Publications

2017
Jocelyn Kelly, Katherine Albutt, Justin Kabanga, Kimberley Anderson, and Michael VanRooyen. 12/2017. “Rejection, acceptance and the spectrum between: understanding male attitudes and experiences towards conflict-related sexual violence in eastern Democratic Republic of Congo.” BMC Women's Health, 17. Read PublicationAbstract
Female survivors of sexual violence in conflict experience not only physical and psychological sequelae from the event itself, but often many negative social outcomes, such as rejection and ostracisation from their families and community. Male relatives – whether husbands, fathers, brothers – play a key role in determining how the family and community respond to a survivor of sexual violence. Understanding these perspectives could help improve services for survivors of sexual violence, as well as their families and communities.
Ronak B. Patel and Kelsey Gleason. 10/2017. “The association between social cohesion and community resilience in two urban slums of Port au Prince, Haiti.” International Journal of Disaster Risk Reduction. Read PublicationAbstract
Multiple recent global agendas have advanced the case for resilience to underpin humanitarian action and disaster risk reduction. These agendas have been incorporated into multiple efforts but evidence to guide action has lagged behind. This study examines a specific link, often cited through qualitative research, between social cohesion and community resilience in two urban slums of Port au Prince, Haiti. Scales to measure social cohesion and resilience are applied to these communities to develop a quantitative measure of these two characteristics. These two characteristics are then analyzed with various other demographic variables of community members to quantitatively explore associations among them. The results show that a higher social cohesion score is statistically associated with a higher resilience score and among the variables tested, social cohesion had the greatest impact on the community resilience as measured by these scales. and shows a statistical association between the two. The findings add to the growing but nascent literature on empirical evidence for resilience characteristics. Further examinations are drawn out of the findings and future investigations should tackle the inductively derived characteristics of resilience to further guide programs and policy.
10/2017. “Crisis Code: Humanitarian Protection in the Digital Age”. Watch VideoAbstract
Crisis Code: Humanitarian Protection in the Digital Age. Panel 1: Humanitarian Threats in the Age of Cyberwar, part of our #SwissTouch events at swissnex San Francisco.
Ronak B. Patel, Jami King, Laura Phelps, and David Sanderson. 10/2017. “Discussion Informed by Recurrent Lessons from a Systematic Review on Targeting Practices in Urban Humanitarian Crises.” PLOS Currents: Disasters. Read PublicationAbstract

Introduction: Urbanization has challenged many humanitarian practices given the complexity of cities. Urban humanitarian crises have similarly made identifying vulnerable populations difficult. As humanitarians respond to cities with chronic deficiencies in basic needs stressed by a crisis, identifying and prioritizing the most in need populations with finite resources is critical.

Methods: The full systematic review applied standard systematic review methodology that was described in detail, peer-reviewed, and published before the research was conducted.

Results: While the science of humanitarian practice is still developing, a systematic review of targeting vulnerable populations in urban humanitarian crises shed some light on the evidence base to guide policy and practice. This systematic review, referenced and available online, led to further findings that did not meet the pre-defined inclusion and exclusion criteria for evidence set out in the full review but that the authors, in their expert opinion, believe provide valuable insight nonetheless given their recurrence.

Vincenzo Bollettino, Patrick Vinck, Tilly Alcayna, and Philip Dy. 9/2017. “Introduction to Socio-Ecological Resilience.” Oxford Research Encyclopedia of Natural Hazard Science. Read PublicationAbstract

In recent years, the notion of resilience has grown into an important concept for both scholars and practitioners working on disasters. This evolution reflects a growing interest from diverse disciplines in a holistic understanding of complex systems, including how societies interact with their environment. This new lens offers an opportunity to focus on communities’ ability to prepare for and adapt to the challenges posed by natural hazards, and the mechanism they have developed to cope and adapt to threats. This is important because repeated stresses and shocks still cause serious damages to communities across the world, despite efforts to better prepare for disasters.

