Humanitarian Emergencies Research Articles

Sustainable Design of Temporary Buildings in Emergency Situations

Unforeseen circumstances that occur anywhere in the world following natural disasters, humanitarian and health emergencies, armed conflicts, or in the presence of migratory flows, require adequate and immediate responses. This work aims to analyze the project requirements useful to realizing modular systems for residential, multifunctional, and hospital intended use, which, even if temporary, can ensure a high-performance standard in terms of comfort and energy efficiency, and at the same time guarantee the possibility of use in the widest possible range and in rapid execution times. The considered requirements have been those of settlement in the territory, energy efficiency, transportability, and re-usability. Temporary modular systems put in place with the abovementioned requirements are the basis of the design proposal; to realize this, they are made with dry technology to be reusable and energy-efficient. Furthermore, this enables the reduction of the minimum modules’ production and times of execution in applying both requirements of standardization and modular coordination. All these requirements also add to the ones relating to energy efficiency, transportability, and reusability, which are the pillars of the project for the achievement of performance above all in terms of standards and comfort levels as it is possible to find in the sustainable building of the living period.

Gender-based violence (GBV) coordination in humanitarian and public health emergencies: a scoping review

BackgroundGender-based violence (GBV) is a global health, human rights, and protection issue, which can increase during emergencies. GBV coordination is an essential component of every humanitarian response, ensuring that, from the earliest phases of a crisis, accessible and safe services are available and prevention and mitigation mechanisms are implemented to reduce GBV. We sought to address the limited evidence on GBV coordination, by reviewing literature on GBV coordination in emergencies, identifying facilitators and barriers influencing effectiveness.MethodsWe conducted a scoping review on GBV coordination in emergencies from 1990 to 2020. Studies explicitly discussing GBV coordination in humanitarian, natural disaster and public health emergencies, in low or middle-income countries, were included. Using thematic analysis, we developed a six-topic framework to synthesise evidence on effective GBV coordination and present recommendations for strengthening GBV coordination in emergencies.FindingsWe included 28 of 964 sources identified, covering 30 different emergency settings across 22 countries. Sources spanned emergency settings, with minimal evidence in public health emergencies and none focussed solely on GBV coordination. Several sources suggested that timely establishment of GBV coordination mechanisms, led by dedicated, experienced coordinators, increased funding and strengthened service provision. GBV risk mitigation was compromised by weak commitment across sectors, poor accountability systems, and limited engagement of affected women. Inclusive GBV coordination, involving national and local actors is vital but engagement efforts have been inadequate and localisation funding targets not yet achieved. Implementation of the GBV Information Management System has reinforced coordination, funding allocation and service provision. While specialist GBV services remain insufficient, emergencies can present opportunities for expansion. Sustainability and long-term impact are compromised by over-reliance on international leadership and funding, weak commitment by governments, and limited attention to GBV prevention.ConclusionDespite enhanced global commitments to addressing GBV in recent years, it remains consistently under-prioritised and under-resourced. Recommendations to strengthen GBV coordination in emergencies include: funding dedicated GBV coordination positions across all types of emergencies, building the global GBV coordination workforce, expanding inclusion of national actors and investing in GBV risk mitigation and prevention through multiyear funding. The evidence-based framework for effective GBV coordination presented here, can guide further research in diverse emergencies.

Predictors of exceeding emergency under-five mortality thresholds using small-scale survey data from humanitarian settings (1999 – 2020): considerations for measles vaccination, malnutrition, and displacement status

