This study seeks to identify the psycho-social, economic and epidemiologic burden of injury morbidity in the aftermath of conflict in support of the EC's policies in the Mediterranean region. Both Lebanon and the Occupied Territories are coping with health systems that are being reorganised following a period of prolonged conflict. The main focus of this study is on the evaluation of specific services being provided to vulnerable populations among disabled adults (in Lebanon) and elderly people (in the Occupied Territories). Multi-disciplinary and multi-sectoral collaboration will ascertain the prevalence of disability and of population-based needs, in specific services. The study hopes, through scientific collaboration, to provide insights into the overall costs of disability in terms of quality of life and foregone incomes for disabled adults, older people and their carers, in the aftermath of conflict.
To assess the nature and prevalence of disability (of mental and physical health) leading to loss of functional autonomy amongst adults (in Lebanon) and elderly people (in the OTs);
To examine the causes of disability and to estimate the impact of war (in Lebanon) on the prevalence of disability;
To examine current social care arrangements and available support focusing on the interface between private and public sector health and social care provision, and their efficacy in meeting the needs of disabled adults and elderly people in the aftermath of conflict;
To explore where feasible the economic and social burden of disability by estimating the costs of maintaining adults with impaired functions by the household in terms of lost earnings and quality of life factors;
To evaluate and contrast current approaches to health and social support (i.e. rehabilitation centres, family aid, extension workers, one to one support) in terms of family preferences, costs equity and effectiveness;
To disseminate findings as widely as possible in the region and internationally on the needs of vulnerable adults, older people and their carers in the aftermath of conflict, making recommendations for specific interventions.
Given the nature of the region, and in particular its isolation due to conflict, many challenging methodological issues will be raised in the process of undertaking this research. It is essential to bring researchers and health practitioners into the debate on issues of disability and rehabilitation through mutual learning. A carefully selected multi-disciplinary team of local and European expertise has been brought together to deal with the task of linking the findings of research with service provision and service usage, with a focus on the needs of users and their families, where appropriate. This has been done in order to highlight linkages between the psycho-social and economic benefits of providing appropriate support to vulnerable populations in the aftermath of conflict.
The expected outcomes are as follows:
* Provide an estimate of the nature, type and economic consequences of disability.
* Provide an evaluation of current services in terms of equity, effectiveness and cost.
* Provide an indication of population need and demand.
* Support long-term networking among researchers in the region and European partners through publications and one regional meeting between providers and user groups, to discuss issues raised by the study.
In the Occupied Territories we are in the process of devising an instrument to ascertain physical and mental well-being among a cross-sectional population sample of adults over 55 years of age in selected rural and urban areas. We are planning to use the SF36 which is a well-validated health status measure currently undergoing international testing to ascertain its appropriateness for use with elderly people. Following translation and adaptation, this instrument will be validated for use among Palestinian elderly people.
In-depth interviews will follow, among a sub-strata of this population, to determine linkages if any between service provision and quality of life for both carers and those with functional disability (Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in the main). Socio demographic and economic variables that may have an impact upon quality of life according to perceived effect will also be explored. The in-depth research will run concurrently with an audit of service provision, current and for the past 5 years (1991-1996), to assess the inter-face between public and private sector provision with an historical perspective (reconstruction in the aftermath of conflict), followed by an evaluation of access, equity and effectiveness vis a vis the population with disabilities and their families. Recommendations for service provision for older adults with disabilities will be made on the basis of our findings on the appropriateness and accessibility of current services
In Lebanon, the study plans to ascertain the prevalence of war-related injury morbidity for both physical and mental health. A cross-sectional study of adults is proposed among a sample of the population, with the use of the General Health Questionnaire (GHQ) to ascertain physical and in particular emotional well-being. A sub-stratum of those identified with disabilities will be involved in in-depth interviewing and screening with instruments (Composite International Diagnostic Instrument (CIDI 10)) to detect post-trauma stress disorder (PTSD) to determine linkages if any, between emotional state and the ability to perform IADL, and the impact upon quality of life where PTSD exists, by socio-demographic and economic variables. The prevalence studies will be followed by an audit and evaluation of current service provision in public, private and voluntary sectors, especially with regard to the efficacy of impact, upon measures of perceived quality of life of disabled persons and their carers.
Recommendations will be made on the expansion (or contraction) of current services on the basis of our findings. These findings will reinforce the major common thread of both studies which is to examine the impact of services for adults and older people with disabilities. Integral to both parts of this study is training for all partners involved, not only in terms of refining and developing cross-national research tools, but also for improved mutual understanding of the service needs of people with disabilities in the aftermath of conflict and on the impact of injury-related disability on the quality of life - training which is of global interest. Regional and international dissemination is planned during the final phases of the project.
Funding SchemeCSC - Cost-sharing contracts