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yes ; The purpose of this paper is to identify how the presence, proliferation, and misuse of small arms and light weapons (SALW) negatively impact children in conflict and post-conflict societies. It examines the impact of these weapons on children's well-being, rights and development, drawing on primary research in Cambodia, Mozambique, and Colombia. It was prepared in the context of the UN Conference on the Illicit Trade in Small Arms and Light Weapons in All Its Aspects in July 2001 and the UN Special Session on Children. Both are key opportunities to examine fully the impact of SALW on children at the international level and to agree global action to prevent and reduce the spread and misuse of the weapons that endanger the safety and undermine the potential of children. While UN agencies, international governmental organisations, human rights and development organisations have documented abuses committed against children, to date there has been no systematic analysis of the numerous ways in which SALW negatively affect the lives of children in conflict and post-conflict situations, let alone in societies at peace. However, the information that has been collected paints a terrible picture of devastation wrought by SALW. The use of small arms by and against children has both direct effects, which include death and injury, human rights abuses, displacement and psychosocial trauma, and indirect effects, which include insecurity, loss of health care, education and opportunities. These direct and indirect effects have both short and long-term impacts on the well-being, rights and development of children. This paper highlights these direct and indirect costs by drawing on the personal testimonies of youth affected by small arms in Cambodia, Mozambique, and Colombia - countries that have felt the devastating impacts of small arms and are currently at different phases of the recovery process. It is often extremely difficult to separate the impact of conflict from the impact of small arms on children but the human suffering caused by small arms is ultimately immeasurable. Indeed, the United Nations Secretary-General, Kofi Annan, has called small arms 'weapons of mass destruction' . These weapons often prolong and deepen the consequences of war and also impede post-conflict resolution and reconstruction. If many small arms remain behind after a conflict ends, they can promote insecurity, which in the extreme, may result in a return to conflict. Even in societies at peace, the presence of SALW can fuel crime and violence, and they can also be used by security forces for the facilitation of human rights violations against the civilian population. These weapons have several characteristics that make them ideal for contemporary conflicts and, in particular, the targeting and use of children in war. Many are so lightweight and simple that a child as young as eight can operate and repair them without difficulty. Equally, they can last over 40 years, meaning they can be exported from conflict to conflict through porous borders and lax national, regional, and international controls.

BACKGROUND: Increasingly, health policy-makers and managers all over the world look for alternative forms of organisation and governance in order to add more value and quality to their health systems. In recent years, the central government in England mandated several cross-sector health initiatives based on collaborative governance arrangements. However, there is little empirical evidence that examines local implementation responses to such centrally-mandated collaborations. METHODS: Data from the national study of Health Innovation and Education Clusters (HIECs) are used to provide comprehensive empirical evidence about the implementation of collaborative governance arrangements in cross-sector health networks in England. The study employed a mixed-methods approach, integrating both quantitative and qualitative data from a national survey of the entire population of HIEC directors (N = 17; response rate = 100%), a group discussion with 7 HIEC directors, and 15 in-depth interviews with HIEC directors and chairs. RESULTS: The study provides a description and analysis of local implementation responses to the central government mandate to establish HIECs. The latter represent cross-sector health networks characterised by a vague mandate with the provision of a small amount of new resources. Our findings indicate that in the case of HIECs such a mandate resulted in the creation of rather fluid and informal partnerships, which over the period of three years made partial-to-full progress on governance activities and, in most cases, did not become self-sustaining without government funding. CONCLUSION: This study has produced valuable insights into the implementation responses in HIECs and possibly other cross-sector collaborations characterised by a vague mandate with the provision of a small amount of new resources. There is little evidence that local dominant coalitions appropriated the central HIEC mandate to their own ends. On the other hand, there is evidence of interpretation and implementation of the central ...

