Displaced Population Research Articles

Sharing for relief: associations of trauma-focused interviews and well-being among war-affected displaced populations in the Middle East

ABSTRACT Nonmaleficence is a key ethical value of research among vulnerable populations. Trauma-focused research typically includes detailed interviews about traumatic life events and post-traumatic symptoms. This raises concerns about causing distress and harm for the affected individuals. We aimed to determine the immediate effects of trauma-focused interviews on participants’ wellbeing. We developed the brief Distress and Harm Scale (DH7) for the assessment of current symptoms of distress and urge to harm oneself or others. Using data from 332 Iraqi and Syrian children and both of their parents (N = 996), we assessed these symptoms before and after participating in trauma-focused interviews. Results showed that the mean levels of self-reported distress and harm impulses were significantly decreased among adults and children rather than increased immediately after the interviews. Once measures to safeguard cases at risk are carefully implemented in research, the potential benefits of participating in trauma-focused interviews outweigh the risk for individuals. Potential implications of the results for ethical review boards evaluating trauma-focused studies are discussed.

Determinantes sociales, síntomas y problemas mentales en población adulta víctima de desplazamiento forzado por conflicto armado interno. Soacha, Colombia, 2019

ObjectiveTo characterise social determinants of health, mental health problems and potentially problematic symptoms in the adult population displaced by internal armed conflict in Colombia. MethodsCross-sectional descriptive study with a random sample of 98 adults forcefully displaced to Soacha, Colombia, due to internal armed conflict. The Self Report Questionnaire to detect potentially problematic mental health problems and symptoms, and a structured questionnaire on social determinants of health were applied. ResultsThe median age was 38 [interquartile range, 28-46] years, and women predominated (69.39%). The median time since displacement was 36 [16-48] months, and time since settlement in Soacha, 48 [5-48] months. 86.32% survived on less than the minimum wage per month and 93.87% did not have an employment contract. 42.86% and 7.14% reported being owners of their homes before and after displacement, respectively. Upon arriving in Soacha, 79.60% went to primary support networks and 3% to institutions. Before displacement, 16.33% lacked health insurance and 27.55% afterwards. Regarding mental health problems; there were possible depressive or anxious disorders in 57.29%; possible psychosis in 36.73%; and potentially problematic symptoms in 91.66%, being more prevalent and serious in women (P=0.0025). ConclusionsA deterioration in living conditions and a higher prevalence of potentially problematic mental health problems and symptoms was reported in displaced adult populations settled in Soacha compared to other regions of the country. Analyses with complementary perspectives are required to evaluate these differences.

Perfection and Disaster

Academic essays typically and quite rightly advance theses and defend them with arguments. In this essay, I do not propose or defend a thesis. Instead, I try to ask, in a sustained way, a straightforward question: what’s the sense in talking about ethical or political perfectionism in a world facing cataclysmic environmental collapse? At what kind of perfection might one aim in a world fundamentally out of balance: a world of mass extinction and dwindling biodiversity, collapsing ecosystems, super-sized droughts and storms, extreme heatwaves, rising and rapidly warming and acidifying oceans and seas, massive displaced populations, increasingly limited access to clean water and adequate food, spreading pandemic disease, and the economic collapse and political chaos that such cascading disasters will bring in their wake? In such a world, is the good life even conceivable?

Refuge and Resistance: Theater with Kurds and Yezidi Survivors of ISIS

This essay looks at ongoing efforts to revitalize arts and culture among the Yezidi and broader Iraqi Kurdish communities. The Yezidi are survivors of the 2014 genocide perpetrated by the Islamic State (ISIS, also known by its Arabic acronym Da’esh) which resulted in mass killing, captivity and expulsion from their ancestral homeland of Mt. Sinjar in northern Iraq. They are part of the Kurdish people, who have engaged in centuries of struggle to protect their cultural and political identity, establish autonomy and ensure their security in the broader Middle East. After a brief overview of the Yezidi genocide and its aftermath, we trace some theatrical efforts in the 20–21st century and look at two embryonic theater initiatives in Iraqi Kurdistan. The description of cultural projects at Springs of Hope Foundation (Shariya Camp) is followed by personal reflection and analysis of the aims, uses and challenges of Applied Theater. This ‘umbrella term’ refers to a process that uses a theatrical tool-kit in non-theater contexts. The aesthetic, ethical and political challenges inherent in this work are considered: the essay explores questions of ethical care and the implications and pitfalls of working with vulnerable and displaced populations, issues of representation, and creating spaces for healing and expression through participatory theater. Finally, we discuss a new initiative in Iraqi Kurdistan that seeks to address ethnic and political fissures through theater. The essay culminates with a consideration of belonging and re-imagining home.

