Publications

2019
Heather M Prendergast, Sara W Heinert, Timothy B Erickson, Trevonne M Thompson, and Terry L Vanden Hoek. 2019. “Evaluation of an Enhanced Peer Mentoring Program on Scholarly Productivity and Promotion in Academic Emergency Medicine: A Five-Year Review.” J Natl Med Assoc, 111, 6, Pp. 600-605.Abstract
OBJECTIVE: To design, implement, and evaluate the effectiveness of an enhanced peer mentoring program (EPMP) for faculty in emergency medicine aimed at overcoming traditional mentoring challenges. METHODS: Full time faculty (Clinical Instructor, Assistant, and Associate levels) were placed into peer groups (based upon their primary academic roles) led by senior faculty advisors at the Professor level. Peer groups met at least quarterly from 2012 to 2017. In lieu of a structured curriculum, session topics were informed by individual faculty surveys and peer group consensus. Areas of focus included work-life balance, prioritizing academic commitments, identification of mentors (both within and external to the department and university), networking opportunities, promotions goals, and career satisfaction. RESULTS: Effectiveness of the EPMP was evaluated by academic productivity and advancement over a 5- year period. A total of 22 faculty members participated in the program. There was an increase in promotions to the next academic level, from 3 promotions in the five years before the program to 7 promotions in the five years of the program. Total grant funding increased 3-fold from $500,000 to $1,706,479 from the first year to the last year of the evaluation period. CONCLUSIONS: This enhanced peer mentoring program was effective in mitigating many of the traditional mentoring challenges faced by faculty in academia and was successful in improving both academic productivity and advancement.
2018
Emmanuel Tronc and Anaïde Nahikian. 12/2018. Fragile Future: The human cost of conflict in Afghanistan. Read PublicationAbstract
This context analysis examines the humanitarian, political, societal, and economic dimensions that make the protracted conflict in Afghanistan intractable and precarious for civilian populations. The report is based on field visits to numerous regions in Afghanistan in July 2018 — which included interviews and consultations with a variety of actors, including political stakeholders, humanitarian agencies, and populations affected by conflict — as well as a review of recent and relevant literature. The purpose of this analysis is to (1) provide a current assessment of the conflict, drawing from field interviews and an in- depth assemblage of various reports and resources, (2) examine the interconnected and interdependent interests fueling the conflict, and (3) suggest that if these dynamics persist in the way they have for decades, recent elections and peace talks will represent yet another setback for Afghan communities and a peaceful future for the country.
Ronak B. Patel. 12/2018. “Precision Health in Disaster Medicine and Global Public Health.” Prehospital and Disaster Medicine, 33, 6, Pp. 565 - 566. Read PublicationAbstract
Current debates about precision medicine take different perspectives on its relevance and value in global health. The term has not yet been applied to disaster medicine or humanitarian health, but it may hold significant value. An interpretation of the term for global public health and disaster medicine is presented here for application to vulnerable populations. Embracing the term may drive more efficient use and targeting of limited resources while encouraging innovation and adopting the new approaches advocated in current humanitarian discourse.
Emmanuel Tronc, Rob Grace, and Anaïde Nahikian. 11/2018. Humanitarian Access Obstruction in Somalia: Externally Imposed and Self-Inflicted Dimensions . Read PublicationAbstract

Access obstruction in conflict settings has emerged as a critical operational and policy concern across the humanitarian sector, but there remains a dearth of analysis regarding the ways in which humanitarian organizations perpetuate self-inflicted access obstacles. Drawing on qualitative interviews conducted with local and international actors negotiating frontline humanitarian access in Somalia, this paper will examine the ways in which this context elucidates this phenomenon. Toward this end, this paper examines two dimensions of humanitarian access obstruction in this context. The first set of dynamics consists of externally imposed obstacles that stem from governmental actors, Al-Shabaab, access "gatekeepers" motivated by financial gain, and the insecure nature of the environment. The second set of dynamics consists of self-inflicted dimensions of access obstruction that emanate from decisions that international humanitarian organizations (IHOs) have made at the strategic or policy level. These issues include the physical "bunkerization" of IHOs, programmatic shortcomings, the discounting of local humanitarian actors' agency, and the ways that IHOs exhibit programmatic partiality in response to donors' interests and counterterrorism legislation. Through examining these issues, this paper highlights fact that, although the discourse on humanitarian access obstruction tends to emphasize difficulties arising from externally imposed obstacles, it is also important to interrogate the value and methods of humanitarian programming itself.

