Humanitarian Health Workers Research Articles

Safety of rVSV-ZEBOV vaccination of humanitarian health workers against Ebola virus disease: experience from a French pre-travel clinic.

Safety of rVSV-ZEBOV vaccination of humanitarian health workers against Ebola virus disease: experience from a French pre-travel clinic.

'We will never give up': a qualitative study of ethical challenges Syrian health workers face in situations of extreme violence.

Active conflict settings constitute challenging operating environments for humanitarian health organisations and workers. An emerging feature of some conflicts is direct violence against health workers, facilities, and patients. Since the start of the war in 2011, Syria has endured extreme and deliberate violent attacks on health facilities and workers. This paper reports on the findings from a qualitative study that examined the lived experiences of Syrian humanitarian health workers facing extreme ethical challenges and coping with moral distress. In-depth interviews were carried out with 58 front-line health workers in north-western and southern Syria. Participants described a number of ethical and operational challenges experienced while providing services in extreme conditions, as well as strategies used to deal with them. The complex intersection of personal and organisational challenges is considered and findings are linked to key ethical and humanitarian principles. Both practical recommendations and action steps are provided to guide humanitarian health organisations.

Using Virtual Learning to Develop Palliative Care Skills Among Humanitarian Health Workers in the Rohingya Refugee Response in Bangladesh.

BackgroundPalliative care is an essential component of health responses in humanitarian settings, yet it remains largely unavailable in these settings, due to limited availability of palliative care training for healthcare professionals. Online training programs which connect experts to clinicians in the field have been proposed as an innovative strategy to build palliative care capacity humanitarian settings.ObjectiveTo describe the implementation and evaluate the impact of delivering palliative care education using an established virtual learning model (Project ECHO) for healthcare clinicians working in the Rohingya refugee response in Bangladesh. Program acceptability and the impacts on learners’ self-reported knowledge, comfort, and practice changes were evaluated.MethodsUsing the Project ECHO model, an education program consisting of 7 core sessions and monthly mentoring sessions was developed. Each session included a didactic lecture, case presentation and interactive discussion. Surveys of participants were conducted before and after the program to assess knowledge, confidence, and attitudes about palliative care as well as learning experiences from the program.ResultsThis virtual palliative care training program engaged 250 clinicians, including nurses (35%), medical assistants (28%) and physicians (20%). Most participants rated the program as a valuable learning experience (96%) that they would recommend to their colleagues (98%). Participants reported improvements in their knowledge and comfort related to palliative care after participation in the program, and had improved attitudes towards palliative care with demonstrated statistical significance (p < 0.05).ConclusionsVirtual training is a feasible model to support healthcare providers in a humanitarian health response. Project ECHO can help to address the urgent need for palliative care in humanitarian responses by supporting healthcare workers to provide essential palliative care to the growing number of individuals with serious health-related suffering in humanitarian settings.

Feasibility and safety of rVSV-ZEBOV vaccination of humanitarian health workers against Ebola virus disease: an observational study.

Geneva University Hospitals were granted a temporary authorization to administer the recombinant live vesicular stomatitis virus rVSV-ZEBOV (Ervebo®) vaccine to expatriate humanitarian frontline workers (FLWs) prior to mission deployment. Our aims were to assess the feasibility of FLW vaccination before deployment and to report adverse events (AEs). FLWs received a single injection of rVSV-ZEBOV (>7.2E7 plaque forming unit) during their pre-deployment medical check-up at the Travel Medicine Clinic of the Geneva University Hospitals (Day 0). A safety questionnaire regarding potential AEs was emailed to FLWs on Days 3 and 21. Early and delayed AEs were those starting within 3 or 21 days of vaccination, respectively. Between 1 August 2019 and 30 June 2020, 124 FLWs received the rVSV-ZEBOV vaccine. Eighty-six volunteers (86/124; 69%) received a concomitant vaccine. The response rate to the follow-up questionnaire was 88 and 55% at Days 3 and 21, respectively. Most respondents (105/109; 96.3%), experienced at least one AE, with a mean of three (±SD 1.75) AEs per person. The most common AE was injection site pain, followed by fever (53/109; 48.6%), fatigue (51/109; 46.7%) and myalgia (49/109; 44.9%). Most early AEs (360/377; 95.4%) resolved within 3 days, reflecting vaccine reactogenicity. Delayed AEs were reported by 6/69 (7.2%) subjects, the median time to symptom onset was 11 days (range: 5-14); half of them were joint-related AEs (3/6). Four serious adverse events (SAE) were observed: two cases of high grade fever, one rash and one case of arthritis. Two suspected unexpected serious adverse reactions were observed: one case of continuing recurrent transient dizziness and fatigue considered related to the vaccine; and one case of presbyopia that was deemed unrelated. AEs to rVSV-ZEBOV were common but in general transient and were well tolerated, pre-deployment rVSV-ZEBOV vaccination in FLW is feasible and can be included with pre-mission check-up.