BackgroundQuantifying the effect of measles containing vaccine (MCV) coverage and the prevalence of global acute malnutrition (GAM) on mortality levels in populations of displaced and crisis-affected resident children is important for intervention programming in humanitarian emergencies.MethodsA total of 1597 surveys containing data on under-five death rate, population status (internally displaced, refugee, or crisis-affected resident), measles containing vaccine coverage, and global acute malnutrition were extracted from the Complex Emergency Database (CE-DAT). Under-five mortality rates were dichotomized to those exceeding critical levels or otherwise. A Bayesian multivariable mixed-effect logistic regression model was used to assess the association between an under-five death rate (U5DR) exceeding this threshold and population status (i.e., internally displaced, refugees or residents), GAM prevalence (proxy for food security), and MCV coverage.ResultsThe prevalence of GAM, MCV and U5DR were higher in internally displaced children (IDC) with values of 14.6%, 69.9% and 2.07 deaths per 10 000 per day, respectively. Refugee populations had lower average under-five mortality rate (0.89 deaths per 10 000 per day), GAM of 12.0% and the highest measles containing vaccine coverage (80.0%). In crisis-affected residents the prevalence of GAM, MCV and average U5DR are 11.1%, 65.5% and 1.20 deaths per 10 000 per day respectively. In mixed-effect logistic model taking 2 deaths per 10 000 children less than five years old per as emergency threshold (Model III); MCV (AOR = 0.66, 95% Highest Density Interval (HDI): 0.57, 0.78), GAM (AOR = 1.79, 95% HDI: 1.52, 2.12) were associated with a reduction of the odds of U5DR exceeding critical level accounting for country-specific levels of variability. The odds of U5DR exceeding critical level (2/10000/day) in crisis-affected resident children and refugees were 0.36 (95% HDI: 0.22, 0.58) and 0.25(95% HDI: 0.11, 0.55) less than amongst IDP children adjusting for GAM and MCV. In considering country specific yearly median U5DR (model IV) the odds of U5DR exceeding twice the median U5DR were associated with MCV (AOR = 0.72, 95% HDI: 0.64, 0.82), GAM (AOR = 1.53, 95%HDI: 1.34, 1.76). The odds of U5DR exceeding critical level in crisis-affected resident children was 0.30(95% HDI: 0.20, 0.45) less than IDP children, after adjusting for MCV and GAM. We found no difference between the odds of U5DR exceeding twice the country level median U5DR in the refugee population compared to the IDPs.ConclusionsIn this study vaccination coverage and global acute malnutrition (proxy for food security) were associated with U5DR exceeding critical level. The emergency threshold for IDPs and affected residents is significantly different and consistent across the different outcomes, whereas the result is inconsistent for IDPs and refugees. Continued improvement in measles vaccination coverage and reduction of malnutrition in humanitarian emergencies have the potential to minimize the deterioration of mortality level amongst children in emergency settings. To generate a robust understanding of the critical level of child mortality in displaced and affected resident populations, studies accounting for the impact of the duration of displacement, contextual factors in humanitarian settings, and the level of humanitarian assistance provided are needed.

Who lost Ethiopia? The unmaking of an African anchor state and U.S. foreign policy

ABSTRACT In November 2020, Ethiopia descended into full-scale civil war which, owing to mass atrocities and regional intervention, metastasized into among the most acute humanitarian emergencies in the world. The violent fragmentation of state authority tarnished Ethiopia’s internationally sanctioned role as regional peacekeeper and developmental leader—an “anchor state” of the Pax Americana in the Horn of Africa. While acknowledging the complex, multi-dimensional origins of the conflict, this article examines how efforts by the U.S. government to reinvent the strategic relationship during the 2018–2020 political transition in Addis Ababa helped pave the road to war. We argue that U.S. policymakers provided largely unconditional support to Ethiopia’s new Prime Minister Abiy Ahmed, creating problems of moral hazard that encouraged confrontation between rival political forces. The story of U.S. engagement in Ethiopia in this period illustrates the perils of Washington’s efforts to rebalance fraught relations with its most important regional anchors.

