Suchergebnisse

Aim. To analyze modern organizational and economic approaches to functioning of pharmacies in Poland.Materials and methods. The data from the legislative and regulatory framework governing the pharmaceutical activity in Poland, as well as the data from specialized literature were used. The historical, analytical-comparative, system, logical, mathematical and statistical research methods were applied.Results. Currently, the system of pharmaceutical provision of the population in Poland is developing in the direction of strengthening the state regulation of availability of pharmaceutical care through the introduction of mechanisms of influence on pricing, drug reimbursement and development of the pharmacy network (geographical, demographic, financial and economic factors of regulation). On average, one pharmacy institution in Poland is per 2600-2767 inhabitants, and it corresponds to the average European indicators for development of a pharmacy chain. It was proven that the retail segment of the market quickly responded to the introduction of new approaches in the reimbursement of drugs in 2012. In 2011, its volume amounted to 28.14 billion zł, and in 2012 it decreased by 2 billion zł (26.50 billion zł). The greatest impact of the reimbursement system reform is the influence on development of the prescription market segment. After the introduction of legislative changes ("Apteka dla aptekarza"), there was a significant decrease in the number of pharmacies from 14838 at the end of December 2017 to 14419 in October 2018 (-2.8%). In 2018, a significant increase in the number of closed pharmacies in rural areas was observed. Thus, during July 2017 – July 2018 out of 352 closed pharmacies – 100 accounted for the countryside. It was found that in 2018 there was a significant prevalence of the number of the licenses revoked over the licenses obtained for activities at the retail pharmaceutical market in Poland.Conclusions. Problems at the Polish pharmaceutical market must be solved taking into account the increasing demands of society to the effectiveness of pharmaceutical care provided, as well as the socio-economic level of availability of drugs recommended by the WHO. ; Цель: анализ современных организационно-экономических подходов к функционированию аптечных учреждений в Польше.Материалы и методы: данные законодательно-нормативной базы, регулирующей фармацевтическую деятельность в Польше, а также данные специальной литературы; исторический, аналитико-сравнительный, системный, логический, математико-статистический методы исследований.Результаты исследования. В настоящее время система фармацевтического обеспечения населения в Польше развивается в направлении усиления государственного регулирования доступности фармацевтической помощи посредством внедрения механизмов влияния на ценообразование, реимбурсацию лекарств и развитие аптечной сети (географические, демографические, финансово-экономические факторы регуляции). В среднем на одно аптечное учреждение в Польше приходится 2600-2767 жителей, что соответствует среднеевропейским показателям развития аптечной сети. Доказано, что розничный сегмент рынка быстро среагировал на внедрение в2012 г. новых подходов в проведении реимбурсации лекарств. В2011 г. его объем составил 28,14 млрд злотых, а в2012 г. он уменьшился на 2 млрд злотых (26,50 млрд злотых). Наибольшее влияние реформа системы реимбурсации имела на развитие рецептурного сегменте рынка. После внедрения законодательных изменений («Apteka dla aptekarza») наблюдалось значительное снижение количества аптечных учреждений – с 14838 в декабре2017 г. до 14419 в октябре2018 г. (-2,8 %). В2018 г. наблюдается значительное увеличение количества закрытых аптек в сельской местности. Так, на протяжении июля2017 г. – июля2018 г. из 352 закрытых заведений 100 приходилось на сельскую местность. Установлено, что в2018 г. имело место значительное превалирование количества отозванных над количеством полученных лицензий на осуществление деятельности на розничном фармацевтическом рынке Польши.Выводы. Проблемы на фармацевтическом рынке Польши должны решаться с учетом повышения требований общества к эффективности предоставленной фармацевтической помощи, а также социально-экономического уровня доступности лекарств, рекомендованных ВОЗ. ; Мета: аналіз сучасних організаційно-економічних підходів до функціонування аптечних закладів у Польщі.Матеріали і методи: дані законодавчо-нормативної бази, що регулює фармацевтичну діяльність у Польщі, а також дані спеціальної літератури; історичний, аналітико-порівняльний, системний, логічний, математико-статистичний методи досліджень.Результати дослідження. На сьогодні система фармацевтичного забезпечення населення у Польщі розвивається у напрямку посилення державного регулювання доступності фармацевтичної допомоги через упровадження механізмів впливу на ціноутворення, реімбурсацію ліків та розвиток аптечної мережі (географічні, демографічні, фінансово-економічні фактори регуляції). У середньому на один аптечний заклад у Польщі припадає 2600-2767 мешканців, що відповідає середньоєвропейським показникам розвитку аптечної мережі. Доведено, що роздрібний сегмент ринку швидко зреагував на упровадження у 2012 р. нових підходів щодо проведення реімбурсації ліків. У 2011 р. його обсяг склав 28,14 млрд злотих, а у 2012 р. він зменшився на 2 млрд злотих (26,5 млрд злотих). Найбільший вплив реформа системи реімбурсації мала на розвиток рецептурного сегменту ринку. Після упровадження законодавчих змін («Apteka dla aptekarza») спостерігалось значне зниження кількості аптечних закладів – із 14838 у грудні 2017 р. до 14419 у жовтні 2018 р. (–2,8 %). У 2018 р. спостерігається суттєве збільшення кількості закритих аптек у сільській місцевості. Так, упродовж липня 2017 р. – липня 2018 р. із 352 закритих закладів 100 припадає на сільську місцевість. Установлено, що у 2018 р. мало місце значне превалювання кількості відкликаних над кількістю отриманих ліцензій на здійснення діяльності на роздрібному фармацевтичному ринку Польщі.Висновки. Проблеми на фармацевтичному ринку Польщі мають вирішуватися з урахуванням підвищення вимог суспільства до ефективності наданої фармацевтичної допомоги, а також соціально-економічного рівня доступності ліків, рекомендованих ВООЗ.