Enduring Epidemic: Aesthetic Aftershocks of the 1914 Plague and the Segregation of Dakar

AbstractIn 1914, an epidemic of bubonic plague ravaged colonial Dakar. The panicked French colonial administration blamed the native population and evicted indigenous Africans from the city center before burning their homes. The Dakarois fought back through a general strike, political maneuvering, and, finally, by taking to the streets. Out of this year of disease, politics, racism, and resistance came the new, segregated neighborhood of Médina, which was created to house the displaced African population of Dakar. Over the twentieth century, as Dakar swelled into a metropolis around it, Médina was a unique space in the Senegalese capital—a hotbed of cultural creativity, a crossroads for waves of migrants, and a potent and enduring contrast with the nearby downtown, known as the Plateau. This article explores the ways in which the plague of 1914 reshaped Dakar and left a lasting impression on a century of Senegalese cultural production.

Prevalence and risk factors of acute malnutrition among pre-school children in internally displaced person settlements within Abuja Municipal Area Council

Background: Malnutrition is pervasive among displaced populations worldwide. Adequate nutrition is essential to the growth and development of all children, particularly in the preschool age.
 Methodology: This cross-sectional study was conducted in four internally displaced person (IDP) settlements and their host communities within the Abuja municipal area council between April and May 2019. Using a multistage sampling method, subjects were recruited after parents’ informed consent, from the IDP settlements and equal numbers were drawn from their host communities. The proportion of acute malnutrition using weight for height, MUAC, BMI-for-age Z scores were compared to the 2006 WHO standards. Predictors were determined by logistic regression and statistical significance was set at p less than 0.05.
 Results: There were 1,179 children aged six to 59 months recruited in each group. The prevalence of wasting was 7.7% (91), moderate acute malnutrition was 7.2% (85), and severe acute malnutrition was 3.1% (37) among the IDPs while they were 7.1% (84), 6.5% (77) and 2.9% (34) respectively in the host communities. The predictors for wasting in both groups were age below 24months (Adj OR, 95% CI - 3.88, 2.38 - 6.32), low birth weight (Adj OR, 95% CI – 2.70, 1.55 – 4.71) and diarrheal disease (Adj OR, 95% CI - 5.45, 2.38 - 12.44). Location was predictive only in the host communities (Adj OR, 95% CI – 2.69, 1.37 – 5.28).
 Conclusion and recommendation: Acute malnutrition was high among the pre-school children in this study. The nutritional needs of displaced children in the FCT should be met and their families educated on prompt recognition and treatment of diarrhoea.

The culturally and contextually sensitive assessment of mental health using a structured diagnostic interview (MINI Kid) for Syrian refugee children and adolescents in Lebanon: Challenges and solutions.

Elevated rates of mental health difficulties are frequently reported in conflict-affected and displaced populations. Even with advances in improving the validity and reliability of measures, our knowledge of the performance of assessment tools is often limited by a lack of contextualization to specific populations and socio-political settings. This reflective article aimed to review challenges and share lessons learned from the process of administering and supervising a structured clinical interview. We administered the MINI International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) and used the Clinical Global Impression (CGI) severity scale with N = 119 Syrian refugee children (aged 8-17) resident in ITSs in Lebanon. Qualitative data were derived from supervision process notes on challenges that arose during assessments, analyzed for thematic content. Five themes were identified: (1) practical and logistical challenges (changeable nature of daily life, competing demands, access to phones, temporary locations, limited referral options); (2) validity (lack of privacy, trust, perceptions of mental health, stigma, false positive answers); (3) cultural norms and meaning (impact of different meanings on answers); (4) contextual norms (reactive and adaptive emotional and behavioral responses to contextual stress); and (5) co-morbidity and formulation (interconnected and complex presentations). The findings suggest that while structured assessments have major advantages, cultural and contextual sensitivity during assessments, addressing practical barriers to improving accessibility, and consideration for inter-connected formulations are essential to help inform prevalence rates, treatment plans, and public health strategies.

