Humanitarian Crisis Research Articles

Lebanon’s ‘Concomitant Crises’ and Consociationalism as a Leading Form of Conflict Management

Abstract Consociationalism is often perceived as a go-to response to ethnicized conflict, a form of ‘political prescription’ proffered by both external mediators and domestic constitutional designers alike. Power-sharing theory posits that extended periods of cross-community cooperation can lessen divisions, allowing the system to give way to more ‘normal’ politics. However, increasing evidence from Lebanon and elsewhere tracks a different set of incentives. Rather than facilitating a virtuous cycle of cooperation and consensus, a more vicious cycle of immobilism, intransigence, and institutional collapse emerges. In Lebanon, this has coincided with a set of intersecting political, economic, and humanitarian crises. This paper outlines how consociationalism’s causal logic has undergone a full reversal in Lebanon, maps the manifestations and implications for the country, and reflects on what power-sharing theory can learn from Lebanon’s consociational experience.

Khartoum War's echoes in oil and energy sectors: Economic and environmental implications for Sudan and South Sudan

The energy sector is a main driver of African growth, particularly in regions with geopolitical conflicts like Sudan and South Sudan. The oil and gas industry notably influences these regions' economy, politics, humanitarian situation, and social stability. This study seeks to investigate how the Khartoum War affected the energy sector of both Sudan and South Sudan, particularly looking at the disruptions caused by recent conflicts and their impact on oil production, economic stability, and environmental conditions. The study employs a multi-disciplinary approach, utilising different sources such as regional legal agreements, government reports, academic articles, and press releases from international organisations. The key methodology includes qualitative analysis of several documents and quantitative assessment of production data and economic reports. The study's key findings show a significant decline in oil production and transportation due to the shutdown of key oilfields and pipelines, intensifying economic and humanitarian crises. Additionally, the damage to oil infrastructure has presented serious environmental risks, highlighting the delicate balance between resource management and regional stability. In conclusion, the study's findings underscore the intense impact of the Khartoum War on the energy sector of Sudan and South Sudan, and the urgent need for policy recommendations to mitigate these effects and foster sustainable development.

Public Health Word of the Year 2023 — Conflict

ABSTRACTThe term “conflict” resonated throughout 2023, echoing prolonged civil wars and heightened global tensions in geopolitical disputes, escalating ongoing rifts among global communities, and exacerbating the humanitarian crisis. This article explores the complex relationship between conflicts and public health, providing a thorough analysis of their dynamics and current prevalence. It aims to illuminate the diverse challenges posed and delineate a holistic path forward to mitigate violent conflicts and ameliorate health disparities, particularly among affected low‐ and middle‐income countries, by advancing an equitable and resilient healthcare system. The expanded perspective of “conflict” reveals far‐reaching consequences that extend beyond borders, significantly straining public health capacity. The world is in dire need of reinvigorating healthcare systems and de‐escalating such violent conflicts due to the relentless exhaustion of resources and the increasing demand for medical emergencies that current responses inadequately address. The damage to vital healthcare facilities in conflict zones severely hampers the provision of necessary and timely medical care, affecting a wide range of health services, including treatment for chronic illnesses, maternal and child care, and mental health support. Additionally, the continuous displacement of people in these areas increases their susceptibility to infectious diseases, raising the possibility of new outbreaks and worsening long‐standing public health challenges. Therefore, prioritizing public health in diplomatic efforts is essential for resolving conflicts and aiding recovery, through building a strong public health strategic approach for a more stable and peaceful global community.

Group Antenatal Care (G-ANC): A way forward to improve Afghanistan's utilisation of maternity care.

In Afghanistan, maternal mortality and infant mortality - two key indicators of population health - are among the highest in the developing world, partly because of nearly a half-century of conflict and persistent socioeconomic instability [1]. The latest data in 2017 show that Afghanistan's maternal mortality ratio (638 per 100,000 live births) and infant mortality rate (36 per 1,000 live births) are much higher than other countries with comparable economic development [1]. Poor health infrastructure, political upheaval, reductions in donor funding and corresponding disruptions in health services, insecurity, climate change, and escalating humanitarian crises further intensify these issues [1].

