Humanitarian Crisis Research Articles

DECENTRALIZED PLATFORM FOR FINANCING CHARITY PROJECTS

The rapid development of new technologies, together with the emergence of new military conflicts and humanitarian crises, creates the need for quick response and the introduction of new methods of effective assistance to the affected population and the restoration of damaged territories. Decentralized charity became one of these methods of assistance. To implement the task, the latest technologies were used, which combine maximum transparency and complete security when forming and working with charitable payments. The main technologies that were used: blockchain and smart contracts on it, protocols of liquidity pools and profitable farming, as well as web development technologies for creating a web application. The research analyzed existing approaches, methods of software solutions for financing decentralized charity; developed and improved the mathematical model and architecture of the software application. A system of smart contracts was created using additional administrative modules, and on its basis, a decentralized charitable platform for assistance to Ukraine was implemented in the form of a web application. Such a decentralized system can be freely used and implemented nowadays to finance the most necessary charitable projects of our country with crypto-assets in various spheres: humanitarian, social or in matters of security and weapons.

The Effect of Sudan's April 2023 War on Medical Education and Prospects for Recovery

Background: Sudan’s historical narrative is marked by enduring sociopolitical challenges and deep cultural divisions that have sparked numerous conflicts. A recent escalation in hostilities on 2023, April 15 has dangerously pushed the nation to the brink of a full-scale civil war with potential regional ramifications. The resultant humanitarian crisis involves over 9000 fatalities, 12,000 injuries, and the displacement of six million people, now grappling with dire conditions in their new settlements. The ongoing conflict in Sudan has had a profound impact on the nation’s already challenged medical education (ME) sector, resulting in the complete destruction of buildings and infrastructure, widespread looting in conflict zones, and a nationwide disruption of educational activities. This review sheds light on the urgent and still unfolding crisis in ME and explores potential solutions to enhance global understanding of crisis management.Methods: The review utilizes the crisis management framework and draws insights from diverse sources such as literature, student-led webinars, and discussions with Sudanese ME experts. We have examined pre-existing challenges, analyzed the war’s impact on ME, and proposed a path forward. Results: Despite the profound devastation, this crisis offers a unique opportunity to revamp Sudan’s struggling ME system, introducing a community-centric and socially accountable approach. Conclusion: Through collaborative efforts, Sudan’s ME system has the potential to serve as a model for similar nations, effectively addressing the needs of its populace and fostering sustainable development.

Sustainable Strategies for Improving Humanitarian Supply Chain Management in the United Nations Using Dynamic Capability Theory

The purpose of the qualitative multiple case study was to explore the strategies some supply chain managers of the United Nations (UN) use to leverage operational efficiencies in the UN humanitarian programs. As a result, communities supporting sustainability and peace or those fostering economic development will be able to respond effectively to humanitarian crises. Moreover, the UN can remain operational and engage in political and conflict-reduction interventions integral to economic and social recovery and sustainability. This study applied the qualitative multiple case study through semi-structured interviews with nine supply chain managers in the United Nations, direct observations, document analysis, and artifacts. The research is grounded in the dynamic capability theory (DCT). The research revealed several strategies that supply chain managers of the UN use to ensure operational efficiencies grouped around three themes: (a) analytical, innovation, and knowledge management strategies; (b) effective supply chain management leadership strategies; and (c) risk management strategies. This study is one of the first to apply generic findings of humanitarian supply chain studies to the United Nations, the global organization with diverse mandates that continuously strives to achieve efficiencies required by donors providing financial support, thus remaining operational. The study’s results could help leaders in the various humanitarian organizations who operate in vulnerable environments and under strict scrutiny from donors to deliver their aid programs most efficiently by understanding dynamic capabilities. Previous studies indicate the lack of strategic frameworks applicable to the United Nations that could improve decision-making at the strategic, tactical, and operational levels, facilitate collaboration among supply chain stakeholders, and reduce the costs of the operational performance of the supply chain system in the UN.

Nowe szlaki migracyjne przez Polskę

The purpose of this article is to analyze the migration routes leading through Poland to Western European countries since 2021, that is, the emergence of a humanitarian crisis on the Polish-Belarusian border. In addition, the article focuses on the actions of the Polish authorities in response to the increase in illegal migration flows through Poland. The caesuras of the analysis cover the years 2021–2023. The article posits that the creation of new restrictions (visas, the introduction of temporary border controls, the construction of walls on the borders) has the effect of changing migration routes, increasing illegal travel and temporarily slowing down population flows.