Application of telemedicine in infectious diseases

IntroductionInfectious pathologies can benefit from the application of Telemedicine (TM). This study provides a description of the infectious pathology treated by the Telemedicine Service of the Hospital Central de la Defensa Gómez Ulla (STM-HCDGU). MethodsAnalysis of the e-consultations made by members of the Armed Forces (FA) of Spain displaced to the area of ​​operations (ZO) in the period between 01/1/2015 and 31/12/2018 who developed infectious symptoms. Results127 infectious diseases were diagnosed, the most frequent being those of respiratory etiology and later malaria. Geographically Africa and embarked contingents were the most significant. It was necessary to evacuate 18 patients to the HCDGU, being the diagnosis of malaria the most frequent reason for evacuation, cause of the only fatal case. Conclusionsinfectious diseases benefit from the application of TM, being an important tool for the diagnosis and treatment of these, constituting an opportunity to expand to other displaced or remote populations.

SEARCH FOR THE CONCEPT OF REVIVAL AND SPATIAL DEVELOPMENT OF UKRAINE AND ITS REGIONS: THE VIEW OF THE ARCHITECT

For Ukraine, which is at war and facing various challenges, the revival, transformation and development of the state require an effective spatial policy. Strategic priorities today are the restoration of territorial integrity and strengthening the real sovereignty of the state within its borders, creating modern systems and effective mechanisms for national security, the formation of a new postwar spatial reality of the state and its regions. The article considers the spatial consequences of the war, attempts to outline the ways of transformation and development of regions and cities of Ukraine, reveals in detail the problem of displaced population, preservation of social, economic, cultural activity, maximum integration into the new socio-cultural space. etc). Substantiation of the concepts of transformation and development of the region and the state is accompanied by creative search and scientific substantiation of ideas, principles of organization and development, as well as macro-characteristics of the system. Specific recommendations are given, which should be integrated into joint programs for the implementation of spatial development policy of the region, taking into account new realities: development of the resettlement system (dispersion, priority for small towns, villages and settlements, employment prospects); territorial (land) - inventory of land for significant national needs and purposes, to prevent trade in land during the war and at the stage of restoration of destroyed infrastructure; formation of engineering and forms of housing and construction (energy and resource supply, development of social and other types and forms of housing), etc. All issues raised in the publication are revealed in the context of spatial reorganization and development of Ukraine.

Strengthening Diabetes Care in Humanitarian Crises in Low- and Middle-income Settings.

Amid the growing global diabetes epidemic, the scale of forced displacement resulting from armed conflict and humanitarian crises is at record-high levels. More than 80% of the displaced population lives in lower- and middle-income countries, which also host 81% of the global population living with diabetes. Most crises are protracted, often lasting decades, and humanitarian aid organizations are providing long-term primary care to both the local and displaced populations. Humanitarian crises are extremely varied in nature and occur in contexts that are diverse and dynamic. The scope of providing diabetes care varies depending on the phase of the crisis. This paper describes key challenges and possible solutions to improving diabetes care in crisis settings. It focuses on (1) ensuring a reliable supply of life preserving medications and diagnostics, (2) restoring and maintaining access to health care, and (3) adapting service design to the context. These challenges are illustrated through case studies in Ukraine, Mali, the Central African Republic, and Jordan.

Displacement, Polygyny, Romantic Jealousy, and Intimate Partner Violence: A Qualitative Study among Somali Refugees in Ethiopia.

Romantic jealousy is a well-known relational driver of intimate partner violence (IPV), but is under-studied among displaced and polygynous populations. This study aimed to explore factors that elicit jealousy among Somali refugees in the Bokolmayo Refugee camp in Ethiopia, and the pathways leading from jealousy to IPV against women and men, to inform interventions. We conducted an exploratory, thematic analysis of 30 in-depth interviews with both women and men who were Somali refugees, as well as elders and religious leaders, organizational and service providers, policy makers, and host community members. We found that jealousy experienced by women was elicited by an unequal distribution of money and affection between co-wives, which was exacerbated by displacement-related economic hardship, and women in monogamous partnerships suspecting their husband of having other relationships. The jealousy experienced by men was elicited by their wives’ increased financial independence and interactions with other men when working outside of the home, which became more common because of displacement-related economic hardship and relaxed patriarchal gender norms. IPV interventions should address jealousy and controlling behaviors in all relationship types. Addressing conflict and relationship dynamics in polygynous households and in humanitarian settings may require specialized content, acknowledging the complex interactions and resource allocation between co-wives. Gender-transformative interventions that move away from masculinities that are built on the provider role and the introduction of alternative masculinities could also be effective in reducing IPV in this and other similar contexts.

