Susan A Bartels

• MD, MPH, FRCPC
• Medical Professional at Queen's University

The United Nations (UN) has operated a longstanding peacekeeping mission in the Democratic Republic of the Congo (DRC), while simultaneously contributing to rule-of-law building and transitional justice processes. Sexual violence is widespread in the DRC including routine allegations against UN peacekeepers. The operation of numerous legal systems...

This mixed-methods study explores negative patient experiences within emergency departments (EDs), aiming to uncover systemic challenges and propose evidence-informed solutions. Of 2114 shared ED experiences, 306 (14.5%) were reported as "bad" or "very bad." Younger age, Indigenous status, financial instability, mental health disabilities, and non-...

Emergency departments (EDs) are important for mental health (MH) care among youth, however, are often ill equipped to meet their needs, resulting in care dissatisfaction. The objective of this research is to better understand the ED care experiences among youth with MH concerns. Data was used from a cross-sectional, mixed-methods study comparing ED...

Our study aimed to explore the lived experiences of Venezuelan refugee/migrant women and girls with disabilities to guide humanitarian assistance. The data analysed was part of a larger cross-sectional study whereby refugees and migrants in Ecuador, Peru, and Brazil were asked to share the migration experiences of a Venezuelan woman or girl. The sa...

Introduction Equity-deserving groups (EDGs) face societal barriers, including healthcare barriers within the emergency department (ED), due to discrimination. Most patient-care experience research considers only a single-axis perspective, neglecting multifaceted impacts of discrimination, or intersectionality. Methods Detailed is a secondary analy...

Introduction: Visible minorities, a growing segment of Canada's population, have voiced concerns about experiencing racism while receiving care in the emergency department (ED). Understanding the ED care experiences of visible minorities is crucial to improving care and reducing health disparities. Methods: From June to August 2021, we collected...

Background: Substance use disorders (SUD) significantly impact the physical, social, and mental health of individuals, their families, and the wider community. Parental substance use can lead to long-term social and health problems for children. Examining resilience and its determinants among families directly affected by SUD (e.g., having a parent...

Background Persons with disabilities (PWD) are more likely to visit the emergency department (ED) and often have complex health needs when accessing care in the ED. Yet there is limited understanding of ED care experiences among PWD, especially in a Canadian context. The aim of this study was to examine the ED care experiences of PWD in contrast to...

The Canadian Association of Emergency Physicians’ (CAEP) Global Emergency Medicine committee presents a four-part series that builds upon the Academic Symposium recommendations from the CAEP 2018 meeting (Collier et al. in CJEM 21(5):600–606, 2019). This series presents best practices and offers practical tools for the development and practice of G...

In 2018, the Canadian Association of Emergency Physicians (CAEP) academic symposium included developing recommendations on supporting global emergency medicine (EM) in Canadian departments and divisions. Members of CAEP’s Global EM committee created a four-part series to be published in CJEM that would build upon the symposium recommendations. The...

Introduction With global cesarean section rates rising, there’s concern about increase in obstetric vesico-uterine fistula (OVUF). Very little is known about this anatomoclinical entity of obstetric fistula in Africa in general and in DRC in particular. Our purpose was to describe the epidemiological, clinical, and therapeutic aspects of OVUF in th...

Purpose The aim of this study was to assess quality of life (QoL) using the WHOQOL-BREF questionnaire among obstetric fistula (OF) patients before and after surgical repair of OF (SROF). Methods A longitudinal cohort study was conducted between November 2022 and October 2023 in the Democratic Republic of the Congo (DRC) among OF patients to assess...

Background Adverse childhood experiences (ACEs), in combination with adverse community environments, can result in traumatic stress reactions, increasing a person’s risk for chronic physical and mental health conditions. Family resilience refers to the ability of families to withstand and rebound from adversity; it involves coping with disruptions...

The UN may sanction peacekeeping operations (POs) to neutralize armed groups and promote democratization. This research presents perceptions from beneficiaries of assistance related to POs and relations between local women/girls and peacekeepers within two post-colonial contexts: the DRC and Haiti. Using cross-sectional, mixed-methods data collecte...