By the numbers and in their own words: A mixed methods study of unmet needs and humanitarian inclusion of older Syrian refugees in Lebanon.

Older people constitute an overlooked vulnerable population in humanitarian crises. Lebanon is a small country that hosts the largest number of refugees per capita in the world. With exacerbating socioeconomic conditions, exclusionary policies against refugees, and a fragmented humanitarian system, the status of older Syrian refugees (OSRs) requires special attention. This study aimed to explore OSRs' unmet needs, coping strategies, available humanitarian services, and some indicators of the humanitarian inclusion standards focusing on the shelter, health, nutrition and food security, and water, sanitation and hygiene sectors. We conducted a convergent mixed-methods study between December 2021 and March 2022 in the North and Bekaa, including a cross-sectional survey with 461 participants and 14 semi-structured interviews. Results show that OSRs lived in inappropriate shelters (cold, leaking rainwater), especially in informal tented settlements. High rent prices pushed refugee households with elderly to prioritize paying rent at the expense of other needs such as food and medication, particularly when food cash transfer is the sole source of income, jeopardizing food security and intake. Access to dignifying and accessible bathing facilities was compromised in ITSs with shared facilities. Substantial medical costs hindered OSRs access to healthcare such as surgeries. Due to the crisis, chronic medications are not always available in dispensaries for subsidized cost, pushing OSRs to non-compliance and selling food assistance to buy medications. Soaring fuel prices hindered OSRs access to heating and transportation to receive healthcare. No efforts were reported in collecting data on OSRs' needs, targeting them with information on services, or soliciting feedback for programming, especially in the absence of any age-tailored interventions. Findings shed light on the precarious living conditions of OSRs in Lebanon and add to the body of evidence documenting their invisibility to the humanitarian response. An age-inclusive response is needed through holistic, tailored, and sustainable interventions.

Diversity and multiplicity in uncertain times: the category of “difficult knowledge” in the sensitive contexts of education and social research

This article explores the category of “difficult knowledge” within the sensitive contexts of education and social research amidst contemporary global transformations. Uncertain times marked by humanitarian crises, wars, migration, and socio-economic shifts challenge the stability and security of societies. Difficult knowledge encompasses emotionally charged, complex topics integral to social, political, and educational spheres, compelling individuals and groups to confront uncomfortable truths and deconstruct human understanding. This concept, introduced by Britzman (1998), addresses the cognitive and emotional struggles in engaging with traumatic representations of historical and social events. The paper highlights the necessity for educators and researchers to navigate these challenges, fostering critical and reflective analyses while managing their psychological impacts. It underscores the dual role of researchers as both empathetic human beings and objective professionals, particularly in extreme field conditions. Additionally, it discusses the implications of conspiracy theories as a form of difficult knowledge, emphasizing the need for educational strategies that promote critical thinking and resilience. The article calls for greater attention to the sensitivities of the research process and the ethical responsibilities in studying and teaching difficult knowledge.

Urgent action is needed to address Sudan’s growing humanitarian crisis

Urgent action is needed to address Sudan’s growing humanitarian crisis

Implementation of maternal and perinatal death surveillance and response and related death review interventions in humanitarian settings: A scoping review.

