Telemedicine in war zones: prospects, barriers, and meeting the needs of special populations

Abstract

Telemedicine is the application of electronic communications to transfer medical information across locations in order to enhance a patient's medical condition [1] .Since its development in the 1950s, the industry has expanded to become a diverse range of services utilized in private homes, medical offices, and hospitals worldwide. Beyond the conventional requirement for remote care, its application has grown to address the difficulty in accessing healthcare specialists [1].The use of telemedicine has numerous advantages. Access to specialized care could be made easier with the use of telemedicine. Not only does telemedicine facilitate easy access to medical professionals, but it also permits primary care physicians to confer with specialists and smaller hospitals to contract out the evaluation of x-rays to specialists. In the end, telemedicine will increase specialized care accessibility and cultivate a more intimate doctor-patient bond. Patients will be given the confidence to oversee their own care and take control of their health ]2-5].Globally, telemedicine consultations have become increasingly popular among medical professionals as a result of the coronavirus pandemic (COVID- 19). The use of special applications like WhatsApp to consult with specialists has become more popular than ever since social distancing has become a significant technique for reducing the danger of COVID-19 exposure for patients and providers [6][7][8].However, telemedicine still has disadvantages despite its possible benefits. Among the possible drawbacks are poor coverage, greater initial expenses, and the inability to modify workflows. Furthermore, not all patients have access to it, and a large number of them are underprivileged or lack computer literacy [9].Telemedicine, however, has a promising future because to new technologies. This trend can only get stronger over time, and if decision-makers are determined to see it through to implementation, it will expand and be extensively adopted [9].In challenging and dangerous circumstances, telemedicine is an invaluable tool that can help save lives. For example, in a number of contexts, such as conflict zones and during natural catastrophes, telemedicine is a worthful instrument.Because it makes it possible for persons who are in danger to receive medical attention, telemedicine is particularly helpful in these situations. Telemedicine can be utilized in conflict zones to treat soldiers who are sick or injured medically as well as to support soldiers psychologically as they cope with the stress of fighting.Telemedicine can be utilized in a natural disaster to treat individuals who are trapped or have trouble receiving medical care. Support for mental health can also be given via telemedicine to those who are struggling with the stress of a natural catastrophe.Telemedicine is frequently utilized in conflict areas to help soldiers with their mental health: for soldiers, talking to someone face-to-face about their experiences and emotions might be challenging. However, they can consult with a counselor via telemedicine while remaining secure within their own base [10]. However, while telemedicine offers a viable remedy for many of the problems in the complicated global healthcare system, it also creates new ones. In the case of elderly patients who are not accustomed to using technology, telemedicine presents an additional technological challenge to the already complicated field of healthcare [2,9].The last ten years have seen significant advancements in technology that have fundamentally altered the way we communicate, work, and live. Over 90% of people in developed nations have a mobile phone, and over 65% of Americans own a smartphone. These percentages are even greater among healthcare professionals. Recent years have seen telemedicine become a crucial component in the delivery of healthcare [11,12].Prior to these technological advancements, a patient had to schedule an in-person visit in order to consult a medical specialist. The result of this was decreased access to healthcare professionals, , extended wait periods, missed workdays and unsatisfactory patient care.. Healthcare practitioners have been looking for alternatives to this time-consuming procedure lately, particularly through telemedicine. These days, social media or instant messaging apps allow patients and Primary Care Physicians (PCPs) to communicate directly with medical specialists, which may shorten the time it takes for a diagnosis and subsequent therapy [13][14][15].The World Health Organization (WHO) has long supported telemedicine, and in 2005 it established the Global Observatory for eHealth, which includes telemedicine. The Sustainable Development Goals on Universal Health Coverage are one of the objectives for which WHO has promoted the use of eHealth solutions (the use of information and communication technologies for health). Telecardiology, teleradiology, tele-mental health, tele-intensive care unit (ICU), and teledermatology are a few instances of telemedicine interventions in low-and middle-income countries (LMICs) [16][17][18].Although telemedicine may not be suitable for all patients, research indicates that a majority of doctors and patients endorse it [19,20].Although a study of clinical trials employing video teleconferencing found broadly identical outcomes, researchers are still looking into whether patients using the virtual services fare as well as those receiving in-person care [21].Video consultations, phone conversations, secure texting, and wearable-based remote patient monitoring are examples of traditional telehealth services. In addition to the clinician-to-patient category of telehealth services, Healthcare & Public Health Sector Coordinating Councils emphasize the significance of clinician-to-clinician services, which involve clinicians communicating with one another to exchange clinical information and talk about patient care, telementoring, and training [22,23].During COVID-19, telehealth proved to be advantageous for both the general public and senior citizens in the United States. In a qualitative review, doctors noted that telemedicine was quickly and iteratively adopted, with utilization waning as the prevalence of coronavirus sickness in 2019 decreased. Interventions and regulations that support telehealth for continuous healthcare delivery and guarantee its accessibility for senior citizens can be informed by physician experiences during the epidemic [20].Although telemedicine presents a promising solution to numerous issues in the worldwide malfunctioning healthcare system, it also introduces new ones. Telemedicine adds a technological hurdle to the already complex field of health care, particularly for older people who are not used to using technology [24,25].The integration of telemedicine solutions in low-and middle-income countries (LMICs) or conflict areas is hindered by various factors such as inadequate financial, material, and human resources, unstable electrical supply, and poor connection. Additional issues include inadequate implementation, a lack of effect evaluation, and a weak body of data, especially in contexts influenced by conflict [18].In order to guarantee fair access to health care, especially during pandemics like the COVID-19, the main obstacles to the use of telemedicine, such as lower educational levels, digital