Publications

    Erica Nelson and Saira Khan. 8/1/2021. “Climate and Migration in East and the Horn of Africa: Spatial Analysis of Migrants’ Flows Data”.Abstract

    The International Organization for Migration (IOM) Regional Data Hub (RDH) for the East and Horn of Africa partnered with the Humanitarian Geoanalytics Program (HumGeo) at the Harvard Humanitarian Initiative (HHI) to analyze the complexities of and interactions between migration, conflict, environmental changes, and climate-related events in Yemen, and the East and Horn of Africa between 2018 and 2020.

    This research aims to answer the following questions through a variety of geospatial analyses:

    1) How did out-migration rates in any given administrative region change over time and, was it statistically significant compared to administrative regions around it?

    2) How do the numbers of migrants and the overall migration trends vary across space and time, for each cited reason for migration (aka ‘driver of migration’)?

    3) How do environmental variables, e.g. temperature and precipitation, correlate with outmigration in in the East and Horn of Africa?

    This study provides new insights into out-migration patterns in the region, demonstrates a novel way to investigate changing reasons for out-migration using a variety of spatial analysis methods, and establishes a foundation for future studies to analyze the complex and evolving relationship between migration and climate change that will continue to intensify in the years to come.

    Erica Nelson and Saira Khan. 8/2021. Climate and Migration in East and the Horn of Africa: Spatial Analysis of Migrants’ Flows Data.Abstract

    The drivers of human displacement are becoming more and more complex, ranging from conflict and persecution to the increasingly pertinent variables of heightened mobility and social media influences. Of rapidly but appropriately escalating concern is the impact of climate change. While the intensity and severity of climate-induced disasters and climate-related migration will be unevenly distributed across space and time, the World Bank estimates that approximately 140 million people will be displaced globally due to climate-related reasons by 2050. The effects of climate change are expected to be particularly pronounced in Africa, where rising temperatures, unpredictable anomalous rainfall and high vulnerability to extreme natural hazards will continue to exacerbate conflict and harm local and regional human, economic, and environmental security.

    In the East and Horn of Africa (EHoA) in particular, the dependence on rain-fed agriculture and pastoralism means that livelihoods and food security are inextricably linked and affected by long-term or sudden environmental changes and natural hazards. The extreme natural hazards that have struck EHoA in recent years have caused widespread hunger, displacement, loss of critical infrastructure and livelihoods, and death

    In an effort to understand the complex variables that influence migration, the International Organization for Migration (IOM) developed the Displacement Tracking Matrix (DTM) to track and gather information about populations on the move. The Flow Monitoring Registry (FMR) captures a wealth of data about the migratory routes, the demographics and nationality of migrants, reasons for migration, modes of transportation used to facilitate movement, and vulnerabilities experienced by these populations. While the descriptive data provides a wealth of information, more can be done to analyze the complexities of and interactions between migration, conflict, environmental changes, and climate-related events. Climate projections further suggest that environmental changes will likely further lead to decreased water availability, lowered agricultural productivity, and increased disease transmission in the region, producing complex ramifications regarding local and regional conflicts, economics, politics, and migration.

    The porous borders in EHoA have contributed to some of the highest volumes of cross border movement in the world. In 2020 alone, EHoA hosted 6.5 million internally displaced persons (IDPs) and 3.5 million refugees and asylum seekers.6 In the same year, the Horn of Africa experienced unusually high levels of precipitation leading to disastrous floods and landslides and creating ideal conditions for an detrimental locust plague towards the end of 2019 that devastated crops and disrupted livelihoods. The extreme precipitation experienced across much of the Horn in 2019 was preceded by anomalous rainfall the previous year. 2018 was particularly hot and dry in the Horn of Africa, with positive temperature anomalies of around 2°C and below-average precipitation contributing to drought-like conditions in Somalia, Eritrea, and Djibouti while Kenya and Sudan experienced above-average precipitation.8 The drought-like conditions in Somalia, Eritrea, and Djibouti contributed to widespread food insecurity that affected approximately 12 million people. These extreme weather conditions are increasingly exacerbating the already complex and interconnected factors driving migration in the Horn of Africa, and are only expected to escalate in the future.

