Humanitarian Crisis Situations Research Articles

Comparing the effectiveness of narrative therapy and EMDR-GTEP protocols in the treatment of post-traumatic stress in children exposed to humanitarian crises

BackgroundThe mental health of children living in humanitarian crisis situations is a major issue. Post-traumatic stress disorder (PTSD) causes great psychological suffering and has negative consequences on children's development. The aim of the study was to analyze retrospective data collected in a mental health and psychosocial support program for children in the Central African Republic, and to compare results of two trauma-focused treatment interventions: the narrative protocol Action contre la Faim (ACF)/KONO; and the EMDR-based Group Trauma Episode Protocol (G-TEP). Both protocols are proposed in a group setting and led by paraprofessionals.MethodsIn the program, 884 children attended a psychoeducation session and after that, 661 children (290 for ACF/KONO and 371 for G-TEP) benefited from all treatment sessions. PTSD was measured by the Children's Revised Impact of Event Scale (CRIES-8). General distress was measured by the Child Psychosocial Distress Screener (CPDS). Data were collected before and after treatment, and measured 5 months after the end of treatment for 185 children.ResultsParticipants in the ACF/KONO group show a significant reduction on CRIES-8 (t = 44.8; p < 0.001, effect size = 2.63) and CPDS (t = 38.2; p < 0.001, effect size = 2.24). Participants to the G-TEP protocol show a significant effect with reduced scores on the CRIES-8 (t = 49.2; p < 0.001, effect size = 2.55) and CPDS (t = 57.2; p < 0.001, effect size = 2.97). A Student's t-test comparing the ACF/KONO and G-TEP groups shows no significant difference between the two types of treatment between pre- and post-treatment CRIES-8 scores (t = 1.744; p = 0.514, effect size = 0.040) and CPDS scores (t = 1.688; p = 0.092, effect size = 0.323). An analysis of the follow-up data for the 185 children shows that the effects of both protocols are maintained over time with mean scores after treatment and follow-up below the clinical cut-off for both CPDS (<8) and CRIES-8 (<17).ConclusionsBoth protocols have been shown to be effective in reducing traumatic symptoms in children exposed to conflict; they can be conducted by paraprofessionals and used in humanitarian crisis situations.

A study into shared reading groups, with specific relation to religious reading.

This paper examines a live shared-reading group conducted through The Reader Organization, with the approval of the University of Liverpool's ethics committee. It is a revised excerpt from a successful inter-disciplinary Ph.D. thesis undertaken within the School of Psychology. The intention in forming the group was to explore the reading of Marilynne Robinson's Home by a wide variety of modern readers of different backgrounds and persuasions, in the light of religious writing in an age of diminished religious tradition. The main research question was to test what literature can do in carrying meaning which can be seen as religious, or was previously deemed religious, among readers who may not think of themselves in such terms. The second was to see how a shared community-group setting can enable collaborative engagement with the challenge to develop different ways of thinking, beyond the individual default of either religious dogma or anti-religious prejudice. The method employed overall in the wider Ph.D. study was Grounded Theory: essentially, empirical analysis rather than top-down conceptualization. Grounded Theory, in refusing to begin from rigidly preassembled categories, is appropriate to a literature-inflected study and, in particular, a literary study that is concerned with religious meaning in situations of humanitarian crisis. It allows the possibility of empirical work and careful detailed analysis, amid a complex of overlapping psychological, spiritual, and family concerns entangled within the experience of modern life. In this particular case study, which may be described as a form of Action Research, the researcher, also acting as the reader leader of the group, brought developed tools taken from psychologist Wilfred Bion, introduced to the reading group itself during the sessions as a means of measurement and navigation through the novel. If the aim was simply to undertake a study of the text, then this paper would be more narrowly literary, but the concern was with wider real-world effects in relation to individuals within the group work. Through close examination of the week-by-week transcripts of the reading group, this study highlights the search for moments of development, or what might have stood in the way of development. The researcher used a consensus group of three supervisors to check the selection of the best moments (failing or succeeding in coming closer to what will be called below, after Bion, "0") recorded in the written transcripts of the sessions. One of the most powerful findings in this study is what will be called a mini-tradition developed by the group members in praxis, in terms of practices which they find, use, and come back to during their work with more difficult and painful passages in the text.

