Humanitarian Programs Research Articles

Evaluating the mental health of recently arrived refugee adults in Western Australia

Purpose – The purpose of this paper is to measure the levels of psychological distress in adults entering Western Australia (WA) as refugees through the Australian Humanitarian Programme. To determine if the introduction of mental health screening instruments impacts on the level of referrals for further psychological/psychiatric assessment and treatment. Design/methodology/approach – Participants were 300 consecutive consenting refugee adults attending the Humanitarian Entrant Health Service in Perth, WA. This service is government funded for the general health screening of refugees. The Kessler-10 (K10) and the World Health Organisation’s post-traumatic stress disorder (PTSD) screener were the principal outcome measures used. Findings – Refugees had a high rate of current probable PTSD (17.2 per cent) as measured with the PTSD screener and mean K10 scores were significantly higher than general population norms. The K10 showed high accuracy for discriminating those with or without probable PTSD. Being married and having more children increased the risk of probable PTSD. In regard to region of origin, refugees from Western and Southern Asia had significantly higher scores on both screeners followed by those from Africa with those from South-Eastern Asia having the lowest scores. Referral rate for psychiatric/psychological treatment was 18 per cent compared to 4.2 per cent in the year prior to the study. Practical implications – This study demonstrates increased psychological distress including a high rate of probable PTSD in a recently arrived multi-ethnic refugee population and also demonstrates significant variations based on region of origin. In addition, it supports the feasibility of using brief screening instruments to improve identification and referral of refugees with significant psychological distress in the context of a comprehensive general medical review. Originality/value – This was an Australian study conducted in a non-psychiatric setting. The outcomes of this study pertain to refugee mental health assessed in a general health setting. The implications of the study findings are of far reaching relevance, inclusive of primary care doctors and general physicians as well as mental health clinicians. In particular the authors note that the findings of this study are to the authors’ knowledge unique in the refugee mental health literature as the participants are recently arrived refugees from diverse ethnic groups.

Surgery in low‐income countries during crisis: experience at Médecins Sans Frontières facilities in 20 countries between 2008 and 2014

The global burden of trauma and surgical conditions fall disproportionately on lowand middle-income countries (LMICs) [1, 2]. Inopportunely, developing countries are least equipped to provide essential surgical care [3]. As a result, LMICs have a significant burden of unmet surgical needs [4]. When these fragile health systems are disrupted by conflict, a natural disaster or an epidemic the capacity for and quality of surgical care decreases even further [5]. In response, M edecins Sans Fronti eres (MSF) provides surgical humanitarian assistance in countries affected by crisis through one of the five operation centres; one of these is Operations Centre Brussels (OCB). Describing the epidemiology of surgical care at MSFOCB projects improves planning for humanitarian assistance and provides a unique opportunity to examine surgical needs that were otherwise unmet by national healthcare systems [6]. From 2008 through 2014, MSFOCB performed 119 524 operations at 45 projects in 20 countries. The majority of operations were obstetric (range 28–42% of operations by year), general surgical (e.g. hernias, appendicitis; range 15–49%) and unintentional trauma-related (e.g. road traffic crash, burn; range 10– 42%). Violence was also a common cause of surgical need (e.g. land mine or bomb injury, gunshot wound; range 7– 15%) (Table 1). MSF-OCB teams provided safe anaesthesia, often by task sharing, in the face of complex care needs evidenced by low perioperative death rates (i.e. death from time of anaesthesia care to discharge from the recovery ward; 0.2–0.3% of operations). From 2008 through 2014, the orthopaedic care capacity was deliberately improved to meet the needs of conflict-related projects (Figure 1). This was done by developing fracture care guidelines for nonorthopaedists, as well as recruiting expatriate orthopaedic surgeons. More detailed operative epidemiology of these sites has been reported previously [6–8].

