Publications

    Sean M Kivlehan, Amy Allen, Olha Viun, Dmitry A Makarov, Daniel Schnorr, Sonny Patel, Sergii A Ryzhenko, Phuong Pham, and Timothy B Erickson. 6/14/2022. “Evaluation of change in emergency care knowledge and skills among front-line healthcare providers in Ukraine with the Basic Emergency Care course: a pretest/post-test study.” BMJ Open. Read PublicationAbstract

    Objective: Evaluate the change in participant emergency care knowledge and skill confidence after implementation of the WHO-International Committee of the Red Cross (ICRC) Basic Emergency Care (BEC) course.

    Design: Pretest/post-test quasi-experimental study.

    Setting: Mechnikov Hospital in Dnipro, Ukraine.

    Participants: Seventy-nine participants engaged in the course, of whom 50 (63.3%) completed all assessment tools. The course was open to healthcare providers of any level who assess and treat emergency conditions as part of their practice. The most common participant profession was resident physician (24%), followed by health educator (18%) and prehospital provider (14%).

    Interventions: The 5-day WHO-ICRC BEC course.

    Primary and secondary outcome measures: Change in pre-course and post-course knowledge and skill confidence assessments. Open-ended written feedback was collected upon course completion and analysed for common themes.

    Results: Participant knowledge assessment scores improved from 19 (IQR 15–20) to 22 (IQR 19–23) on a 25-point scale (p<0.001). Participant skill confidence self-assessment scores improved from 2.5 (IQR 2.1–2.8) to 2.9 (IQR 2.5–3.3) on a 4-point scale (p<0.001). The most common positive feedback themes were high-quality teaching and useful skill sessions. The most common constructive feedback themes were translation challenges and request for additional skill session time.

    Conclusions: This first implementation of the WHO-ICRC BEC course for front-line healthcare providers in Ukraine was successful and well received by participants. This is also the first report of a BEC implementation outside of Africa and suggests that the course is also effective in the European context, particularly in humanitarian crisis and conflict settings. Future research should evaluate long-term knowledge retention and the impact on patient outcomes. Further iterations should emphasise local language translation and consider expanding clinical skills sessions.

    Valerie A. Dobiesz, Madeline Schwid, Roger D. Dias, Benjamin Aiwonodagbon, Baraa Tayeb, Adrienne Fricke, Phuong Pham, and Timothy B. Erickson. 4/2022. “Maintaining Health Professional Education During War: A Scoping Review.” Medical Education. Read PublicationAbstract

    Purpose: War negatively impacts health professional education when healthcare is needed most. The aims of this scoping review are to describe the scope of barriers and targeted interventions to maintaining health professional education during war and summarize the research.

    Methods: We conducted a scoping review between June 20, 2018, and August 2, 2018. The search was restricted to English publications including peer reviewed publications without date ranges involving war and health professional education (medical school, residency training, and nursing school), with interventions described to maintain educational activities. Two independent reviewers completed inclusion determinations and data abstraction. Thematic coding was performed using an inductive approach allowing dominant themes to emerge. The frequency of barrier and intervention themes and illustrative quotes were extracted. Articles were divided into modern/postmodern categories to permit temporal and historical analysis of thematic differences.

    Results: Screening identified 3,271 articles, with 56 studies meeting inclusion criteria. Publication dates ranged from 1914-2018 with 16 unique wars involving 17 countries. The studies concerned medical students (61.4%), residents (28.6%) and nursing students (10%). Half involved the modern era and half the postmodern era. Thematic coding identified 5 categories of barriers and targeted interventions in maintaining health professions education during war: curriculum, personnel, wellness, resources, and oversight, with most involving curriculum and personnel. The distribution of themes among various health professional trainees was similar. The frequency and specifics changed temporally reflecting innovations in medical education and war, with increased focus on oversight and personnel during the modern era and greater emphasis on wellness, curriculum, and resources during the postmodern era.

    Conclusions: There are overarching categories of barriers and targeted interventions in maintaining health professional education during war which evolve over time. These may serve as a useful framework to strategically support future research and policy efforts.