Politicians, pathogens, and other threats to aid workers: a material semiotic analysis of violence against health care in the Syrian conflict

ABSTRACT This paper analyses humanitarian security in the framework of Donna Haraway’s political material semiotics. It begins by arguing that targeted violence against health care constitutes a trope: a figure of speech that challenges and disrupts the established narrative of humanitarian security. Drawing on 20 in-depth expert interviews, the paper explores a case study of weaponisation of health care in the Syrian conflict (2011-present). It illustrates how different material-semiotic actors – such as politicians, pathogens, and medical infrastructure – condition and shape the security of humanitarian health workers in the opposition-held parts of the country. Taking medical facilities as its key unit of analysis, the paper shows how armed violence is not only directed towards these material-semiotic entities but amplified and transformed as it passes through them. In doing so, the paper sheds light on the formative role that nonhuman materialities play in the protection of aid workers and other civilian entities in armed conflict. The paper's findings also contribute towards an improved understanding of how previously under-appreciated variables impact the delivery of medical aid in complex humanitarian emergencies.

Making Health Work for Peace in Humanitarian Situations

From the time of Florence Nightingale, humanitarian health and aid workers have dedicated themselves to the welfare of patients outside of their own communities, nobly sacrificing their own safety, economic well being, mental health, and sometimes even life. They witness and deal with the human consequences of violent conflict and care for those that are directly affected by it. Dedicated humanitarian professionals such as Albert Schweitzer, Henri Dunant, founder of the Red Cross, and James Orbinski, representing Médecins sans Frontières (MSF), all accepted Nobel Peace Prizes for such work. The primary mission during natural and “human-made” disasters may be to assist persons in need, to shine a ray of hope, and to create humanitarian space, but health professionals in particular, are also potentially in influential positions to promote peace. With their direct involvement in healing they have a certain credibility with the global community, which can contribute to their influence as advocates for peace, whether through raising awareness of relevant issues with the general public or specific interest groups, or by influencing decision makers directly.

Ebola vaccines: ready to use for humanitarian health workers?

Ebola vaccines: ready to use for humanitarian health workers?

The rite of passage of becoming a humanitarian health worker: experiences of retention in Sweden

ABSTRACTBackground: Low retention of humanitarian workers poses constraints on humanitarian organisations’ capacity to respond effectively to disasters. Research has focused on reasons for humanitarian workers leaving the sector, but little is known about the factors that can elucidate long-term commitment.Objective: To understand what motivates and supports experienced humanitarian health workers to remain in the sector.Methods: Semi-structured interviews were conducted with 10 experienced nurses who had been on at least three field missions with Médecins Sans Frontières Sweden. Interviews explored factors influencing the decision to go on missions, how nurses were supported and how they looked back on those experiences. Transcripts were analysed through content analysis informed by van Gennep’s concept of ‘Rite of Passage’, combined with elements of the self-determination theory.Results: The findings indicate that their motivations and how nurses thought of themselves, as individuals and professionals, changed over time. For initiation and continued engagement in humanitarian work, participants were motivated by several personal and professional ambitions, as well as altruistic principles of helping others. When starting their first humanitarian missions, nurses felt vulnerable and had low self-esteem. However, through experiencing feelings of autonomy, competence and relatedness during missions, they underwent a process of change and gradually adjusted to new roles as humanitarian health workers. Reintegration in their home community, while maintaining the new roles and skills from the missions, proved very challenging. They individually found their own ways of overcoming the lack of social support they experienced after missions in order to sustain their continuation in the sector.Conclusions: The findings highlight the importance of social environments that facilitate and support the adjustment of individuals during and after field missions. Learning from positive examples, such as nurses with several years of experience, can strengthen strategies of retention, which can ultimately improve the delivery of humanitarian assistance.

Counterterrorism policies and practices: health and values at stake.

Counterterrorism policies and practices: health and values at stake.