Background It is estimated that since 2014, approximately 7.3 million Venezuelan migrants/refugees have left the country. Although both male and female migrants/refugees are vulnerable, female migrants/refugees are more likely to face discrimination, emotional, physical, and sexual violence. Currently there is a lack of literature that explores the...

Introduction Obstetric fistula (OF) repair surgery aims to restore the anatomical and functional integrity of the urinary tract, allowing affected women to regain their dignity and quality of life. However, in some cases, this surgical repair may fail. The objective of this study was to develop a predictive score to identify factors associated with...

Background Equity-deserving groups (EDG), including those who identify as two-spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex, and/or asexual (2SLGBTQQIA+), are disproportionately treated in the Emergency Department (ED). This study aimed to understand ED care experiences of 2SLGBTQQIA+ individuals compared to those who do...

The UN’s Zero Tolerance Policy, which bans all relationships between UN staff and locals, portrays all relationships as exploitative, fails to account for nuances in these relationships and does not acknowledge the agency of local women or communities. This study uses community-based qualitative data from eastern DRC that shares narratives on a wid...

Background People who use substances (PWUS) encounter significant barriers to accessing care for their complex health needs. As a result, emergency departments (EDs) often become the first point of healthcare access for many PWUS and are a crucial setting for the study of health inequities. This study aimed to understand the ED healthcare experienc...

Background In prior studies exploring the experiences of Syrian refugee girls in Tripoli, Beqaa, and Beirut, especially in relation to child marriage, our data showed distinct variations in response patterns from Tripoli relative to the other regions. To gain a deeper understanding of these contrasting experiences and to ascertain the unique needs...

Background Early reports raised alarms that intimate partner violence (IPV) increased during the COVID-19 pandemic, but initial studies showed that visits to emergency departments (EDs) decreased. This study assessed the impact of the prolonged pandemic and its associated restrictions on both rates of urgent care-seeking and injury severity for IPV...

Objective Over the past decade, geopolitical turmoil in Venezuela has resulted in the displacement of 7.1 million people, resulting in a migration and refugee crisis. Methods and analysis This current cross-sectional, mixed-method research, which is focused on women and girls, examines differences in Venezuelan refugee/migrant demographics, migrat...

The Democratic Republic of Congo hosts the longest-running and largest United Nations peacekeeping mission in history. The United Nations also has reckoned with sexual exploitation and abuse in its own ranks and, in 2003, recognized its importance with a Bulletin which became known as the ‘zero tolerance policy’. Policymakers and researchers have p...

Background: Venezuela has been experiencing an intense and rapid outflow of migrants/refugees unprecedented in Latin America. It is estimated that since 2014, approximately 7.3 million Venezuelans have left the country. Although both male and female migrants/refugees are vulnerable, female migrants/refugees are more likely to face discrimination, e...

This study examined the lived experiences of Syrian refugee child brides to understand their needs as they navigate new social roles after marriage. A cross-sectional study was conducted in Lebanon using SenseMaker® to collect narratives from married Syrian girls age 13 and older and from their parents. Thematic analysis using inductive coding was...

Natural disasters, including floods, earthquakes, and hurricanes, result in devastating consequences at the individual and community levels. To date, much of the research reflecting the consequences of natural disasters focuses heavily on victims, with little attention paid to the personnel responding to such disasters. We conducted a systematic re...

Abstract Background Emergency departments (EDs) serve an integral role in healthcare, particularly for vulnerable populations. However, marginalized groups often report negative ED experiences, including stigmatizing attitudes and behaviours. We engaged with historically marginalized patients to better understand their ED care experiences. Method P...

This literature review synthesises existing evidence and offers a thematic analysis of primary care and emergency department experiences of lesbian, gay, bisexual, transgender, queer and/or any other sexual or gender minority (LGBTQ+) individuals in Canada. Articles detailing first-person primary or emergency care experiences of LGBTQ + patients we...

Background Early reports raised alarms that intimate partner violence (IPV) increased during the COVID-19 pandemic, but initial studies showed that visits to emergency departments (EDs) decreased. This study assessed the impact of the prolonged pandemic and its associated restrictions on both rates of urgent care-seeking and injury severity for IPV...