Antecedentes: la competencia cultural fortalece los cuidados de Enfermería coherentes y efectivos en respuesta a la diversidad cultural existente. Objetivo: Describir e interpretar la competencia cultural (entendida y manifestada) y la percepción por parte de los profesionales de enfermería frente al cuidado realizado y de la población indígena Embera Chamí del departamento de Caldas frente al cuidado recibido. Método: investigación cualitativa etnográfica interpretativa. Los datos fueron recolectados a través de la observación participante y entrevista a profundidad. El análisis de los datos se realizó con las posturas de Leininger. Resultados y discusiones: contempla 15 subcategorías, 7 categorías y 2 patrones culturales sintetizados en un tema cultural sobre la competencia cultural de la enfermera de salud pública. Los resultados fortalecen la definición de competencia cultural, corroboran algunas afirmaciones teóricas, exponen el aporte que hace la enfermera a la cultura del indígena Embera y ponen de manifiesto la empatía enfocada en la comunicación como elemento prioritario de la competencia cultural. Conclusiones: la competencia cultural es entendida como un sistema ordenado que hace parte de la percepción de satisfacción de la enfermera y del indígena con resultados positivos para la salud. ; Abstract. Background: Cultural competence strengthens coherent and effective Nursing care in response to existing cultural diversity. Objective: To describe and interpret the cultural competence understood and manifested by nursing professionals in public health when they care for the indigenous population of Embera Chamí in the department of Caldas and the perception of both professionals and indigenous people in the face of care and received. Method: interpretative ethnographic qualitative research. Data were collected through participant observation and in-depth interview. Data analysis was performed using Leininger postures. Results and discussions: it includes 15 subcategories, 7 categories and 2 cultural patterns synthesized in a cultural theme on the cultural competence of the public health nurse. The results strengthen the definition of cultural competence, corroborate some theoretical affirmations, expose the nurse's contribution to the Embera indigenous culture and show the empathy focused on communication as a priority element of cultural competence. Conclusions: cultural competence is understood as an orderly system that entails and is part of the perception of satisfaction of the nurse and the indigenous with positive results for health. ; Doctorado