    For this study, the IOM RDH in Nairobi partnered with the Humanitarian Geoanalytics Program at the Harvard Humanitarian Initiative to leverage spatial analytics to investigate migration flows in the East and Horn of Africa and Yemen. Geospatial analytics hold tremendous potential to introduce new ways of thinking, build research capacity, study impacts, and facilitate costeffective programming. The adoption of geospatial methods into research oriented towards populations on the move, gives us the capacity to accurately characterize the spatial heterogeneity of migrating populations. Furthermore, by incorporating environmental variables into this spatial analysis, we begin to reveal relationships previously undiscovered that could contribute to a richer understanding regarding migration in the region.

    Virginia M. Tran, Laila Fozouni, Jana K. Denkinger, Caroline Rometsch, Florian Junne, Patrick Vinck, and Phuong Pham. 7/2021. “Factors influencing utilization and perception of health care: a qualitative study among traumatized Yazidi refugees in Germany.” BMC Psychiatry. Read PublicationAbstract

    Background: Ensuring adequate utilization of healthcare services for displaced populations is critical, yet there are well-documented treatment gaps. Yazidi women captured by the Islamic State (IS) were subjected to extreme trauma and violence. This study aims to understand perceptions of healthcare providers and utilization of these services among women who experienced extreme trauma.

    Methods: This is a qualitative study with voluntary participation offered to approximately 400 women resettled through the Special Quota Program. An empirical approach was used to collect data and a grounded theory approach was used for content analysis. Participants ranked their interactions with providers on a Likert scale. Posttraumatic stress disorder (PTSD) symptoms were assessed using the impact of event scale-revised questionnaire.

    Results: A total of 116 Yazidi women participated in this study. The women experienced an average of 6.8 months of captivity by IS and 93% met criteria for probable PTSD. Eighty-three percent of the women interacted with a physician; 80% found this interaction helpful. Sixty-nine percent interacted with psychologists; 61% found this interaction helpful. Six themes emerged: “reminders of trauma” and “hopelessness” in relation to the traumatic experience; “immediate relief” and “healing through pharmaceutical treatment” in relation to provider interventions, and “support” and “cultural differences” in relation to interactions with providers.

    Conclusions: There exist major barriers to care for Yazidi women who experienced extreme trauma, particularly in regards to psychiatric care. Perceptions of healthcare providers and perceived effectiveness of therapy are critical factors that must be taken into consideration to improve healthcare utilization and outcomes.

    Jana Katharina Denkinger, Caroline Rometsch, Martha Engelhardt, Petra Windthorst, Johanna Graf, Phuong Pham, Niamh Gibbons, Stephan Zipfel, and Florian Junne. 5/2021. “Longitudinal Changes in Posttraumatic Stress Disorder After Resettlement Among Yazidi Female Refugees Exposed to Violence.” JAMA Network Open.Abstract

    Importance: Posttraumatic stress disorder (PTSD) is highly prevalent among refugees surviving mass atrocities, especially among women. Longitudinal studies investigating factors associated with PTSD course are essential to enable adequate treatment yet widely lacking.

    Objective: To identify longitudinal changes in PTSD severity and posttraumatic coping among severely traumatized female refugees as well as risk and protective factors for PTSD course.

    Design, Setting, and Participants: This prospective cohort study took place in 14 German cities in the context of a humanitarian admission program that resettled 1000 especially vulnerable women and children from northern Iraq to Germany. Approximately 400 adult beneficiaries of the humanitarian admission program were eligible for the study. At baseline, a total of 116 of the 400 beneficiaries (29.0%) participated, with 96 (82.8%) of these women participating in the follow-up assessment. The study included a baseline assessment conducted 2 years after resettlement (September 1, 2017, to January 12, 2018) and a 1-year follow-up (August 29, 2018, to January 15, 2019).

