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Background <p>Mortality surveys in conflict-affected settings are essential for documenting the human cost of armed conflict, guiding the humanitarian response, and promoting accountability. The success of such studies relies on the participation of the affected populations. Yet, we know little about how the public in conflict-affected countries perceives such studies, their willingness to participate, or the barriers they face to participate. This study aimed to explore public perceptions, willingness and barriers to participate in mortality surveys in six conflict-affected countries of the Eastern Mediterranean Region.</p> Methods <p>An exploratory, cross-sectional mixed-methods study was conducted in Sudan, Somalia, Syria, Lebanon, Iraq, and Yemen between March and June 2025. An online self-administered questionnaire captured both quantitative and qualitative data. Quantitative data were analyzed using descriptive statistics and bivariate tests, while qualitative responses underwent inductive content analysis.</p> Results <p>Among 3455 participants (median age 29 years; 56.5% female), 94% (<i>n</i> = 3254) considered mortality surveys during armed conflicts important. Two-thirds (66.7%, <i>n</i> = 2306) expressed willingness to participate in mortality surveys, with a preference for electronic surveys. Willingness to participate was positively associated with older age, male sex, nationality, presence in the country during conflict, comfort with data sharing in social media, and absence of perceived cultural and religious barriers (<i>p</i> &lt; 0.05). More than 40% of respondents reported trusting to provide death data to the government (44.3%, <i>n</i> = 1529) and international organizations (43.8%, <i>n</i> = 1515). Respondents reporting no trust to provide this data mentioned lack of credibility and political bias were the main reasons for distrust. Only 13.1% (<i>n</i> = 453) of the respondents perceived mortality surveys as harmful; key concerns included retaliation, political manipulation, and psychological distress. 19% (<i>n</i> = 658) cited cultural or religious barriers, most linked to sectarianism, honor, and the sanctity of death, as an obstacle to participation.</p> Conclusion <p>Perceptions captured across the six conflict-affected EMR countries among the digitally-active adult respondents reflect both recognition of the importance of mortality surveys and concerns about safety, trust, and cultural sensitivities. Enhancing confidentiality, engaging trusted institutions in data collection, and adopting culturally sensitive approaches are critical to strengthening participation and ensuring the ethical implementation of mortality surveys in conflict zones.</p>

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Public perceptions of mortality studies in conflict-affected areas of the Eastern Mediterranean Region: an exploratory study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月14日

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  • Esra Abdallah Abdalwahed Mahgoub,
  • Ali Alshalah,
  • Farah El Halabi,
  • Manasik Mamoun,
  • Azzam Ali Mohammad Fare’a,
  • Leina Elomeiri,
  • Sajjad Alazzawi,
  • Abdirahman Khalif Mohamud,
  • Awni Mokhtar Sallam Ali Awn,
  • Mohammed Aref Ali Saeed Ahmed,
  • Zahraa Zibara,
  • Fadila Alhamwi,
  • Noseiba Mahamoud Adam Abdelmoemen,
  • Nour Jamal Houri,
  • Mohamad Al Merhabi,
  • Ola Ali Alftaeih,
  • Mohamed Abdulkadir Ahmed Farah,
  • Moneer Ali Abdallah Ali,
  • Alessandra Ferrario

摘要

Background

Mortality surveys in conflict-affected settings are essential for documenting the human cost of armed conflict, guiding the humanitarian response, and promoting accountability. The success of such studies relies on the participation of the affected populations. Yet, we know little about how the public in conflict-affected countries perceives such studies, their willingness to participate, or the barriers they face to participate. This study aimed to explore public perceptions, willingness and barriers to participate in mortality surveys in six conflict-affected countries of the Eastern Mediterranean Region.

Methods

An exploratory, cross-sectional mixed-methods study was conducted in Sudan, Somalia, Syria, Lebanon, Iraq, and Yemen between March and June 2025. An online self-administered questionnaire captured both quantitative and qualitative data. Quantitative data were analyzed using descriptive statistics and bivariate tests, while qualitative responses underwent inductive content analysis.

Results

Among 3455 participants (median age 29 years; 56.5% female), 94% (n = 3254) considered mortality surveys during armed conflicts important. Two-thirds (66.7%, n = 2306) expressed willingness to participate in mortality surveys, with a preference for electronic surveys. Willingness to participate was positively associated with older age, male sex, nationality, presence in the country during conflict, comfort with data sharing in social media, and absence of perceived cultural and religious barriers (p < 0.05). More than 40% of respondents reported trusting to provide death data to the government (44.3%, n = 1529) and international organizations (43.8%, n = 1515). Respondents reporting no trust to provide this data mentioned lack of credibility and political bias were the main reasons for distrust. Only 13.1% (n = 453) of the respondents perceived mortality surveys as harmful; key concerns included retaliation, political manipulation, and psychological distress. 19% (n = 658) cited cultural or religious barriers, most linked to sectarianism, honor, and the sanctity of death, as an obstacle to participation.

Conclusion

Perceptions captured across the six conflict-affected EMR countries among the digitally-active adult respondents reflect both recognition of the importance of mortality surveys and concerns about safety, trust, and cultural sensitivities. Enhancing confidentiality, engaging trusted institutions in data collection, and adopting culturally sensitive approaches are critical to strengthening participation and ensuring the ethical implementation of mortality surveys in conflict zones.