Addressing Mental Health Concerns in Refugees and Displaced Populations: Is Enough Being Done?

There are over 82.4 million forcibly displaced people worldwide, about a quarter of whom are resettling as refugees. In the wake of the global refugee crisis spurred by conflict, religious and political persecution, human rights violations, and climate disasters, a mental health has crisis followed. Not only does trauma experienced in home countries and as part of forced migration affect mental health, so too do post-migration traumatic events, discrimination, lack of access to quality and affordable healthcare and housing, and acculturation. To address mental health concerns in refugees and displaced populations, collective action is needed not only from health care providers but also from mental health researchers, funders, journals, resettlement agencies, government entities, and humanitarian organizations. The present review highlights the work of numerous scholars and organizations with the goal of understanding the mental health concerns of forcibly displaced persons within and across ecological systems. The present review seeks to bring attention to the experiences of forcibly displaced persons, summarize the growing body of research understanding the acute and chronic effects of forced displacement and possible interventions, and give a call to action for all members of the global community at every level to engage in joint efforts to improve mental health in refugees and displaced persons. Notably, there is a need for more interventions at the familial and community level that serve not only as treatment but also as prevention. Smartphone-based interventions, mind-body modalities, and interventions delivered by lay and non-clinician community members hold promise. Numerous strides could be made in refugee mental health and treatment when funding agencies include these goals in their research priorities. Despite the challenges they have faced, persons who resettle as refugees are incredibly resilient and deserve to be afforded every right, opportunity, dignity, and respect.

Exploring the Protective Value of Using Sexting for Condom Negotiation on Condom use Determinants and Practices Among Forcibly Displaced Adolescents in the Slums of Kampala, Uganda.

Given the global growth of adolescent texting, we evaluate texting-based sexual communication as a potential site for interventions encouraging condom use cascades, particularly among displaced adolescents-a population with disproportionate levels of sexually transmitted infections, including HIV. With data from 242 forcibly displaced adolescents in the slums of Kampala, Uganda, we used path analysis to examine pathways from gender/dating relationship to condom determinant (knowledge of where to access condoms) and practices (access/use of condoms), through sexting-based condom negotiation, controlling for sexting practices. We found direct pathways from gender (boys vs. girls) and from dating relationship (dating vs. not) to condom determinant. Sexting-based condom negotiation partially mediated the pathway from gender/dating relationship to condom determinant, and fully mediated the pathways from gender/dating relationship to condom practices. Future digital sexual health interventions should consider the utility of texting-based applications in promoting knowledge and use of condoms among adolescents.

Practical needs and considerations for refugees and other forcibly displaced persons with neurological disorders: Recommendations using a modified Delphi approach.

Background: There are >70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology. Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in accordance with the Delphi method. Results: A consensus list of priority interventions for treating neurological conditions in displaced people was created, agnostic to cost considerations, with the ten highest ranking tests or treatments ranked as: computerized tomography scans, magnetic resonance imaging scans, levetiracetam, acetylsalicylic acid, carbamazepine, paracetamol, sodium valproate, basic blood tests, steroids and anti-tuberculous medication. The most important contextual considerations (100% consensus) were all economic and political, including the economic status of the displaced person's country of origin, the host country, and the stage in the asylum seeking process. The annual cost to purchase the ten priority neurological interventions for the entire displaced population was estimated to be 220 million USD for medications and 4.2 billion USD for imaging and tests. Conclusions: A need for neuroimaging and anti-seizure medications for forcibly displaced people was emphasized. These recommendations could guide future research and investment in neurological care for forcibly displaced people.