Systematic review on chronic non-communicable disease in disaster settings

BackgroundNon-communicable diseases (NCDs) constitute the leading cause of mortality globally. Low and middle-income countries (LMICs) not only experience the largest burden of humanitarian emergencies but are also disproportionately affected by NCDs, yet primary focus on the topic is lagging. We conducted a systematic review on the effect of humanitarian disasters on NCDs in LMICs assessing epidemiology, interventions, and treatment.MethodsA systematic search in MEDLINE, MEDLINE (PubMed, for in-process and non-indexed citations), Social Science Citation Index, and Global Health (EBSCO) for indexed articles published before December 11, 2017 was conducted, and publications reporting on NCDs and humanitarian emergencies in LMICs were included. We extracted and synthesized results using a thematic analysis approach and present the results by disease type. The study is registered at PROSPERO (CRD42018088769).ResultsOf the 85 included publications, most reported on observational research studies and almost half (48.9%) reported on studies in the Eastern Mediterranean Region (EMRO), with scant studies reporting on the African and Americas regions. NCDs represented a significant burden for populations affected by humanitarian crises in our findings, despite a dearth of data from particular regions and disease categories. The majority of studies included in our review presented epidemiologic evidence for the burden of disease, while few studies addressed clinical management or intervention delivery. Commonly cited barriers to healthcare access in all phases of disaster and major disease diagnoses studied included: low levels of education, financial difficulties, displacement, illiteracy, lack of access to medications, affordability of treatment and monitoring devices, and centralized healthcare infrastructure for NCDs. Screening and prevention for NCDs in disaster-prone settings was supported. Refugee status was independently identified both as a risk factor for diagnosis with an NCD and conferring worse morbidity.ConclusionsAn increased focus on the effects of, and mitigating factors for, NCDs occurring in disaster-afflicted LMICs is needed. While the majority of studies included in our review presented epidemiologic evidence for the burden of disease, research is needed to address contributing factors, interventions, and means of managing disease during humanitarian emergencies in LMICs.

Resilience and the role of equids in humanitarian crises.

In times of crisis, working equids can play a pivotal role in supporting vulnerable people in lower middle income countries. However, their contributions are rarely acknowledged in academic research, media reporting, international policy, and development initiatives. This paper explores the involvement of working equids in humanitarian emergencies, notably those pertaining to conflict, drought, climate change, and natural hazards. It presents ‘critical cases’, informed by document analysis of policy papers, historical texts, and academic publications. In addition, it includes the findings of semi‐structured interviews with key informants, primarily field staff working for frontline services in crisis zones, conducted in mid 2020. The paper develops evidence on the role of working equids in crisis situations—expanding the concept of ‘resilience’ to include working animals and contributing to recent academic discussions in the fields of disaster and development studies—highlighting their importance for global policy, resilience programming, and disaster risk reduction, including efforts to achieve the Sustainable Development Goals.

Breastfeeding and humanitarian emergencies: the experiences of pregnant and lactating women during the earthquake in Abruzzo, Italy

BackgroundEmergencies have a great impact on infant and young child feeding. Despite the evidence, the recommended feeding practices are often not implemented in the emergency response, undermining infant and maternal health. The aim of this study was to explore the experiences of pregnant and lactating women during the earthquake emergency that occurred in L’Aquila on 6 April 2009.MethodsThe study design was qualitative descriptive. Data were collected by individual semi-structured interviews, investigating the mother’s experiences of pregnancy, childbirth, breastfeeding, infant formula or complementary feeding during the emergency and the post emergency phase. Data analysis was categorical and was performed by using N-Vivo software.ResultsSix women who were pregnant at the time of the earthquake were interviewed in January 2010. In addition to the essential needs of pregnant and lactating women, such as those related to the emergency shelters conditions, the main findings emerged from this study were: the reconfiguration of relationships and the central role of partners and family support; the need of spaces for sharing experiences and practices with other mothers; the lack of breastfeeding support after the hospital discharge; the inappropriate donations and distribution of Breast Milk Substitutes.ConclusionsDuring and after L’Aquila earthquake, several aspects of infant and young child feeding did not comply with standard practices and recommendations. The response system appeared not always able to address the specific needs of pregnant and lactating women. It is urgent to develop management plans, policies and procedures and provide communication, sensitization, and training on infant and young child feeding at all levels and sectors of the emergency response.

Advancing Posttraumatic Stress Disorder Diagnosis and the Treatment of Trauma in Humanitarian Emergencies via Mobile Health: Protocol for a Proof-of-Concept Nonrandomized Controlled Trial.