Abstract Background: The present study aims to estimate childhood overweight and obesity prevalence and their association with individual and population-level correlates in Eastern and Western European countries. Methods: Data were obtained from the School Children Mental Health in Europe, a cross-sectional survey conducted in 2010 in Italy, Germany, the Netherlands, Romania, Bulgaria, Lithuania and Turkey. The sample consists of 5,206 school children aged 6 to 11 years old. Information on socio-demographics, children's height and weight, life-style and parental attitude were reported by the mothers. Country-level indicators were obtained through several data banks. Overweight and obesity in children were calculated according to the international age and gender-specific child Body Mass Index cut-off points. Multivariable logistic regression models included socio-demographic, lifestyle, mothers' attitude, and country-level indicators to examine the correlates of overweight. Results: Overall prevalence was 15.6% (95% CI = 19.3-21.7%) for overweight and 4.9% (95% CI = 4.3-5.6%) for obesity. In overweight (including obesity), Romanian children had the highest prevalence (31.4%, 95% CI = 28.1-34.6%) and Italian the lowest (10.4%, 95% CI = 8.1-12.6%). Models in the pooled sample showed that being younger (aOR = 0.93, 95% = CI 0.87-0.97), male (aOR = 1.24, 95% CI = 1.07-1.43), an only child (aOR = 1.40, 95% CI = 1.07-1.84), spending more hours per week watching TV (aOR = 1.01, 95% CI =1.002-1.03), and living in an Eastern Country were associated with greater risk of childhood overweight (including obesity). The same predictors were significantly associated with childhood overweight in the model conducted in the Eastern region, but not in the West. Higher Gross Domestic Product and Real Domestic Product, greater number of motor and passenger vehicles, higher percentage of energy available from fat, and more public sector expenditure on health were also associated with lower risk for childhood overweight after adjusting for covariables in the pooled sample and in the east of Europe, but not in the West. Conclusions: Prevalence rates of overweight and obesity in school children is still high, especially in Eastern regions, with some socio-demographic factors and life-styles associated with being overweight. It is also in the Eastern region itself where better macro-economic indicators are related with lower rates of childhood overweight. This represents a public health concern that deserves special attention in those countries undertaking economic and political transitions.

To protect the elderly population, the Colombian Government needs to rethink the current pension system, considering the issues pointed by different sectors of Colombian society, such as the diverse demographic dynamics, the new composition of the labor market, and the parameters established by the 1991 Political Constitution. This reform must guarantee people's access to retirement, disability, and survival pensions, health care needs, hospitalization, and other complementary social services that the elderly population requires. Therefore, it has to review the mechanisms established to keep the purchasing power of pensions and rethink the effectiveness of replacement indemnities and repayments of balances to guarantee people's pension rights. Likewise,the Government must adopt a comprehensive public policy, executed at the highest level of the State, which allows establishing permanent financial mechanisms to guarantee the economic sustainability of the pension system in Colombia. This reform must implement a mixed scheme to ensure resources that enable the Government to secure the inalienable rights to social security and social protection under conditions of equality for all inhabitants. ; En Colombia se debe hacer una reforma integral en materia pensional para dar protección a la población mayor, en la cual se aborden múltiples razones expuestas por diversos sectores de la sociedad y se tengan en cuenta elementos relacionados con la estructura demográfica de la población, la nueva composición del mercado de trabajo y una evaluación del actual Sistema General de Pensiones, a partir de los parámetros establecidos por la Constitución Política de 1991, de manera que se revisen los ajustes que se han hecho al actual sistema, se haga una reflexión profunda sobre el contenido del derecho a las pensiones de invalidez, vejez y de sobrevivencia, sin que se limite al reconocimiento de las mesadas pensionales, dejando de lado las necesidades asistenciales de salud, hospitalización y demás servicios sociales complementarios que requiere la población mayor; los mecanismos establecidos para mantener el poder adquisitivo de las pensiones; se replantee la eficacia de las indemnizaciones sustitutivas y las devoluciones de saldos, frente a la garantía del derecho pensional de las personas; se adopte una política integral de pensiones que pueda ser ejecutada al más alto nivel del Estado y se establezcan mecanismos financieros permanentes que garanticen la sostenibilidad financiera del sistema pensional en Colombia, mediante una metodología que incorpore esquemas de tipo contributivo y distributivo de los recursos para que el Estado pueda garantizar los derecho irrenunciables a la seguridad social y a la protección social en condiciones de igualdad para todos los habitantes.