    Exposures: Violence and/or captivity during the 2014 genocide in northern Iraq by the so-called Islamic State.

    Main Outcomes and Measures: Posttraumatic stress disorder severity and coping strategies were assessed in interpreter-aided interviews using the Impact of Event Scale–Revised.

    Results: A total of 116 women (mean [SD] age, 32.2 [8.2] years; 115 [99.1%] Yazidi; 1 [0.9%] Christian) participated at baseline. According to the Impact of Event Scale–Revised, a high PTSD severity was found (mean [SD] raw sum score, 60.88 [15.75] of 88, with higher scores indicating greater distress), with no significant change over time. Helpful coping strategies included prayer, belief in collective strength, and belief in personal strength. Earlier symptoms of intrusions (β = 0.389, P = .007) and longer captivity (β = 0.218, P = .02) were identified as being associated with PTSD severity 1 year later. Longer captivity was associated with PTSD aggravation over time (β = 0.227, P = .04). Posttraumatic strengthening in faith (β = −0.206, P = .05) and in social relationships (β = −0.221, P = .03) were associated with a reduction in PTSD symptoms.

    Conclusions and Relevance: These findings suggest that female refugee survivors of genocide are at high risk for severe and chronic PTSD beyond the initial years of resettlement. The findings provide suggestions for mental health care specialized for particularly vulnerable populations.

    Saira Khan, Isaac Baker, and Rob Baker. 11/2019. Satellite Imagery Interpretation Guide of Landscape Features in Somaliland.Abstract

    This guide outlines the tools and techniques to establish a foundation for visual analysis and discusses how these techniques can assist in identifying notable landscape features pertaining to agriculture, settlements, water catchment, and livestock in northern Somalia. To the knowledge of the Signal Program analysts, there is no systematic open-source remote sensing documentation of frequently occurring natural and man-made features in Somalia. This guide helps users to identify and analyze these features, particularly humanitarian practitioners supporting activities in the Horn of Africa. This project, titled “Children on the Move: Using Satellite Data Analysis in Conflict/Famine-Affected Areas,” was carried out in collaboration with UNICEF, the GovLab at NYU, and the Signal Program on Human Security and Technology at Harvard Humanitarian Initiative.

    Saira Khan, Rob Baker, Caitlin Howarth, Erica Nelson, Isaac Baker, Natalia Adler, and Stefaan Verhulst. 11/2019. Lessons Learned Report: Using Satellite Data Analysis in Conflict/Famine-Affected Areas.Abstract
    This report captures the lessons learned during a project titled, “Children on the Move: Using Satellite Data Analysis in Conflict/Famine-Affected Areas.” This document details the project’s progression and the rationale for transitioning from satellite imagery analysis to agent-based modeling as the primary mode of analysis. This project was conducted in collaboration with the Governance Lab at New York University, the Signal Program on Human Security and Technology at Harvard Humanitarian Initiative, and UNICEF. 
    Mark Latonero, Danielle Poole, and Jos Berens. 3/2018. Refugee Connectivity: A Survey of Mobile Phones, Mental Health, and Privacy at a Syrian Refugee Camp in Greece.Abstract
    The report, Refugee Connectivity: A Survey of Mobile Phones, Mental Health, and Privacy at a Syrian Refugee Camp in Greece, is the result of 2017 field research by Data & Society, the Harvard Humanitarian Initiative’s (HHI) Signal Program on Human Security and Technology, and Centre for Innovation at Leiden University. Lead authors of the report are Mark Latonero, Ph.D. of Data & Society, Danielle Poole of HHI/Signal and the Harvard School of Public Health, and Jos Berens, formerly of Leiden University. 
    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.