NOAA’s African Desk: Twenty Years of Developing Capacity in Weather and Climate Forecasting in Africa

Abstract Drought is one of the leading causes of death in Africa because of its impact on access to sanitary water and food. This challenge has mobilized the international community to develop famine early warning systems (FEWS) to bring safe food and water to populations in need. Over the past several decades, much attention has focused on advance risk planning in agriculture and water and, more recently, on health. These initiatives require updates of weather and climate outlooks. This paper describes the active role of NOAA’s African Desk in FEWS and in enhancing the capacity of African institutions to improve forecasts. The African Desk was established in 1994 to provide services to U.S. agencies and African institutions. Emphasis is on the operational products across all time scales from weather to climate forecasts in support of humanitarian relief programs. Tools to provide access to real-time weather and climate information to the public are described. These include the downscaling of the U.S. National Multimodel Ensemble (NMME) to improve seasonal forecasts. The subseasonal time scale has emerged as extremely important to many socioeconomic sectors. Drawing from advances in numerical models, operational subseasonal forecasts are included in the African Desk product suite. These capabilities along with forecast skill assessment, verifications, and regional hazards outlooks for food security are discussed. Finally, the African Desk residency training program, an effort aimed at enhancing the capacity of African institutions to improve forecasts, and supported by this seamless approach to operational forecasting, is described.

Humanitarian Programs and Interventions in Turkey

In this article, the concept of humanitarian aid, the basic needs in crisis situations, the definition of eye movement desensitization and reprocessing (EMDR), and EMDR as a humanitarian intervention are explained. General needs and needs in Middle East are discussed. Some of the published studies about the EMDR therapy as a humanitarian intervention are summarized. Training and humanitarian programs in Turkey are documented. Two of our important humanitarian projects with EMDR including Marmara earthquake training and Intervention and Kilis Syrian refugees projects are described in detail. The aim of this article is to underline the importance of basic elements of natural and man-made disasters in terms of organization, financing, training, and intervention.

Landscape of WASH-relevant Training for Humanitarian Emergencies

Background: Both employed humanitarian personnel as well as those seeking to start a career as an aid worker are often provided with or seek training on the theme of humanitarian water, sanitation, and hygiene (WASH). The objective of this study was to conduct a landscaping exercise of the available WASH-relevant training for humanitarian emergencies.Methods: An open internet search was performed with specific terms related to humanitarian WASH. Retained search results included those training opportunities (including past ones) that were themed around or with a mentioned relevance to humanitarian WASH.Results and Discussion: A total of 42 training courses relevant to humanitarian emergency WASH were retained. In addition to the more generic/introductory trainings, some provided thematic variations such as coordination of WASH responses, project management, risk reduction, information, education and communication (IEC), and complex emergencies. Timely topics such as urban WASH, Ebola, and WASH innovations were also observed indicating the responsiveness of the training providers to the changing needs of humanitarian WASH response programmes. This survey also revealed a large variety in terms of target audience, duration, fees, location, and language of courses. There was no centralised listing of courses available on the Internet. Limitations of this exercise were also discussed.

The World's hungry. American NGOs and new private-public partnerships after WWII

Food aid for hungry people is not a modern phenomenon. The transport of supplemental food to areas affected by temporary or chronic food scarcity has been a part of state-level diplomacy since antiquity. The second half of the Twentieth century has seen the rise of a new and broader food aid regime, however: Marked by growing Cold War tensions, global economic disparities, and the rise of development thinking, food aid (often from unsellable food surplus) emerged as a new international transfer regime between the US and the «developing nations». The actual programs were often carried out by private players. As early as during WWI private voluntary agencies started to cooperate with the US government in humanitarian food distribution programs to hungry people abroad. This article takes a closer look at these programs tracing their development from the war and inter-war period to the aid endeavor during WWII and into the Fifties and Sixties when food aid schemes were significantly professionalized. It is argued here that the relationship between the US government, recipients and private voluntary agencies entered into a new phase after the end of WWI as public private partnerships in food aid distribution turned from a temporary tool for ad-hoc relief and surplus reduction into more permanent and highly subsidized institutions within the official framework of US foreign and agricultural policy.