Assessment of the Potential for Spread of Deadly Ebola Virus across International Borders by Returnee Travelers and Humanitarian Health Workers from West Africa

The recent Ebola Virus Disease (EVD) outbreak in West Africa is so far the largest and deadliest in recorded history. The rapid spread of the disease in the region and its potential for international spread prompted the World Health Organization to declare the outbreak a public health emergency of international concern. (1) This paper assesses the potential for the spread of the disease across international borders by returnee travelers and humanitarian health workers, given that the disease spreads through physical contact. The surveillance data published by both the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) were reviewed to identify the EVD epidemiological situation in West Africa from March 2014 to September 2014. The risk assessment data published by Public Health England (PHE) and CDC travel updates were reviewed to identify travel group(s) most at risk of transmitting EVD across international borders. Studies focusing on West African cultural practices were also reviewed to identify aspects that carry risk of EVD transmission. The study found that the risk of travelers transmitting EVD across international borders is low and would remain so on two conditions. First, all travelers must avoid direct physical contact with a sick or d ead person or animal infected with EVD. Second, international humanitarian health workers in affected areas of West Africa who will eventually return to their home countries must work in safe environments with adequate protective equipment. The risk of travelers acquiring EVD is considered very low, yet there is serious concern that the disease may spread further within West Africa and across international borders. Local burial practices exacerbate the disease spread while poor working environments and inadequate supply of equipment increase risk of exposure to EVD of humanitarian workers. This researcher recommends addressing the issues through local awareness, pre-travel advice and capacity investment in the healthcare infrastructure in the EVD affected areas.

Counterterrorism, ethics, and global health.

AbstractThe intersection of national security, foreign policy, and health has been explored in a number of arenas, but little attention has been devoted to the ethical issues surrounding the global health impact of current counterterrorism policy and practice. In this essay, we’ll review a range of harms to population health traceable to counterterrorism operations, identify concerns involving moral agency and responsibility—specifically of humanitarian health workers, military medical personnel, and national security officials and operatives—and highlight two interrelated policy issues: the need for a conception of national security that incorporates a cosmopolitan concern for health, and the need for shared health governance, including governance of activities affecting health.

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.

Motivation in humanitarian health workers: a self-determination theory perspective

This paper emerged from the authors' interest in why humanitarian health workers initially engage and remain in humanitarian work, often in the face of threats to safety and personal well-being. Semi-structured qualitative interviews assessed the consciously available reasons why individuals engaged in humanitarian health work. Interview data was unpacked through a thematic analysis. Using self-determination theory as a guiding framework, data suggested introjected and identified motivations are applicable to this occupational domain. Introjected motivation is implicated in initial reasons to engage the work, while identified motivation is implicated in reasons to continue. Theoretical and practical implications of these findings are discussed.Motivation parmi les travailleurs humanitaires dans le domaine de la santé : un point de vue basé sur la théorie de l'autodéterminationCet article a émané de l'intérêt de l'auteur concernant les raisons pour lesquelles les travailleurs humanitaires dans le domaine de la santé s'engagent initialement et continuent de travailler dans l'humanitaire, souvent malgré les menaces qui pèsent sur leur sécurité et sur leur bien-être personnel. Des entretiens qualitatifs semi-structurés ont permis d'évaluer les raisons consciemment disponibles qui expliquent que certaines personnes se soient engagées dans le travail humanitaire dans le domaine de la santé. Les données obtenues grâce aux entretiens ont été examinées au moyen d'une analyse thématique. En prenant la théorie d'autodétermination comme cadre d'orientation, les données ont suggéré que des motivations introjectées et identifiées sont applicables à ce domaine professionnel. La motivation introjectée intervient dans les raisons initiales de s'engager dans ce type de travail, tandis que la motivation identifiée intervient dans les raisons de continuer. Les implications théoriques et pratiques de ces conclusions font l'objet d'une discussion.Motivação para Trabalhadores Humanitários da Área da Saúde: Uma Perspectiva da Teoria da Auto-DeterminaçãoEste artigo surgiu do interesse dos autores em saber por que os trabalhadores humanitários da área da saúde engajam-se inicialmente e depois permanecem no trabalho humanitário, frequentemente enfrentando ameaças à segurança e bem-estar pessoal. Entrevistas qualitativas semiestruturadas avaliaram as razões dos indivíduos engajarem-se no trabalho humanitário na área da saúde, razões estas conscientemente apresentadas. Dados da entrevista foram processados através de uma análise temática. Utilizando a teoria da auto-determinação como estrutura de orientação, os dados sugeriram que as motivações introjetadas e identificadas são aplicáveis a este domínio ocupacional. A motivação introjetada está associada às razões iniciais de se engajar no trabalho, enquanto a motivação identificada está associada às razões de se permanecer no trabalho. As implicações teóricas e práticas destes resultados são discutidas.La motivación en los trabajadores humanitarios de salud: una perspectiva de la teoría de la autodeterminaciónEste ensayo surgió del interés de los autores en cómo los trabajadores humanitarios de salud inician su trabajo y permanecen en él a pesar de las frecuentes amenazas a su seguridad y bienestar personal. Las entrevistas cualitativas semiestructuradas realizadas revelaron las razones enunciadas conscientemente de porqué los individuos participan en el trabajo humanitario en salud. Se evaluaron las entrevistas a través de un análisis temático. Utilizando la teoría de la autodeterminación como marco, las entrevistas sugieren la existencia de motivaciones tanto introyectadas como identificadas en este ámbito de trabajo. La motivación introyectada se refiere a las razones para iniciar el trabajo y la motivación identificada a las razones para seguir en él. El ensayo examina las implicaciones teóricas y prácticas de estos resultados.