    Adam Khalifa. 6/2014. “Cancer in refugees in Jordan and Syria between 2009 and 2012: challenges and the way forward in humanitarian emergencies.” The Lancet Oncology, 15, 7, Pp. E290-E297. Read PublicationAbstract

    Treatment of non-communicable diseases such as cancer in refugees is neglected in low-income and middle-income countries, but is of increasing importance because the number of refugees is growing. The UNHCR, through exceptional care committees (ECCs), has developed standard operating procedures to address expensive medical treatment for refugees in host countries, to decide on eligibility and amount of payment. We present data from funding applications for cancer treatments for refugees in Jordan between 2010 and 2012, and in Syria between 2009 and 2011. Cancer in refugees causes a substantial burden on the health systems of the host countries. Recommendations to improve prevention and treatment include improvement of health systems through standard operating procedures and innovative financing schemes, balance of primary and emergency care with expensive referral care, development of electronic cancer registries, and securement of sustainable funding sources. Analysis of cancer care in low-income refugee settings, particularly in sub-Saharan Africa, is needed to inform future responses.

    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.

    Brittany Card, Samuel Plasmati, Ziad Al Achkar, Joan P. Heck, Benjamin I. Davies, Isaac L. Baker, and Nathaniel A. Raymond. 6/2013. Sudan: Anatomy of a Conflict .Abstract
    The Signal Program on Human Security and Technology at the Harvard Humanitarian Initiative has released its first study, Sudan: Anatomy of a Conflict. 
    This study is the first geospatial-based history of a conflict created primarily through a fusion of remote sensing and previously public event data.  The researchers of the Signal Program spent many months cross-referencing and analyzing over 40,000 square kilometers of archival satellite imagery of Sudan with more than 2,000 published reports of incidents occurring between January 2011 and mid-2012.
    Key findings of the study include evidence of the apparent intentional destruction of more than 2,000 civilian dwellings and other structures; the intentional targeting and destruction of four humanitarian facilities; identification of specific armed actors, units, and chains-of-command allegedly involved in specific attacks in Sudan; and evidence of the mass displacement of civilian populations.
    Ronak B. Patel, David Alejandro Schoeller-Diaz, Victoria-Alicia Lopez, and John Joseph “Ian” Kelly IV. 6/2012. Hope in the Face of Displacement and Rapid Urbanization.Abstract
    This study seeks to offer a practical examination of resilience in complex urban landscapes for the academic community and humanitarian actors at the local and international levels. Distrito de Aguablanca (Cali, Colombia), a complex settlement area with some 600,000 residents, functions as a case study in human security and resilience that can inform public policy and community level decision making in especially difficult humanitarian environments, with sociopolitical volatility, large populations of internally displaced persons, and high crime and violence rates.
    Laura M. Janneck, Ronak B. Patel, Shada A. Rouhani, and Frederick M. Burkle Jr. 3/2012. “Toward Guidelines for Humanitarian Standards and Operations in Urban Settings .” Prehospital and Disaster Medicine. Read PublicationAbstract

    Rapid urbanization represents the most significant demographic change of the twenty-first century. 2008 marked the first time in human history that over half of the world population lived in urban settings. The process of urbanization, fueled by economic and social foreces, has particularly accelerated in countries in the Global South. By the year 2050, it is predicted that 70% of the world's population will live in urban settings. 

    Not On Our Watch, The Enough Project, Google, DigitalGlobe, Harvard Humanitarian Initiative, and LLC Trellon. 1/2012. Chokepoint: Evidence of SAF Control of Refugee Route to South Sudan .Abstract

    Satellite Sentinel Project (SSP), through HHI’s analysis of DigitalGlobe satellite imagery, has confirmed that at least a battalion sized unit of Sudan Armed Forces (SAF) appear to control the main route civilians reportedly use to flee South Kordofan for Yida refugee camp. The interior of the apparent base, which is located in the town of Toroge, contains objects consistent with 80 to 90 tent-like structures, infantry fighting vehicles (IFVs), artillery, and heavy armor vehicles, which appear to be main battle tanks. In Siege: Evidence of SAF Encirclement of the Kauda Valley released 25 January 2012, SSP reported that the SAF had restricted access to the road leading towards South Sudan from South Kordofan. The imagery in this report specifically identifies a new fortified chokepoint along that road under apparent SAF control, which was established sometime after 23 November 2011.