Scholars from a variety of disciplines have developed resilience frameworks both to guide macro-level policy decisions about where to invest in preparedness and to measure which systems perform best in limiting losses from disasters and ensuring rapid recovery. Yet there are competing conceptions of what resilience encompasses and how best to measure it. While there is a significant amount of scholarship produced on resilience, the lack of a shared understanding of its conceptual boundaries and means of measurement make it difficult to demonstrate the results or impact of resilience programs.

If resilience is to emerge as a concept capable of aiding decision-makers in identifying socio-geographical areas of vulnerability and improving preparedness, then scholars and practitioners need to adopt a common lexicon on the different elements of the concept and harmonize understandings of the relationships amongst them and means of measuring them. This article reviews the origins and evolution of resilience as an interdisciplinary, conceptual umbrella term for efforts by different disciplines to tackle complex problems arising from more frequent natural disasters. It concludes that resilience is a useful concept for bridging different academic disciplines focused on this complex problem set, while acknowledging that specific measures of resilience will differ as different units and levels of analysis are employed to measure disparate research questions.

Caitlin Howarth. 9/2017. “A Rights-based Approach to Information in Humanitarian Assistance.” PLOS Currents: Disasters. Read PublicationAbstract
Crisis-affected populations and humanitarian aid providers are both becoming increasingly reliant on information and communications technology (ICTs) for finding and provisioning aid. This is exposing critical, unaddressed gaps in the legal and ethical frameworks that traditionally defined and governed the professional conduct of humanitarian action. The most acute of these gaps is a lack of clarity about what human rights people have regarding information in disaster, and the corresponding obligations incumbent upon governments and aid providers.  This need is lent urgency by emerging evidence demonstrating that the use of these technologies in crisis response may be, in some cases, causing harm to the very populations they intend to serve.  Preventing and mitigating these harms, while also working to responsibly ensure access to the benefits of information during crises, requires a rights-based framework to guide humanitarian operations. In this brief report, we provide a commentary that accompanies our report, the Signal Code: A Human Rights Approach to Information During Crisis, where we have identified five rights pertaining to the use of information and data during crisis which are grounded in current international human rights and customary law. It is our belief that the continued relevance of the humanitarian project, as it grows increasingly dependent on the use of data and ICTs, urgently requires a discussion of these rights and corresponding obligations.
Summer Marion and Michael R. Snyder. 8/2017. “Book Review: The Power Behind Global Health .” International Peace Institute Global Observatory. Read PublicationAbstract
Doctoral student Summer Marion recently published “The Power Behind Global Health,” a review of Chelsea Clinton and Devi Sridhar’s recent book, Governing Global Health: Who Runs the World, and Why? The review was co-authored with Michael R. Snyder, a research analyst at Johns Hopkins Bloomberg School of Public Health, and published by the International Peace Institute’s Global Observatory. In their book, Clinton and Sridhar profile the inner workings of four of the biggest players in global heath, including two traditional institutions -- the World Health Organization (WHO) and the World Bank – and their younger cousins, known as public-private partnerships (PPPs) – the Global Fund to Fight Aids, Tuberculosis, and Malaria; and Gavi, the Vaccine Alliance. Marion and Snyder analyze the book’s empirical contributions to the field of global health governance, examining disruption and innovation brought about by the rise of PPPs. Additionally, the review highlights the close relationships among PPPs, global health reform, and recent shifts toward earmarked and philanthropic funding. Finally, the book review evaluates Clinton and Sridhar’s contributions to principal-agent theory, a commonly used framework in studies of multilateral aid, and potential for elaboration in future research.
Kristin Bergtora Sandvik and Nathaniel A. Raymond. 5/2017. “Beyond the Protective Effect: Towards a Theory of Harm for Information Communication Technologies in Mass Atrocity Response.” Genocide Studies and Prevention: An International Journal, 11, 1, Pp. 9-24. Read PublicationAbstract
Information Communication Technologies (ICTs) are now being employed as a standard part of mass atrocity response, evidence collection, and research by non-governmental organizations, governments, and the private sector. Deployment of these tools and techniques occur for a variety of stated reasons, most notably the ostensible goal of “protecting” vulnerable populations. However, these often experimental applications of ICTs and digital data are occurring in the absence of agreed normative frameworks and accepted theory to guide their ethical and responsible use. This article surveys the current state-of-the-art of ICT use in mass atrocity response and research to identify harms and hazards inherent in the use of ICT-centric approaches in mass atrocity producing environments. The article proposes an initial theory of harm for evaluating the potential risks and impacts of these applications as a critical component of developing ethical standards for the responsible use of ICTs in the mass atrocity response context.
Katherine Albutt, Jocelyn Kelly, Justin Kabanga, and Michael VanRooyen. 4/2017. “Stigmatisation and rejection of survivors of sexual violence in eastern Democratic Republic of the Congo.” Disasters, 41, 2, Pp. 211-227. Read PublicationAbstract
Studies report that between 6 per cent and 29 per cent of survivors of sexual violence in eastern Democratic Republic of the Congo (DRC) are rejected by their families and communities. This research project was designed to provide insights into survivors' experiences of stigmatisation and rejection. Surveys were conducted with 310 women as they sought psychosocial services in eastern DRC. In total, 44.3 per cent of women reported suffering rejection after sexual violence. The majority of women felt that their status in the household (58.0 per cent) and community (54.9 per cent) diminished after rape. The odds of rejection were greater among women reporting ongoing displacement, pregnancy owing to sexual violence, worsening family relations, and diminished community status. This work highlights the extremely high levels of loss associated with the war in eastern DRC, particularly among survivors of sexual violence. The rejection of a survivor of rape has concrete and devastating psychosocial consequences.
Faine Greenwood, Caitlin Howarth, Danielle Escudero Poole, Nathaniel A. Raymond, and Daniel P. Scarnecchia. 1/2017. The Signal Code: A Human Rights Approach to Information During Crisis.Abstract

