Publications

Recent Publications

Phuong Pham, Tadesse Simie Metekia, Negussie Deyessa, Abdulkadir Mah, Luciana Vosniak, and Patrick Vinck. 11/2023. Ethiopia Peace & Justice Survey 2023.Abstract

Ethiopia has a long history of human rights violations and conflicts that have deeply affected the nation. Most recently, the period from 2020 to 2022 saw intense conflict in the Tigray, Amhara and Afar regions with considerable loss of life and allegations of serious violations by all parties to the conflict.

The November 2022 Pretoria Agreement on cessation of hostilities and the subsequent Nairobi Agreement created opportunities to address historical grievances and confront gross rights violations, including the adoption of a comprehensive transitional justice process. However, violence continues in regions like Benishangul-Gumuz, Gambella, Sidama and Oromia due to protracted intercommunal conflicts. Climate change and droughts have exacerbated food insecurity, while armed conflict persists in Oromia, where peace talks have not progressed so far, and violence has erupted in Amhara.

Before the Tigray conflict, Prime Minister Abiy Ahmed introduced transitional justice initiatives to distance Ethiopia from the abuses of previous regimes. This
included the establishment of the 2018 Ethiopian Reconciliation Commission pursuant to a newly enacted Reconciliation Law and acknowledgment of the pre-2018 regime's violence against the Ethiopian people. Institutions like the Attorney General's Office have initiated procedures to hold past perpetrators
accountable for corruption and other forms of abuses committed before and during the 2018 transition. Amidst the Tigray war, Ethiopia continued transitional
justice efforts. The government shut down the Reconciliation Commission and established the National Dialogue Commission, adding a dialogue process parallel to the transitional justice process. The government also established the Transitional Justice Working Group of Experts (TJWGE), which released a
Green Paper on policy options after the 2023 Cessation of Hostilities Agreement. The TJWGE has undertaken national consultations ahead of drafting a national
transitional justice policy for Ethiopia.

Peace processes often neglect affected communities' perspectives, despite their crucial role in sustaining peace and preventing atrocities. The TJWGE consultations, while important, might not have fully captured the population's diverse views across all regions. To complement this process, the Harvard
Humanitarian Initiative (HHI) in collaboration with the Partnership for Pastoralist Development Association (PAPDA) and local universities, and with support from
the Global Initiative for Justice, Truth and Reconciliation (GIJTR), and the International Coalition of Sites of Conscience (ICSC), implemented a rigorous,
representative, and methodologically robust consultation to gain a deeper understanding of the population's perceptions about peace and justice. This
comprehensive mixed-method research gathered data from diverse communities across all regions of Ethiopia, including a survey of 6,689 randomly selected adult Ethiopians. Its results are presented in this report.

11/2023. Understanding Climate, Conflict, and Environmental Impacts in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM).Abstract

In 2022, the World Risk Report ranked the Philippines as the most disaster-prone country in the world. As such, the country is highly vulnerable to climate change, under which both the frequency and intensity of disasters are projected to increase. Yet, more frequent typhoons, rising sea levels, and loss of biodiversity will have especially severe consequences for communities living in fragile contexts experiencing conflict and environmental degradation. With this in mind, HHI and MSU-IIT have established a joint research area of focus: to expand and strengthen knowledge on the intersection of climate change, conflict, and the environment. Through a collaborative research initiative that examines this intersection in the BARMM, HHI and MSU-IIT seek to better inform practice and policy across the humanitarian, development, and peace and security sectors and ultimately support community resilience in conflict affected areas.

To launch this research initiative, HHI and MSU-IIT welcomed representatives from academia, local, national, and international NGOs, and community and local government leaders to MSU-IIT’s Iligan City campus for a two-day workshop entitled “Understanding Climate, Conflict, and Environmental Impacts in the Bangsamoro Autonomous Region in Muslim Mindanao.”

This report documents the process of designing and implementing the workshop, summarizes its outputs, and discusses steps for continued engagement in research and practice at the intersection of climate change, environmental degradation, and conflict.

Ganesh Dhungana, Hannah Stoddard, and Vincenzo Bollettino. 9/2023. Towards Resilient Communities: Scoping Study Report | Nepal.Abstract

Nepal is a hotspot for natural hazards and has repeatedly experienced different geological, hydrological, meteorological, and biological hazards. The frequent changes in the type, magnitude, and frequency of these hazards exacerbated by changing phenomena of climatic extremes necessitate reviewing existing preparedness practices and suggesting more work on preparedness measures.


The HHI Program on Resilient Communities has undertaken a scoping study to review existing practices and identify opportunities for strengthening preparedness in Nepal. The scoping study is the first phase in a project that seeks to improve community resilience to disasters through applied research relevant to effective disaster preparedness and management.