Envejecer en el complejo entorno venezolano

Aging substantially and progressively transforms the individual health situation, it also influences the structure and dynamics of the family and society. Children, pregnant women and older adults represent the most vulnerable groups of the population, and in situations of humanitarian crisis their lag behind environmental opportunities deepens. Even though they are the focus of attention, grandparents are always the most neglected. Objective. Review the complex Venezuelan environment, the dimensions that make it up, its impact on the course of life and how it affects the living conditions of the elderly. Materials and methods. Demographic indicators was analyzed; socioeconomic, such as income levels, poverty and hyperinflation, quality of public services; health and food and nutritional security, labor inactivity and social protection and how they affect the living conditions of the elderly. Results. Dimensions was observed that show the negative impact on the quality of life of the elderly, who must now also overcome COVID 19, in addition to facing the orphanhood of the accelerated migration of their offspring, which has caused the loss of the demographic bonus and a decrease in life expectancy. Conclusions. The systematization of knowledge of the living conditions of this important group of the population is essential to guide the design of public policies aimed at their protection that includes decent pensions, health care and care, so that this population can count on autonomy, independence, and participation in the development of the nation.

SUPPORTING THE MANAGEMENT OF HUMANITARIAN OPERATIONS CONCERNING MIGRATION MOVEMENTS WITH REMOTE SENSING

Abstract. The various forms of humanitarian operations include operations concerning the management of migrant movements and refugees. Managing those operations is non-trivial. A large number of refugees have to be welcomed, registered, forwarded, and be given supplies and accommodation. This is due to a lack of current and sufficient information about the refugees, making planning and execution of operations challenging, expensive and cumbersome. The earlier information about the refugees is available, the better. The method “Dwelling Detection”, conducted on satellite imagery of refugee camps, can provide large-scale heads-up information fast, complementing information already available to operators at the ground. With “Dwelling Detection”, dwellings in a camp and their extent are detected using machine learning methods. An estimate of inhabitants of the camp is computed using the number and the extent of the detected dwellings. Our workflow uses a Faster R-CNN, an object detection network. To train the network, we developed a fast training data annotation workflow. We use the dwellings detected by the faster R-CNN to estimate a number of inhabitants. The quality of the analysis can be evaluated by a confidence-metric, computed out of the results of the Faster R-CNN. The results can be used in humanitarian operations. We tested the workflow using different configurations and data. From those tests, we give recommendations on how to build a dwelling detection classifier. We propose to humanitarian operators to build a dwelling detection classifier according to our recommendations and use satellite images in actual humanitarian operations. This could help to reduce stress for all people involved in a humanitarian (crisis) situation.

A victims’ rights approach to the prevention of, and response to, sexual exploitation and abuse by United Nations personnel

ABSTRACTSince its foundation in 1945, the United Nations’ role in situations of conflict, humanitarian crisis and development has expanded and diversified. As it has done so, victims of sexual exploitation and abuse by United Nations personnel have come forward, reporting their experiences to United Nations and civil society staff, the media and others. Over the past 20 years, the United Nations has developed and implemented increasingly comprehensive system-wide policies to prevent and respond to these harmful behaviours. In 2017, the United Nations Secretary-General introduced a “new approach” to these endeavours, which places the rights and dignity of victims at the forefront, including by creating the position of Victims’ Rights Advocate (VRA). I was appointed the first VRA and began work in mid-September 2017. Since that time, I have sought to implement the Secretary-General’s policy by elevating the rights of victims. In doing so, I contribute to the United Nations’ quest to protect people in communities around the world from sexual exploitation and abuse by its uniformed and civilian staff and those who implement its programmes on the ground.

Investigating Pneumonia Etiology Among Refugees and the Lebanese population (PEARL): A study protocol.