    HHI Resilient Communities. 3/2022. Symposium Report: The Impacts of the COVID-19 Pandemic on Vulnerable Communities in the Philippines.Abstract

    The COVID-19 pandemic has caused the loss of millions of lives, disrupted the global economy, and created secondary impacts on livelihoods, education, and mental health across the globe. No country or economic group has been immune to the direct impacts of the pandemic, but marginalized communities are particularly vulnerable to the secondary impacts including some public health measures like extended lockdowns. Marginalized populations are those excluded from mainstream social, economic, educational, political, and/or cultural life. They can be excluded or discriminated due to multiple factors such as their race, ethnicity, age, gender identity, sexual orientation, disability, religion, language, and/or displacement, among others. The Harvard Humanitarian Initiative's (HHI) Resilient Communities Program sought to understand how vulnerable or marginalized communities in the Philippines experienced COVID-19, and how communities coped and adapted in response to direct and indirect effects of COVID-19, including public health measures. To do this, HHI invited Filipino authors exploring this central question to submit papers for consideration to be selected to present and share in a symposium. In addition to its research objectives, the symposium sought to connect researchers and practitioners to create a network of professionals dedicated to serving the needs of marginalized communities in the country.

    Watch the full symposium: https://www.youtube.com/watch?v=4zC1FzWRUuo

    Sean M. Kivlehan, Kathryne Tenney, Samuel Plasmati, Vincenzo Bollettino, Katie Farineau, Eric J. Nilles, Greg Gottlieb, and Stephanie R. Kayden. 5/2021. “Humanitarian Training with Virtual Simulation during a Pandemic.” Disaster Medicine and Public Health Preparedness. Read PublicationAbstract

    There is an ongoing and established need for humanitarian training and professionalization. The COVID-19 pandemic disrupted training programs designed to accomplish this goal, including the Humanitarian Response Intensive Course, which includes a three-day immersive simulation to prepare humanitarian workers for future field work. To provide program continuity, the three day simulation was quickly adapted to a virtual format using a combination of video conferencing, short messaging service, and cloud-based file storage software. Participants were geographically dispersed and participated virtually. Learning objectives were preserved while some components not amenable to a virtual format were removed.

    A virtual humanitarian training simulation is a feasible, acceptable, and affordable alternative to an in-person simulation. Participants were engaged and experienced minimal technological disruptions. The majority of students felt the format met or exceeded expectations. However, feedback also emphasized the importance of providing sufficient time for team collaboration and deliverable preparation in the simulation schedule. The virtual format was more affordable than the traditional in-person simulation and diverse expert faculty who could not have attended in-person were able to participate. This format could be used to overcome other barriers to in-person simulation training, including geographic, financial, time, or security.

    Adrienne Fricke and Rahaf Safi. 3/2021. Window of Hope: Sustaining education of health professionals in northwest Syria.Abstract
    This report is based on a comprehensive needs assessment carried out remotely by the HHI team in Syria in 2019. The OSF HESP grant was awarded to a larger project to understand the impact of humanitarian emergencies, including armed conflict, on students enrolled in medical and nursing programs. The goal is to produce a needs assessment toolkit to help support professional health care education programs during conflict. In addition to Syria, where the conflict is ongoing, the project examines Colombia, a recent post-conflict setting, and Rwanda, a developed post-conflict setting.
    Krzysztof Goniewicz, Mariusz Goniewicz, Frederick M. Burkle Jr., and Amir Khorram-Manesh. 10/2020. “The Impact of Experience, Length of Service, and Workplace Preparedness in Physicians' Readiness in the Response to Disasters.” Journal of Clinical Medicine.Abstract
    With an increasing number of natural and man-made disasters, the need for preparedness in all levels of management is obvious. Among healthcare professionals responding to these emergencies, physicians are of particular importance due to their significant roles as leaders and frontline workers in minimizing morbidity and mortality of the affected population. This study analyses the preparedness of 549 physicians from all medical centers in Lublin, Poland to formulate their observations, suggestions, and recommendations concerning the improvement of the chain of response in disaster management. The results of this study show that the perceived preparedness of physicians for disaster management and response is not as high as it should be, and the majority of the respondents perceived their disaster preparedness insufficient. Training of physicians in disaster management and principles of disaster medicine is needed, by focusing on the specificity of rescue response to emergencies following disasters, and medical and non-medical aspects of the response with particular emphasis on a management approach covering all hazards.
    6/2018. “An Innovative Global Diplomacy Public Health Student Program – Lessons from the Field in a Post-Conflict Medellin, Colombia”.Abstract

    For over fifty years, Colombia has been embroiled in conflict, displacing nearly seven million people, second only to Syria for the highest number of internally displaced persons (IDPs) in the world. Most are displaced to urban environments into dense informal settlements with inadequate water, sanitation, shelter and power infrastructure. The city of Medellín, has become home to over 200,000 IDPs in informal agglomerations. Medellín’s transformation to a city of progress and innovation through the promotion of “social urbanism” is an example of how collaboration between city institutions and government sectors can address issues of poverty, violence, equality, engagement, and reintegration of displaced populations in Colombia.