When individuals in the United States face civil justice issues, they are not entitled to legal counsel and therefore must secure paid counsel, proceed pro se or qualify for free legal assistance. As a result of the economic downturn, the number of Americans who are unable to afford legal counsel is now at an all-time high. In response to this ever-widening justice gap, the public interest community has launched multiple initiatives to supplement the underfunded legal aid system. Though valiant, this article argues that this approach has unfortunately created a complex, fragmented and overlapping delivery system for legal aid. This article first provides an understanding of the current civil legal landscape, especially as it impacts low-income and modest-means Americans. This article then examines the many initiatives developed as a means of closing the justice gap and whether such initiatives have helped or harmed underserved populations. Finally, this article proposes three specific reforms – the development of a comprehensive triage mechanism, the infusion of business process improvement within legal aid organizations and the creation of legal information exchange organizations – all of which, if implemented, will make great strides toward streamlining the delivery system for civil legal aid.

In recent years sport-based interventions have been implemented as a mechanism via which to target marginalised youth in relation to the development of social inclusion. Much of the political rhetoric surrounding social inclusion programmes highlights engagement with education, employment, or training, as key metrics. This has led some scholars to observe that conceptualising social inclusion in this way can act to further marginalise young people who fail to engage with these metrics. In contrast, this paper seeks to employ an alternative understanding of social inclusion, which uses the concepts of recognition and acceptance, to infer how participation in sports-based programmes may enable marginalised youth to meet mainstream societal expectations and aid with social assimilation. Drawing upon findings from two small-scale studies of sport-based interventions located in three UK cities, this paper places participant accounts at the centre of the analysis to explore broader notions of pro-social development in relation to recognition and interpersonal acceptance. The paper concludes by suggesting that within contexts in which young people are able to generate strong interpersonal relationships with key personnel (such as coaches), and which are built upon trust, recognition and developing self-worth, there is clear potential for sport-based programmes to incubate social assimilation.

European (EU) economic integration has always involved a commitment to the free movement of labour, services and capital. However, the development by EU institutions of specific rights with respect to labour mobility has been slow. This paper explores this issue from the perspective of pension rights, among the most long‐lasting for citizens. It shows that the literature on this topic has focussed mainly on EU regulations, their scope and limitations. The paper argues that, although important, this work has led to the neglect of a more fundamental issue: the potential impact on mobility of the relative generosity of pension schemes and large national wealth variations, an increasingly salient issue since the expansion of the EU into Eastern and Central Europe. Thus, on the basis of a detailed review of dominant intra‐EU migratory patterns, the paper investigates the impact on pension rights of movement between Beveridgean and Bismarckian pension systems and between countries of substantially different wealth. It shows that lower income workers who move from Beveridgean to Bismarckian countries would be most at risk of pension losses. However, such movement is unusual; instead, the majority of intra‐EU migrants move from Bismarckian systems of low generosity in the poorer east to Beveridgean and more generous Bismarckian in the richer west. Workers who make this move are more likely to experience pension gains than losses. For them, free movement is achieved

After Poland's accession to the European Union in 2004, Polish migration within Europe has increased considerably. Still, little is known about this large and growing group of immigrants. Using unique panel data from the Dutch population registers, we first apply sequence analysis to explore and describe the variety of family life courses among young adult (aged 20–30 at migration) Polish migrants in the Netherlands. Each individual family life career is followed for a 5-year period on a monthly time base. Optimal matching analysis is applied to compute (dis)similarities between individuals, in order to cluster into predominant life paths. Second, a series of logistic regression analyses were carried out to determine the main factors of importance on the different family life paths. Findings showed a strong impact of the partner's origin on the type of union and likelihood of return migration. Unemployment was found to be another important trigger of return migration. With regard to gender differences, we found that men are more likely to remain single and to leave the Netherlands at some point, while women more often cohabit and tend to stay.