The following report summarizes existing literature and highlights findings from a series of consultations with agencies working in disaster risk reduction and management in the country. These consultations found that despite significant progress in legislation and institutional arrangements for preparedness and risk reduction, there are still gaps in effective implementations of endorsed legislation, coordination among agencies, and resources (human, technical and financial).


The study highlights the need to capacitate government officials working at the local and national levels by enhancing understanding and knowledge of shifting patterns of hazards and its effective management techniques.


Similarly, the study also pinpoints the need for advanced trainings in search and rescue operations for key responders. The study concludes by highlighting the importance of coordination with academic and research institutions to project future scenarios of hazards for better management, indicating a need for national-level research and training programs and initiatives dedicated to disaster management.

Vincenzo Bollettino, Rachel Isely, Godfred Nyarko, Chloe Rudnicki, Karima Rehmani, Hannah Stoddard, and Patrick Vinck. 7/2023. “Challenges in Humanitarian Response Implementation: A Large-Scale Review of Aid Worker Perspectives.” Disasters. Read PublicationAbstract

Aid workers offer important perspectives for better understanding the most pervasive challenges that arise when implementing emergency response programming in humanitarian settings. This study provides a global review of these perspectives, derived from 4,679 applications of aid workers applying to the National NGO Program on Humanitarian Leadership (NNPHL), in which applicants were asked to respond to the question, “What do you consider to be the biggest challenges in the implementation of emergency response programming in today's humanitarian settings.” Through a qualitative coding process, the research team identified 14 major challenges that were pervasive across the applicant responses and cross-tabulated these with applicant demographics. Coordination (30%) and the operating environment (29.5%) were the most frequently reported challenges by the applicant pool. The study finds a significant association between challenges identified and certain demographic variables, including region of applicant origin, type of organization worked at, and number of years of experience. The results produced by the study's large sample size and methodology supplement a body of literature that is largely made up of small-scale, context specific studies in which disaggregation of data by demographics is not possible.

Ronak B. Patel, Caitriona Dowd, Kelsey Gleason, Samuel Polzin, Denise Ripamonti, and Angela Garvey. 2023. Conflict and Food Systems Sudan Report.Abstract
This research sought to investigate the impact of conflict on various elements of the food system in Sudan to identify those with the biggest influence on food and nutrition security amongst people experiencing extreme poverty. This research systematically maps components of local and national food systems; identifies specific pressure points where conflict interacts with them; and proposes operational, policy and research actions tailored to supporting and strengthening food systems disrupted and transformed by conflict in Sudan.
Ronak B. Patel, Caitriona Dowd, Kelsey Gleason, Samuel Polzin, Denise Ripamonti, and Angela Garvey. 2023. Conflict and Food Systems Somalia Report.Abstract
This research sought to investigate the impact of conflict on various elements of the food system in Somalia to identify those with the biggest influence on food and nutrition security amongst people experiencing extreme poverty. This research systematically maps components of local and national food systems; identifies specific pressure points where conflict interacts with them; and propos operational, policy and research actions tailored to supporting and strengthening food systems disrupted and transformed by conflict in Somalia.
Ronak B. Patel, Caitriona Dowd, Kelsey Gleason, Samuel Polzin, Denise Ripamonti, and Angela Garvey. 2023. Conflict and Food Systems Haiti Report.Abstract
This research sought to investigate the impact of conflict on various elements of the food system in Haiti to identify those with the biggest influence on food and nutrition security amongst people experiencing extreme poverty. This research systematically maps components of local and national food systems; identifies specific pressure points where conflict interacts with them; and proposes operational, policy and research actions tailored to supporting and strengthening food systems disrupted and transformed by conflict in Haiti.
Ronak B. Patel, Caitriona Dowd, Kelsey Gleason, Samuel Polzin, Denise Ripamonti, and Angela Garvey. 2023. Conflict and Food Systems Synthesis Report.Abstract

This research sought to investigate the impact of conflict on various elements of the food system to identify those with the biggest influence on food and nutrition security amongst people experiencing extreme poverty. Drawing on evidence from Somalia, Haiti and Sudan, this cross-country research systematically mapped components of local, national and international food systems; identified specific pressure points where conflict interacts with them; and proposed operational, policy and research actions tailored to supporting and strengthening food systems disrupted and transformed by conflict.

The research finds that across all three country contexts, conflict has a negative impact on the food system in ways that are Connected - complex interconnections between different nodes in the food system; Cumulative - successive, repeated exposure to specific distortions and disruptions in the food system that intensify impacts; and Compounding - combined impacts of co-occurring effects on the food system that act together to multiply impacts.