The global population impacted by humanitarian crises continues to break records each year, leaving strained and fractured health systems reliant upon humanitarian assistance in more than 60 countries. Yet little is known about implementation of maternal and perinatal death surveillance and response (MPDSR) within crisis-affected contexts. This scoping review aimed to synthesise evidence on the implementation of MPDSR and related death review interventions in humanitarian settings. We searched for peer-reviewed and grey literature in English and French published in 2016-22 that reported on MPDSR and related death review interventions within humanitarian settings. We screened and reviewed 1405 records, among which we identified 25 peer-reviewed articles and 11 reports. We then used content and thematic analysis to understand the adoption, appropriateness, fidelity, penetration, and sustainability of these interventions. Across the 36 records, 33 unique programmes reported on 37 interventions within humanitarian contexts in 27 countries, representing 69% of the countries with a 2023 United Nations humanitarian appeal. Most identified programmes focussed on maternal death interventions; were in the pilot or early-mid implementation phases (1-5 years); and had limited integration within health systems. While we identified substantive documentation of MPDSR and related death review interventions, extensive gaps in evidence remain pertaining to the adoption, fidelity, penetration, and sustainability of these interventions. Across humanitarian contexts, implementation was influenced by severe resource limitations, variable leadership, pervasive blame culture, and mistrust within communities. Emergent MPDSR implementation dynamics show a complex interplay between humanitarian actors, communities, and health systems, worthy of in-depth investigation. Future mixed methods research evaluating the gamut of identified MPDSR programmes in humanitarian contexts will greatly bolster the evidence base. Investment in comparative health systems research to understand how best to adapt MPDSR and related death review interventions to humanitarian contexts is a crucial next step.

The use of digital platforms by citizen aid actors during the Ukraine humanitarian crisis

Following the Ukraine humanitarian crisis, which was a result of the war in Ukraine, ordinary citizens stepped up to spontaneously coordinate various humanitarian responses to support affected populations. In this article such individuals who founded or coordinated this form of spontaneous humanitarian aid are referred to as citizen aid actors (CAA). This paper explores the work of citizen aid actors in Poland, a country which received many of the people displaced by the war in Ukraine. The study applies the concept of digital affordances to illustrate and argue that citizen aid actors relied on the features available on digital platforms to attain their goals. It is an outcome of a qualitative research approach where interviews, participant observation, and analysis of relevant online material about the studied citizen aid actors were used as methods of collecting data. The findings indicate that these actors used diverse digital platforms at different stages of the humanitarian aid projects, from establishment, organization and sustenance. While this study demonstrates how specific digital platforms contributed to the accomplishment of the work done by CAAs, it also highlights how problematic it can be when the actors largely rely on digital platforms. As such, potential risks associated with overreliance on digital platforms as a way of implementing projects are factored in. Ensuing concerns include the presence of online trolls, the spreading of fake news, and internet disruptions as potential obstacles for the success of the aid projects.

Suffering Together: Photos and Stories of Nsukka Residents During Nigeria's 2023 Currency Redesign Crisis

The Central Bank of Nigeria's (CBN) attempt to redesign the 200, 500, and 1000 naira notes by December 2022 led to a cash crunch and humanitarian crisis, exposing the federal government's shortsightedness and inherent weakness. Amidst the crisis that peaked between late January and February 2023, opportunities for social connections and shared experiences emerged. In this essay and visual archive, I explore the financial crisis phenomenon in Nsukka metropolis, Southeastern Nigeria, from a historical perspective, integrating personal insights, respondents' views, and archival sources. Analysis of observational notes, visual and textual data through the lens of Critical Theory reveals the importance of social connection and cultural ideology among Nsukka residents during a difficult time in Nigerian history. Photographic images of crowded bank scenes and remarks like "You are not the only person" evoke personal and public misery and frustration during the currency redesign crisis. The argument is that those in power can create complex situations like artificial scarcity of valuable commodities for questionable reasons, while the masses bear the brunt and enact and demonstrate servility in the process.

“I wanted to show the faces of these migrant workers, their struggles to breathe, and their undignified deaths”: In conversation with Puja Changoiwala

ABSTRACT Journalist and author Puja Changoiwala has been critically acclaimed for her passionate writings on crime and social issues across India, such as gender discrimination and poverty. Her debut novel, Homebound (2021), details the impact of the COVID-19 pandemic on Indian society, which saw the largest exodus of people since Partition, the majority of whom were from India’s poorest regions. In the book, Changoiwala tells the stories of Indian migrant labourers, showing how years of exploitation converged in a single moment of humanitarian crisis and homelessness. In this interview, Changoiwala talks about her experience as a journalist and an author in unveiling the atrocious realities of migrant life in front of a largely complacent nation and world. The discussion highlights Changoiwala’s reflections upon the conveniently neglected history of oppression that has contributed to the silencing of these marginalized populations, and her call for an awareness of such discrimination through her fiction.