    The Post-Conflict Colombia Public Health Project is a collaborative academic exchange program aimed at bringing together public health students from the United States and Colombia for the purpose of understanding between the people of both countries. The project aims to educate students while also providing direct service and fostering long-term cross-cultural relationships and sustainable projects. Seminars, skill building workshops, cultural experiences, and community engagement are used to build professional competencies and inform policy recommendations for future projects. Despite the limited research on the educational impact of short-term global emersion programs, small scale evaluations point to an increase in learners’ cross-cultural adaptability. The believed benefit to students’ professional and personal development must be balanced with ethical considerations including preparedness of students, health and safety risks, cultural sensitivity, and issues of sustainability. In order to address these concerns, programs should be developed collaboratively through bi-directional participatory relationships, incorporating both education and direct service components, and promoting local capacity building and long-term sustainability.

    Our course pairs 16 carefully selected graduate-level public health and medical students from Harvard and Universidad de Antioquia, who will serve as both student and citizen ambassadors, to come together and share about their culture, values, and experiences through the lens of diplomacy and dialogue to make a meaningful impact in the people and country of Colombia. The course examines the social development model of Medellín and its impact on advances in peace, social equity, and health. Beyond the theoretical concepts, students will learn to apply them to the Granizal community in order to create practical solutions that are sustainable, scalable, innovative, and measurable.

    As other disciplines move away from curricula limited to rote learning and fact-based content, public health and policy education will also benefit from incorporating experiential and competency-based learning with an emphasis on skill building in leadership, management, policy-making, and research.5 The Institute of Medicine’s 2003 report, Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century, recommends eight content areas as essential to graduate level public health education programs: informatics, genomics, communication, cultural competence, community-based participatory research, global health, policy and law, and public health ethics.6 The report further acknowledges the importance of developing international relationships between academic institutions, community organizations, and health agencies for collaboration in interdisciplinary and community-based research, learning, and service. Health disparities, issues of social justice, and public health threats from infectious disease are less and less confined by political and geographic boundaries. The future generation of leaders in public health and policy must be able to bridge nations and cultures through diplomacy and be equipped to develop innovative strategies and partnerships across professional disciplines and on a global scale.

    While several public health approaches have been documented in the literature, we describe a model for a multi-institutional and cross-cultural collaboration based on The Post-Conflict Colombia Public Health Project, a three-week intensive course developed in partnership between the Harvard Humanitarian Initiative, the Open Hands Initiative, and the University of Antioquia. While this model is a public health course focusing on Colombia, the concepts and educational strategies can be applied across academic disciplines and to other countries and communities.

     

    Susan Andrea Bartels, Saja Michael, Sophie Roupetz, Stephanie Garbern, Lama Kilzar, Harveen Bergquist, Nour Bakhache, Colleen Davison, and Annie Bunting. 1/2018. “Making sense of child, early and forced marriage among Syrian refugee girls: a mixed methods study in Lebanon.” BMJ Global Health, 3, 1. Read PublicationAbstract

    The Syrian conflict has resulted in over 2.3 million child refugees in the Middle East and the prevalence of early marriage has reportedly increased among displaced Syrian families. This study explores the underlying factors contributing to child marriage among Syrian refugees in Lebanon with the goal of informing community-based strategies to address the issue.

    In July–August 2016, trained interviewers collected self-interpreted stories in Lebanon using Cognitive Edge’s SenseMaker, a mixed-method data collection tool. Participants included married and unmarried Syrian girls, Syrian parents as well as married and unmarried men. Each participant shared a story about the experiences of Syrian girls and then interpreted the story by plotting their perspectives on a variety of questions. Patterns in the responses were analysed in SPSS and the accompanying qualitative narratives were reviewed to facilitate interpretation of the quantitative results.

    Brett D. Nelson, Michael VanRooyen, Maya Fehling, Margaret E. Tiernan, Zina Maan Jarrah, Saeed Albezreh, Narra Martineau, and Abdulmohsen Alhokair. 1/2015. Examining the needs of at-risk youth in the Middle East and North Africa: A multi-method landscape analysis and systematic literature review.Abstract
    Opportunities for youth can be severely limited among many communities in the Middle East and North Africa (MENA) region that are disrupted by conflict or impoverishment. Recent political and economic factors, as well as a rapidly growing youth population, have greatly increased the vulnerability of at-risk youth in the MENA region. This HHI study utilized a multi-method approach -- including systematic reviews of the peer-reviewed and gray literatures, stakeholder analyses, and in-region discussions with youth and stakeholders -- to identify the current needs, activities, stakeholders, and opportunities related to at-risk youth in the MENA region. It is our hope that this initial report and its recommendations will be a starting point of discussion and collaboration as we develop a cross-disciplinary, cross-institutional Middle East Youth in Crisis Project based at the Harvard Humanitarian Initiative.
    Phuong Pham and Patrick Vinck. 7/2014. Fragile Peace, Elusive Justice: Population-Based Survey on Perceptions and Attitudes about Security and Justice in Abidjan, Côte d’Ivoire. Read PublicationAbstract