Background: Global Health opportunities are popular, with many reported benefits. There is a need however, to identify and situate Global Health competencies within postgraduate medical education. We sought to identify and map Global Health competencies to the current CanMEDS physician competency framework to assess the degree of equivalency and un...

In the last two decades, academic research has made significant progress exploring the life courses of so-called “children born of war” (CBOW). Similarly, the unintended consequences of peacekeeping operations, including the experiences of victims of sexual exploitation and abuse, and children born of these interactions, have received preliminary a...

Sexual exploitation and abuse (SEA) by United Nations (UN) peacekeepers causes severe physical and psychological consequences. Where SEA leads to pregnancy and childbirth, peacekeepers typically absolve themselves of their paternal responsibilities and paternity suits are largely unsuccessful. The lack of support for peacekeeper-fathered children (...

Intimate partner violence (IPV) is a public health problem that has devastating physical, psychological, and economic consequences. The emergency department (ED) is an important point of contact for individuals experiencing IPV. However, there are few studies synthesizing interactions between patients experiencing IPV and providers. We aimed to sum...

Emergency departments (EDs) are an important source of care for people with mental health (MH) concerns. It can be challenging to treat MH in EDs, and there is little research capturing both patient and provider perspectives of these experiences. We sought to summarize the evidence on ED care experiences for people with MH concerns in North America...

The narrow framing of Sexual Exploitation and Abuse (SEA) and the United Nations Zero-Tolerance Policy inadequately accounts for the range of sexual interactions in peacekeeping contexts and obscures the wider social contexts within which sexual decision making occurs. We draw on personal narratives from women who have had such sexual interactions,...

The Vietnam War left a legacy of mostly mixed-race children fathered by American (or other foreign) soldiers and born to Vietnamese mothers. These Vietnamese Amerasian children often had difficulties integrating into their post-conflict societies due to stigmatisation, and they were typically economically severely disadvantaged. This paper compares...

Purpose: This systematic review investigates the methodological and ethical implications of using remote data collection tools to measure sexual/reproductive health (SRH) and gender-based violence (GBV) outcomes among women and girls in humanitarian and fragile settings. Methods: We included empirical studies of all design types that collected any...

The United Nations Missions in the Democratic Republic of Congo have faced heavy allegations of peacekeeper-perpetrated sexual exploitation and abuse. Reports indicate that sexual encounters between members of peacekeeping forces and female civilians have resulted in the birth of children; however, no conclusive information on these children exists...

In 2010, Haiti experienced one of the deadliest cholera outbreaks of the 21st century. United Nations (UN) peacekeepers are widely believed to have introduced cholera, and the UN has formally apologized to Haitians and accepted responsibility. The current analysis examines how Haitian community members experienced the epidemic and documents their a...

Children fathered and abandoned by United Nations peacekeepers are an unintended consequence of peacekeeping operations. Research suggests that the social identity of peacekeeper-fathered children (PKFC) is complex and contradictory. While economically disadvantaged, PKFC’s biracial background confers elements of racial privilege. Using the Democra...

Sexual abuse and exploitation (SEA) perpetrated by UN peacekeepers while on mission is a violation of human rights and undermines the goal of upholding human rights in countries that host peacekeeping missions. In addition to survivors, children fathered by peacekeepers are also victims of SEA that need protection. Stigma poses negative life course...

Background Hepatitis B infection is a major health concern in Myanmar. Hepatitis B birth dose vaccination to prevent mother-to-child transmission is not universal, especially in births outside of health care facilities. Little is documented about delivery of immunization programs in rural Myanmar or in conflict-affected regions. To address this gap...

Background Sexual exploitation and abuse (SEA) by UN peacekeepers perpetrated against local women and girls is a concern in the Democratic Republic of Congo (DRC). While stigma associated with sexual and gender-based violence is well documented more broadly, little is known about stigma associated with peacekeeper-perpetrated SEA. Methods The aim...

Background: In Myanmar, formerly known as Burma, conflicts between ethnic minorities, the government, and the military have been ongoing for decades. Enduring unrest has caused thousands to flee to the region around Mae Sot, a city on Thailand’s western border. Women around the world assume a combination of reproductive and productive responsibilit...