Vincenzo Bollettino, Cheryl Yunn Shee Foo, Hannah Stoddard, Mark Daza, Antonio C Sison, Mendiola Teng-Calleja, and Patrick Vinck. 6/2023. “COVID-19-related mental health challenges and opportunities perceived by mental health providers in the Philippines.” Asian Journal of Psychiatry, 84. Publisher's VersionAbstract
This paper outlines the psychosocial impacts of the COVID-19 pandemic as reported by 145 licensed mental health providers in the Philippines in an online survey. Respondents perceived an increase in observed mental health disorders in their beneficiaries and an overall decrease in stigma associated with receiving mental health care services during the pandemic. Respondents further identified specific stigma-related help-seeking barriers during the pandemic. Positive impacts of telehealth and importance of increased public education of mental health were highlighted, with implications for improving the landscape of mental health care for Philippines post-pandemic.
Sonny S. Patel. 2022. Community Resilience When Disaster Strikes Security and Community Health in UK Flood Zones. Springer. Read PublicationAbstract

This book addresses the operationalization of community resilience in the United Kingdom (UK) in connection with severe floods. Written for early academic professionals, students, and community practitioners, it investigates the educational and practical meaning and application of community resilience using a UK-centric local-level case study. Exploring the perceptions of both those who have been affected by a natural hazard and those who have not, the book reveals how trust, community resources, and neighborhood security can offer effective ways of bringing communities together after a natural hazard.

The author introduces the topic of community resilience as it applies to disasters in Chapter 1 and its implications for securing and improving the wellbeing of disaster-affected communities in Chapters 2 and 3. In Chapter 4, the lessons learned contributing to the available information and research on community resilience are reviewed. Finally, the author offers recommendations and outlines future directions in coping with the uncertainty and insecurity caused by natural hazards in Chapter 5.

Phuong Pham, Katrina Keegan, Lisa Grazina Johnston, Jose Rodas, Maria Alejandra Restrepo, Carol Wei, and Patrick Vinck. 10/2022. “Assessing the impact of the COVID-19 pandemic among Venezuelan refugees and migrants in Colombia using respondent-driven sampling (RDS.” BMJ Open. Read PublicationAbstract

Objectives: To determine factors associated with adherence to COVID-19 mitigation measures, related symptoms and testing, as well as pandemic-related income loss among Venezuelan refugee and migrant adults in urban and border areas of Colombia.

Design: Phone-based respondent-driven sampling

Setting: Bogotá and Norte de Santander, Colombia.

Participants: 605 adult Venezuelan refugees and migrants residing in Bogotá (n=305) and Norte de Santander (n=300), who arrived in Colombia after 2014 and completed the survey in August and September 2020.

 

Primary and secondary outcome measures: Full COVID-19 compliance (vs incomplete or no compliance), any COVID-19-related symptoms (vs none) and income loss due to isolation measures in Colombia (vs no income change or increase in income).

Results: Older age was associated with lower odds of compliance with physical distancing measures (0.94, 0.90–0.99; p=0.01) for those in Bogotá. Nearly 15% of refugees and migrants in both locations (81 of 605) experienced at least one symptom consistent with COVID-19. Having a health condition was associated with higher odds of experiencing COVID-19-related symptoms in Bogotá (4.00, 1.22–13.06; p=0.02) and Norte de Santander (6.99, 1.95–24.99; p=0.003). Around 8% in both locations (48 of 605) were tested for COVID-19. Around 90% in both locations (537 of 605) had trouble earning an income after the introduction of isolation measures, and the median reported monthly income decreased by half in Bogotá and by 30% in Norte de Santander. A higher level of education (3.46, 1.02–11.75; p=0.05) was associated with higher odds of income loss among participants in Norte de Santander.

Conclusions: Results indicate high compliance with COVID-19 mitigation measures, low testing rates and high pandemic-related income loss among Venezuelan refugees and migrants in Colombia. This study provides insights into a hard-to-reach refugee and migrant population in Colombia; additional study on the effects of the pandemic on hidden populations is warranted.

 

