Risk, Resilience, and Response

Sylvia Kehlenbrink, James Smith, Eimhin Ansbro, Daniela C Fuhr, Anson Cheung, and Ruwan Ratnayake. 8/1/2019. “The burden of diabetes and use of diabetes care in humanitarian crises in low-income and middle-income countries.” The Lancet, 7, 8, Pp. 638-647.Abstract
Human suffering as a result of natural disasters or conflict includes death and disability from non-communicable diseases, including diabetes, which have largely been neglected in humanitarian crises. The objectives of this Series paper were to examine the evidence on the burden of diabetes, use of health services, and access to care for people with diabetes among populations affected by humanitarian crises in low-income and middle-income countries, and to identify research gaps for future studies. We reviewed the scientific literature on this topic published between 1992 and 2018. The results emphasise that the burden of diabetes in humanitarian settings is not being captured, clinical guidance is insufficient, and diabetes is not being adequately addressed. Crisis-affected populations with diabetes face enormous constraints accessing care, mainly because of high medical costs. Further research is needed to characterise the epidemiology of diabetes in humanitarian settings and to develop simplified, cost-effective models of care to improve the delivery of diabetes care during humanitarian crises.
Philippa Boulle, Sylvia Kehlenbrink, James Smith, David Beran, and Kiran Jobanputra. 3/13/2019. “Challenges associated with providing diabetes care in humanitarian settings.” The Lancet, 7, 8, Pp. 648-656. Publisher's VersionAbstract
The humanitarian health landscape is gradually changing, partly as a result of the shift in global epidemiological trends and the rise of non-communicable diseases, including diabetes. Humanitarian actors are progressively incorporating care for diabetes into emergency medical response, but challenges abound. This Series paper discusses contemporary practical challenges associated with diabetes care in humanitarian contexts in low-income and middle-income countries, using the six building blocks of health systems described by WHO (information and research, service delivery, health workforce, medical products and technologies, governance, and financing) as a framework. Challenges include the scarcity of evidence on the management of diabetes and clinical guidelines adapted to humanitarian contexts; unavailability of core indicators for surveillance and monitoring systems; and restricted access to the medicines and diagnostics necessary for adequate clinical care. Policy and system frameworks do not routinely include diabetes and little funding is allocated for diabetes care in humanitarian crises. Humanitarian organisations are increasingly gaining experience delivering diabetes care, and interagency collaboration to coordinate, improve data collection, and analyse available programmes is in progress. However, the needs around all six WHO health system building blocks are immense, and much work needs to be done to improve diabetes care for crisis-affected populations.
Sylvia Kehlenbrink and Lindsay M Jaacks. 6/6/2019. “Diabetes in humanitarian crises: the Boston Declaration.” The Lancet, 7, 8. Publisher's VersionAbstract
Nearly three out of every four deaths worldwide in 2017 were caused by non-communicable diseases (NCDs). Many countries have made progress reducing risk factors for NCDs such as tobacco use, hyperlipidaemia, and hypertension, but no countries have successfully reversed the increasing trends in diabetes prevalence and mortality from diabetes. This situation represents a massive global health failure, since type 2 diabetes is largely preventable with lifestyle modification and cost-effective treatments exist for both type 2 and type 1 diabetes.  Type 1 diabetes is of particular concern, since it is fatal in the absence of insulin treatment.
Patrick Vinck, Phuong Pham, Eric Stover, Andrew Moss, and Marieke Wierda. 2007. Research Note on Attitudes About Peace and Justice in Northern Uganda.Abstract

In light of human rights violations in Northern Uganda, this research note presents preliminary data on Ugandans’ attitudes on peace and justice. The findings reflect the respondents’ desires for truth reconciliation as well as their desires to hold perpetuators of violence accountable for their actions. However, the findings show that justice is not a top priority for Ugandans in comparison to more tangible needs for health, peace, money, and education. A majority of Ugandans in the North are open to the reintegration of former LRA members in society, albeit conditionally on diminished social and political rights for past LRA leaders.

Laurel E. Fletcher, Phuong Pham, Eric Stover, and Patrick Vinck. 6/2006. Rebuilding After Katrina: A Population-Based Study of Labor and Human Rights in New Orleans.Abstract

In August 2005, Hurricane Katrina swept through New Orleans and the surrounding communities, inflicting massive destruction and displacing hundreds of thousands. In the wake of the disaster, the U.S. Department of Homeland Security lifted minimum wage restrictions, thus creating an environment ripe for exploitation of both documented and undocumented workers by their employers. This study presents the experiences of laborers in the construction industry following Hurricane Katrina, and makes recommendations for how federal, state, and local authorities may protect Gulf Coast laborers against exploitation and unfair treatment.

Phuong Pham, Patrick Vinck, Nehal Bhuta, and Nida Alahmad. 5/2004. Iraqi Voices: Attitudes Toward Transitional Justice and Social Reconstruction.Abstract

In attempt to move beyond a past marked by conflict, terror, and violence, Iraq has many hurdles to overcome in achieving social reconstruction and transitional justice. This study reflects the views of Iraqis regarding past human rights abuses, justice and accountability, truth-seeking and remembrance, amnesty, reparations, and reconciliation. Using this data, the study makes recommendations on how Iraq may address the needs and wants of its citizens for fairness, accountability, and justice, while simultaneously prioritizing a peaceful future.