 

The Signal Code is the result of a six month study by the Signal Program on Human Security and Technology at the Harvard Humanitarian Initiative (HHI) at the Harvard T.H. Chan School of Public Health to identify what human rights people have to information during disasters. The Signal Code identifies five rights from multiple sources of international human rights and humanitarian law and standards that already exist and apply to humanitarian information activities (HIAs). 

These five rights are the following: 1. The Right to Information; 2. The Right to Protection; 3. The Right to Privacy and Security; 4. The Right to Data Agency; and 5. The Right to Rectification and Redress. The goal of the Signal Code is to provide a foundation for the future development of ethical obligations for humanitarian actors and minimum technical standards for the safe, ethical, and responsible conduct of HIAs before, during, and after disasters strike.

Visit the Signal Code Minisite

 

signalcode_final.pdf
Ronak B. Patel, Jami King, Laura Phelps, and David Sanderson. 1/2017. What Practices Are Used to Identify and Prioritize Vulnerable Populations Affected by Urban Humanitarian Emergencies?. Humanitarian Evidence Programme. Read PublicationAbstract

Individuals and organizations responding to humanitarian crises recognize the need to improve urban emergency response and preparedness – including the need to devise better methods for assessing vulnerability within urban populations. 

This systematic review represents the first ever attempt to systematically search, sort and synthesize the existing evidence in order to consolidate findings on the tools, methods and metrics used to identify and prioritize vulnerable people, households and communities, including those displaced within and to urban areas. It is accompanied by a stand-alone executive summary and evidence brief. It forms part of a series of humanitarian evidence syntheses and systematic reviews commissioned by the Humanitarian Evidence Programme