    This report presents the results of a mixed-methods study conducted in Abidjan, Côte d’Ivoire, to assess the population’s perceptions, knowledge, and attitudes about security and justice. The study included a survey of 1,000 randomly selected adult residents, to provide results that are representative of the population of the city of Abidjan. The specific objectives of this study were to:

    1. Assess the overall exposure to violence among the population in Abidjan.
    2. Document attitudes and opinions about transitional justice mechanisms.
    3. Examine how the population gathers information about the International Criminal Court (ICC), what factors influence Ivorians’ knowledge of the Court, and what correlation exists between information sources and perceptions.

    Detailed results provided in the report outline the challenges of rebuilding peace and achieving justice after a decade of conflict, and just two years after a dramatic post-election crisis. The report reveals a population that has little or no trust in its government and in each other, concerned with its economic well-being, and somewhat divided about holding accountable the perpetrators of serious crimes during the postelection violence.

    Program Humanitarian Policy Conflict on and Research. 1/2014. Harvard Field Study Non-Paper on Syrian Refugees .Abstract

    The Syrian refugee crisis represents one of the greatest humanitarian challenges the international community has faced over the recent years, prompting record-high levels of international aid. In view of the complexity of the political and social environment in which these challenges arise and the historical scale of the population affected, innovative and creative programmatic responses are essential to address the short and middle-term needs of refugees and reducing instability in the Middle East region.

    Jennifer Scott, Sarah Averbach, Anna Merport Modest, Michele Hacker, Sarah Cornish, Danielle Spencer, Maureen Murphy, and Parveen Parmar. 11/2013. “An Assessment of Attitudes Toward Gender Inequitable Sexual and Reproductive Health Norms in South Sudan: a Community-based Participatory Research Approach.” Conflict and Health. Read PublicationAbstract

    Communities in South Sudan have endured decades of conflict. Protracted conflict exacerbated reproductive health disparities and gender inequities. This study, conducted prior to the country’s 2011 independence, aimed to assess attitudes toward gender inequitable norms related to sexual relationships and reproductive health and the effects of sex, age, and education on these attitudes.

    Jocelyn Kelly and Lindsay Branham. 1/2013. "We Suffer From War and More War": An Assessment of the Impact of the Lord's Resistance Army on Formerly Abducted Children and their Communities in northeastern Democratic Republic of the Congo .Abstract

    This study highlights the voices of individuals currently affected by the Lord’s Resistance Army to detail the extensive and systematic devastation felt specifically by formerly abducted children and their communities in northeastern Democratic Republic of the Congo. Respondents stressed that the international community must assist with providing essential services through long-term engagement, including life-saving health services; improving water and sanitation access; and providing psychosocial and educational interventions to formerly abducted children and adults. While these communities are facing emergency-level challenges now, the need for solutions that will last into the future.

    Rights Resilience and Program on Gender. 1/2013. "We Came Back with Empty Hands": Understanding the Disarmament, Demobilization and Reintegration of Children Formerly Associated with Armed Groups in the Democratic Republic of the Congo .Abstract

    This report documents the experiences and attitudes of former underage combatants in eastern Democratic Republic of the Congo (DRC) who went through the reintegration process, the families and communities who received them and the organizations that funded and implemented reintegration programming. Despite increasing attention to the scope and importance of child soldiering globally, there is still limited systematic research on the successes and challenges of reintegration programming for former underage combatants. This project, a collaboration between the Harvard Humanitarian Initiative and Eastern Congo Initiative, used DRC as a case study to examine the community experiences and attitudes around Disarmament, Demobilization and Reintegration (DDR) programming to generate lessons learned for improving future programming for former underage combatants and at-risk youth.

    Sherine Jayawickrama. 10/2011. Developing Managers and Leaders: Experiences and Lessons from International NGOs.Abstract

    This report, sponsored by the Hauser Center for Nonprofit Organizations and HHI, is based on interviews with senior managers affiliated with a variety of well-known INGOs. It elucidates ways that these organizations approach management and leadership development. It identifies best practice and lessons learned from their differing approaches; finds commonalities between their management programs; and proposes considerations for further expanding these efforts.