Sexual exploitation and abuse (SEA) of women and girls by United Nations (UN) peacekeepers is an international concern. However, the typical binary measurement of SEA (indicating that it occurred, or it did not) disregards varying exposure levels and the complex circumstances surrounding the interaction. To address this gap, we constructed an index...

Background Despite the United Nation's disapproval of child physical discipline and its association with numerous negative outcomes, physical discipline continues to be used globally and is often present in countries experiencing financial or political instability. Burmese migrants living in Mae Sot, Thailand experience instability due to their exp...

Haiti’s instability at the turn of the millennium demanded unprecedented changes towards community-based peacekeeping strategies. While deemed successful by some in reducing actualised violence, the UN Peace Support Operation, MINUSTAH, was wrought with allegations of sexual exploitation and abuse (SEA) and mired by the inadvertent introduction of...

Background The United Nations Organization Stabilization Mission in the Democratic Republic of Congo (MONUSCO) has been marred by widespread allegations of sexual exploitation and abuse (SEA) of women and girls by UN peacekeepers. There is minimal research conducted on the perceptions of communities most affected by the SEA themselves, and even les...

In 2017, malaria accounted for 435 000 deaths worldwide. Eleven percent (11%) of these deaths occurred in the Democratic Republic of Congo (DRC), where malaria continues to be a leading cause of morbidity and mortality. Children are amongst the most vulnerable to malaria, which causes 40% of childhood deaths in the country. Although many risk facto...

Purpose-This paper aims to analyze the lived experience of seeking justice and reparations related to conceiving a peacekeeper-fathered child. Design/methodology/approach-Based on 18 semi-structured qualitative interviews conducted across Haiti in 2017, the authors mapped the experiences of Haitian mothers of peacekeeper-fathered children onto th...

Introduction and Objectives: It is well-documented that single mothers in sub-Saharan Africa face unique psychosocial challenges which can lead to child health and developmental disadvantages, often impacting life trajectories for both the mother and child. Years of instability, conflict, and widespread poor governance within the Democratic Republi...

Background: The current crisis in Syria has led to unprecedented displacement, with neighbouring Lebanon now hosting more than 1.5 million conflict-affected migrants from Syria. In many situations of displacement, adolescent girls are a vulnerable sub-group. This study explores and describes the self-reported unmet needs of Syrian adolescent girls...

Introduction: Peacekeeper-perpetrated sexual exploitation and abuse (SEA) in the Democratic Republic of Congo (DRC) account for 36% of the global reports of formal SEA allegations to the UN between 2007 and 2021. However, formally reported SEA represents only a fraction of that which occurs, and community experiences of peacekeeper-perpetrated SEA...

Peacekeeping missions have been marred by reports of sexual exploitation and abuse (SEA) against local community members. However, there is limited research on how SEA against women/girls versus men/boys is perceived in peacekeeping host societies. In 2017 we collected micro-narratives in Haiti and then conducted a thematic analysis to understand h...

Background In sub-Saharan Africa, the use of modern contraception (MC) is a critical intervention aimed at reducing mortality rates associated with unintended, high-risk pregnancies. However, among Congolese women aged 15–49, the prevalence of MC use is low. Research suggests that women’s general participation in decision-making is important in inc...

Abstract Background Both conflict and non-conflict sexual violence have been well described in the Democratic Republic of Congo (DRC). However, there is little empiric data comparing sexual violence patterns for males and females in the DRC, and little is known about how post-sexual assault care experiences may differ between the two sexes. Methods...

During the United Nations Stabilization Mission in Haiti (MINUSTAH), reports of sexual abuse and exploitation and children fathered by peacekeepers were brought forward to the UN. In 2017, a cross-sectional mixed-methods survey was administered by Haitian research assistants using SenseMaker® (Cognitive Edge, Singapore), a rapid data collection too...

Feminist scholarship has analyzed the gendered dynamics of national- and international-level risk factors for peacekeeper-perpetrated sexual exploitation and abuse (SEA); however, the gendered dynamics within the host country have not been adequately considered. Using the United Nations Stabilization Mission in Haiti (MINUSTAH) as a case study, thi...

Pregnancy is associated with several physical and psychosocial challenges that influence women’s health and wellbeing. However, prenatal mental health has received little attention. Therefore, this study examined the prevalence and correlates of prenatal depression, anxiety and current suicidal behaviors among pregnant women in the Volta Region of...