literacy skills, or access to internet connectivity, must be overcome [ -26 8 2 ].Even if more sophisticated technology is available, it is crucial to offer low-tech, userfriendly solutions for individuals who are less tech-savvy in order to increase acceptance even further [24,25]. Accordingly, the experience in Ukraine demonstrates that, out of the 62,000 telemedicine consultations carried out by Telehelp Ukraine and Health Tech Without Borders, 98% of them were limited to textbased contact between the patient and the physician via a secure telehealth platform [29].There are also barriers to telemedicine adoption by the physicians themselves, especially when it perceived as high-risk activity involving difficulties on making proper diagnosis [30,31].In addition to the challenges associated with remote diagnosis, there are circumstances in which remote counseling is inappropriate, and there are worries regarding the abuse or misuse of this platform, which could hinder patients' access to in-person medical surveillance in the clinic and jeopardize their follow-up and medical interventions, which are not always feasible to monitor remotely. Furthermore, physicians have reported that certain objective measures of care quality, such as blood pressure, glucose, or cholesterol measurements, may decline in quality and frequency as they have to rely on patients to report and maintain their vitals through home monitoring devices during telehealth visits [32].Telemedicine has emerged as a vital tool in war zones, enabling healthcare professionals to provide care remotely and bridge the gap created by conflictinduced disruptions to traditional healthcare systems. The use of telehealth technologies, such as video conferencing, remote patient monitoring, and teleconsultations, has proven invaluable in delivering essential medical services in situations where access to physical facilities and medical personnel is limited.During armed conflicts, telemedicine can play a crucial role in providing primary care and managing chronic conditions, facilitating mental health support, offering specialized consultations for complex cases and even training and supporting local healthcare providers [33][34][35][36].Telemedicine can be useful in providing access to persons affected by conflict or in helping those affected by the conflict to access medical experts in dangerous and difficult-to-reach placesThis is crucial for older adults who struggle physically to access the medical care they require, both in normal circumstances and during times of conflict. For this population, telemedicine can also provide mental support, which is very important in these situations [33][34][35][36][37][38].Getting healthcare professionals to enter or remain in a war zone is extremely difficult because they are already a scarce resource. Therefore, individuals who stayed behind can receive healthcare thanks to telemedicine. The majority of individuals in conflict areas use their phones, and all they need for a telemedicine call is phone connectivity and cellular access [33][34][35][36].Long-lasting, intricate armed conflicts have a negative impact on the health of the populace as well as local health systems; these impacts include harm to the infrastructure of healthcare facilities and the departure or death of healthcare professionals, creating a labor shortage. The health of the populace is progressively harmed by this, especially in cases where the most skilled or specialized healthcare professionals have been forcibly relocated, which has an impact on the education and training of less experienced healthcare professionals. When specialized input is needed or there is a shortage of healthcare staff, telemedicine might offer the possibility of remote support. In conflict-affected areas, it can offer a creative, affordable, and reliable form of help; yet, its implementation may be hampered by a lack of local human resources, infrastructure, and connectivity [10,[33][34][35][36].In Ukraine, numerous hospitals suffered damage, and emergency medical personnel were attacked. Internally displaced people make up about 6.5 million of the citizenries. The majority of them live in the areas that are experiencing hostilities and the occupied territory. The most pertinent method of getting health care at this time is remote, given the conditions. Telemedicine's ability to provide access to medical care under such extreme situations is what allows for a significant impact on the situation. This judgment is made naturally by Ukrainian doctors. Typically, they use messengers and phones to offer their patients the ability to independently seek guidance. On social media, doctors have made hundreds of these kinds of offers. Medical specialists and family physicians are among them [29].Numerous healthcare organizations have launched programs that allow physicians to consult remotely. During peacetime, the majority of them also made active use of these consultation tools. Using telemedicine at a time of war, they were able to expeditiously optimize the treatment and diagnostic process thanks to this expertise.The experience in Ukraine shows that, of the 62,000 telemedicine consultations conducted by Health Tech Without Borders (HTWB) and Telehelp Ukraine, 98% of them consisted solely of text communication between the doctor and patient on a secure telehealth platform [29].Telemedicine solutions also offer psychological support to the populace and avert potential effects, such as post-traumatic stress disorder [22,29] .Recently, the Ministry of Health of Ukraine launched an additional initiative whereby anyone can dial a single number and be connected to the appropriate professional.The continuing Russian-Ukrainian conflict has prompted Ukrainian doctors to employ telemedicine more frequently in order to deliver high-quality care to patients even on the front lines. Physicians in Ukraine employed a range of telemedicine options, with direct phone calls and messengers making up the majority of the workflow. Compared to their less experienced counterparts, experienced medical doctors used gadgets and devices for remote patient monitoring, SMS, and email more frequently [29].Despite the many advantages of using telemedicine in war zones, it is important to note that the effectiveness of telemedicine in war zones depends on several factors, including the availability of reliable communication infrastructure, the accessibility of appropriate medical equipment, and the ability to overcome language and cultural barriers [10].In the context of armed conflict, certain populations face heightened vulnerabilities and require tailored approaches to healthcare delivery. These special populations include refugees and internally displaced persons (IDPs), children and pregnant women, people with disabilities, and elderly individuals, Individuals with chronic illnesses. These groups often lack access to basic healthcare services and may experience compounded health risks due to displacement, trauma, malnutrition, and limited access to essential medications. Addressing their specific needs is paramount in ensuring equitable and effective healthcare delivery in war zones [37].In emergency situations, these populations can be even more affected: some elderly people are evicted from their homes and disconnected from their natural environment, and from access to their permanent medical system. 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