Book Review on Medani P. Bhandari (2023). Live and Let Others Live – In Reference to Sustainability and Environment Conservation

This autobiographical short book intricately captures the journey of an environmentalist, humanitarian, and knowledge producer, weaving a narrative that is as much about the individual experience as it is about the collective endeavors of countless people worldwide. The protagonist’s journey is a profound personal transformation driven by a deep-seated commitment to environmental stewardship and social justice. This story begins with humble origins, tracing the author’s awakening to the pressing environmental issues and humanitarian crises that plague our world. As the narrative unfolds, readers are introduced to pivotal moments of activism and advocacy, where the protagonist collaborates with like-minded individuals and organisations to champion causes such as sustainable development, conservation, and equitable resource distribution. These efforts are not just portrayed as isolated acts of heroism, but as part of a broader, global movement of dedicated individuals working tirelessly for the common good, inspiring readers to consider their own role in this collective effort. The book’s strength lies in its ability to transcend the personal, making the reader feel part of a larger community of change-makers. The protagonist’s successes and challenges are mirrored in the lives of many others who have similarly devoted themselves to protecting the planet and improving human lives. Through detailed anecdotes and reflections, the book not only highlights the interconnectedness of environmental and humanitarian efforts but also calls on the readers to take action, emphasising that the health of our ecosystems and the well-being of society are inextricably linked and that each individual has a role to play in this interconnected web. Ultimately, this narrative is an inspiring testament to the power of individual and collective action. It invites readers to reflect on their roles in this global mission and to find their place in the ongoing struggle for a more just and sustainable world.

Intersecting realities: Exploring the nexus between armed conflicts in eastern Democratic Republic of the Congo and Global Health

The eastern Democratic Republic of the Congo (DRC) grapples with entrenched armed conflicts, creating a complex humanitarian crisis with far-reaching implications for global health. This paper explores the intersection between armed conflict in the region and the risks of zoonotic disease transmission, shedding light on interconnected challenges and proposing integrated strategies for mitigation. Armed conflict disrupts healthcare systems, affecting healthcare facilities (HCF) and healthcare workers (HCW), destroying millions of lives, impoverishing communities, and weakening surveillance systems. This deleterious situation is a bottleneck to achieving the Sustainable Development Goals (SDGs), especially Universal Health Coverage (UHC), as it prevents millions of Congolese from accessing healthcare services. The direct impact of armed insecurity undermines Global Health Security (GHS) by fostering natural habitat degradation and biodiversity loss, exacerbating vulnerabilities to zoonotic disease outbreaks. Forced population displacement and encroachment on natural habitats amplify human-wildlife interaction, facilitating zoonotic disease spillover and increasing the risk of regional and global spread. Biodiversity loss and poaching further compound these challenges, underscoring the need for holistic approaches that address both conservation and public health concerns. Mitigating zoonotic disease risks requires strengthening surveillance systems, promoting community engagement, and integrating conservation efforts with conflict resolution initiatives. By adopting a comprehensive approach, including the incorporation of One Health considerations in all peace-seeking and humanitarian efforts, stakeholders can enhance Global Health Security, scale up UHC, and promote sustainable development in conflict-affected regions. Creativity and strategic foresight are essential to safeguarding the well-being of human, livestock, plant, and wildlife populations in the Eastern DRC.

Refugees as Entrepreneurs? A Challenge to HDP Programmes

ABSTRACT Protracted refugee situations in territories of war or natural hazards challenge the logic of the humanitarian-development-peace (HDP) nexus that inspires liberal humanitarianism. The organised expression of that nexus is the so-called ‘integrated approach’ in which humanitarian aid, development aid and peacebuilding are intertwined in missions aimed at promoting a durable peace. The experiences of camps for Palestinian and Syrian refugees in Jordan and of South Sudanese and Congolese refugees in Uganda question some basic assumptions of the HDP programmes. In the last two decades, the policies adopted in these locations show a two-fold reconfiguration of the HDP liberal programme: first, the aim of containing humanitarian crises locally, in the peripheries, thereby preventing their adverse effects spreading to the core of the international system; second, a focus on refugees’ capacity to become more resilient and entrepreneurial in order to overcome their vulnerable condition. Overall, this so-called neoliberal approach to humanitarianism with its focus on containment and individual entrepreneurship-inspired resilience has moved away from its liberal configuration as part of a systemic reconfiguration of local social fabric.