SUNY College of Environmental Science and Forestry Humanitarian Engineering: Small Scale College Components and Analysis

The State University of New York College of Environmental Science and Forestry (SUNY-ESF) enrolls approximately 1900 bachelor students and 600 master’s and PhD students focusing on the science and engineering of environmental sustainability. To satisfy student and employer interests in sustainable international development, ESF has developed a humanitarian engineering program. The program includes theoretical and field based course work, trips abroad, student organizations, and the establishment of the National Academy of Engineering Grand Challenges Scholar’s Program (NAE GCSP). This manuscript describes the history, components, challenges, best practices, lessons learned, case studies, and outcomes of ESF’s small-scale yet successful humanitarian engineering program.

Lessons from a student-led development project in Peru: Aligning technical and educational perspectives

With the growth of student interest in humanitarian engineering development projects, a critical assessment of the strengths and weaknesses of this type of work is crucial to success. While a number of models exist for joining development with technical expertise in humanitarian engineering projects, this paper focuses on the experiences of students working on a program in Peru within the Greater Austin Chapter of Engineers Without Borders (EWB)-USA. This program is a unique EWB-USA program that builds on ongoing academic research in the Peruvian Andes at the University of Texas at Austin and regional efforts by The Mountain Institute to mitigate the effects of climate change on Peruvian communities that need technical solutions to water issues. We contrast the benefits and struggles of pursuing a student-led initiative with a regional scope. Specifically, this case study shares how the roles of partnerships between universities, private sector, government, and nongovernmental organizations create challenges and opportunities for a student-led humanitarian engineering program. The key challenges identified are (1) effectual use of U.S. team members, (2) building trust and open communication with in-country partners, and (3) understanding community dynamics and adapting projects to their local context. We present how development of a ‘non-traditional engineering classroom’ framework can serve as a proactive means for facilitating effective knowledge transfer, critical reflection, and service-learning to improve project outcomes.

The Political and the Humanitarian in Lebanon. Social Responsiveness to Emergency Crisis from the 2006 War to the Syrian Refugee Influx

This paper primarily aims at enlarging qualitative knowledge on how social settings and personal relations change while turning into spaces of humanitarian aid provision. The two major emergencies that Lebanon has faced so far will be taken into analysis: the Israel-Lebanon July War in 2006 and today’s unprecedented influx of Syrian refugees. In this framework, while dealing with the sudden presence of non-state actors replacing the void historically left by the central state, this paper will illustrate how the 2006 displaced and now the Syrian refugees have locally developed moral resilience, gratitude or mistrust towards the humanitarian programmes, and cultivated expectations of mutual assistance. In the wake of what has been first applauded—and then discarded—as the “Arab Spring”, a phenomenological analysis of the social changes, engendered by the temporary presence of humanitarian actors in chronically neglected settings, can offer an inner perspective of how people socially respond to emergency crises.

Vehicle Supply Chains in Humanitarian Operations: Decentralization, Operational Mix, and Earmarked Funding

The work of international humanitarian organizations (IHOs) frequently involves operating in remote locations, decentralized decision‐making, and the simultaneous implementation of development and disaster response programs. A large proportion of this work is funded by “earmarked” donations, since donors often exhibit a preference for the programs they are willing to fund. From extensive research involving qualitative descriptions and quantitative data, and applying system dynamics methodology, we model vehicle supply chains (VSCs) in support of humanitarian field operations. Our efforts encompass the often‐overlooked decentralized environment by incorporating the three different VSC structures that IHOs operate, as well as examining the entire mix of development and disaster response programs, and the specific (and virtually unexplored) effects of earmarked funding. Our results suggest that earmarked funding causes a real—and negative—operational impact on humanitarian disaster response programs in a decentralized setting.