    Phuong Pham, Patrick Vinck, and Tino Kreutzer. 6/2011. Talking Peace: A Population-Based Survey on Attitudes about Security, Dispute Resolution, and Post-Conflict Reconstruction in Liberia.Abstract

    Liberia has made progress in peacebuilding and reconstruction in the aftermath of a 14-year long civil war, but the country continues to face challenges in overcoming the results of a legacy of violence. This study, undertaken in November and December 2010, provides insight into Liberians’ current priorities for peacebuilding, their perceptions of post-conflict security, and existing dispute and dispute resolution mechanisms.  The findings suggest that while Liberians are generally positive about the country’s prospects for peace and security, the fears and inequalities perpetuated by years of civil strife continue to reverberate throughout the country. This study provides recommendations to address the existing problems of gaping socioeconomic disparities, limited access to information, a weakened security sector, and the diminished quality of current dispute resolution systems. It also supports inter-ethnic national dialogue on truth, reconciliation, and the underlying causes of the war.

    Jocelyn Kelly, Michael VanRooyen, Beth Maclin, Justin Kabanga, and Colleen Mullen. 4/2011. Hope for the Future Again: Tracing the effects of sexual violence and conflict on families and communities in eastern Democratic Republic of the Congo .Abstract

    This report outlines how violence in general, and sexual violence in particular, has changed the family foundations, economies and community structures of those touched by it in eastern Democratic Republic of the Congo (DRC). Analyzing data from focus group discussions with a range of community members in the area, it suggests recommendations for serving the holistic needs of regions affected by sexual violence.

    Jennifer Chan. 9/2010. Applied Technologies Module Evaluation.Abstract

    In 2010, the Humanitarian Studies Course incorporated applied technologies into the coursework for the second consecutive year. The goal of this evaluation report is to reflect upon and determine the next steps for the Applied Technology Learning Module and to better understand its impact on participant learning during the 2010 Humanitarian Studies Course. This evaluation concludes that improvements in 1) didactics and preparation 2) integration of crowdsourcing and GIS technology 3) satellite communications and 4) volunteer capacity resulted in a successful educational experience for future humanitarian responders.

    Theresa Betancourt, Claude Bruderlein, Mary Kay Smith Fawzi, Chris Desmond, and Jim Y. Kim. 5/2010. “"Children Affected by HIV/AIDS: SAFE, A Model for Promoting their Security, Health and Development".” Psychology, Health & Medicine, 15, 3, Pp. 243-265. Read PublicationAbstract

    A human security framework posits that individuals are the focus of strategies that protect the safety and integrity of people by proactively promoting children's well being, placing particular emphasis on prevention efforts and health promotion. This article applies this framework to a rights-based approach in order to examine the health and human rights of children affected by HIV/AIDS. The SAFE model describes sources of insecurity faced by children across four fundamental dimensions of child well-being and the survival strategies that children and families may employ in response. The SAFE model includes: Safety/protection; Access to health care and basic physiological needs; Family/connection to others; and Education/livelihoods. We argue that it is critical to examine the situation of children through an integrated lens that effectively looks at human security and children's rights through a holistic approach to treatment and care rather than artificially limiting our scope of work to survival-oriented interventions for children affected by HIV/AIDS. Interventions targeted narrowly at children, in isolation of their social and communal environment as outlined in the SAFE model, may in fact undermine protective resources in operation in families and communities and present additional threats to children's basic security. An integrated approach to the basic security and care of children has implications for the prospects of millions of children directly infected or indirectly affected by HIV/AIDS around the world. The survival strategies that young people and their families engage in must be recognized as a roadmap for improving their protection and promoting healthy development. Although applied to children affected by HIV/AIDS in the present analysis, the SAFE model has implications for guiding the care and protection of children and families facing adversity due to an array of circumstances from armed conflict and displacement to situations of extreme poverty.

    Harvard Humanitarian Initiative. 1/2010. From Rapid Response to Sustainable Solutions: Disaster Response and Recovery in Post-Earthquake Haiti.Abstract

    On the one-year anniversary of the earthquake in Haiti, HHI released this report, chronicling eleven months of the Harvard Humanitarian Initiative's disaster response and recovery efforts in Haiti.  The report offers a brief overview of the establishment of the Disaster Recovery Center, the transition from complex disaster response to recovery phase operations, and the impact of HHI's medical and public health programming through outpatient medical clinic "Klinik Lespwa."

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