The current situation of health equity in underserved areas of Afghanistan.

In Afghanistan, providing universal health coverage (UHC) in accordance with the principles of the UHC declaration is challenging on two fronts: the geographic topography of the country and the prevailing gender dynamics within the local culture. We conducted a desk review of underserved areas in the context of health services by gathering and analyzing existing literature, reports, and data using a combination of keywords and phrases such as: "underserved areas," "healthcare disparities," "access to healthcare," and "health services." The primary data were derived from an analysis of underserved populations conducted by the World Health Organization (WHO) Afghanistan's Emergency Program, supplemented by information from in-country partners. In addition to other reports, this review focused on analyzing the geographical availability of primary healthcare (PHC) services by employing the guidelines set forth in the SPHERE framework. It also took into account the social dynamics within the Afghan population that may create barriers to equity in terms of demand and access to PHC services. Although there are a significant number of primary healthcare facilities in operation (4,242), they are unevenly distributed across different regions of Afghanistan, resulting in almost 25% of the population being underserved. The underserved population is nearly equally distributed between genders, with the majority residing in rural communities. Women of childbearing age represent 28% of the underserved population. Children under the age of five represent 16-18% of the underserved population in all regions, except in the western region, where they represent between 12 and 13%. Individuals over 60 years of age represent 1-3% of the underserved population across all regions. More than 50% of the population in the Central Highlands of Afghanistan is underserved, followed by the western and southern regions. Ghor province in the western region has the highest proportion of underserved populations, followed by Zabul province in the southern region. Afghanistan is currently experiencing a protracted humanitarian crisis, with millions of people living in poverty and lacking access to healthcare. This situation exposes them to serious risks such as disease epidemics, starvation, and maternal and child mortality. It is crucial to implement alternative strategies to reach the most affected populations and to increase funding for the delivery of healthcare services in Afghanistan.

Zarażenia pasożytami jelitowymi u dzieci ukraińskich − uchodźców wojennych mieszkających w Warszawie

Introduction and objectiveThe war and the humanitarian crisis in Ukraine have resulted in a mass migration of millions of Ukrainians into the EU countries. According to the data obtained from Statistics Poland, a governmental agency collecting and publishing the country’s statistical data, the number of Ukrainian children currently living in Poland is approximately 500,000. The massive influx of immigrants into Poland poses a considerable challenge to the national health care sector. The aim of this study was to assess the prevalence of intestinal parasitic infections among Ukrainian child war refugees living in Warsaw.Material and methodsThe study involved a total of 25 Ukrainian children, patients of the Clinic of Paediatrics, Nephrology and Paediatric Allergology at the Military Institute of Medicine – National Research Institute in Warsaw. Parasitological diagnostic work-up was carried out in October 2023 at the Department of Epidemiology and Tropical Medicine, the Military Institute of Medicine – National Research Institute in Gdynia. Stool tests for the presence of intestinal parasites were conducted by light microscopy using three different methods (direct smear in Lugol’s solution, decantation with distilled water, Fülleborn’s flotation).ResultsA total of 20% of the children studied (5/25) were found to be infected with potentially pathogenic stramenopile <i>Blastocystis</i> spp. In addition, two of the children were also infected with non-pathogenic <i>Endolimax</i> nana and <i>Entamoeba</i> coli protozoa. There were no infections with nematodes, cestodes or trematodes among the study participants.ConclusionsThe confirmation of potentially pathogenic <i>Blastocystis</i> spp. in stool samples collected from Ukrainian children, war refugees living in Warsaw, justifies the necessity to re-introduce a large-scale routine screening for intestinal parasites in the paediatric population in Poland.

Implementing a pragmatic randomised controlled trial in a humanitarian setting: lessons learned from the TISA trial