Ethics in Humanitarian Aid Work: Learning From the Narratives of Humanitarian Health Workers

Little analysis has been made of ethical challenges encountered by health care professionals (HCPs) participating in humanitarian aid work. This is a qualitative study drawing on Grounded Theory analysis of 20 interviews with health care professionals who have provided humanitarian assistance. We collected the stories of ethical challenges reported by expatriate HCPs who participated in humanitarian and development work. Analysis of the stories revealed that ethical challenges emerged from four main sources: (a) resource scarcity and the need to allocate them, (b) historical, political, social and commercial structures, (c) aid agency policies and agendas, and (d) perceived norms around health professionals’ roles and interactions. We discuss each of these sources, illustrating with quotes from the respondents the consequences of the ethical challenges for their personal and professional identities. The ethical challenges described by the respondents are both familiar and distinct for bioethics. The findings demonstrate a need to provide practical ethics support for humanitarian health care workers in the field.

The Professionalization of Humanitarian Health Assistance: Report of a Survey on What Humanitarian Health Workers Tell Us

While the number of humanitarian health workers has grown considerably along with the emphasis on evidence-based humanitarian practice over the last 15 years, no organization exists to ensure ongoing professionalization of this area of expertise. To determine whether and to what degree the community of humanitarian health workers self-identify as a professional group; whether a need for a professional society exists to support such a group; and if so, what fundamental elements and activities should it encompass and provide. A humanitarian, listserv-based survey was undertaken to evaluate humanitarian professional self-identification, needs for and interest in professional support functions, and priorities toward developing a professional organization to provide needed services. The resulting respondent population represented a broad distribution of age and experience with education and experience being equally important factors in defining humanitarian health professionals. Respondents viewed themselves as humanitarian professionals nearly to the extent they viewed themselves as health-specific technical experts who happen to work in humanitarian assistance; they expressed a strong desire to establish a professional society reflecting that self-identification; and that body should focus on activities of education and training, networking and dialogue, and developing and refining core competencies to support best practices. Humanitarian health workers self-identify as professionals in humanitarian assistance and as technical experts. A professional organization with specific support functions would be of interest to many humanitarian health professionals.

Human Resources in Humanitarian Health Working Group Report

Humanitarian responses to conflict and disasters due to natural hazards usually operate in contexts of resource scarcity and unmet demands for healthcare workers. Task shifting is one avenue for delivering needed health care in resource poor settings, and on-the-ground reports indicate that task shifting may be applicable in humanitarian contexts. However, a variety of obstacles currently restrict the ability to employ task shifting in these situations, including issues of regulation, accreditation, funding, and a lack of commonly agreed-upon core competencies for different categories of humanitarian health workers. The Human Resources in Humanitarian Health (HRHH) Working Group during the 2009 Humanitarian Action Summit evaluated the potential strengths and weaknesses of task shifting in humanitarian relief efforts, and proposed a range of strategies to constructively integrate task shifting into humanitarian response.

Complex emergencies in Indonesia.

Recently, Indonesia has experienced six major provincial, civil, armed conflicts. Underlying causes include the transmigration policy, sectarian disputes, the Asian economic crisis, fall of authoritarian rule, and a backlash against civil and military abuses. The public health impact involves the displacement nationwide of > 1.2 million persons. Violence in the Malukus, Timor, and Kalimantan has sparked the greatest population movements such that five provinces in Indonesia each now harbor > 100,000 internally displaced persons. With a background of government instability, hyperinflation, macroeconomic collapse, and elusive political solutions, these civil armed conflicts are ripe for persistence as complex emergencies. Indonesia has made substantial progress in domestic disaster management with the establishment of central administrative authority, strategic planning, and training programs. Nevertheless, the Indonesian experience reveals recurrent issues in international humanitarian health assistance. Clinical care remains complicated by absences of treatment protocols, inappropriate drug use, high procedural complication rates, and variable referral practices. Epidemiological surveillance remains complicated by unsettled clinical case definitions, non-standardized case management of diseases with epidemic potential, variable outbreak management protocols, and inadequate epidemiological analytic capacity. International donor support has been semi-selective, insufficient, and late. The militia murders of three UN staff in West Timor prompted the withdrawal of UN international staff from West Timor for nearly a year to date. Re-establishing rules of engagement for humanitarian health workers must address security, public health, and clinical threats.