BackgroundDecentralized health systems in low- and middle-income countries (LMICs) affected by humanitarian crises lack resources and a qualified workforce to attend to the overwhelming demand for mental health care in emergencies. Innovative approaches that are safe, cost-effective, and scalable are needed to address the burden of traumatic stress caused by emergencies. High mobile phone ownership rates combined with the precision of neural, cognitive, and biometric measures of trauma and their feasible integration with artificial intelligence makes digital app interventions a promising pathway to promote precision diagnosis and high-impact care.ObjectiveThis study aimed to advance methods for the objective diagnosis and treatment of trauma in emergencies across LMICs by examining neural, cognitive, and biometric markers and the efficacy of the eResilience app, a neuroscience-informed mobile health mental health app intervention, via changes in clinical symptomatology, cognitive performance, and brain activity.MethodsTrauma-exposed African refugees residing in Australia were selected for this study. A research software version of the eResilience app with advanced monitoring capabilities was designed for this trial. Participants completed the eResilience app at home during a 7-day period. Clinical, cognitive, and electrophysiological data were collected at baseline, along with posttest measurements to examine biomarkers of trauma and the efficacy of the proposed digital intervention for the treatment of trauma and its potential outcomes, including depression, anxiety, physical symptoms, self-harm, substance misuse, and cognitive impairment. In addition, biofeedback, well-being, and subjective stress data points were collected via the app during the treatment week, followed by clinical interviews at 1, 3, 6, and 12 months after the intervention.ResultsData collection was conducted between 2018 and 2020. A total of 100 participants exposed to war were screened; 75 (75%) were enrolled and assigned to a trauma-exposed control (38/75, 51%) or posttraumatic stress disorder condition (37/75, 49%); and 70 (70%) completed all baseline, treatment, and posttest assessments. A total of 89% (62/70) of those who completed the intervention opted to enroll in the 3-, 6-, and 12-month follow-ups. Data collection is complete. As of May 2022, the results of all proposed analyses are being prepared for publication. If proven efficacious, this proof-of-concept clinical trial will inform fully powered randomized clinical trials in LMICs to further develop artificial intelligence–powered, app-based diagnostic and prognostic features and determine the app’s cross-cultural efficacy for the treatment of trauma in emergency settings.ConclusionsThis protocol provides researchers with a comprehensive background of the study rationale, a detailed guideline for replication studies interested in examining the feasibility and efficacy of the eResilience app across varied demographics, and a robust framework for investigating low-cost objective diagnostic markers in mental health interventions. Methodological limitations and suggestions are also provided.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12616001205426; https://tinyurl.com/yckwc4d7International Registered Report Identifier (IRRID)RR1-10.2196/38223

Seguridad humana de los desplazados de Venezuela en Chile frente a la crisis regional y el COVID-19

The phenomenon of migration and displacement of Venezuelans to Chile will be investigated from a multidisciplinary perspective and hermeneutic, interpretative and documentary analysis. The phenomenon will be observed from various theoretical perspectives, whose central construct is migration and displacement as a phenomenon that impacts human security. The Venezuelan humanitarian emergency of the period 2017–2021 will be studied in the context of COVID-19, and the idea of a supraregional universal jurisdiction will be analyzed, in view of the obligation to protect citizens by the States in Latin America. The research question is: what are the limits of the State’s responsibility to respond to the human security of migrants and displaced persons based on the Venezuelan experience in Chile in the years 2017–2021? The author will verify the hypothesis that human security in the region is an aspiration that needs supranational actions to ensure that the human rights of migrants and displaced persons are respected and protected by the authorities of the nation-states of Latin America.

Context matters: a systematic review of neonatal care in humanitarian emergencies

BackgroundOf the 15 countries with the highest neonatal mortality rates, 13 are characterised by conflict and political instability. Despite well-documented evidence of best practice interventions for neonatal survival, it remains less clear on how these practices are implemented in humanitarian emergency settings.ObjectiveTo conduct a systematic review of published and grey literature on the implementation strategies and challenges in addressing neonatal care in humanitarian emergencies.MethodsA systematic literature search was conducted in SCOPUS, MEDLINE, Web of Science, CINHAL and Global Health for studies published between 1 January 2003 and 30 June 2018. Additionally, websites of organisations actively working in humanitarian emergencies were searched. Interventions were reviewed against the existing essential newborn care framework according to the standards outlined in the Newborn Health in Humanitarian Settings Field Guide.ResultsTwenty-one studies were identified: eight reporting on conflict and refugee settings, nine followed natural disasters and four discussed multiple emergency settings. Few studies addressed all the components of essential newborn care outlined in the field guide regardless of the emergency type. The review of literature demonstrated challenges in addressing essential newborn care identified in all humanitarian settings including the lack of adequate equipment, financing, and trained staff. Implementation strategies identified included quality improvement training for staff, the development of evacuation procedures, integrating with local and government resources and generating spaces in health facilities specifically for newborn care.ConclusionsThe requirements and initiatives needed to deliver essential newborn care in humanitarian settings are highly variable and context dependent. Given the diversity of factors needing to be addressed by the field guide, more research should be directed towards the adaptability of the implementation strategies to differing emergency contexts.Trial registrationPROSPERO registration ID: CRD42018098824