IntroductionHigh-quality evidence is crucial for guiding effective humanitarian responses, yet conducting rigorous research, particularly randomised controlled trials, in humanitarian crises remains challenging. The TISA (“traitement intégré de la sous-nutrition aiguë”) trial aimed to evaluate the impact of a Water, Sanitation and Hygiene (WASH) intervention on the standard national treatment of uncomplicated Severe Acute Malnutrition (SAM) in children aged 6–59 months. Implemented in two northern Senegalese regions from December 22, 2021, to February 20, 2023, the trial faced numerous challenges, which this paper explores along with the lessons learned.MethodsThe study utilised trial documentation, including field reports, meeting minutes, training plans, operational monitoring data and funding proposals, to retrace the trial timeline, identify challenges and outline implemented solutions. Contributions from all TISA key staff—current and former, field-based and headquarters—were essential for collecting and interpreting information. Challenges were categorised as internal (within the TISA consortium) or external (broader contextual issues).ResultsThe TISA trial, executed by a consortium of academic, operational, and community stakeholders, enrolled over 2000 children with uncomplicated SAM across 86 treatment posts in a 28,000 km2 area. The control group received standard outpatient SAM care, while the intervention group also received a WASH kit and hygiene promotion. Initially planned to start in April 2019 for 12 months, the trial faced a 30-month delay and was extended to 27 months due to challenges like the COVID-19 pandemic, national strikes, health system integration issues and weather-related disruptions. Internal challenges included logistics, staffing, data management, funding and aligning diverse stakeholder priorities.Discussion and conclusionDespite these obstacles, the trial concluded successfully, underscoring the importance of tailored monitoring, open communication, transparency and community involvement. Producing high-quality evidence in humanitarian contexts demands extensive preparation and strong coordination among local and international researchers, practitioners, communities, decision-makers and funders from the study’s inception.Trial registrationClinicaltrials.gov NCT04667767.

A Scoping Review of Factors Associated with HIV Acquisition in the Context of Humanitarian Crises.

Humanitarian crises-natural or human-made events that can threaten communities' health, safety, security, and well-being-may affect the HIV epidemic dynamics. Common aspects of humanitarian crises such as poverty, powerlessness, disruptions to the health systems, and social instability can contribute to a person's vulnerability to HIV infection through increased risk behaviors and limited access to health services. Guided by the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, we conducted a scoping review of literature published in English between January 1990 and March 2022 to characterize the global evidence of modifiable and non-modifiable factors for HIV acquisition in the context of humanitarian crises. We systematically searched, screened, and synthesized literature from MEDLINE, Embase, Global Health (all accessed via Ovid), and Scopus, and also grey literature through websites of humanitarian agencies and relevant non-government organizations, the International AIDS Society's abstract databases, and Google Scholar. We considered studies presenting empirical data on HIV prevalence, incidence, or risk factors in humanitarian crises-affected populations, including refugees, asylum seekers, and internally displaced persons. Forty-nine studies met the inclusion criteria. The majority of studies were quantitative (n = 43, 87.8%) and cross-sectional (n = 37, 75.5%) in design. Most were single-country studies (n = 43, 87.8%) and conducted in Sub-Saharan Africa (n = 31, 63.3%). We identified 5 non-modifiable factors for HIV acquisition (i.e., age, gender, location, place of birth or origin, and ethnicity) and 60 modifiable factors that we further classified into five categories, namely 18 policy and structural, 9 sociocultural, 11 health and mental health, 16 sexual practice, and 6 humanitarian crisis-related traumatic event factors. Within the modifiable categories, factors that were most often investigated were education level, marital status, sexually transmitted infection diagnosis, condom use, and experience of rape or sexual trauma, respectively. Informed by the findings, we applied the social-ecological model to map the identified multidimensional factors associated with HIV acquisition at the levels of individual, social and sexual networks, community, public policy, and the context of humanitarian crises. The current review provides a comprehensive, global analysis of the available evidence on HIV prevalence, incidence, and risk factors in humanitarian crises and implications for potential programs and research. Future research is warranted to further understand the directionality of the non-modifiable and modifiable factors affecting HIV acquisition, and the multilevel barriers and facilitators to the uptake of HIV prevention strategies in the context of humanitarian crises. Such research can generate actionable evidence to inform the development of ethical, trauma-informed, and culturally appropriate HIV prevention interventions in humanitarian settings.

Government short-termism and the management of global challenges

Crises and global challenges are pervasive in contemporary politics and societies worldwide. Climate change, economic recessions, humanitarian crises, health emergencies, wars and international conflicts put tremendous pressure on the functioning of democratic political systems and other government models. This study is located in the special issue for the 25th anniversary of the British Journal of Politics and International Relations. Leveraging an original longitudinal dataset covering more than 700 governments and 400 elections in 21 democracies dating back to the 1940s, we show that completing the constitutionally mandated term is increasingly difficult for ruling parties in Western Europe. Short-termism raises serious questions about democratic governments’ ability to manage global challenges effectively. Considering the potentially detrimental consequences of short-termism, we contribute to the scientific examination of the politics of global challenges, shedding light on effective and ineffective management strategies.