Background: Community-acquired pneumonia (CAP), a leading cause of mortality, mainly affects children in developing countries. The harsh circumstances experienced by refugees include various factors associated with respiratory pathogen transmission, and clinical progression of CAP. Consequently, the etiology of CAP in humanitarian crisis situations may differ to that of settled populations, which would impact appropriate case management. Therefore, the Pneumonia Etiology Among Refugees and the Lebanese population (PEARL) study was initiated with the objective of identifying the causal pathogenic microorganisms in the respiratory tract of children and adults from both the refugee and host country population presenting with signs of CAP during a humanitarian crisis. Methods: PEARL, a prospective, multicentric, case-control study, will be conducted at four primary healthcare facilities in Tripoli and the Bekaa valley over 15 months (including two high-transmission seasons/winters). Sociodemographic and medical data, and biological samples will be collected from at least 600 CAP cases and 600 controls. Nasopharyngeal swabs, sputum, urine and blood samples will be analyzed at five clinical pathology laboratories in Lebanon to identify the bacterial and viral etiological agents of CAP. Transcriptomic profiling of host leukocytes will be performed. Conclusions: PEARL is an original observational study that will provide important new information on the etiology of pneumonia among refugees, which may improve case management, help design antimicrobial stewardship interventions, and reduce morbidity and mortality due to CAP in a humanitarian crisis.

Investigating Pneumonia Etiology Among Refugees and the Lebanese population (PEARL): A study protocol

Background: Community-acquired pneumonia (CAP), a leading cause of mortality, mainly affects children in developing countries. The harsh circumstances experienced by refugees include various factors associated with respiratory pathogen transmission, and clinical progression of CAP. Consequently, the etiology of CAP in humanitarian crisis situations may differ to that of settled populations, which would impact appropriate case management. Therefore, the Pneumonia Etiology Among Refugees and the Lebanese population (PEARL) study was initiated with the objective of identifying the causal pathogenic microorganisms in the respiratory tract of children and adults from both the refugee and host country population presenting with signs of CAP during a humanitarian crisis. Methods: PEARL, a prospective, multicentric, case-control study, will be conducted at four primary healthcare facilities in Tripoli and the Bekaa valley over 15 months (including two high-transmission seasons/winters). Sociodemographic and medical data, and biological samples will be collected from at least 600 CAP cases and 600 controls. Nasopharyngeal swabs, sputum, urine and blood samples will be analyzed at five clinical pathology laboratories in Lebanon to identify the bacterial and viral etiological agents of CAP. Transcriptomic profiling of host leukocytes will be performed. Conclusions: PEARL is an original observational study that will provide important new information on the etiology of pneumonia among refugees, which may improve case management, help design antimicrobial stewardship interventions, and reduce morbidity and mortality due to CAP in a humanitarian crisis.

The Obligation to Investigate in Peace Operations: The Role of Cooperation in Ensuring Effectiveness

Reports concerning crimes and abuses committed by peace operations personnel deployed in situations of humanitarian crisis often hit the news. In these instances, troop-contributing States (TCSs) retain both a prerogative and a duty to undertake criminal investigations as prescribed by international law. To investigate effectively, however, a TCS will need to interact with the other actors involved in a peace operation: the host State, the leading international organization, and other TCSs. When a local is killed, for example, the investigating TCS must seek the authorization of the host State in order to perform an autopsy on the victim’s body, so not as to infringe on the latter’s sovereignty. In this sense, partial or total non-cooperation on the part of the host State may hamper a TCS’s ability to conduct an effective investigation. The present article examines the obligation to investigate in the context of peace operations, particularly as deriving from human rights law and international humanitarian law (IHL). It further explores how the specific agreements applicable in UN and NATO operations address investigative cooperation, aiming to map relevant normative gaps. The article finally proposes an interpretation de lege ferenda of existing obligations under human rights law and IHL, according to which the duty to investigate would require TCSs (a) to regulate investigative cooperation with the other actors involved in a peace operation and (b) to ensure that such actors conduct investigations in line with the required standards of effectiveness.

Negotiating and Navigating Access to Refugees and Residents While Researching Palliative Care in Humanitarian Crisis Situations: Results from 4 Case Studies

Negotiating and Navigating Access to Refugees and Residents While Researching Palliative Care in Humanitarian Crisis Situations: Results from 4 Case Studies

Partners under pressure: humanitarian action for the Syria crisis.