Phuong Pham, Patrick Vinck, Marieke Wierda, Eric Stover, and Adrian di Giovanni. 7/2005. Forgotten Voices: A Population-Based Survey on Attitudes About Peace and Justice in Northern Uganda.Abstract

After two decades of armed conflict waged by the Lord’s Resistance Army (LRA) in Northern Uganda, Ugandans and the international community remain divided on how to effectively pursue and obtain peace and justice. This study presents Ugandans’ exposures to violence, the needs and concerns of displaced peoples, and opinions on specific transitional justice mechanisms as the country moves forward. Additionally, the study proposes that controversies over interventions in the region may be resolved by the local and international adoption of a comprehensive strategy that aims to achieve both peace and justice.

Phuong Pham, Patrick Vinck, Eric Stover, Andrew Moss, Marieke Wierda, and Richard Bailey. 12/2007. When the War Ends: A Population-Based Survey on Attitudes about Peace, Justice, and Social Reconstruction in Northern Uganda.Abstract

Ravaged by 21 years of war and destruction, Northern Uganda faces serious obstacles in achieving reconciliation and accountability for violations of human rights and international humanitarian law. While security in the region has improved since the migration of the Lord’s Resistance Army to the Congo, Ugandans continue to struggle with the aftereffects of an era of violence. This study relays Ugandans’ views on peace, mechanisms for justice, and reintegration, and consequently recommends that the Ugandan government and international community act in concert to develop a strategy for peace-building, justice, socioeconomic development, and poverty reduction in the North.

Ronak B. Patel and Thomas F. Burke. 8/2009. “Urbanization - An Emerging Humanitarian Disaster.” The New England Journal of Medicine, 361, 8, Pp. 741-743.Abstract

This paper describes the current rates of urbanization and the developing health consequences framed as a humanitarian crisis. The authors go on to analyze the current state of knowledge and policy on urban health. They lay out the priorities for future research and work and the role for academics, governments and international agencies to prevent the impending deterioration in global health due to rapid urbanization.

Phuong Pham, Patrick Vinck, Mychelle Balthazard, Sokhom Hean, and Eric Stover. 1/2009. So We Will Never Forget: A Population-Based Survey on Attitudes About Social Reconstruction and the Extraordinary Chambers in the Courts of Cambodia.Abstract

30 years after the end of the Khmer Rouge Regime in Cambodia, citizens of the country continue to see themselves as victims of the regime and desire some form of reparations. Nonetheless, citizens wish that the country prioritize problems that Cambodians face in their everyday lives rather than concentrate on punishing crimes committed by the Khmer Rouge. This study presents the views and experiences of Cambodians regarding exposure to violence, overall priorities, and the national criminal justice system. Additionally, the study reveals that citizens desire more knowledge of the regime, feel hatred toward the Khmer Rouge, and demand accountability. Furthermore, the study calls for changes in the structure and governance of the Extraordinary Chambers of the Courts of Cambodia (ECCC) so that Cambodians’ faith in their criminal justice system may be restored.

Physicians Human for Rights and Harvard Humanitarian Initiative. 5/2009. Nowhere to Turn: Failure to Protect, Support and Assure Justice for Darfuri Women.Abstract

Nowhere to Turn is a report documenting the scope and long-term impact of rape and other sexual violence experienced by women who fled attacks on their villages in Darfur and are now refugees in neighboring Chad. The report is based on a scientific study, conducted in partnership with Physicians for Human Rights, of women's accounts of rape and other crimes against humanity that they have experienced in Darfur, as well as rape and deprivations of basic needs in refugee camps in Chad.

Patrick Vinck, Phuong Pham, Suliman Baldo, and Rachel Shigekane. 8/2008. Living With Fear: A Population-Based Survey on Attitudes About Peace, Justice, and Social Reconstruction in Eastern Democratic Republic of Congo.Abstract

After years of armed conflict, instability, and human rights violations, in 2006 the Democratic Republic of Congo (DRC) held its first elections since independence. Despite this success, eastern DRC grapples with major challenges in achieving security, social reconstruction, and transitional justice. This study presents the needs and priorities of the Congolese population in light of prevailing social and political instability, and recommends that the Congolese government and international community take steps to monitor and implement peace negotiations, security, and good governance as the country moves forward.

Harvard Humanitarian Initiative. 8/2009. Characterizing Sexual Violence in the Democratic Republic of the Congo: Profiles of Violence, Community Responses, and Implications for the Protection of Women.Abstract

This report uses both quantitative and qualitative methods to explore sexual violence in the Democratic Republic of Congo.  Results from this report show the sexual violence perpetrated by armed actors in the DRC has features that indicate rape is being used as a weapon of war. The violence in DRC embodies a new kind of war emerging in the 21st century - one that occurs in villages more than battlefields and affects more civilians than armed combatants.

More reciprocal, cohesive local collaborations needed for disaster risk reduction in the Philippines

Massachusetts, USA — For the Philippine disaster risk reduction (DRR) system to further strengthen and be sustainable, local humanitarian actors need to conduct more cohesive and reciprocal collaborations with each other, researchers from the Harvard Humanitarian Initiative (HHI) have recommended based on their recent study.

“Local organizations are best placed to prepare for and respond disasters. Our research suggests that international aid agencies continue to play a large role in the network of Philippines disaster agencies, pointing to the need to build greater ties...

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