{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T19:16:34Z","timestamp":1754162194156,"version":"3.41.2"},"reference-count":70,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,6,8]],"date-time":"2025-06-08T00:00:00Z","timestamp":1749340800000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,5,5]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Conflict has not been a public health priority for governmental organisations, and evidence on civil society organisation (CSO) contributions to the issue is limited. The present study synthesised the available evidence on the role of CSOs in conflict and health in Africa.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We employed a systematic review using a systematic search of MEDLINE, PubMed, CINHAL, Web of Science and Scopus for English written articles between 1 January 2000 to 31 December 2023. The four concepts for the search included CSO or non-governmental organisation (NGO), conflict, health and Africa.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>14 documents are included in the review. We found that CSOs were engaged in (a) advocacy\u2014CSOs have been advocating to local and national governments, international bodies, and for fund raising; (b) social and medical provision\u2014CSOs have been filling services gaps through delivering medical, health and psychological care and outreach services; (c) material support\u2014CSOs have been providing shelter, food, clothing, and building public infrastructure such as health facilities, roads and water; (d) health diplomacy\u2014CSOs act as Global health diplomats as health is also a key factor in foreign affairs, security and trade policy and (e) accountability\u2014CSOs have been examining the broader role of NGOs or governance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The present systematic review highlights potential areas for future research, emphasising the importance of prioritising key areas for further investigation and suggesting the need for special attention to rarely addressed activities such as health diplomacy given that civil society engagement around healthcare is an important driver of Health For All.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-018541","type":"journal-article","created":{"date-parts":[[2025,6,8]],"date-time":"2025-06-08T15:40:22Z","timestamp":1749397222000},"page":"e018541","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Civil society and perilous medicine in Africa: a systematic review"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3531-4400","authenticated-orcid":false,"given":"Hailay","family":"Gesesew","sequence":"first","affiliation":[{"name":"Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia"},{"name":"Faculty of Health and Medicine, Lancaster University, Lancaster, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1916-0819","authenticated-orcid":false,"given":"Hafte Kahsay","family":"Kebede","sequence":"additional","affiliation":[{"name":"Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia"},{"name":"Pharmacy, Mekelle University College of Health Sciences, Mekelle, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2294-1368","authenticated-orcid":false,"given":"Fran","family":"Baum","sequence":"additional","affiliation":[{"name":"Stretton Institute, The University of Adelaide, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Ward","sequence":"additional","affiliation":[{"name":"Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Connie","family":"Musolino","sequence":"additional","affiliation":[{"name":"Stretton Institute, The University of Adelaide, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,6,8]]},"reference":[{"key":"2025072914040702000_10.6.e018541.1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2979\/africonfpeacrevi.2.1.1","article-title":"The Health Consequences of Armed Conflict in Sub-Saharan Africa: How Much Do Conflict Intensity and Proximity Matter?","volume":"2","author":"Openshaw","year":"2012","journal-title":"Afr Confl Peacebuild Rev"},{"key":"2025072914040702000_10.6.e018541.2","unstructured":"Nations U . 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Perilous medicine: the struggle to protect health care from the violence of war. New York, USA: Columbia University Press, 2021:7.","DOI":"10.7312\/rube19246"},{"key":"2025072914040702000_10.6.e018541.24","unstructured":"Haar R , Sirkin S . Strengthening data to protect healthcare in conflict zones. International Peace Institute; 2022."},{"key":"2025072914040702000_10.6.e018541.25","unstructured":"Lee K . Civil Society Organizations and the Functions of Global Health Governance: What Role within Intergovernmental Organizations? Glob Health Gov 2010;3."},{"key":"2025072914040702000_10.6.e018541.26","unstructured":"Organization WH . Tracking universal health coverage: 2021 global monitoring report. World Health Organization IBfRaD, 2022."},{"key":"2025072914040702000_10.6.e018541.27","doi-asserted-by":"crossref","unstructured":"Narayan R , Schuftan C , Donegan B , et al . The people\u2019s health movement. 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An overview of content analysis. 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The contribution of civil society engagement to the achievement of health for all (CSE4HFA). 2018."},{"key":"2025072914040702000_10.6.e018541.52","unstructured":"PHM . Health workers- Tigray: PHM (people\u2019s health movement). 2022. Available: https:\/\/phmovement.org\/health-workers-tigray [Accessed 12 Jul 2024]."},{"key":"2025072914040702000_10.6.e018541.53","unstructured":"UN . Civil society briefing \"the role of civil society in times of humanitarian crisis: United Nations (UN). 2022. Available: https:\/\/www.youtube.com\/watch?v=95UMuLcldFI [Accessed 12 Jul 2024]."},{"key":"2025072914040702000_10.6.e018541.54","first-page":"209","article-title":"Is Africa Different? Historical Conflict and State Development","volume":"34","author":"Dincecco","year":"2019","journal-title":"Econ Hist Dev Reg"},{"key":"2025072914040702000_10.6.e018541.55","unstructured":"Ziemke-Dickens CF , Buckley KJ , Hassig KO , et al . Civil society in West Africa \u2014 past and present. Roundtable Proceedings \u2014 Strengthening the Civil Society Africa Needs:: Institute for Defense Analyses; 2012."},{"key":"2025072914040702000_10.6.e018541.56","unstructured":"WHO . Declaration of Alma-Ata. Nternational Conference on Primary Health Care Alma-Ata: Declaration of Alma-Ata; 1978."},{"key":"2025072914040702000_10.6.e018541.57","unstructured":"UN . Resolution adopted by the general assembly. International cooperation on humanitarian assistance in the field of natural disasters, from relief to development. 64th session agenda item 70 (a). United Nations; 2010."},{"key":"2025072914040702000_10.6.e018541.58","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1080\/09581596.2019.1650892","article-title":"Methodological challenges in researching activism in action: civil society engagement towards health for all","volume":"30","author":"Bodini","year":"2020","journal-title":"Crit Public Health"},{"key":"2025072914040702000_10.6.e018541.59","unstructured":"Civicus . 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Stand up for Palestine. 2023."},{"key":"2025072914040702000_10.6.e018541.66","unstructured":"PHM . Statement of solidarity with people of Palestine. 2023."},{"key":"2025072914040702000_10.6.e018541.67","unstructured":"L\u2019Hostis M . UNmute civil society: amplifying civil society voices for a stronger UN future: Forus. Available: https:\/\/www.forus-international.org\/en\/custom-page-detail\/106388-unmute-civil-society-amplifying-civil-society-voices-for-a-stronger-un-future [Accessed 26 Nov 2024]."},{"key":"2025072914040702000_10.6.e018541.68","doi-asserted-by":"crossref","DOI":"10.1186\/s12992-023-00999-6","article-title":"Challenges in international health financing and implications for the new pandemic fund","volume":"19","author":"Brown","year":"2023","journal-title":"Global Health"},{"key":"2025072914040702000_10.6.e018541.69","doi-asserted-by":"crossref","unstructured":"Almeida C . Global Health diplomacy: a theoretical and analytical review. 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