Perspectives on sustainability in humanitarian supply chains

Purpose– The purpose of this paper is to develop a framework for analysing how humanitarian organisations (HOs) address different expectations regarding sustainability.Design/methodology/approach– Quantitative and qualitative content analysis is used to assess the annual reports (ARs) of HOs for their discussions on sustainability overall, and in relation to contextual expectations, subsystems and supply chains, organisational structure and strategy.Findings– HOs address sustainability primarily from the perspective of contextual expectations from society and beneficiaries. Some fits between supply chain design and societal expectations are attended to, but fits between programmes and contextual expectations are not discussed explicitly.Research limitations/implications– ARs express what organisations want to portray of their activities rather than being direct reflections of what occurs in the field, hence the use of ARs for the study delimits its findings. However, HOs rarely publish sustainability reports.Practical implications– Even though there is a general pursuit of the elusive aim of aid effectiveness, organisational structures need to be further aligned with societal aims as to support these.Social implications– Beneficiaries are still seen as external to the humanitarian supply chain and humanitarian programmes, though their role may change with the introduction of more cash components in aid, voucher systems, and ultimately, their empowerment through these.Originality/value– The suggested conceptual framework combines elements of contingency theory with a prior four perspectives model on sustainability expectations. The framework helps to highlight fits between the humanitarian context, operations and programmes as well as misalignments between these.

PUBLIC RELATIONS ON THE EDUCATIONAL MARKET OF REPUBLIC OF TATARSTAN: HISTORY AND PROSPECTS

Modern domestic science designed periodization of the development of public relations in Russia as a kind of professional activity. The authors traced the path of development of public relations as an academic specialty at the federal and regional levels (the experience of the Republic of Tatarstan). The chronological scope of the study: 1990 - to the present day. Characteristic features of the educational market of Tatastan are: demographic failure, the reduction of budget places on humanitarian academic programs, high competition among universities. The purpose of the study was to examine the possibilities of using the tools of integrated marketing communications in promotion of academic program «Advertising and Public Relations» (BA) in the educational market of the Republic of Tatarstan. Data for this study were collected by the experience of the Department of History and Public Relations of the Kazan National Research Technical University named after A.N. Tupolev. The Methods of the undertaking the work: theoretical analysis, sociological survey, information audit, interviews. The results of the study show the necessity to use these tools to promote academic program «Advertising and Public Relations»: advertising, public relations, special events, exhibition activities, Internet communications, direct marketing, and informal communication.

Tapping the Untapped Potential: Community Based Initiatives in Response to Malnutrition and Food Insecurity in the Face of HIV and AIDS in Rural Zimbabwe: Case Study of Chakari Community in Sanyati Rural District

As a result of the problems associated with HIV and AIDS, Zimbabwe’s rural economies in recent times have been the focus of most development interventions when measured up to the urban areas. It is for this reason that rural areas have been major recipients of aid and support towards development and humanitarian programs to tackle the hitch head on. In spite of all these directed efforts, poverty, HIV and AIDS, food insecurity, malnutrition and other development ills have paradoxically continued to carry the face of Zimbabwe’s’ rural areas. The wake-up call for developing nations is the reality of donor fatigue over the past two decades as witnessed by a decline in the amount of aid flowing from the donor countries towards the developing countries as a catalyst for development antidote to the said social vices. This treaties contends that the panacea to the said development quandary bedeviling Zimbabwe and Africa in general lies in its capacity to harness and puddle together the fragmented local community effort and knowledge in response to their development challenges, leading to the jettisoning of orthodox approaches to development in favor of people centered development.