Ronak B. Patel and Leah Nosal. 1/2017. Defining the Resilient City. United Nations University Centre for Policy Research. Read PublicationAbstract
This background note is part of the United Nations University project on Resilience and the Fragile City and is meant to complement the paper ‘Conceptualizing City Fragility and Resilience’ (de Boer, Muggah, Patel 2016) which formally presents the fragile and resilient cities assessment framework. As resilience has become a more prominent and pervasive concept, this paper explores its application for urban environments in contexts of fragility (i.e. urban zones characterized by complex crises that often involve high levels of violence, extreme poverty, and disaster simultaneously) (see de Boer 2015). The paper reviews dozens of resilience frameworks and highlights a number of important findings: 1) the majority of existing resilience frameworks are useful for assessing resilience to natural disasters, yet few are effective in understanding resilience in contexts of fragility; and (2) many existing frameworks have yet to be empirically tested and largely rest on a Theory of Change. This means that very few indicators have been independently derived based on empirical data of what works. To fill these gaps, the paper concludes by proposing an approach to assessing resilience in contexts of urban fragility, which is then fully developed in the framework paper mentioned above.
Timothy B Erickson and Navneet Cheema. 2017. “Arthropod Envenomation in North America.” Emerg Med Clin North Am, 35, 2, Pp. 355-375.Abstract
Arthropods (phylum Arthopoda) account for a higher percentage of morbidity and mortality to humans than do mammalian bites, snake bites, or marine envenomation. They are ubiquitous in domestic dwellings, caves, and campsites and in wilderness settings such as deserts, forests, and lakes. Although arthropods are most intrusive during warmer months, many are active throughout the winter, particularly indoors. Arthropods are also nocturnal and often bite unsuspecting victims while they are sleeping. Encounters with humans are generally defensive, accidental, or reactive. An individual stung by an insect or bitten by an arachnid may experience pain and local swelling, an anaphylactic reaction, or life-threatening toxicity. This review discusses the clinical presentation and latest treatment recommendations for bites and stings from spiders, scorpions, bees, ants, ticks and centipedes of North America.
Frederick M Burkle, Timothy B Erickson, Johan von Schreeb, Anthony D Redmond, Stephanie Kayden, and Michael VanRooyen. 2017. “A declaration to the UN on wars in the Middle East.” Lancet, 389, 10070, Pp. 699-700.
Peter R Chai, Stephanie Carreiro, Megan L Ranney, Ketki Karanam, Marko Ahtisaari, Robert Edwards, Kristin L Schreiber, Lubabah Ben-Ghaly, Timothy B Erickson, and Edward W Boyer. 2017. “Music as an Adjunct to Opioid-Based Analgesia.” J Med Toxicol, 13, 3, Pp. 249-254.Abstract
Epidemic increases in opioid use in the USA and globally highlight the need for effective adjunctive therapies to opioid-based analgesia. Given the shortcomings of behavioral adjuncts to opioid-based pain treatment, an urgent need exists for pain-related behavioral interventions that resonate with broad patient populations, can be delivered confidentially in any environment, and can incorporate new content automatically. Understanding the potential for automated behavioral therapies like music therapy in modulating the experience of pain may unlock methods to transition patients to lower doses of pharmacologic therapy or provide alternatives to opioids during acute exacerbations of pain. This manuscript describes the neurologic mechanism of action, theoretical basis, and potential applications of personalized music as a smartphone-based mHealth intervention for acute and chronic pain management.
Frederick M Burkle, Timothy Erickson, Johan von Schreeb, Stephanie Kayden, Anthony Redmond, Emily Yy Chan, Francesco Della Corte, Hilarie Cranmer, Yasuhiro Otomo, Kirsten Johnson, and Nobhojit Roy. 2017. “The Solidarity and Health Neutrality of Physicians in War & Peace.” PLoS Curr, 9.Abstract
The wars in the Middle East have led to unprecedented threats and attacks on patients, healthcare workers, and purposeful targeting of hospitals and medical facilities. It is crucial that every healthcare provider, both civilian and military, on either side of the conflict become aware of the unique and inherent protections afforded to them under International Humanitarian Law. However, these protections come with obligations. Whereas Governments must guarantee these protections, when violated, medical providers have equal duty and obligations under the Law to ensure that they will neither commit nor assist in these violations nor take part in any act of hostility. Healthcare providers must not allow any inhuman or degrading treatment of which they are aware and must report such actions to the appropriate authorities. Failure to do so leads to risks of moral, ethical and legal consequences as well as penalties for their actions and inactions. There must be immediate recognition by all parties of the neutrality of health care workers and their rights and responsibilities to care for any sick and injured patient, regardless of their nationality, race, religion, or political point of view.
2016
Ziad Al Achkar and Nathaniel Raymond. 11/2016. Data preparedness: connecting data, decision making and humanitarian response .Abstract

Signal Program Standards and Ethics Series - Issue 1

Data are a central component of humanitarian response. Frequently, however, there is a disconnect between data, decision-making and response. Informed decisions need to be made in the first hours and days of an emergency, and if the elements to effectively gather, manage and analyse data are not in place before a crisis, then the evidence needed to inform response will not be available quickly enough to matter. What's more, a lack of readiness to use data can even cause "big data disasters".

