be aware they can be co-opted by disinformation campaigns.

  • The medical community needs to be prepared for emerging technologies that will allow for sophisticated disinformation campaigns.

  • Adequate cyber security infrastructure is essential to combatting disinformation

Conroy, K. M., Krishnan, S., Mittelstaedt, S., & Patel, S. S. (2020). Technological advancements to address elderly loneliness: practical considerations and community resilience implications for COVID-19 pandemic. Working with Older People , 24 (4), 257-264. Publisher's VersionAbstract

Loneliness has been a known severe public health concern among the elderly population during the COVID-19 pandemic. This paper aims to discuss the practicalities of using emerging technologies to address elderly loneliness and its implications and adaptations to the outbreak of corona virus disease–2019.

The authors draw on examples from the literature and their own observations from working with older adults, to provide an overview of possible ways technology could help this population in the current COVID-19 pandemic.

Technological advancements have offered remarkable opportunities to deliver care and maintain connections despite the need to stay physically separated. These tools can be integrated into crisis communications, public health responses and care programs to address loneliness among the elderly. However, it must be done strategically and informed by the type of loneliness at play, environmental factors, socioeconomics and technological literacy.

Practical implications
Care-providing organizations and policymakers should consider the risk of loneliness while responding to COVID-19 outbreak, particularly within elderly populations. As a part of a broader plan, technological solutions and low-tech approaches can make a difference in mitigating loneliness. Solutions should be accessible to and usable by older adults. Provision of equipment, training and guidance may be necessary to execute a technology-centric plan; for some communities and individuals, approaches that do not rely on advanced technology may be more effective.

Technological advancements can be a valuable tool in addressing known public health concerns, such as loneliness among the elderly populations. However, the use of this tool should be governed by the specific situation at hand, taking into consideration individual needs and environmental factors, especially the compounded effects caused by the coronavirus pandemic. Different technological programs and approaches are appropriate for different types of loneliness. For example, online therapy such as internet-based cognitive behavior therapy may mitigate loneliness caused by fear and online interaction such as videoconferencing may relieve loneliness caused by lack of social engagement.