Partnerships between organisations in humanitarian crisis situations generally are challenging, but at the apex are those established as part of remote management in a context of extreme insecurity. To date, little systematic research has been conducted on arrangements between local organisations that have access to crisis-affected populations and international organisations that hold the purse strings. This paper presents the findings of nine months of qualitative research conducted with five Syrian local organisations and their international partners engaging in humanitarian action across the Turkey-Syria border, and presents insights into the components of successful partnerships. It redefines capacity along organisational and operational lines, and unpacks how monitoring and evaluation and donor requirements create tension and, at times, place local organisations at risk. The paper highlights the centrality of trust in successful partnerships, and describes the personalisation of the conflict by local organisations. Based on a historical case study of civil society in northern Iraq, it closes with some suggestions for long-term sustainability.

Investigating Pneumonia Etiology Among Refugees and the Lebanese population (PEARL): A study protocol

Background: Community-acquired pneumonia (CAP), a leading cause of mortality, mainly affects children in developing countries. The harsh circumstances experienced by refugees include various factors associated with respiratory pathogen transmission, and clinical progression of CAP. Consequently, the etiology of CAP in humanitarian crisis situations may differ to that of settled populations, which would impact appropriate case management. Therefore, the Pneumonia Etiology Among Refugees and the Lebanese population (PEARL) study was initiated with the objective of identifying the causal pathogenic microorganisms in the respiratory tract of children and adults from both the refugee and host country population presenting with signs of CAP during a humanitarian crisis. Methods: PEARL, a prospective, multicentric, case-control study, will be conducted at four primary healthcare facilities in Tripoli and the Bekaa valley over 15 months (including two high-transmission seasons/winters). Sociodemographic and medical data, and biological samples will be collected from at least 600 CAP cases and 600 controls. Nasopharyngeal swabs, sputum, urine and blood samples will be analyzed at five clinical pathology laboratories in Lebanon to identify the bacterial and viral etiological agents of CAP. Transcriptomic profiling of host leukocytes will be performed. Conclusions: PEARL is an original observational study that will provide important new information on the etiology of pneumonia among refugees, which may improve case management, help design antimicrobial stewardship interventions, and reduce morbidity and mortality due to CAP in a humanitarian crisis.

Coordination of health-service provision in humanitarian crises: a systematic review of suggested models

BackgroundNational and international humanitarian relief organizsations play an important part in humanitarian crises. There is evidence of lack of coordination between organisations providing health services in public health emergencies. Our objective was to identify published models of coordination between organisations funding or delivering health services in situations of humanitarian crisis worldwide. MethodsWe followed standard systematic review methodology. We searched Medline (1946 to week 1 of March, 2014), PubMed, EMBASE (1980 to week 10 of 2014), the Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library. We only included papers published in English. We used search terms such as “refugee”, “disaster”, “conflict”, “coordination”, “cooperation”, “international organization” and “non profit organization”. Two teams of two reviewers screened titles and abstracts in duplicate and independently for potential eligibility, retrieved full texts of citations judged as potentially eligible by at least one reviewer, screened full texts in duplicate and independently for eligibility, and resolved disagreement by discussion. When disagreement was not resolved, a third reviewer made the final decision. We also searched websites of relevant organisations. One reviewer reviewed titles of search hits. We then obtained full texts of articles identified as potentially eligible, and two reviewers screened them in duplicate and independently, compared their results, and resolved any disagreement by discussion. We included reports describing models of coordination in sufficient detail to allow reproducibility. We also included reports describing implementation of identified models as case studies. FindingsOur search captured 14 309 citations. The screening process identified five models of coordination of delivering health services: the health cluster approach (with 15 case studies), the “who is where, when, doing what” mapping tool (4Ws; four case studies), the sphere project model (two case studies), the 5×5 model (one case study), and the model of information coordination (one case study). The 4Ws and 5x5 models focused on coordination of services for mental health, while the remaining models did not focus on a specific health topic. The health cluster approach appeared to be the most widely used. One case study used a mixed implementation of the health cluster approach and the sphere model. We did not identify any model of coordination related to funding of health services. InterpretationThis systematic review identified three proposed coordination models that have been implemented by organisations funding or delivering health services in situations of humanitarian crisis. There is a need to compare the effectiveness and efficiency of these different models. FundingAlliance for Health Policy and Systems Research, National Council for Scientific Research.