Contextualising Australia’s Role in UN Peacekeeping Operations: A Comprehensive Analysis from 1947 to Present

Purpose: This scholarly article rigorously analyses Australia’s engagement in United Nations (UN) peacekeeping operations from 1947 to the present, focusing on the nation's substantial contributions, significant policy transitions, and the broader implications for international relations and global governance frameworks. Materials and Methods: Utilizing a qualitative methodological approach, this study systematically reviews over sixty peacekeeping missions involving Australia, drawing upon a diverse array of primary and secondary sources, including governmental reports, academic journals, and UN documentation. The timeframe spans critical historical moments, beginning with Australia’s initial involvement in international peacekeeping initiatives in the late 1940s and evolving through distinct geopolitical eras, including the Cold War, post-Cold War period, and contemporary conflicts (Baldwin et al., 2022; McDonald, 2023). The analysis is grounded in a constructivist framework intertwined with realism, allowing for a nuanced understanding of how Australia’s peacekeeping roles reflect and reinforce the interplay of national interests and international obligations. This theoretical lens facilitates an exploration of the changing nature of global conflicts, operational mandates, and evolving international norms (Kirton, 2023). Findings: The research reveals that Australia’s peacekeeping contributions have evolved significantly, marked by key policy shifts from unilateralism to multilateralism within the UN paradigm. The country’s notable involvements in critical missions, such as those in East Timor and the Solomon Islands, exemplify its commitment to regional stability while also reflecting strategic partnerships with key allies (Cousens & Kumar, 2022). Furthermore, these contributions highlight Australia’s capacity to respond to complex emergencies and humanitarian crises effectively, reinforcing its role as a key player in regional peace and security. Implications to Theory, Practice and Policy: This examination elucidates the implications of Australia’s peacekeeping operations for its foreign policy trajectory and international standing. As the nation grapples with contemporary security challenges - including humanitarian crises, intrastate conflict, and post-colonial nation-building - the analysis reveals that Australia’s peacekeeping engagements align with broader international relations trends. Notably, there is an increasing emphasis on multilateralism, the principle of state sovereignty, and collaborative security efforts among nations (Hawkins, 2023).

Femicide in Ireland 2012–2023

IntroductionFemicide represents the dramatic end-point on a spectrum of violence against women and is an increasingly prevalent medico-legal issue. Whilst there is no definition of femicide in the Irish legal system, femicide can be understood as the gender based killing of women or girls.1 The pervasiveness of gender-based violence against women is a growing cause for concern with 2018 estimates by the World Health Organisation (WHO) revealing that 1 in 3 women have experienced Intimate Partner Violence (IPV).2 Femicide remains poorly defined and underreported worldwide due to enduring stigmatisation, shame and a lack of official statistics addressing national femicide rates. AimThe aim of this study was to explore Irish cases of femicide, quantify the prevalence of femicide in Ireland and identify any emerging trends over a 12-year-period. MethodsAll homicides referred to the Office of the State Pathologist (OSP) from 2012 to 2023 were reviewed and a total of 97 cases of femicide were ?identified and included in this study. ResultsFemicide rates increased from 1 in 5 (19 %) homicides referred to the OSP in 2012–2020 to 3 in 10 from 2021 to 2023 (29 %). Domestic femicides accounted for 74 % of cases, with 41 % of women murdered in the home they shared with their killer. 56 % of women were killed by a current or former intimate partner and 20 % by a family member. Sharp force injuries were present in 75 % of femicides associated with a history of sexual violence. These cases had the highest average number of injuries per case (n = 30) and a significantly lower average age than that of the entire cohort (19 years versus 41 years). ConclusionThe true scale of gender-based violence against women remains largely hidden due to a lack of focused official statistics and a clear definition of femicide. As populations become more diverse, and displacement secondary to environmental, or humanitarian crises becomes more common, it is essential that official data is collected in order to understand and ultimately prevent gender-based violence in this vulnerable cohort.

Interplay between sanctions, donor conditionality, and food insecurity in complex emergencies: the case of Syria.