Program Resilient on Communities. 9/2018. Cagayan Valley Region: Household Preparedness.Abstract
Typhoon Ompong (Mangkhut) has had a major impact on the north of the Philippines damaging in excess of 76,000 homes in Cagayan Province (Region II Cagayan Valley) and completing destroying more than 10,000 homes there. The Philippines government and many national and international non-governmental organizations (NGOs) will be involved in the response. To help tailor the response it is useful to know what the level of preparedness for disaster was in Cagayan Valley Province before the storm hit.
The following statistics, compiled by the Harvard Humanitarian Initiative, were gathered between March and April of 2017.
cagayan_valley_hhi_infographic_.pdf
Program Resilient on Communities. 9/2018. Cordillera Administrative Region: Household Preparedness.Abstract
Typhoon Ompong (Mangkhut) has had a major impact on the north of the Philippines displacing more than 50,000 people in Cordillera Administrative Region (CAR) and resulting in over PhP 14 billion in agriculatural damages (equivalent to approx. USD 270 million). The Philippines government and many national and international non-governmental organizations (NGOs) will be involved in the response. To help tailor the response it is useful to know what the level of preparedness for disaster was in Cordillera Administrative Region before the storm hit. The following statistics, compiled by the Harvard Humanitarian Initiative, were gathered between March and April of 2017.
car_hhi_infographic.pdf
Vincenzo Bollettino, Tilly Alcayna, Krish Enriquez, and Patrick Vinck. 6/2018. Perceptions of Disaster Resilience and Preparedness in the Philippines.Abstract

The Philippines is one of the world’s most disaster-prone countries. Located along the boundary of major tectonic plates and at the center of a typhoon belt, its islands are regularly impacted by floods, typhoons, landslides, earthquakes, volcanoes, and droughts. The Philippines also ranks among the top three countries in the world for population exposure and vulnerability to hazards. The Philippine government has developed strong coping mechanisms over their long history of experience with disasters. Yet, significant gaps remain in disaster management capacities across different regions of the Philippines and surprisingly little data are available referencing local levels of disaster resilience and preparedness.

This research aims to address the gap in knowledge on both local disaster resilience and preparedness by providing a comprehensive overview of household measures of resilience and levels of disaster preparedness. This is the first nationwide household survey on measures of disaster resilience and disaster preparedness carried out in the Philippines. It comes at a time of critical importance as efforts are being made to ensure disaster management is based on evidence, especially at the local level and amid national discussions on centralizing disaster resilience efforts under a single national agency.

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prc-phillippine-report-final_0.pdf
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.

 

global_health_diplomacy_student_ambassador_program.pdf
Phuong Pham, Vandana Sharma, Rebecca Hémono, Jessica Jean-Francois, and Jennifer Scott. 5/2018. DEPP Evaluation Summative Phase Report.Abstract
This report provides the summative results from the three-year external impact evaluation of the Disasters and Emergencies Preparedness Programme (DEPP) conducted by a team at the Harvard Humanitarian Initiative (HHI). The DEPP was a £40 million programme funded by the Department for International Development (DFID) that aimed to strengthen skills and capacity and improve the quality and speed of humanitarian response in countries that are at risk of natural disasters or emergencies.
summative_phase_report_final.pdf
Phuong Pham, Vandana Sharma, Rebecca Hémono, Jessica Jean-Francois, and Jennifer Scott. 5/2018. DEPP Evaluation Summative Phase Report Annexes.Abstract

This report provides the summative results from the three-year external impact evaluation of the Disasters and Emergencies Preparedness Programme (DEPP) conducted by a team at the Harvard Humanitarian Initiative (HHI). The DEPP was a £40 million programme funded by the Department for International Development (DFID) that aimed to strengthen skills and capacity and improve the quality and speed of humanitarian response in countries that are at risk of natural disasters or emergencies.

This document provides the annexes of the report. 

summative_report_annexes_final.pdf
Stuart R. Campo, Caitlin N. Howarth, Nathaniel A. Raymond, and Daniel P. Scarnecchia. 5/2018. Signal Code: Ethical Obligations for Humanitarian Information Activities.Abstract

Humanitarians today lack sufficient ethical guidance adapted to the realities of humanitarianism in the information age to responsibly navigate the challenges and realities of the digital age.