yes ; Historically, UN conferences have been criticised for resulting more in compromises than in commitments to real change, which is also a charge that has been levelled against the UN Conference on the Illicit Trade in Small Arms and Light Weapons in All Its Aspects (UN Small Arms Conference). The consensus-based approach adopted throughout the negotiations had the advantage of binding all participating States to all aspects of the agreed Programme of Action (PoA), but it also ensured that it would be difficult to achieve a sufficiently rigorous and comprehensive agreement on all of the measures required to tackle the trafficking, proliferation and misuse of small arms and light weapons (SALW). Therefore, in spite of the efforts of many governments and NGOs, the UN Small Arms Conference did not agree sufficiently robust agreements in several areas. Nonetheless, it was a valuable and productive process. The resulting PoA includes a reasonably comprehensive set of key principles and commitments, which provide a basis for taking forward action at national, regional and global levels. The PoAwas agreed by all of the participating States, amounting to more than 100, and each are politically bound to adopt and implement it. Given that the UN Small Arms Conference was the first of its kind, its achievement in generating political will and momentum for efforts to control SALW is important. Although many of the commitments are weaker and less comprehensive than hoped for by many governments and organisations, it is significant that the PoAcontains at least some important commitments in all but two of the `core¿ issue areas raised by States. The two exceptions relate to transfers to non-State actors and to civilian trade, possession and use of SALW, restrictions which were strongly opposed by the USA. Equally, human rights related issues were noteworthy by their absence in the PoA. Whilst the process of reaching agreement began with a far-reaching draft PoA in December 2000 (A/Conf.192/L.4), most of the comments that were tabled on this text during the second Preparatory Committee in January 2001 came from countries that sought to weaken its commitments. The subsequent draft (A/Conf.192/L.4/Rev.1) was therefore weaker, with the result that progressive States faced an uphill task in seeking to strengthen its provisions. The next draft PoA emerged at the UN Small Arms Conference itself in the form of a third draft (A/Conf.192/L.5). Although still limited in a number of key areas ¿ such as export criteria and transparency ¿ this document went further than L.4/Rev.1 in a number of respects and included specific international commitments, including on brokering and tracing lines of supply. This, however, proved too ambitious an agenda for a small group of States and in the end the document that was adopted by consensus (A/Conf.192/L.5/Rev.1) represented a lower-level compromise. Despite the difficulties of agreeing the consensus-based PoA, the process culminating in the agreement was perhaps as important as the agreement itself. UN Small Arms Conference represented the first time that all UN Member States had met to discuss the illicit trade in SALW in all its aspects with a view to agreeing a comprehensive set of measures to address the problem. Although many of the commitments contained in the PoAare couched in equivocal language that will allow States to do as much or as little as they like, it is clear that the UN Small Arms Conference has contributed to a much better understanding, amongst all stakeholders, of the nature of the illicit trade in SALW and of the particular concerns and priorities of different countries and sub-regions. It is also clear that although the Programme of Action provides a set of minimum standards and commitments which all states should adopt, it also encourages further action from all States willing to adopt more stringent commitments and stronger programmes. There is a willingness among a number of States to build upon the PoAand take more concrete and far-reaching measures at national, sub-regional, regional and international levels, such as specific arrangements for tracing co-operation, or mechanisms to co-ordinate e fforts to improve stockpile security or weapons destruction. This briefing provides a critical assessment of key provisions in the UN Small Arms Conference PoA. Section 1 measures the overall outcomes of the conference against those that the Biting the Bullet (BtB) project proposed as optimal conclusions, and suggests ways to put the commitments contained in the PoA into practice. Section 2 assesses the implementation and follow-up commitments contained in the PoA, and identifies ways of promoting the implementation of Sections III and IV, as well as options for making the most of the Biennial Meetings of States and the Review Conference in 2006. Section 3 examines funding and resourcing possibilities for the PoA including identifying needs, mobilising resources and matching needs with resources. The final section of the briefing focuses on the way forward, and in particular on how implementation of the PoA could build on existing regional initiatives and develop common international approaches to controlling SALW proliferation, availability and misuse. It also examines how action to prevent and combat the illicit trade in SALW in all its aspects can be taken forward at sub-regional and regional levels in conjunction with all major stakeholders, including civil society, in the period leading up to the first Review Conference.

Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.