Contrasting Narratives of the Israeli-Palestinian Conflict in Polish History Textbooks

The research critically evaluates ways of narrating the Israeli-Palestinian conflict in Polish secondary-school history textbooks. Based on a repeated critical reading and discourse analysis of both Israeli and Arab-Palestinian narratives, the study focuses on the choice of pro-Palestinian and pro-Israeli designations when naming the conflict and the incorporation or silencing of pro-Israeli and/or pro-Palestinian voices in textbook narratives. Reducing Palestinians to a displaced population and depicting Palestinian liberation movement as terrorism are some elements of the anti-Palestinian/pro-Israeli textbook narrative. Reducing Israel to the status of a Zionist State and presenting Zionism as a colonial movement are the examples of pro-Palestinian textbook narrative. The research found that although the over-simplistic “aggressor-victim” format is not dominant, the coverage of Israeli-Palestinian conflict in most of the analyzed textbooks is unbalanced, sometimes even misleading and implying asymmetrical relations between Jews/Zionists and Arabs/Palestinians.

Practical needs and considerations for refugees and other forcibly displaced persons with neurological disorders: Recommendations using a modified Delphi approach

Background: There are >70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology. Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in accordance with the Delphi method. Results: A consensus list of priority interventions for treating neurological conditions in displaced people was created, agnostic to cost considerations, with the ten highest ranking tests or treatments ranked as: computerized tomography scans, magnetic resonance imaging scans, levetiracetam, acetylsalicylic acid, carbamazepine, paracetamol, sodium valproate, basic blood tests, steroids and anti-tuberculous medication. The most important contextual considerations (100% consensus) were all economic and political, including the economic status of the displaced person’s country of origin, the host country, and the stage in the asylum seeking process. The annual cost to purchase the ten priority neurological interventions for the entire displaced population was estimated to be 220 million USD for medications and 4.2 billion USD for imaging and tests. Conclusions: A need for neuroimaging and anti-seizure medications for forcibly displaced people was emphasized. These recommendations could guide future research and investment in neurological care for forcibly displaced people.

To what extent can urban ventilation features cool a compact built-up environment during a prolonged heatwave? A mesoscale numerical modelling study for Hong Kong

Recent advances in numerical tools and data for the study of urban microclimates have helped to evaluate countermeasures for urban heat in heterogeneous and high-rise cities such as Hong Kong. Thus, two ventilation strategy designs, point ('oases') and linear ('corridors') features, were numerically simulated during a typical heatwave using the multi-layer coupled MesoNH-SURFEX-TEB mesoscale atmospheric model. These strategies proved to be effective at night with respect to thermal comfort but caused a localised increase in heat stress during the day in the ventilated areas, which were less shaded. There was no significant deterioration in the wind performance around the developments that were redesigned to accommodate the displaced population due to the construction of the ventilation features; however, an improvement was observed in thermal comfort during the daytime. The simulated impacts were relatively localised, suggesting the importance of increasing porosity across the entire urban fabric. The corridors, especially when built along the axis of the prevailing winds, exhibited better ventilation at the pedestrian level than the oases. Nevertheless, the oases remain interesting features in the context of progressive urban ventilation planning that involve the implementation of isolated, connected, and eventually a network of features to provide benefits at the megalopolis scale.

‘For the first time in my life, I am living in a home with separate lavatory and kitchen’: examining stakeholders’ satisfaction with the Bui hydroelectric power resettlement project

ABSTRACT There is evidence to suggest that effective planning and tailoring resettlement schemes to the circumstances of displaced population are more likely to satisfy the target population. In spite of this, the topic is not well explored in the developing countries. To address this research gap, we employed mixed methods to analyse surveys and interviews. We found that although the resettled population were satisfied with new typology of housing, they were unhappy about their limited access to productive assets and the low compensatory packages given them. We encourage policymakers to make provisions for adequate productive assets in future resettlements.

Camp-Life and Social Integration: Case of the Displaced Biharis in Khulna, Bangladesh

This research aims to examine how the spatialities of the camp affect a permanent displaced population’s acculturation and social integration. Using the case of the largest Bihari camps in Khulna, Bangladesh, it found that Biharis’ many cultural customs and practices have been compromised by internal and external reasons despite their best efforts to retain them. Ill-maintained civic facilities, encroachment of public infrastructures, and the political use of out-of-context religious practices/infrastructures have also affected their social relations. The camp’s physical setting has played the double role of an instrument and a stage, while its exceptionalities negatively influenced their overall social integration.

Access to community-based reproductive health services and incidence of low birthweight delivery among refugee and displaced mothers: a retrospective study in the Thailand-Myanmar border region

ObjectivesOver 2.4 million people have been displaced within the Thailand-Myanmar border region since 1988. The efficacy of community-driven health models within displaced populations is largely unstudied. Here, we examined the...