Humanitarian inversions: COVID-19 as crisis.

COVID‐19 is a multi‐spectral crisis that has added an acute layer over a panoply of complex emergencies across the world. In the process, it has not only exposed actually‐existing emergencies, but also exacerbated them as the global gaze has turned inward. As a crisis, COVID‐19 straddles and challenges the boundaries between humanitarianism, development, and global health—the frames and categories through which emergencies are so often understood and intervened upon. Reflection on these fundamental categories is, we argue, an important geographical endeavour. Drawing on Geoffrey Bowker's analytical lens of the ‘infrastructural inversion’, we explore how humanitarianism has been upended by COVID‐19 along two axes that are of core concern to geographers: (1) the spatial and (2) the temporal. We first contextualise current debates on the humanitarian endeavour and its future within recent geographical research. We then set out the complex structure by which COVID‐19 has been both imagined and intervened upon as a humanitarian emergency. In so doing, we then pave the way for a deeper empirical analysis of the spatial and temporal inversions that have been brought forth by COVID‐19. The paper concludes by examining the conceptual value of the ‘inversion’ in developing geographical research agendas better attuned to the increasing porosity of humanitarianism, development, and global health.

Pre-processing data to reduce biases: full matching incorporating an instrumental variable in population-based studies.

Epidemiologists are often concerned with unobserved biases that produce confounding in population-based studies. We introduce a new design approach-'full matching incorporating an instrumental variable (IV)' or 'Full-IV Matching'-and illustrate its utility in reducing observed and unobserved biases to increase inference accuracy. Our motivating example is tailored to a central question in humanitarian emergencies-the difference in sexual violence risk by displacement setting. We conducted a series of 1000 Monte Carlo simulations generated from a population-based survey after the 2010 Haitian earthquake and included earthquake damage severity as an IV and the unmeasured variable of 'social capital'. We compared standardized mean differences (SMDs) for covariates after different designs to understand potential biases. Mean risk differences (RDs) were used to assess each design's accuracy in estimating the oracle of the simulated data set. Naive analysis and pair matching equivalently performed. Full matching reduced imbalances between exposed and comparison groups across covariates, except for the unobserved covariate of 'social capital'. Pair and full matching overstated differences in sexual violence risk when displaced to a camp vs a community [pair: RD = 0.13, 95% simulation interval (SI) 0.09-0.16; full: RD = 0.11, 95% SI 0.08-0.14). Full-IV Matching reduced imbalances across observed covariates and importantly 'social capital'. The estimated risk difference (RD = 0.07, 95% SI 0.03-0.11) was closest to the oracle (RD = 0.06, 95% SI 0.4-0.8). Full-IV Matching is a novel approach that is promising for increasing inference accuracy when unmeasured sources of bias likely exist.

Opportunities and challenges in preventing violence against adolescent girls through gender transformative, whole-family support programming in Northeast Nigeria