Does exposure to refugees change the political preferences of natives towards far-right parties, and how does this change in preferences occur? This paper examines the political economy of refugee-hosting. Using the opening of refugee centers in France between 1995 and 2017, I show that voting for far-right parties in cities with such opening between two presidential elections has fallen by about 2 percent. The drop in far-right voting is higher in municipalities with a small population, working in the primary and secondary sectors, with low educational levels and few migrants. I show that this negative effect can not be explained by an economic channel , but rather by a composition channel, through natives' avoidance, and a contact channel, through natives' exposure to refugees. I provide suggestive evidence that too-disruptive exposure to refugees, as measured by the magnitude of the inflows, the cultural distance and the media salience of refugees, can mitigate the beneficial effects of contact on reducing far-right support.

Does exposure to refugees change the political preferences of natives towards far-right parties, and how does this change in preferences occur? This paper examines the political economy of refugee-hosting. Using the opening of refugee centers in France between 1995 and 2017, I show that voting for far-right parties in cities with such opening between two presidential elections has fallen by about 2 percent. The drop in far-right voting is higher in municipalities with a small population, working in the primary and secondary sectors, with low educational levels and few migrants. I show that this negative effect can not be explained by an economic channel , but rather by a composition channel, through natives' avoidance, and a contact channel, through natives' exposure to refugees. I provide suggestive evidence that too-disruptive exposure to refugees, as measured by the magnitude of the inflows, the cultural distance and the media salience of refugees, can mitigate the beneficial effects of contact on reducing far-right support.

Does exposure to refugees change the political preferences of natives towards far-right parties, and how does this change in preferences occur? This paper examines the political economy of refugee-hosting. Using the opening of refugee centers in France between 1995 and 2017, I show that voting for far-right parties in cities with such opening between two presidential elections has fallen by about 2 percent. The drop in far-right voting is higher in municipalities with a small population, working in the primary and secondary sectors, with low educational levels and few migrants. I show that this negative effect can not be explained by an economic channel , but rather by a composition channel, through natives' avoidance, and a contact channel, through natives' exposure to refugees. I provide suggestive evidence that too-disruptive exposure to refugees, as measured by the magnitude of the inflows, the cultural distance and the media salience of refugees, can mitigate the beneficial effects of contact on reducing far-right support.

Does exposure to refugees change the political preferences of natives towards far-right parties, and how does this change in preferences occur? This paper examines the political economy of refugee-hosting. Using the opening of refugee centers in France between 1995 and 2017, I show that voting for far-right parties in cities with such opening between two presidential elections has fallen by about 2 percent. The drop in far-right voting is higher in municipalities with a small population, working in the primary and secondary sectors, with low educational levels and few migrants. I show that this negative effect can not be explained by an economic channel , but rather by a composition channel, through natives' avoidance, and a contact channel, through natives' exposure to refugees. I provide suggestive evidence that too-disruptive exposure to refugees, as measured by the magnitude of the inflows, the cultural distance and the media salience of refugees, can mitigate the beneficial effects of contact on reducing far-right support.

Does exposure to refugees change the political preferences of natives towards far-right parties, and how does this change in preferences occur? This paper examines the political economy of refugee-hosting. Using the opening of refugee centers in France between 1995 and 2017, I show that voting for far-right parties in cities with such opening between two presidential elections has fallen by about 2 percent. The drop in far-right voting is higher in municipalities with a small population, working in the primary and secondary sectors, with low educational levels and few migrants. I show that this negative effect can not be explained by an economic channel , but rather by a composition channel, through natives' avoidance, and a contact channel, through natives' exposure to refugees. I provide suggestive evidence that too-disruptive exposure to refugees, as measured by the magnitude of the inflows, the cultural distance and the media salience of refugees, can mitigate the beneficial effects of contact on reducing far-right support.