PROTECTION OF HUMAN RIGHTS IN ARMED CONFLICT

Respect of human rights is considered from the actual international law as a condition ensuring peace and international security. The responsibility to provide human rights protection lies in first hand with every single Sovran country. Nevertheless, protection of human rights remains an external issue outside of countries exclusive jurisdiction. International community cannot indifferently stand to human rights violation in a country. When civilian population suffers serious abusing of human rights either because the government fails to bring it to an end, or is the reason of the abusing, then it becomes an international community responsibility. International community must make use of all available means to ensure human rights respect in all countries where massive and systematic violations of these rights may represent a threat against peace. Violations initially have to face peaceful alternatives i.e. public pressure, legal actions to responsible individuals, economical and diplomatic sanctions. A great importance is achieving an international consensus toward massive atrocities prevention which cause humanitarian crisis. In some of the cases, abusement of human rights has been at a level where use of force was seen as the only possibility to end the abusings. But since war itself represents a threat to life and could probably bring further casualties, military force must be the last resort to be used in humanitarian cases. In order for humanitarian intervention to be effective and used only for humanitarian reasons without misuse from powerful contries, it must be framed within a legal outline. Achieving an international consensus for a legal bases of humanitarian interventions, would facilitate and abilitate international com-munity to appropriately act in humanitarian crisis situations and would avert possibilities for countries’ individual interests use by exploiting humanitarian intervention as pretext.

Reassurance or reason for concern: Security forces as a crisis management strategy

This paper examines effects of the deployment of security forces to a popular winter migrant destination faced with a unique humanitarian crisis situation. The study surveyed past winter migrants to the region to evaluate their perceptions regarding sociocultural, economic, and psychological impacts of security forces deployed to the region. In addition, this study evaluates the deployment's impact on satisfaction with life in the region, return intention and likelihood of recommending the region to others to find that perceived safety from the security forces significantly affected community factors and that satisfaction with life fully mediated community factor effects on destination loyalty. These finding significantly add to the limited research in crisis management response effects and substantiates the use of signaling and signal crimes perspective in managing crises.

A decomposition-based heuristic for stochastic emergency routing problems

This paper proposes a decomposition-based heuristic for a network delivery problem in which relief workers acquire valuable emergency supplies from relief warehouses, and transport them to meet the urgent needs of distressed population centres. The problem context dictates that the relief items reach these population centres before critical deadlines. However, co-ordination challenges and random disruptions introduce uncertainty in both network travel times and the destination deadlines. Hence, relief workers have to negotiate the tension between ensuring a high probability of punctual delivery and maximising the combined value of the relief supplies delivered. For an arbitrary routing scheme which guarantees punctual delivery in an uncertainty-free state of nature, the heuristic yields an upper bound on the probability that, under uncertainty, the routing scheme described will lead to tardy delivery. We demonstrate our solution approach on a small numerical example and glean insights from experiments on a realistically sized problem. Overall, our central model and proposed solution approach are useful to managers who need to evaluate routing options and devise effective operational delivery plans in humanitarian crisis situations.

Mitigating humanitarian crises during non-international armed conflicts—the role of human rights and ceasefire agreements

Situations of humanitarian crisis are often caused by armed conflicts. Given the prevalence of non-international armed conflicts today, ways of ameliorating these situations are at the forefront of concerns. The international humanitarian law rules governing non-international armed conflict remain much less developed than those for international armed conflicts. This makes governing the behaviour of non-state parties to non-international armed conflicts (non-state armed groups) extremely challenging. This is exacerbated by the lack of direct human rights obligations for non-state armed groups. Although several initiatives have been taken to encourage non-state actors to mitigate situations of humanitarian crisis, the role of human rights law is somewhat under-developed in this respect. The paper aims to assess what role human rights may have in improving humanitarian crises, suggesting one specific way in which they may be used. In order to achieve this, the paper will first discuss the international laws applicable to situations of non-international armed conflict. The paper will then critically analyse some of the initiatives that have already been taken to mitigate the disparity in human rights protection during armed conflicts. Based on the findings of this analysis, a new measure—the possibility of using a ceasefire agreement to impose specific human rights obligations on all parties to a conflict—will be assessed. An evaluation of the merits and challenges raised by this suggestion will lead to a conclusion as to the role that human rights and ceasefire agreements could have during humanitarian crises.

