{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T12:34:09Z","timestamp":1786365249480,"version":"build-2736575974"},"reference-count":46,"publisher":"Cambridge University Press (CUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S104795112611364X_as1\">\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>The 2025 Global Peace Index highlights that there are now 59 active state-based conflicts, the highest number since the Second World War, and overall levels of peacefulness are at their lowest since the index began. For children with CHD, this escalation means that more regions face disruption of surgical services, growing backlogs of untreated cases, and greater risks of displacement and loss to follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S104795112611364X_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We aimed to conduct a narrative review mapping existing evidence on the provision, models, outcomes, barriers, and enablers of paediatric cardiac surgery in conflict-affected and disaster settings while identifying gaps to inform future research and practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S104795112611364X_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Conflicts and disasters amplify the burden of both congenital and acquired paediatric heart disease, worsened by late presentation and progressive loss of operability. The collapse of hospital infrastructure, targeting of health workers, interruption of supply chains, and diversion of resources to trauma care severely limit the feasibility of surgery. Perioperative challenges, including the absence of paediatric intensive care, infection control difficulties, and disrupted follow-up, frequently compromise outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S104795112611364X_as4\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Conflict and disaster settings significantly exacerbate existing structural weaknesses in congenital cardiac care and may introduce additional system shocks that disrupt infrastructure, workforce stability, supply chains, and continuity of care. Future humanitarian health frameworks should explicitly include congenital and paediatric cardiac care within non-communicable disease response, supported by pre-positioned critical equipment, telemedicine, and long-term partnerships.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s104795112611364x","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T12:26:24Z","timestamp":1781699184000},"page":"1124-1130","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Cardiac surgery for children in war and disaster zones: global experiences and lessons"],"prefix":"10.1017","volume":"36","author":[{"given":"Vivienne","family":"Mathews","sequence":"first","affiliation":[{"name":"Aberdeen Royal Infirmary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8017-8727","authenticated-orcid":false,"given":"Jeevan","family":"Francis","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/054gk2851","id-type":"ROR","asserted-by":"publisher"}],"name":"St Thomas\u2019 Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramanish","family":"Ravishankar","sequence":"additional","affiliation":[{"name":"Aberdeen Royal Infirmary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabil","family":"Hussein","sequence":"additional","affiliation":[{"name":"Great Ormond Street Hospital for Children"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"George","sequence":"additional","affiliation":[{"name":"Birmingham Women\u2019s and Children\u2019s NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Ismail","sequence":"additional","affiliation":[{"name":"Palestine Medical Complex"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ed","family":"Peng","sequence":"additional","affiliation":[{"name":"Royal Hospital for Children"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4506-6113","authenticated-orcid":false,"given":"William","family":"Novick","sequence":"additional","affiliation":[{"name":"University of Tennessee Health Science Center"},{"name":"Global Cardiac Alliance"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"S104795112611364X_ref31","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11172411"},{"key":"S104795112611364X_ref38","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-0356"},{"key":"S104795112611364X_ref32","doi-asserted-by":"publisher","DOI":"10.1097\/MS9.0000000000002874"},{"key":"S104795112611364X_ref1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.023544"},{"key":"S104795112611364X_ref36","doi-asserted-by":"publisher","DOI":"10.1177\/2333794X241285964"},{"key":"S104795112611364X_ref16","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezac347"},{"key":"S104795112611364X_ref11","unstructured":"11. World Health Organization. Health system at breaking point as hostilities further intensify in Gaza, WHO warns. [online] Who.int. 2025. https:\/\/www.who.int\/news\/item\/22-05-2025-health-system-at-breaking-point-as-hostilities-further-intensify--who-warns. Accessed January 01, 2026."},{"key":"S104795112611364X_ref45","unstructured":"45. Campbell, J. Amid war and strife, surgeons push to save children\u2019s lives [Internet]. National Geographic Adventure. 2017. https:\/\/www.nationalgeographic.com\/adventure\/article\/saving-childrens-hearts-in-Libya. [cited 2026 Feb 28]. Accessed January 01, 2026."},{"key":"S104795112611364X_ref17","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951118002457"},{"key":"S104795112611364X_ref30","unstructured":"30. DHL Group. DHL delivers the world\u2019s first mobile heart clinic to Burundi [Internet]. Bonn, Gitega: DHL Group. 2025. https:\/\/group.dhl.com\/en\/media-relations\/press-releases\/2025\/dhl-delivers-the-worlds-first-mobile-heart-clinic-to-burundi.html. [cited 2026 Feb 28]. 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Humanitarian Action at the Frontlines: Field Analysis Series","author":"Tronc","year":"2018"},{"key":"S104795112611364X_ref41","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2013.05.003"},{"key":"S104795112611364X_ref13","doi-asserted-by":"publisher","DOI":"10.1051\/ject\/2025004"},{"key":"S104795112611364X_ref34","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-022-06621-x"},{"key":"S104795112611364X_ref9","unstructured":"9. Institute for Economics & Peace. Global Peace Index 2025: identifying and Measuring the Factors that Drive Peace, Sydney. 2025. https:\/\/visionofhumanity.org\/resources. Accessed January 01, 2026."},{"key":"S104795112611364X_ref21","unstructured":"21. Safeguarding Health in Conflict Coalition (n.d. a) Safeguarding health in conflict coalition. https:\/\/safeguarding-health.com\/. Accessed December 04, 2025."},{"key":"S104795112611364X_ref25","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezaa213"},{"key":"S104795112611364X_ref8","unstructured":"8. Deshpande, C. Medical devices supply hit by Russia-Ukraine war, heart surgeries on hold in Nagpur. [online] The Times of India. 2022. https:\/\/timesofindia.indiatimes.com\/city\/nagpur\/medical-devices-supply-hit-by-russia-ukraine-war-heart-surgeries-on-hold\/articleshow\/93379476.cms. Accessed November 27, 2025."},{"key":"S104795112611364X_ref14","article-title":"New knowledge from research \u2013 can global congenital cardiac surgery play a part? A call for international collaboration","volume":"1","author":"Francis","year":"2022","journal-title":"J Hum Cardiovasc Med"},{"key":"S104795112611364X_ref18","unstructured":"18. The Society of Thoracic Surgeons. Undaunted and determined, surgeon saves lives in Ukraine [Internet]. STS News. 2022. https:\/\/www.sts.org\/news\/undaunted-and-determined-surgeon-saves-lives-ukraine. [cited 2026 Feb 28]. Accessed January 01, 2026."}],"container-title":["Cardiology in the Young"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S104795112611364X","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T12:24:51Z","timestamp":1786364691000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S104795112611364X\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":46,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["S104795112611364X"],"URL":"https:\/\/doi.org\/10.1017\/s104795112611364x","relation":{},"ISSN":["1047-9511","1467-1107"],"issn-type":[{"value":"1047-9511","type":"print"},{"value":"1467-1107","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. 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