La migración conlleva el desencadenamiento de una serie de fenómenos sociales, políticos, jurídicos y económicos que pueden representar tanto oportunidades como amenazas para la buena convivencia en los lugares receptores. De allí que esta investigación tenga por objeto caracterizar socioeconómicamente a la población migrante proveniente de Venezuela residente en el AMB durante el periodo comprendido entre enero de 2017 y junio de 2019 y, contribuir al diseño de indicadores de línea base para la formulación de una política pública de atención integral al migrante venezolano con residencia en esta región del país; Para ello, se realizaron consultas en la Sala de Procesamiento Especializados Externo (SPEE ) del DANE, en alrededor de 61.830 registros y 1.299 variables, de los cuales se substrajeron 921 registros que cumplían con la condición de "población migrante del país origen Venezuela y con residencia en el área metropolitana de Bucaramanga.". Registros que, al aplicar el factor de expansión del diseño de la muestra, de la operación GEIH a cada uno de sus variables, técnica y estadísticamente podemos inferir el total de migrantes venezolanos y caracterizarlos en las dimensiones: vivienda, hogar, sexo, edad, estado civil, seguridad social en salud, educación, inactivos, fuerza laboral, ocupados y desocupados. ; INTRODUCCIÓN 9 MARCO TEÓRICO 12 Migración 12 Causas de la migración 13 Consecuencias de la migración 16 Migración y políticas públicas 19 ASPECTOS METODOLÓGICOS 21 Tipo de investigación 21 Objetivo de investigación 21 Población 22 Muestra 24 Procesamiento de la información 25 Variables y categorías de análisis 28 RESULTADOS 30 Vivienda 30 Hogares 33 Características demográficas. 39 Seguridad social en salud. 47 Educación 48 Población Económicamente Inactiva 50 Población Económicamente Activa o Fuerza laboral. 53 Ocupados 55 Desocupados 65 CONCLUSIONES Y RECOMENDACIONES 71 ; Maestría ; Migration entails the unleashing of a series of social, political, legal and economic phenomena that can represent both opportunities and threats for good coexistence in the receiving places. Hence, this research aims to characterize socioeconomically the migrant population from Venezuela residing in the AMB during the period between January 2017 and June 2019 and contribute to the design of baseline indicators for the formulation of a public policy comprehensive care for the Venezuelan migrant residing in this region of the country; For this, consultations were made in the External Specialized Processing Room (SPEE) of DANE, in around 61,830 records and 1,299 variables, from which 921 records were subtracted that met the condition of "migrant population from the country of origin Venezuela and with residence in the metropolitan area of Bucaramanga. ". Records that, by applying the expansion factor of the sample design, of the GEIH operation to each of its variables, technically and statistically we can infer the total number of Venezuelan migrants and characterize them in the dimensions: housing, household, sex, age, marital status, social security in health, education, inactive, labor force, employed and unemployed.