A stepwise model for delivering medical humanitarian aid requiring complex interventions

Cardiothoracic surgeons and practitioners of cardiovascular medicine have a long history of humanitarian aid. Although this is worthwhile at multiple levels and occasionally described in some detail, few efforts have a proven algorithm with demonstrable outcomes that suggest effective educational methodology or clinical results approaching accepted standards in developed countries. Our report provides a stepwise approach to developing highly successful self-sustainable, replicable, and scalable humanitarian congenital cardiac surgical programs, and provides data to allow insight into the efficacy of our model. This program model has evolved over 25 years, during which it has been replicated several times and scaled throughout a vast and populous country. Since 1989, Russia has undergone considerable social, political, and economic changes. Our program model proved successful throughout this time despite dynamic social, political, and medical landscapes. The positive results of our program model indicate that these methodologies may be helpful to others attempting to address the worldwide shortage of cardiovascular care and particularly the complex interventions required in the management of congenital cardiovascular disease.

Framework for advancing otolaryngology: head and neck surgery in Ethiopia.

The American Academy of Otolaryngology--Head and Neck Surgery and its members have shown continuing commitment to improving global otolaryngology care through humanitarian and international outreach programs. These efforts, based on a surgical mission model, have produced only modest improvements in otolaryngologic care in Ethiopia. In cooperation with the Ethiopian Ministry of Health and 2 Ethiopian medical schools, we present a framework for otolaryngology education for the next decade. It recognizes the limitations of the current didactic paradigm and aims to use available domestic and international resources to improve the quality and availability of head and neck surgical and medical services.

Control and Biopower in Contemporary Humanitarian Aid: The Case of Supplementary Feeding

The concept of biopower is often used in the analysis of contemporary aid. Referring to a power that is exercised over life and that operates through self-government, it seems very appropriate for the operations of humanitarian agencies, particularly in refugee contexts. This article critiques the application of biopower in studies of humanitarianism, arguing that many aid operations are based on top-down control, rather than self-government and the internalization of norms. As an illustration, I examine a supplementary feeding programme in South Sudan, looking at how food was provided, how hunger was measured, and pointing out the hierarchical and paternalistic control involved. As well as suggesting that biopower often lacks relevance in refugee contexts, I also argue it has been applied too broadly. By being associated with a vast array of humanitarian practices, it risks losing any analytical utility, becoming a substitute for detailed descriptions of power. This article seeks to return to that detail, describing a humanitarian programme and pointing out some discrepancies with the ever-popular notion of biopower, which, I argue, has a tendency to be applied without an adequate definition.

Vehicle Procurement Policy for Humanitarian Development Programs

This article aims to identify optimal vehicle procurement policies for organizations engaged in humanitarian development programs and to derive general insights on the characteristics of these policies. Toward that end, we follow an inductive approach. First, we study the operations of the International Committee of the Red Cross (ICRC) in three representative countries: Sudan, Afghanistan, and Ethiopia. Using a linear programming (LP) model primed with field data provided by the ICRC, we calculate the optimal vehicle fleet size and compare it with the policies actually implemented. Second, drawing from results of the LP model, we develop a stylized quadratic control model and use it to characterize the general structure of the optimal policy under different demand scenarios and operational constraints. After demonstrating that the results of the control model are consistent with those of the LP model in the specific context analyzed, we discuss the optimal policies and the applicability of the former as a practical tool for strategic asset planning.

Partnership for sustainability in cardiac surgery to address critical rheumatic heart disease in sub-Saharan Africa: the experience from Rwanda.

Rheumatic heart disease (RHD) in the developing world results in critical disability among children, adolescents, and young adults-marginalizing a key population at its peak age of productivity. Few regions in sub-Saharan Africa have independently created an effective strategy to detect and treat streptococcal infection and mitigate its progression to RHD. We describe a unique collaboration, where the Rwanda Ministry of Health, the Rwanda Heart Foundation, and an expatriate humanitarian cardiac surgery program have together leveraged an innovative partnership as a means to expand Rwanda's current capacity to address screening and primary prevention, as well as provide life-saving cardiac surgery for patients with critical RHD. Interviews with key personnel and review of administrative records were conducted to obtain qualitative and quantitative data on the recruitment of clinical personnel, procurement of equipment, and program finances. The number of surgical cases completed and the resultant clinical outcomes are reviewed. From 2008 to 2013, six annual visits were completed. A total of 128 prosthetic valves have been implanted in 86 complex patients in New York Heart Association (NYHA) class III or IV heart failure, with excellent clinical outcomes (5 % 30-day mortality). Postoperative complications included a cerebrovascular accident (n = 1) and hemorrhage, requiring reoperation (n = 2). All procedures were performed with participation of local personnel. This strategy provides a reliable and consistent model of sophisticated specialty care delivery; inclusive of patient-centered cardiac surgery, mentorship, didactics, skill transfer, and investment in a sustainable cardiac program to address critical RHD in sub-Saharan Africa.