Thirteen years into conflict, Syria remains one of the world's major humanitarian crises. Food insecurity has reached unprecedented levels in the country, with millions of civilians facing starvation and hunger. The key drivers of this are conflict-related, nature-induced, and, importantly, man-made policies. Semi-comprehensive sanctions against the country and donor conditionality vis-à-vis humanitarian operators' work are prime examples of the latter. These policies are inextricably linked with food insecurity in Syria and have direct and indirect impacts on it. Understanding the ongoing crisis as a complex emergency, this paper examines the interplay between sanctions, donor conditionality, and food insecurity, an understudied subject in the Syrian context. It explores how sanctions and donor conditionality influence three key dimensions of food security, namely, availability, affordability and economic access, and utilisation, and subsequently worsen the conditions confronting the Syrian population. The paper contributes to discussions on food security in conflict settings and how sanctions negatively affect civilians in targeted countries.

Mental health problems in Somalia after decades of humanitarian crises: a qualitative exploration of perceptions and experiences

BackgroundHumanitarian crises increase the risk of mental health problems. Somalia has been affected by conflict, insecurity, and economic turmoil for over three decades, as well as climatic shocks. However, 80–90% of Somalis who have mental health problems do not have access to good-quality, and affordable mental health care. To develop an evidence-based, effective, equitable, and humane programme for mental health, we need to have a holistic understanding of mental health problems and care in relation to people’s perceptions, experiences, and behaviour related to mental health.MethodsWe undertook a qualitative study to explore Somalis’ perceptions and experiences of mental health problems. We conducted three key informant interviews, two in-depth interviews, nine focus group discussions, 12 observations in private and public health facilities and more than 12 informal discussions. We used case vignettes translated into Somali during our discussion. We also studied three cases with experience of mental health problems to understand care-seeking behaviour and the experiences with services available.ResultsSomalia has been moving from a traditional pastoral nomadic lifestyle to a settled one. A strong informal support system exists in the community within clans or family relations. Armed conflict often among clans, natural disasters, and khat use are the three main factors affecting mental health. The prevalence of mental problems is likely greater than is evident. It is perceived that about 95% of people suffering from mental illness remain outside of appropriate care. Few people seek care for mental health problems because they are not aware of it and because it is highly stigmatized and neglected. Those who do seek care usually go to traditional healers because of culture and cost. Resources for mental health care are grossly inadequate with a limited and often poorly trained workforce. At least two levels of barrier to mental health care exist, at the individual/family level (e.g. poor awareness of mental health and stigma) and service provider level (e.g. lack of staff and limited ability to diagnose, treat, or refer persons with mental health problems and stigma). No tool or evidence-based programme is available to address these barriers.ConclusionA qualitative data-driven mental health programme that addresses all these issues is needed with more trained mental health professionals. Given the stigma about mental health problems, there is also a need for a tool to raise awareness about mental health and the importance of mental health care among both the public and health workers.

The ravages of war: challenges and resilience in medical education in Sudan

The armed conflict between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) beginning on April 15, 2023, has thrust Sudan into a worsening humanitarian crisis, severely affecting all aspects of Sudanese life, including medical education and healthcare systems. This commentary explores the current state of medical training in Sudan amidst this conflict and discusses potential strategies to address the challenges faced by both students and educators.Following a comprehensive literature review of articles using keywords, and published from 2015 to the present, 2024, the challenges were categorized into issues related to the curriculum, educational resources, wellbeing of students and educators, human resources, and oversight by governing bodies. The proposed solutions involve the government, humanitarian organizations, medical schools, and innovative curricular strategies. Partnerships and the involvement of the Sudanese diaspora are crucial for situational assessment and execution of culturally sensitive, contextualized solutions. Alliances with other medical schools can facilitate the relocation of students and faculty. Faculty development programs and student support are paramount during this phase.Deploying distant learning strategies combined with small group learning, such as e-learning, problem-based learning (PBL), team-based learning (TBL), and ambulatory teaching, can mitigate some adversities in the Sudanese educational experience during war. Implementing collaborative evaluations and solutions can help Sudan's educational system navigate the conflict, enhance resilience, promote healthcare, and facilitate planning for the post-conflict period.