BackgroundHousehold violence is one of the most prevalent forms of gender-based violence faced by adolescent girls in humanitarian settings. A growing evidence base demonstrates the extent to which multiple forms of familial violence, including intimate partner violence, violence against children, and sibling violence overlap in the same households. However, existing evidence of family support programming that effectively reduces violence against girls by addressing intersecting forms of household violence are limited, particularly in the Global South. Through a qualitative implementation evaluation informed by a grounded theoretical approach, we explored the perceived impact of a gender transformative, whole-family support intervention aimed at building adolescent girls’ protective assets against violence, among program participants in two communities of internally displaced people Maiduguri, Borno State, Northeast Nigeria.MethodsWe conducted six in-depth interviews and six focus group discussions with adult caregivers; six participatory activities and four paired interviews with adolescent girls and boys; and 12 key informant interviews with program staff. Criterion sampling was used to recruit 21 male caregivers, 21 female caregivers, 23 adolescent boys, and 21 adolescent girls; purposive sampling was used to recruit 12 program staff to participate in qualitative research activities. We audio recorded, translated, and transcribed all interviews. In a collaborative coding process, a multi-stakeholder team used applied thematic analysis in Dedoose to identify emergent themes in the data.ResultsParticipants reported a decreased tolerance for and perpetration of violence against girls at the household level, and endorsed their right to protection from violence at the community level. However, alongside these self-reported changes in attitude and behavior, aspects of normative, patriarchal norms governing the treatment of adolescent girls were maintained by participants.ConclusionsThis study builds the evidence base for gender transformative, whole-family support programming and its impact on preventing violence against adolescent girls in humanitarian emergencies. Situating our findings in a feminist analysis of violence, this study calls attention to the complexity of gender norms change programming amongst families in conflict-affected settings, and highlights the need for programming which holistically addresses the relational, community, and structural drivers of violence against girls in emergencies.

Covid-19’s Effects on Contraceptive Services Across the Humanitarian–Development Nexus

Sexual and reproductive health (SRH) services, including contraception, save lives in humanitarian emergencies. To document practitioners’ perceptions of the effects of the Covid-19 pandemic on contraceptive programming in humanitarian settings and across the humanitarian–development nexus, the Women’s Refugee Commission conducted 29 key informant interviews with respondents from non-governmental organisations, the United Nations, and government ministries. Disruptions to contraceptive services included closures or repurposing of health facilities, limited availability of health providers, supply chain interruptions, restricted service delivery modalities, and lower demand for services. Adaptations to sustain services included telemedicine, task-shifting and sharing, community-based service delivery, and other innovations. Underlying factors affecting the types and extent of disruptions and adaptations included emergency preparedness for SRH, decision makers’ prioritisation of SRH services, funding, and coordination. Findings reinforce the need to build awareness that SRH services, including contraception, are lifesaving and essential in humanitarian settings, and to improve preparedness, including bridging gaps between humanitarian and development actors.

Molecular Investigation of Recent Canine Parvovirus-2 (CPV-2) in Italy Revealed Distinct Clustering.

Canine parvovirus Type 2 (CPV-2) is a worldwide distributed virus considered the major cause of viral gastroenteritis in dogs. Studies on Italian CPV-2 are restricted to viruses circulating until 2017. Only one study provided more updated information on CPV-2 but was limited to the Sicily region. No information regarding the circulation and genetic characteristics of CPV-2 in Northeast Italy has been made available since 2015. The present study investigated the genetic characteristics of CPV-2 circulating in the dog population of Northeast Italy between 2013 and 2019. The VP2 gene of 67 CPV-2 was sequenced, and phylogenetic analysis was performed to identify patterns of distribution. Phylogenetic and molecular analysis highlighted unique characteristics of Northeast Italian CPV-2 and interestingly depicted typical genetic clustering of the Italian CPV-2 strains, showing the existence of distinct CPV-2 genetic groups. Such analysis provided insights into the origin of some Italian CPV-2 genetic clusters, revealing potential introductions from East European countries and the spread of CPV-2 from South/Central to North Italy. This is the first report that describes the genetic characteristics of recent Italian CPV-2. Tracking the genetic characteristics of CPV-2 nationally and globally may have impact on understanding the evolution and distribution of CPV-2, in particular in light of the current humanitarian emergency involving Ukraine, with the massive and uncontrolled movement of people and pet animals.

Opportunities in crisis for optimising child health and development

The Lancet Series on optimising child and adolescent health and development1–4 arrives at the right time. For many years, the global health community has known that quality primary health care, including antenatal care, immunisation, and optimal nutrition, helps children survive past their fifth birthday and live healthy lives. Child survival has improved because of combined efforts in these areas; but the scale and scope of the global threats to child health and wellbeing, including conflicts, climate crises, and other humanitarian emergencies, all compounded by COVID-19, now put decades of progress at grave risk.