Jaya Prakash, Timothy B. Erickson, and Hanni Stoklosa. 9/20/2022. “Human trafficking and the growing malady of disinformation.” Frontiers in Public Health. Read PublicationAbstract
Disinformation has endangered the most vulnerable communities within our world. The anti-trafficking movement in particular has been adversely impacted by disinformation tactics advanced through the QAnon campaign. QAnon's extremist messaging exacerbates gendered, racist, and xenophobic manifestations of trafficking victimization as well as problematic responses to trafficking that underpin historic structural inequities built into the United States' response to trafficking. We describe an overview of mechanisms used by the QAnon campaign to spread disinformation and illustrate how these mechanisms adversely affect the anti-trafficking movement. Given the critical role of healthcare providers in both the identification and connection to care for trafficked persons, as well as their susceptibility to disinformation, we provide several recommendations for the health sector to leverage their educational and advocacy power to combat trafficking disinformation while addressing the root causes of human trafficking.
Phuong Pham, Thomas O'Mealia, Carol Wei, Kennedy Kihangi Bindu, Anupah Makoond, and Patrick Vinck. 6/2022. “Hosting New Neighbors : Perspectives of Host Communities on Social Cohesion in Eastern DRC”. Read PublicationAbstract
Situations of forced displacement create unique challenges for social cohesion because of the major disruption of social dynamics among both displaced persons and host communities. This paper uses a sequential mixed method approach to analyze the relationship between hosting displaced persons and perceptions of social cohesion in eastern Democratic Republic of Congo. First, participatory research methods in focus groups empowered participants to produce a locally driven definition of social cohesion. The results from these exercises inform the quantitative assessment by dictating measurement strategies when analyzing original surveys. Combining almost 50,000 responses to 11 cross-sectional surveys between 2017 and 2021, displacement is negatively associated with perceptions of social cohesion in aggregate. But at the individual level, those who report hosting displaced populations in their communities often have higher perceptions of social cohesion. These results are strongest among respondents who self-report hosting IDPs as opposed to refugees, but important heterogeneity across indicators, local context, and gender should guide policy meant to promote social cohesion in forced displacement.
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.

6/15/2022. “Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19.” PLOS Water. Read PublicationAbstract

Continuity of key water, sanitation, and hygiene (WASH) infrastructure and WASH practices—for example, hand hygiene—are among several critical community preventive and mitigation measures to reduce transmission of infectious diseases, including COVID-19 and other respiratory diseases. WASH guidance for COVID-19 prevention may combine existing WASH standards and new COVID-19 guidance. Many existing WASH tools can also be modified for targeted WASH assessments during the COVID-19 pandemic. We partnered with local organizations to develop and deploy tools to assess WASH conditions and practices and subsequently implement, monitor, and evaluate WASH interventions to mitigate COVID-19 in low- and middle-income countries in Latin America and the Caribbean and Africa, focusing on healthcare, community institution, and household settings and hand hygiene specifically. Employing mixed-methods assessments, we observed gaps in access to hand hygiene materials specifically despite most of those settings having access to improved, often onsite, water supplies. Across countries, adherence to hand hygiene among healthcare providers was about twice as high after patient contact compared to before patient contact. Poor or non-existent management of handwashing stations and alcohol-based hand rub (ABHR) was common, especially in community institutions. Markets and points of entry (internal or external border crossings) represent congregation spaces, critical for COVID-19 mitigation, where globally-recognized WASH standards are needed. Development, evaluation, deployment, and refinement of new and existing standards can help ensure WASH aspects of community mitigation efforts that remain accessible and functional to enable inclusive preventive behaviors.

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.

Sonny S. Patel and Timothy B. Erickson. 3/2022. “The new humanitarian crisis in Ukraine: Coping with the public health impact of hybrid warfare, mass migration, and mental health trauma.” Disaster Medicine and Public Health Preparedness. Read PublicationAbstract

One of the largest mass movements of displaced people from their homelands in recent history must be recognized and assisted by the Free World. The unprovoked Russian attacks on Ukraine during February-March 2022 will leave long-lasting devastating effects on millions of innocent victims. Nations worldwide, especially NATO member countries, will need to intervene to ameliorate the situation. This letter describes major public health issues apart from the COVID-19 pandemic that are emerging concerns, such as shortages of healthcare professionals, chronic care treatments and health prevention services, disinformation communication campaigns affecting the healthcare infrastructure, and the generational impact of the conflict on people’s mental health. A global response and public health support need immediate action including humanitarian assistance, food security, clean water supplies, adequate shelter, and safe transportation out of the active military zones.

Vincenzo Bollettino and Lea Ivy Manzanero. 3/2022. “Climate Change and Civil-Military Coordination in the Philippines: How climate change disasters will impact aid delivery in areas affected by conflict.” Climate, Disaster and Development Journal. Read PublicationAbstract

The Philippines is one of the most disaster-prone countries in the world and frequently ranks among the top three countries most impacted by disasters. Ongoing conflict with non-state armed actors results in scenarios where civilians are impacted by both conflict and natural hazards. The result is a situation where civilian relief agencies operate in proximity to the military. We argue that there is an important need for principled civil-military coordination in these contexts to ensure the integrity of security operations to support peace and stability while preserving the independence of humanitarian actors serving crisis-affected populations.


The research reveals significant challenges in protecting the integrity of independence of both military and humanitarian actors in areas impacted by both conflict and disaster and underscores the need for principled humanitarian civil-military coordination to avert threats to both humanitarian aid workers and disaster affected populations. The findings are particularly relevant to South East Asia where the use of military in disaster response is common. The findings also underscore the need for research on the role of militaries in responding to disasters in light of anticipated impacts of climate change. 

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

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