In response to Hamas's brutal attack on Israel on October 7, the IDF invaded Gaza with a stated purpose of destroying the terror group. As such, the IDF is fighting what many have come to call a "war of counter-insurgency." Hamas has no "army" in any well accepted sense of the word. Rather, Hamas's military arm is reasonably well-organized (and well-funded) confederation of guerrilla fighters. The IDF's aim is to kill or otherwise incapacitate Hamas's fighters and, insofar as possible, leave civilians alone.But the IDF is not really fighting a war of counter-insurgency in Gaza. What it is fighting is best understood as a "war of occupation." The Israelis left Gaza in 2005, and now they are back as de facto occupiers. This characterization isn't to imply that the IDF will stay in Gaza in the long term. They may, they may not. It is rather an apt description of the challenging and dangerous military situation the IDF faces as it stands today. What is the difference between a war of counter-insurgency and a war of occupation, and is it useful for understanding the war in Gaza?In a war of counter-insurgency — at least as understood by politicians and theorists insisting that such a war is being fought — there are insurgents and civilians. The former are politically motivated, well-armed, and deadly. The civilians are simply "in the way." They are politically neutral if not exactly supportive of the troops sent to "help" them. In the understanding of the counter-insurgency experts, most civilians just want the war to end so they can get on with their lives. The West German operations against the Red Army Faction provide an example of a war of counter-insurgency, as does, perhaps, the American effort against al-Qaida and the Islamic State. In these cases, the insurgents were difficult to identify, but they did not generally enjoy the support of local population. This situation made military operations easier. In a war of occupation, however, there are insurgents and hostile civilians. The former are, as in a war of counter-insurgency, armed and deadly. But the latter — and this is the crucial difference — are decidedly unfriendly to the occupying forces. Whatever their political leanings, the occupied believe that the foreign troop should go home. The civilians may not be active combatants, but they are likely to give aid to the insurgents simply on nationalistic grounds. Thus understood, wars of occupation — often propagandistically called "wars of counter-insurgency" by occupying powers — have been common and deadly in modern times. One need only recall the British in Malaysia, the Americans in Vietnam, the French in Vietnam and Algeria, the Soviets in Afghanistan, and the Americans in Iraq and Afghanistan. In these cases, the insurgents were difficult to identify, but — and very significantly — much of the local population was decidedly hostile to occupying troops. This situation made military operations more difficult.The example of a war of occupation I know best is that of the Vietnam war, and it illustrates how difficult it is to fight — let alone win — such a war. From the beginning, the U.S. said it was fighting a war of counter-insurgency in South Vietnam, a "different kind of war" the Pentagon and successive presidential administrations called it. The U.S. did not invade North Vietnam and it said it did not invade the South Vietnam. But invade is what it did. The U.S. sent 2.6 million military personnel to South Vietnam over the course of the war; at the high point of operations, it had over half a million men there. The U.S., essentially, occupied much of South Vietnam.One of the places the U.S. occupied was Quang Ngai province on the northeast coast of South Vietnam. This, tellingly, is where the My Lai massacre occurred. U.S. ground troops in Quang Ngai hunted — and sometimes engaged — the Viet Cong, the "insurgents" of counter-insurgency theory. But they also encountered a population of South Vietnamese that was profoundly hostile to the Americans. The locals sniped at them, laid boobytraps and mines, aided the Viet Cong, and were generally involved in anti-American resistance.U.S. troops recognized the antagonism of the Vietnamese population in Quang Ngai, a population they were nominally defending. In the wake of the My Lai Massacre, the U.S. Army conducted an investigation to find out what had gone wrong with their counter-insurgency strategy. The investigators asked the perpetrators why they had killed civilians. The soldiers often responded by saying they did not know they were "civilians." The Vietnamese in Quang Ngai were, so the American troops claimed, all "VC sympathizers" and therefore dangerous. It's important to recognize that the American soldiers were not saying that it was (as the common trope goes) "difficult to tell combatants from civilians." They were saying that all the civilians were potentially threatening. In Gaza, the IDF finds itself in a situation like that of the American army in Quang Ngai province. The Israelis are there nominally on a counter-insurgency mission. But in fact, they have occupied Gaza. Hamas does not want them there, but neither do most Gazans who are suffering under the IDF onslaught. Is it too much to say that most Gazans hate the IDF? Perhaps not. Critics might well say that many Gazans hated the IDF before the Israeli invasion. Again, perhaps true. But the invasion and occupation certainly have not improved the situation. In a recent poll conducted by the Palestinian Center for Policy Survey and Research, 57% of Gazans said Hamas was "correct" to attack Israel on October 7. Nearly all of those surveyed — 97% — said the Israelis were committing "war crimes" in Gaza. This fact — a nearly uniformly hostile population — makes IDF military operations very difficult. The Israeli forces must fight Hamas, but they also must worry about hostile Palestinian civilians living under what the Palestinians see as IDF occupation. The dangers of conducting military operations in such a context are numerous, but the most significant — at least from the point of protecting civilians — is that the IDF will come to view the hostile residents of Gaza as "Hamas sympathizers" with tragic results.The perils of inherent in a war of occupation were vividly illustrated on December 15 when the IDF killed three Israeli hostages in Gaza City. According to the IDF, the Israeli troops "mistakenly identified three Israeli hostages as a threat" even though they were unarmed and were waving a white flag. The IDF went on to explain that the killings violated the Israeli rules of engagement. Of course they did, but that's to miss the point: from the perspective of the Israeli ground troops, all Gazans, no matter how innocent they appear, are perceived as a threat. This is particularly true of military-aged males, and all three of the murdered Israeli hostages were military-aged males. In modern times, wars of occupation have not ended well for the occupied or the occupiers. Typically, hostile civilians — what the occupying power sees as "sympathizers" — suffer tremendously and the occupying power leaves defeated. Such was the case in Algeria, Vietnam (twice), and Afghanistan (twice). The IDF knows this fact well, having fought, and lost, a war of occupation in southern Lebanon intermittently from 1982 to 2000. It remains to be seen if the Israelis have truly learned this lesson.