Longitudinal changes on nutritional disorders, nutrient intake and household food insecurity in children ongoing surgery to correct cleft lip and palate (268.8)

Introduction. In Mexico, public health care programs aimed to improve the quality of life of children with cleft lip (CL) and/or palate (CP) are scarce. Instead, humanitarian aid programs like “Thousand Smiles” are gaining recognition nationwide. Objective. To document the longitudinal changes on the prevalence of nutritional disorders, nutrient intake inadequacies and household food insecurity (HFI) among pediatric patients with CL&P participants of “Thousand Smiles” campaigns 2009‐2011. Methods. 123, 101 and 76 (25 being 100% program adherents) patients [CL (13%), CP (26%) and CL&P (61%), mean age 2.4, 68% male] were recruited at stage 1 (before 1st surgery), 2 (before 2nd surgery) and 3 (蠅three weeks after 2nd surgery). Participant´s height & weight, two 24h food recalls, and a socioeconomic & HFI questionnaire, were obtained from each participant per stage. Comparisons across stages were performed for overall stage participants and in those 100% adherents. Results. At stage 1, 20%, 24%, 5% and 5% of all patients showed low weight, stunting, wasting and overweight/obesity respectively, <10% were exclusively breastfed, 35%, 17%, 13% and 7% had iron, vitamin A, vitamin C and calcium inadequacies (蠄75 RDI) and 55% of all households experienced moderate‐to‐severe HFI (HFI‐MS). The prevalence of stunting (p=0.002), inadequacies for iron & vitamin A (p<0.01) and calcium & vitamin C (p<0.05) and HFI‐MS (p=0.002) fell from the 1st to the 3rd stage. Conclusion. “Thousand Smiles” campaigns aimed to correct CL&P of pediatric patients form northwestern Mexico; modify their prevalence of malnutrition, nutrient inadequacy and even household food insecurity.

Changing landscapes, changing practice: Negotiating access to sleeping sickness services in a post-conflict society

For several decades, control programmes for human African trypanosomiasis (HAT, or sleeping sickness) in South Sudan have been delivered almost entirely as humanitarian interventions: large, well-organised, externally-funded but short-term programmes with a strategic focus on active screening. When attempts to hand over these programmes to local partners fail, resident populations must actively seek and negotiate access to tests at hospitals via passive screening. However, little is known about the social impact of such humanitarian interventions or the consequences of withdrawal on access to and utilisation of remaining services by local populations. Based on qualitative and quantitative fieldwork in Nimule, South Sudan (2008–2010), where passive screening necessarily became the predominant strategy, this paper investigates the reasons why, among two ethnic groups (Madi returnees and Dinka displaced populations), service uptake was so much higher among the latter. HAT tests were the only form of clinical care for which displaced Dinka populations could self-refer; access to all other services was negotiated through indigenous area workers. Because of the long history of conflict, these encounters were often morally and politically fraught. An open-door policy to screening supported Dinka people to ‘try’ HAT tests in the normal course of treatment-seeking, thereby empowering them to use HAT services more actively. This paper argues that in a context like South Sudan, where HAT control increasingly depends upon patient-led approaches to case-detection, it is imperative to understand the cultural values and political histories associated with the practice of testing and how medical humanitarian programmes shape this landscape of care, even after they have been scaled down.