Organizations need to be prepared to responsibly and effectively deploy and manage data collection and analysis tools, techniques, skilled staff and strategies in a specific operational context to be ready before a disaster strikes. This process is called “data preparedness”. The concept of data preparedness complements and expands on existing OCHA principles on the use of information management in disaster scenarios. This paper, which was reviewed by OCHA and other UN organizations, seeks to provide a blueprint for how the concept of data preparedness may be put into practice by members of the humanitarian data ecosystem. It is the first issue in the Signal Program's ongoing "Standards and Ethics" white paper series.

data_preparedness_update.pdf
Federica du Pasquier. 11/2016. Gender Diversity Dynamics in Humanitarian Negotiations: The International Committee of the Red Cross as a Case Study on the Frontlines of Armed Conflicts.Abstract
Negotiations for access are crucial for the success of humanitarian operations. They also occur in contexts of armed conflict and violence that typically entrench gender identities. Building on the vast research showing that gender affects the conduct and outcome of negotiations, this paper explores gender dynamics in a humanitarian setting. After outlining its methodology and surveying the relevant literature, this paper sketches out the ways 21 practitioners at the International Committee of the Red Cross see gender dynamics affecting their work in the field. These interviews support previous findings on men and women’s diverging conceptions of gender’s impact and relevance, as well as on the cross-cultural consistency of gender dynamics in war. In a context where, unlike in many corporate settings, women’s work as humanitarian actors is congruent with prescriptive gender stereotypes, this study shows that they can be perceived as more legitimate because they are thought of as selfless caregivers and potential mothers. This paper ultimately argues that, rather than studying the impact of gender in isolation, further research should explore how the intersectionality of different diversity dimensions—such as gender, race/ethnicity, age, and religion—affect humanitarian negotiations. In terms of policy implications, this study makes the case for actively fostering diversity, including in terms of gender, within negotiating teams to ensure they are more flexible in adapting to different scenarios and more creative in dealing with complex problems.
atha_gender_diversity_dynamics_in_humanitarian_negotiations.pdf
10/2016. “Declaration from Academic Humanitarian Training Centers on Syria”.Abstract
Given the current humanitarian crisis in Syria where patients, healthcare workers, and hospitals are under attack, we the undersigned, without presumption of authority or judgment, stand in solidarity with our healthcare colleagues and declare their right to international health neutrality. For many decades, we have provided global healthcare professionals with education and training in humanitarian assistance in sudden onset disasters and conflicts worldwide. In this training and education, each and every healthcare provider, both civilian and military, is made aware of the inherent protections provided to them under international humanitarian law (IHL), including the four Geneva Conventions of 1949, as well as the principles and rules of IHL applicable to the conduct of hostilities, including the targeting of hospitals and medical facilities. These must be upheld. 
un_declaration_letter_final.pdf
Ronak B. Patel, John de Boer, and Robert Muggah. 10/2016. Conceptualizing City Fragility and Resilience. United Nations University Centre for Policy Research. Read PublicationAbstract
This paper introduces a preliminary analytical framework that re-conceptualizes fragility and resilience at the city level. It aligns the two concepts across a range of political, social, economic and environmental factors enabling comparison across thousands of cities globally based on existing data. The framework was then partially applied to map out fragility in over 2,100 cities. It finds that roughly 14 percent of the sample score in the highly fragile range. Another 66 percent report average levels of fragility while 16 percent report low fragility.4 Of course, fragility and resilience are both dynamic and change over time. The paper finds that all cities are fragile to some degree, though intensity varies in relation to the aggregation of risk.

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