The Signal Code: Ethical Obligations for Humanitarian Information Activities translates and applies the foundational sources of ethical humanitarian practice to humanitarian information activities, such as mobile devices, WiFi provision, data collection, storage and analysis, and biometric registration tools. This document represents the first effort to provide humanitarian practitioners and researchers with comprehensive ethical guidance for this increasingly commonplace and critical area of humanitarian practice.

The Obligations builds upon the rights-based approach first articulated in the January 2017 publication of The Signal Code: A Human Rights Approach to Information during Crisis. The Code seeks to identify extant international humanitarian and human rights law and standards, as well as other relevant and accepted international instruments, that provide all people basic rights pertaining to the access to, and provision and treatment of, information during a crisis. The first volume of the Code is employed as an underlying framework for how the Obligations is structured and from where the obligations are, in part, derived.

For more information please visit https://signalcode.org/obligations/

signal_obligations_final_05.24.2018.pdf
Jocelyn Kelly, Elizabeth Colantuoni, Courtland Robinson, and Michele R Decker. 4/2018. “From the battlefield to the bedroom: a multilevel analysis of the links between political conflict and intimate partner violence in Liberia.” BMJ Global Health, 3, 2. Read PublicationAbstract

Objectives Assess the link between levels of armed conflict and postconflict intimate partner violence (IPV) experienced by women in Liberia.

Methods Armed Conflict Location and Event Data Project data were used to measure conflict-related fatalities in districts in Liberia during the country’s civil war from 1999 to 2003. These data were linked to individual-level data from the 2007 Demographic and Health Survey, including past-year IPV. Multilevel logistic models accounting for the clustering of women within districts evaluated the relationship of conflict fatalities with postconflict past-year IPV. Additional conflict measures, including conflict events and cumulative years of conflict, were assessed.

Results After adjusting for individual-level characteristics correlated with IPV, residence in a conflict fatality-affected district was associated with a 50% increase in risk of IPV (adjusted OR (aOR): 1.55, 95% CI 1.26 to 1.92). Women living in a district that experienced 4–5 cumulative years of conflict were also more likely to experience IPV (aOR 1.88, 95% CI 1.29 to 2.75).

Conclusion Residing in a conflict-affected district even 5 years after conflict was associated with postconflict IPV.

Policy implications Recognising and preventing postconflict IPV violence is important to support long-term recovery in postconflict settings.

Harvard Humanitarian Initiative. 3/2018. HHI Annual Report 2017 .Abstract

The HHI 2017 Annual Report provides a look into the research and educational activities of the Harvard Humanitarian Initiative. 

At a time of deepening challenges nationally, globally, and especially in the humanitarian sector, the Harvard Humanitarian Initiative (HHI) is uniquely positioned to shape the future of humanitarian response, research, and education. The crises of the past year - including protracted conflicts, refugee displacement, and worsening natural disasters - have further underscored the importance of our work, and deepened our commitment to advancing the science and practice of humanitarian response. Our growing team of leading researchers, practitioners, and educators is working with local organizations and international institutions to build the evidence-base within the field, exchange knowledge with tens of thousands of current and future practitioners around the globe, and shape the development of policy at the forefront of humanitarian action.

hhi_annual_report_2017.pdf
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. 
refugee_connectivity_web.mb4_.8-2.pdf
International Committee Red of the Cross and Harvard Humanitarian Initiative. 2/2018. Engaging with People Affected by Armed Conflicts and Other Situations of Violence: Recommendations for Humanitarian Organizations and Donors in the Digital Era.Abstract

ICRC & the Harvard Humanitarian Initiative (HHI) launch a joint discussion paper that provides recommendations for humanitarian organisations and donors in today's digital era.

Based on a review of the relevant literature and interviews with representatives of the humanitarian sector, donors, and community-based organizations, the paper offers an overview of how the humanitarian community currently engages with people affected by armed conflict and violence; a review of the opportunities and challenges for meaningful engagement; and a series of recommendations for both humanitarian organizations and donors.

engaging-with-people-in-armed-conflict-recommendationt.pdf
Phuong Pham and Patrick Vinck. 2/2018. “Human Rights and Mixed Methods.” Chance, 31, 1, Pp. 29-37. Read PublicationAbstract
Research in the field of human rights can have many goals. Among others, it serves to uncover and document evidence of crimes, seeks to tell the stories of victims and survivors, and strives to inform and influence policies and strategies to deal with human rights violations. Most commonly, it is defines as seeking to uncover "the truth" - what happened, to whom, by whom, where, when, how, and how many were effected. 
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.