Optimising child and adolescent health and development in the post-pandemic world

Our Series on optimising child and adolescent health and development follows on almost two decades after the original Lancet Series on child survival and its corresponding call for action. 1 The Bellagio Study group on Child SurvivalKnowledge into action for child survival. Lancet. 2003; 362: 323-327 Summary Full Text Full Text PDF PubMed Scopus (184) Google Scholar With less than 10 years left to meet the 2030 Sustainable Development Goals (SDGs), we are concerned that, once again, the world is failing its children. The evidence is strong and calls for change abound; however, effective actions are few and far between. Opportunities in crisis for optimising child health and developmentThe Lancet Series on optimising child and adolescent health and development1–4 arrives at the right time. For many years, the global health community has known that quality primary health care, including antenatal care, immunisation, and optimal nutrition, helps children survive past their fifth birthday and live healthy lives. Child survival has improved because of combined efforts in these areas; but the scale and scope of the global threats to child health and wellbeing, including conflicts, climate crises, and other humanitarian emergencies, all compounded by COVID-19, now put decades of progress at grave risk. Full-Text PDF Health and development from preconception to 20 years of age and human capitalOptimal health and development from preconception to adulthood are crucial for human flourishing and the formation of human capital. The Nurturing Care Framework, as adapted to age 20 years, conceptualises the major influences during periods of development from preconception, through pregnancy, childhood, and adolescence that affect human capital. In addition to mortality in children younger than 5 years, stillbirths and deaths in 5–19-year-olds are important to consider. The global rate of mortality in individuals younger than 20 years has declined substantially since 2000, yet in 2019 an estimated 8·6 million deaths occurred between 28 weeks of gestation and 20 years of age, with more than half of deaths, including stillbirths, occurring before 28 days of age. Full-Text PDF Effects of early-life poverty on health and human capital in children and adolescents: analyses of national surveys and birth cohort studies in LMICsThe survival and nutrition of children and, to a lesser extent, adolescents have improved substantially in the past two decades. Improvements have been linked to the delivery of effective biomedical, behavioural, and environmental interventions; however, large disparities exist between and within countries. Using data from 95 national surveys in low-income and middle-income countries (LMICs), we analyse how strongly the health, nutrition, and cognitive development of children and adolescents are related to early-life poverty. Full-Text PDF What can work and how? An overview of evidence-based interventions and delivery strategies to support health and human development from before conception to 20 yearsProgress has been made globally in improving the coverage of key maternal, newborn, and early childhood interventions in low-income and middle-income countries, which has contributed to a decrease in child mortality and morbidity. However, inequities remain, and many children and adolescents are still not covered by life-saving and nurturing care interventions, despite their relatively low costs and high cost-effectiveness. This Series paper builds on a large body of work from the past two decades on evidence-based interventions and packages of care for survival, strategies for delivery, and platforms to reach the most vulnerable. Full-Text PDF Improving health and social systems for all children in LMICs: structural innovations to deliver high-quality servicesDespite health gains over the past 30 years, children and adolescents are not reaching their health potential in many low-income and middle-income countries (LMICs). In addition to health systems, social systems, such as schools, communities, families, and digital platforms, can be used to promote health. We did a targeted literature review of how well health and social systems are meeting the needs of children in LMICs using the framework of The Lancet Global Health Commission on high-quality health systems and we reviewed evidence for structural reforms in health and social sectors. Full-Text PDF

Childhood pneumonia in humanitarian emergencies in low- and middle-income countries: A systematic scoping review.