Ethical framework and inclusivity: research mechanics of difficult-to-reach migrants in civil military context

In the midst of humanitarian crises, understanding and helping hard-to-reach migrant communities, is a major challenge for researchers. This article addresses the ethical framework and dimensions of inclusivity associated with researching such populations in civilian-military setting. With the overarching aim of improving methodological discourse, this study seeks to understand the mechanisms involved in working with crisis-affected migrants who are often marginalised and geographically isolated. The significance of this research lies in its multi-layered approach to understanding the ethical considerations and inclusivity that are essential to conducting research in crisis situations. By examining existing theories in the field, including participatory research methods, ethnographic studies and community-based research frameworks, this study critically evaluates their applicability in the context of crisis-affected migrant communities. This research contributes to methodological approaches by proposing innovative strategies that emphasise ethical integrity, cultural sensitivity and inclusivity. It argues for the development of collaborative and culturally sensitive research practises that enable migrant communities to actively participate in the research process and ensure that their voices are heard, and their perspectives accurately represented. This study contributes to existing knowledge by illuminating the complexities of researching hard-to-reach migrant communities in civil military setting. This study provides researchers and practitioners with the necessary tools and perspectives required for engaging with crisis-affected migrant communities in a manner that is both ethical, respectful, and impactful.

AN EVALUATION OF THE KOSOVO CRISIS AND NATO INTERVENTION USING THE BASIC PRINCIPLES OF REALISM (NEO-CLASSICAL REALISM)

Concerning the inter-ethnic wars and conflicts that occurred in the former Federal Republic of Yugoslavia (FRY), one of the longest and most critical was the inter-ethnic conflict between the Albanians of Kosovo and the Serbs. Particularly, the most prominent humanitarian crisis that this paper will deal with refers to the period of 1998- 1999. Both; The Kosovo Liberation Army (KLA) and the Armed Forces of the government of Serbia might be classified in the ranks of “defensive realism”. The KLA was struggling to protect the Albanian civilian population from the Milosevic regime, whereas Serbia was committed to preserving and attaining its national security. In addition to this, there stands the principle of the security dilemma, since the KLA was declared a terrorist organization by the state organs at that time. On the other hand, NATO's intervention in Kosovo, even though being missioned for the protection of human values, additionally aimed for its geopolitical and hegemonic strategies in the world of anarchic international political system. Yet, in the theory of international relations, this might be classified as a structure of offensive realism. The main purpose of this article is to investigate the position of realism claiming that; the exclusive monopoly in the use of power belongs to states. In addition, this study aims to unfold the criticisms that realism uses against any foreign interference in domestic affairs. Yet, states are major actors in the anarchic global system that possesses a sole monopoly towards their people and sovereignty. Any kind of domestic disturbances and intervention from abroad is strongly condemned and violates the principle of non-interference in the internal affairs of other sovereign states.

The critical elements of the health system that could make for resilience in the World Health Organization African Region: a scoping review.

Unpredictable events, such as the outbreak of infectious diseases and humanitarian crises, are putting a strain on health care systems. As a result, African countries will need to prepare themselves with appropriate strategies to withstand such occurrences. Therefore, the purpose of this scoping review was to map available evidence about what type and what components of health systems are needed to help countries cope with health emergencies and to foster health system resilience in the WHO African Region. A systematic search was performed independently in Scopus and PubMed electronic databases as well as grey literature. Studies were selected based on set eligibility criteria based on the Joanna Brigg's Institute (JBI) methodology for scoping reviews. The key findings were focused on health system resilience and were mapped based on the WHO's core health system components. Our data were tabulated, and a narrative synthesis was conducted. A total of 28 studies were included in this scoping review, mostly conducted in the WHO African Region and region of the Americas. Studies focused on a variety of strategies, such as the continuous delivery of essential services, the strengthening of the health workforce, including community health care workers, community engagement, the provision of protective mechanisms for the health workforce, and flexible leadership and governance measures. Our findings suggest that strategies to improve health system resilience must include all areas of the healthcare delivery process, including primary care. A resilient health system should be ready for a crisis and have adaptable policies in place to offer adequate response at all levels, as well as post-recovery planning. Such health systems should also seek for continuous improvement. More research is needed to assess the efficacy of initiatives for improving health system resilience, particularly in vulnerable African health systems.