    Ronak B. Patel and Frederick M. Burkle Jr. 7/2011. Urban Health: a 21st Century Crisis .Abstract

    This brief report reviews the health concerns that arise with rapid urbanization and confront humanitarian organizations during acute emergencies.  The authors argue that one way forward is for humanitarian organizations to learn from existing grass-roots efforts.

    Not On Our Watch, The Enough Project, Google, DigitalGlobe, Harvard Humanitarian Initiative, and LLC Trellon. 6/2011. On the Move: Evidence of Civilian Displacement and SAF Control of Kadugli.Abstract

    Satellite Sentinel Project (SSP) analysis of DigitalGlobe satellite imagery collected 17 June 2011 confirms reports that the Sudan Armed Forces (SAF) control Kadugli and that civilians have been displaced to a location north of the town. More than 300 structures consistent with temporary shelters for IDPs (Internally Displaced Persons) are visible close to the wall of the UN Mission in Sudan (UNMIS) compound. However, it is likely many more IDP structures are obscured by the heavy cloud cover visible in the imagery.

    Not On Our Watch, The Enough Project, Google, DigitalGlobe, Harvard Humanitarian Initiative, and LLC Trellon. 5/2011. Burned to the Ground: Evidence of Potential War Crimes and the Intentional Destruction of Abyei Town by the Government of Sudan.Abstract

    Satellite Sentinel Project (SSP) has confirmed through the analysis of DigitalGlobe satellite imagery collected on 27 May the intentional destruction of approximately one-third of all civilian structures in Abyei town by the Government of Sudan and northern-aligned militia forces. SSP has documented multiple violations of international humanitarian law in Abyei town. These abuses can constitute war crimes, including violations of the Geneva Conventions, and in some cases they may represent crimes against humanity.

    Harvard Humanitarian Initiative’s Human Rights Documentation Team, Carr Center Human Rights for Policy, DigitalGlobe, Harvard Humanitarian Initiative, and UNITAR/UNOSAT. 3/2011. Flashpoint: Abyei.Abstract

    The human security situation in the Abyei region of Sudan has rapidly deteriorated in the past week due to renewed violence. Satellite Sentinel Project (SSP) has confirmed through the analysis of DigitalGlobe satellite imagery that buildings consistent with civilian infrastructure appear to have been intentionally burned Maker Abior and Todach villages. Some 100 people in the Abyei region have reportedly died in the clashes to date. According to the humanitarian organisation Médecins Sans Frontières (MSF), tens of thousands of civilians have either been displaced by fighting or fled due to fear of further attacks.

    Phuong Pham and Patrick Vinck. 12/2010. Transitioning to Peace: A Population-Based Survey on Attitudes About Social Reconstruction and Justice in Northern Uganda .Abstract

    Since the withdrawal of the Lord’s Resistance Army (LRC) from Northern Uganda in 2005, the region has been on the slow path to recovery after a long period of danger and destruction. This study presents Ugandans’ views of peace, justice, and post-conflict reconstruction after twenty years of conflicts that ravaged the country. Based on its findings of violence, access to information consumption, and perception of ex-combatants, this study makes the following recommendations to the Ugandan government and the international community: (1) continue to promote reconstruction and development, (2) develop a relevant and realistic reparations program, (3) support national dialogue on the causes and consequences of the conflict, (4) strengthen regional security, (5) build local leadership capacity, (6) develop a responsive criminal justice and police system, (7) reevaluate the International Criminal Court (ICC)’s outreach strategy, and (8) ensure free and fair presidential elections.

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