BackgroundHumanitarian emergencies increase many risk factors for pneumonia, including disruption to food, water and sanitation, and basic health services. This review describes pneumonia morbidity and mortality among children and adolescents affected by humanitarian emergencies.MethodsWe searched MEDLINE, EMBASE, and PubMed databases for publications reporting pneumonia morbidity or mortality among children aged 1 month to 17 years in humanitarian emergencies (eg, natural disaster, armed conflict, displacement) in low- and middle-income countries (LMICs).ResultsWe included 23 papers published between January 2000 and July 2021 from 23 countries, involving refugee/displaced persons camps (n = 5), other conflict settings (n = 14), and natural disaster (n = 3). Population pneumonia incidence was high for children under 5 years of age (73 to 146 episodes per 100 patient-years); 6%-29% met World Health Organization (WHO) criteria for severe pneumonia requiring admission. Pneumonia accounted for 13%-34% of child and adolescent presentations to camp health facilities, 7%-48% of presentations and admissions to health facilities in other conflict settings, and 12%-22% of admissions to hospitals following natural disasters. Pneumonia related deaths accounted for 7%-30% of child and adolescent deaths in hospital, though case-fatality rates varied greatly (0.5%-17.2%). The risk for pneumonia was greater for children who are: recently displaced, living in crowded settings (particularly large camps), with deficient water and sanitation facilities, and those who are malnourished.ConclusionPneumonia is a leading cause of morbidity and mortality in children and adolescents affected by humanitarian emergencies. Future research should address population-based pneumonia burden, particularly for older children and adolescents, and describe contextual factors to allow for more meaningful interpretation and guide interventions.

Perspectives on deployment of humanitarian workers through operational partnerships during the acute emergency health response to the Rohingya refugee crisis in Cox\u2019s Bazar

BackgroundThe unprecedented influx of Rohingya refugees into Cox’s Bazar, Bangladesh, in 2017 led to a humanitarian emergency requiring large numbers of humanitarian workers to be deployed to the region. The World Health Organization (WHO) contributed to this effort through well-established deployment mechanisms: the Global Outbreak Alert and Response Network (GOARN) and the Standby Partnerships (SBP). The study captures the views and experiences of those humanitarian workers deployed by WHO through operational partnerships between December 2017 and February 2019 with the purpose of identifying challenges and good practice during the deployment process, and steps to their improvement.MethodsA mixed methods design was used. A desktop review was conducted to describe the demographics of the humanitarian workers deployed to Cox’s Bazar and the work that was undertaken. Interviews were conducted with a subset of the respondents to elicit their views relating to their experiences of working as part of the humanitarian response. Thematic analysis was used to identify key themes.ResultsWe identified sixty-five deployments during the study period. Respondents’ previous experience ranged between 3 and 28 years (mean 9.7 years). The duration of deployment ranged from 8 to 278 days (mean 67 days) and there was a higher representation of workers from Western Pacific and European regions. Forty-one interviews were conducted with people who experienced differing aspects of the deployment process. Key themes elicited from interviews related to staffing, the deployment process, the office environment and capacity building. Various issues raised have since been addressed, including the establishment of a sub-office structure, introduction of online training prior to deployment, and a staff wellbeing committee.ConclusionsThis study identified successes and areas for improvement for deployments during emergencies. The themes and subthemes elicited can be used to inform policy and practice changes, as well as the development of performance indicators. Common findings between this study and previous literature indicate the pivotal role of staff deployments through partnership agreements during health emergency response operations and a need for continuous improvements of processes to ensure maximum effectiveness.

Crafting constraints: Latin American support for humanitarian-intervention norms

This article explores why, by 2005, most Latin American countries supported the Responsibility to Protect (R2P), a doctrine modifying limits on the use of force to address atrocity crimes. I group existing explanations of why Latin American countries apparently changed their long-standing defence of non-intervention following the main explanatory factor they focus on: power asymmetries, government preferences or coalition politics. I find that these accounts downplay a fundamental dimension informing the approaches of Latin American supporters: how to limit interveners. Drawing on Republican security theory (RST), I argue that Latin American supporters faced a dilemma in the R2P debates, especially after the intervention in Iraq in 2003. Latin American supporters favoured crafting solutions to humanitarian problems that simultaneously addressed crises and prevented arbitrary uses of force. I use the Brazilian and Chilean case studies to explore this argument. Brazilian and Chilean governments concluded that their conventional interpretations of limits on the use of force did not offer answers for both humanitarian emergencies and arbitrary uses of force. As a solution, they modified but did not abandon their diplomatic traditions. These governments calculated that humanitarian-intervention norms could be constraints, even if imperfect, on interveners arbitrarily using military force.