Mitigating Humanitarian Crises During Non-International Armed Conflicts The Role of Human Rights and Ceasefire Agreements

Situations of humanitarian crisis are often caused by armed conflicts. Given the prevalence of non-international armed conflicts today, ways of ameliorating these situations are at the forefront of concerns. The international humanitarian law rules governing non-international armed conflict remain much less developed than those for international armed conflicts. This makes governing the behaviour of non-state parties to non-international armed conflicts (non-state armed groups) extremely challenging. This is exacerbated by the lack of direct human rights obligations for non-state armed groups. Although several initiatives have been taken to encourage non-state actors to mitigate situations of humanitarian crisis, the role of human rights law is somewhat under-developed in this respect.The paper aims to assess what role human rights may have in improving humanitarian crises, suggesting one specific way in which they may be used. In order to achieve this, the paper will first discuss the international laws applicable to situations of non-international armed conflict. The paper will then critically analyse some of the initiatives that have already been taken to mitigate the disparity in human rights protection during armed conflicts.Based on the findings of this analysis, a new measure — the possibility of using a ceasefire agreement to impose specific human rights obligations on all parties to a conflict — will be assessed.An evaluation of the merits and challenges raised by this suggestion will lead to a conclusion as to the role that human rights and ceasefire agreements could have during humanitarian crises.

Trauma-related mental health problems among national humanitarian staff: a systematic review of the literature

BackgroundWorking in humanitarian crisis situations is dangerous. National humanitarian staff in particular face the risk of primary and secondary trauma exposure which can lead to mental health problems. Despite this, research on the mental health of national staff is scarce, and a systematic analysis of up-to-date findings has not been undertaken yet.ObjectiveThis article reviews the available literature on trauma-related mental health problems among national humanitarian staff. It focuses on the prevalence of selected mental health problems in relation to reference groups; sex and/or gender as predictive factors of mental health problems; and the influence of organization types on mental health problems.MethodThree databases were systematically searched for relevant studies published in the English language in peer-reviewed journals.ResultsFourteen articles matched the inclusion criteria. Findings suggest that national staff experience mental health problems and the prevalence of posttraumatic stress disorder, depression, and anxiety among this occupation group is mostly similar to or higher than among reference groups. Research on both substance use disorder and suicidal behavior among national staff is particularly scarce. The relation between sex and/or gender and mental health problems among national staff appears to be complex, and organizational staff support seems to be an important determinant for mental health.ConclusionAll findings call for increased attention from the humanitarian community and further research on the topic.

Brief report: Assessing youth well-being in global emergency settings: Early results from the Emergency Developmental Assets Profile

The 13-item Emergency Developmental Assets Profile measures the well-being of children and youth in emergency settings such as refugee camps and armed conflict zones, assessing whether young people are experiencing adequate positive relationships and opportunities, and developing positive values, skills, and self-perceptions, despite being in crisis circumstances. The instrument was found to have acceptable and nearly identical internal consistency reliability in 22 administrations in non-emergency samples in 15 countries (.75), and in 4 samples of youth ages 10–18 (n = 1550) in the emergency settings (war refugees and typhoon victims, .74) that are the measure's focus, and evidence of convergent validity. Confirmatory Factor Analysis showed acceptable model fit among those youth in emergency settings. Measures of model fit showed that the Em-DAP has configural and metric invariance across all emergency contexts and scalar invariance across some. The Em-DAP is a promising brief cross-cultural tool for assessing the developmental quality of life as reported by samples of youth in a current humanitarian crisis situation. The results can help to inform international relief program decisions about services and activities to be provided for children, youth, and families in emergency settings.

A research agenda for humanitarian health ethics.

This paper maps key research questions for humanitarian health ethics: the ethical dimensions of healthcare provision and public health activities during international responses to situations of humanitarian crisis. Development of this research agenda was initiated at the Humanitarian Health Ethics Forum (HHE Forum) convened in Hamilton, Canada in November 2012. The HHE Forum identified priority avenues for advancing policy and practice for ethics in humanitarian health action. The main topic areas examined were: experiences and perceptions of humanitarian health ethics; training and professional development initiatives for humanitarian health ethics; ethics support for humanitarian health workers; impact of policies and project structures on humanitarian health ethics; and theoretical frameworks and ethics lenses. Key research questions for each topic area are presented, as well as proposed strategies for advancing this research agenda. Pursuing the research agenda will help strengthen the ethical foundations of humanitarian health action.