Solidarity tourism in the humanitarian crisis

This article examines the contribution of solidarity tourism in war-affected countries, specifically Ukraine. It presents activities undertaken as part of solidarity tourism in Ukraine and Poland with the intent to help overcome the crisis caused by the armed conflict. The research methods were secondary data analysis and participant observation. Results show what actions were taken "from above" at the government level in Ukraine and Poland and actions taken "from below" in social activities. The new knowledge brings new light to the perception of tourism as a tool for sustainable social development and can provide examples of good practices for other countries and regions.

Barriers to access to cancer care for patients from the conflict-affected region of the Nagorno-Karabakh Republic: A qualitative study.

Access to essential health services is a basic human right, yet many cancer patients living in conflict-affected regions face multiple obstacles to service use. The (former) Nagorno-Karabakh Republic was a conflict-affected region in the South Caucasus populated predominantly by ethnic Armenians. Multiple acute armed conflicts, the recent military occupation of the region, and the prolonged military blockade of the Lachin Corridor (a humanitarian corridor connecting Nagorno-Karabakh to Armenia) exacerbated existing social, health, economic, and political fragilities in this region. As a result, cancer services were disrupted, with limited clarity on how the ongoing military blockade of a humanitarian corridor affected cancer patients' experiences of accessing cancer care locally and in bordering Armenia. Our study aimed to describe the experiences of patients from Nagorno-Karabakh in accessing the cancer care services they needed. We conducted remote semi-structured interviews with adult (aged ≥18 years) cancer patients receiving cancer care from three university hospitals in Armenia and face-to-face interviews with cancer care professionals from these hospitals. Interviews were conducted during the blockade of the Lachin Corridor between March and May 2023. Data were analysed thematically using a deductive approach. Twelve adult cancer patients (9 women) and 12 cancer care professionals participated. A key barrier to accessing cancer services was attributed to the Azerbaijani military occupation of the region and the blockade of a major roadway connecting Nagorno-Karabakh to Armenia. Patients talked in length about the challenges of finding transport and travelling long distances to reach essential cancer services in Armenia. Policies of free anti-cancer medication provision and decentralised medication supply were paused because of the military occupation, affecting patients' timely access to anti-cancer medication. Out-of-pocket expenses for treatment, anti-cancer medication, travel, and temporary accommodation in Armenia placed a significant financial burden on cancer patients, exacerbated by the humanitarian crisis. Conflict-affected regions blockaded by military forces lack the capacity and targeted support to sustain their essential health services and provide care to those in need of life-saving treatments. Coordinated action from national and international organisations and governments is urgently needed to enhance humanitarian assistance and healthcare support to patients, their families and wider communities affected by military blockades and armed conflicts.

Infant and child mortality in Afghanistan: A scoping review.

Since 1990, global child and infant mortality rates have typically stabilized or decreased due to improved healthcare, vaccination rollouts, and international funding. However, Afghanistan continues to face the highest child and infant mortality rates globally, with 43 deaths per 1000 live births. This study aims to examine the factors contributing to this high mortality rate and propose interventions to address the issue. A comprehensive literature search was conducted using databases such as Google Scholar and PubMed, focusing on articles published in English within the last 10 years (2013-2023). The search terms included "Child mortality," "Infant mortality," "SIDS," "COVID-19," and "Afghanistan." Original studies, systematic reviews, case studies, and reports meeting the inclusion criteria were selected for analysis. Additional sources from organizations such as UNICEF, the World Bank Group, WHO, and EMRO were also reviewed. The study findings reveal significant challenges contributing to Afghanistan's high infant and child mortality rates. These challenges include birth defects, preterm birth, malnutrition, sudden infant death syndrome (SIDS), traumatic injuries, fatal infections, infanticide, and abuse. The ongoing conflict, insecurity, and humanitarian crises further exacerbate the situation, leading to increased child casualties. Despite efforts by international agencies like UNICEF to provide vaccines and maternal education, the infant mortality rate remains high. In conclusion, Afghanistan's child and infant mortality rates are of significant concern, and it is imperative that action be taken to reduce the incidence of child and infant mortality rates.