Migrant Deaths in New Mexico: What is Known; What is Unknown

Executive Summary The United States is no stranger to migration across its borders. In 2020, its Southwestern border saw a drastic increase in apprehensions by the Border Patrol. While imperfect and an undercount of the true number of migration events, apprehension data is often used as a proxy to understand migration patterns. The rise in migration was coupled with an increased but unknown number of deaths along migration routes. This article focuses on the New Mexico portion of the El Paso Border Patrol Sector and the increased migrant caseload at New Mexico’s Office of the Medical Investigator (OMI) over the last few years. To the best of our knowledge, this article is the first academic study to examine migrant deaths in detail in southern New Mexico. We begin by contextualizing the changing pattern of migrant deaths in New Mexico within the broader framework of border policing strategies that have intentionally pushed migration routes to remote areas. We describe the work of the OMI, highlighting its very recent initiatives to track migrant deaths in its database. We then discuss the changes seen by the OMI in its migrant caseload from fiscal year (FY) 2009 to 2023, with the most drastic increase in cases occurring from 2022 to 2023. For instance, the data indicate that most of the identified migrants that have died in New Mexico were recovered in June and July (45 percent), crossed through Doña Ana County (66 percent), were male (60 percent), and among those identified, were from Mexico (65 percent) and between 20 and 39 years of age (69 percent). Of the 248 cases of migrant deaths, 87 percent have been identified. The most common causes of death were undetermined (46 percent) and environmental exposure (41 percent). We then explore the effects of changing governmental policies and state initiatives to curb/reduce migration in the US on OMI’s increased caseload. We discuss the impact that the rapid shift in migration deaths is having on the OMI and how OMI is working to respond and adjust to the dynamic situation. This work highlights the collateral damage of border security measures, underscored by the increasing number of deaths and challenges faced by the OMI. We consider the need for new and amended policies aimed at mitigating the humanitarian crisis that continues to unfold, emphasizing the need for the humane treatment of migrants. Finally, we suggest allocating resources to death investigating agencies. These resources would provide essential support to find, identify, and repatriate migrants, improve agencies’ abilities to collaborate with governmental agencies and programs such as Border Patrol’s Missing Migrant Program, and improve our understanding of the circumstances along the Southwestern border.

Lessons learnt from the implementation of the Covid-19 vaccination programme in the Southwest of England.

Vaccination remains one of the most successful public health interventions in preventing severe disease and death. The roll-out of Covid-19 vaccination programmes has helped protect billions of people around the world against Covid-19. Most of these programmes have been unprecedented in terms of scale and resources, and have been implemented at times of significant humanitarian crisis. This study aims to outline the lessons learnt from the implementation of a regional Covid-19 vaccination programme. These will help inform emergency preparedness and future crisis management. This qualitative study sought to explore the key drivers to the successful implementation of the Covid-19 vaccination programme in a region in the Southwest of England, applying the Normalisation Process Theory lens (NPT) to examine multi-stakeholder perspectives. Data collection involved semi-structured interviews with 75 participants. Document analysis was also used to corroborate the findings emerging from the interviews. Inductive thematic analysis of the data was used to identify the key drivers for the successful implementation of the programme. The NPT lens was then applied to map the themes identified to the domains and constructs of the framework. Ten key drivers to the successful implementation of the Covid-19 vaccination programme locally were identified, including: the clarity and consistency of the programme's goal; the diverse representation of stakeholders within the programme leadership team and the mechanisms created by this team to ensure psychological safety, autonomy, operational flexibility and staff empowerment; Communication and data specialists' input, and collaboration with local communities to maximise the reach of the programme; and allocating funding to tackle health inequalities. This study highlights the lessons learnt from the implementation of the Covid-19 vaccination programme at a local level, and the mechanisms that can be used in future crises to respond efficiently to the needs of individuals, communities and governments.

Providing healthcare under the threat of gang-violence: a survey of Haitian healthcare providers

In addition to having some of the worst health outcomes in the region, Haiti faces a political and economic crisis. The most recent humanitarian crisis includes an increase in homicides and kidnappings in the capital Port-au-Prince. This study is a cross-sectional, mixed methods online survey of health workers and medical students in Port-au-Prince from May 20 – September 15, 2023. It provides evidence of the kidnapping risk healthcare workers face and shares the perspective of a medical community operating in a challenging context to provide a continuity of care under the threat of violence. The survey of Haitian health workers and students show a significant risk of kidnapping with 44% of respondents reporting that they had a colleague kidnapped in the previous 2 years. 5 of the 249 respondents had been kidnapped and all were young, female health workers. 74% of health workers and students surveyed reported they plan to continue their profession abroad. Although teletraining was viewed as a positive opportunity to continue training cadres of medical professionals, health workers shared numerous limitations present for the expansion of telemedicine in the Haitian context. In addition to describing the experience of the Haitian healthcare professional during this crisis and documenting barriers to teletraining and telemedicine, this survey documents design considerations for mobile phone surveys with healthcare providers working in areas affected by conflict.