Elan R Small, Sarah R Burbank, Jeanette M Lorme, Karl Carlson, Timothy B Erickson, and David S Young. 2018. “Apostle Islands National Lakeshore: A Review of Search and Rescue and Emergency Medical Services Operations, 2006-2015.” Wilderness Environ Med, 29, 4, Pp. 463-470.Abstract
INTRODUCTION: Apostle Islands National Lakeshore (APIS) lies at the northern tip of Wisconsin and is home to a network of 21 islands along Lake Superior. The goal of this report is to investigate search and rescue (SAR) and emergency medical services (EMS) trends at APIS in an effort to improve visitor safety and resource allocation. METHODS: This study is a retrospective analysis reviewing APIS SAR reports and annual EMS summary reports from January 1, 2006, to December 31, 2015. Information related to incident type, incident date, individual demographic characteristics and activities, injury/illness type, cost, and contributing factors were recorded and analyzed in frequency tables. RESULTS: From 2006 to 2015, APIS SAR conducted 133 total missions assisting 261 individuals-200 not injured/ill, 57 injured/ill, and 4 fatalities. Median cost per SAR incident involving aircraft totaled $21,695 (range: $2,993-141,849), whereas incidents not involving aircraft had a median cost of $363 (range: $35-8,830). Nonmotorized boating was the most common activity resulting in SAR incidents. All 4 fatalities were attributed to drowning while kayaking or swimming. Cold-related injury/illness accounted for nearly half of all injuries/illnesses (45%) with the most commonly reported contributing factor being high winds. EMS responded to a total of 134 incidents. Trauma and first aid accounted for 43% and 34% of EMS workload, respectively. CONCLUSIONS: Overall, this study highlights the hazards associated with the frigid and rough conditions of Lake Superior. The reported results aim to help APIS personnel more saliently convey risks to visitors and plan appropriately in an effort to decrease the need for future rescues.
Joshua N Goldstein, David M Dudzinski, Timothy B Erickson, and Grace Linder. 2018. “Case 12-2018: A 30-Year-Old Woman with Cardiac Arrest.” N Engl J Med, 378, 16, Pp. 1538-1549.
Robert K Needleman, Isabelle P Neylan, and Timothy B Erickson. 2018. “Environmental and Ecological Effects of Climate Change on Venomous Marine and Amphibious Species in the Wilderness.” Wilderness Environ Med, 29, 3, Pp. 343-356.Abstract
INTRODUCTION: Recent analyses of data show a warming trend in global average air and sea surface ocean temperatures. The atmosphere and ocean have warmed, the amounts of snow and ice have diminished, the sea level has risen, and the concentrations of greenhouse gases have increased. This article will focus on climate change and projected effects on venomous marine and amphibious creatures with the potential impact on human health. METHODS: Retrospective analysis of environmental, ecological, and medical literature with a focus on climate change, toxinology, and future modeling specific to venomous aquatic and amphibious creatures. Species included venomous jellyfish, poisonous fish, crown-of-thorns starfish, sea snakes, and toxic frogs. RESULTS: In several projected scenarios, rising temperatures, weather extremes, and shifts in seasons will increase poisonous population numbers, particularly with certain marine creatures like jellyfish and crown-of-thorns starfish. Habitat expansions by lionfish and sea snakes are projected to occur. These phenomena, along with increases in human populations and coastal development will likely increase human-animal encounters. Other species, particularly amphibious toxic frogs, are declining rapidly due to their sensitivity to any temperature change or subtle alterations in the stability of their environment. If temperatures continue to rise to record levels over the next decades, it is predicted that the populations of these once plentiful and critically important animals to the aquatic ecosystem will decline and their geographic distributions will shrink. CONCLUSION: Review of the literature investigating the effect and forecasts of climate change on venomous marine and amphibious creatures has demonstrated that temperature extremes and changes to climatic norms will likely have a dramatic effect on these toxicological organisms. The effects of climate change on these species through temperature alteration and rising coastal waters will influence each species differently and in turn potentially affect commercial industries, travel, tourism, and human health.

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