Predictors of alignment between aid donors’ and recipients’ interests in evaluating the effectiveness of the Shelter.Ukraine initiative: Contribution analysis

This article evaluates the effectiveness of the Shelter.Ukraine Initiative, a civic response to the humanitarian crisis resulting from Russia’s full-scale invasion of Ukraine. The Initiative aims to address pressing needs through a local umbrella funding approach. Utilizing an evaluative framework that combines multiple approaches, including causal attribution techniques, contribution analysis, and regression analysis, we assess the effectiveness of the Shelter.Ukraine Initiative. We uncover influencing factors that contribute to the Initiative success. These include organizational ambidexterity, learning-by-doing, inter-organizational structure, and advanced technology for financial resource distribution. Our findings underscore the importance of reconfiguring the humanitarian aid architecture to enhance effectiveness. In addition, we suggest that the insights gained from our study can inform future evaluations of humanitarian aid initiatives. By incorporating similar evaluative frameworks and methodologies, researchers can assess the effectiveness of other initiatives and identify key factors contributing to success.

The Post-2011 Yemen Internationalized Civil War: It’s National, Regional and Global Implications

The purpose of this paper is to make an in-depth analysis of the post-2011 Yemen internationalized civil war and its implications on national, regional, and global social, economic, and political spheres of influence. In this place, the study uses a qualitative research approach. On top of this to achieve the stated objectives of the study the data was collected purposively from published and unpublished materials like articles, magazines, reports, and the materials available online. At the national level, Yemen has failed in worsening social, economic, and political situations portrayed by the civil war crisis. The internationalized Yemen civil war triggered grave consequences on infrastructure, and economic activities, in which trade; investment, and business opportunities were demolished. Besides, it caused thousands of civilians displaced, indiscriminately attacked, killed, flee their homes, and become refugees. Similarly, the intensive Yemen civil war deteriorated the free flows of oil production, commodities as well as maritime trade in the region. Significantly, the fragile conditions pave the way for the network of illegal traffic activities in the region. The Yemen post-2011 internationalized civil war has caused potential risk to international shipping transiting to the Red sea which is the strategic route for oil cargo and other commercial movements to the global market. Furthermore, the Yemen civil conflict caused the world’s largest humanitarian crisis and the European Union has responded to the catastrophes.

Collapse of Cancer Care Under the Current Conflict in Sudan.

Sudan has been under an armed conflict between the Sudanese Armed Forces and the Rapid Support Forces (RSF) militia since April 15, 2023. The conflict has turned the country into the largest internal displacement humanitarian crisis with 9.05 million internally displaced persons including 2.2 million children younger than 5 years and caused 1.47 million Sudanese to flee the country as refugees. The conflict has had a major destructive impact on the health system, which has incurred targeting with air raids, ground invasion, vandalization, looting of assets and supplies, and killing of doctors, nurses, and other health personnel. Khartoum Oncology Hospital, Sudan's main cancer hub for treatment, diagnostics, and research has become nonfunctional as a result of the conflict. The National Cancer Institute in Wad Medani, the second largest hub, faced a similar fate as the conflict spread to Al-Gezira State. Patients with cancer have been displaced multiple times in Sudan with grave consequences on the continuity of care, worsening of their disease outcomes and palpable negative impacts on children. The oncology workforce in Sudan have themselves been displaced yet are working hard to provide services and care for patients under impossible circumstances. Sudan's doctors in diaspora have rallied to provide support but they face multiple obstacles. As the conflict continues to spread, we call upon the WHO, the United Nations Children's Fund, St Jude Hospital, and all relevant partners to implement an immediate evacuation operation with urgent air lifts of the affected children to continue their cancer care in neighboring countries as was done in Ukraine and Gaza.