Background: The term ‘last mile’ has been used across disciplines to refer to populations who are farthest away, most difficult to reach, or last to benefit from a program or service. However, last mile research lacks a shared understanding around its conceptualization. Objectives: This project used a concept mapping process to answer the questions...

In 2010 following a catastrophic earthquake, Haiti saw the beginning of what would become the world’s largest cholera epidemic. Nepalese United Nations peacekeepers were later implicated as the source of cholera. Our research examines Haitian community beliefs and perceptions, six-and-a-half years after the outbreak began, regarding the origin of H...

Conflict has displaced 1.5 million Syrians to Lebanon and within this context, child marriage has reportedly increased. We present a thematic intersectionality analysis of focus group discussions examining specific intersections and how they influence marriage practices: (1) immigration status and safety; (2) immigration status and economic instabi...

Background The current crisis in Syria has led to unprecedented displacement, with neighbouring Lebanon now hosting more than 1.5 million conflict-affected migrants from Syria. In many situations of displacement, adolescent girls are a vulnerable sub-group. This study explores and describes the self-reported unmet needs of Syrian adolescent girls w...

Objectives: Global Health (GH) electives offer unique learning opportunities; however, risks to trainees and host populations should be minimized through pre-departure training and post-elective debriefing. In a 2016 study, only three Canadian residency programs mandated such training, although specific data on Emergency Medicine (EM) programs is...

Background The United Nations (UN) Organization Stabilization Mission in the Democratic Republic of Congo (MONUSCO) comprises the largest and longest serving peacekeeping operation to date. Since the launch of the mission in 1999, sexual relations between UN peacekeepers and the local population regularly occur; some resulting in children being con...

Introduction: Two billion people are currently affected by complex humanitarian emergencies (CHEs) resulting from natural disasters and armed confl ict. Many have been displaced into crowded camps with poor access to water, sanitation, and health care. Humanitarian response is challenging under these circumstances, raising concern about the impact...

Introduction: Two billion people are currently affected by complex humanitarian emergencies (CHEs) resulting from natural disasters and armed conflict. Many have been displaced into crowded camps with poor access to water, sanitation, and health care. Humanitarian response is challenging under these circumstances, raising concern about the impact o...

Background: Military presence in fragile settings leads to complex and multifaceted interactions between local women and girls of the host country and foreign military personnel. Children Born of War are one consequence of sexual interactions, whether consensual or not, between foreign armies or peacekeeping forces and women and girls of the host c...

Background: A myriad of factors including socio-economic hardships impact refugees, with females being additionally exposed to various forms of sexual and gender-based violence (SGBV). The aim of this qualitative analysis was to understand and to provide new insight into the experiences of SGBV among Syrian refugee women and girls in Lebanon. Met...

Background: The current crisis in Syria has led to unprecedented displacement, with neighbouring Lebanon now hosting more than 1.5 million conflict-affected migrants from Syria. In many situations of displacement, adolescent girls are a vulnerable sub-group. This study explores and describes the self-reported unmet needs of Syrian adolescent girls...

Background Child abuse is a public health and human rights issue that is prevalent worldwide. All forms of abuse against children can have negative physical and mental health consequences. Under post-disaster situations, where there is a potential for increased stress and decreased social support among caregivers, the risk of child abuse may be hig...

Background: In October 2010, 10 months after a catastrophic earthquake, Haiti experienced the largest and most deadly cholera outbreak of the 21st century with 820,000 reported cases and up to 10,000 deaths. Nepalese United Nations (UN) peacekeepers are widely believed to have introduced cholera, and the UN formally accepted responsibility for the...

Lebanon hosts over one million refugees displaced from Syria as a result of the armed conflict—of whom, approximately 15% are adolescents aged between 12 and 17 years of age. Many female adolescent migrants report a decrease in quality of life and an increase in family tensions. This study sought to investigate the emotional well-being of adolescen...

Background: Adverse childhood experiences (ACEs) are associated with increased morbidity and mortality, lower levels of distress tolerance, and greater emotional dysregulation, as well as with increased healthcare utilization. All these factors may lead to an increased use of emergency department (ED) services. Understanding the experience of ED u...