Conflict

Jocelyn Kelly, Emily Ausubel, Emma Kenny, Meredith Blake, Christine Heckman, Sonia Rastogi, and Vandana Sharma. 9/2021. “Measuring gender-based violence risk mitigation in humanitarian settings: results from a comprehensive desk review and systematic mapping.” BMJ Open. Read PublicationAbstract

Objectives: To systematically document measurement approaches used in the monitoring and evaluation of gender-based violence (GBV) risk mitigation activities, categorise the types of available literature produced by sector, identify existing tools and measures and identify knowledge gaps within the humanitarian sector.

Design: Systematic mapping and in-depth review.

Data sources: Pubmed, Global Health, PsychInfo, ReliefWeb, OpenGrey (grey literature), Google Scholar, Web of Science (Social Science Index)

Eligibility criteria: a structured search strategy was systematically applied to 17 databases as well as registers, websites and other resources to identify materials published between 1 January 2005 and 15 May 2019.

Data extraction and synthesis: Those resources that met the inclusion criteria underwent a comprehensive full-text review. A detailed matrix was developed and key data from each resource were extracted to allow for the assessment of patterns in thematic areas.

Results: A total of 2108 documents were screened. Overall, 145 documents and 112 tools were reviewed, representing 10 different humanitarian sectors. While numerous resources exist, many lack sufficient information on how to monitor outputs or outcomes of GBV risk mitigation activities. There is also limited guidance on how to integrate the measurement of GBV risk mitigation into existing monitoring and evaluation frameworks. Those reports that aimed to measure GBV risk mitigation activities mostly employed qualitative methods and few measured the impact of a GBV risk mitigation with robust research designs.

Conclusions: Recent efforts to adapt humanitarian response to COVID-19 have highlighted new and existing challenges for GBV risk mitigation. There is a significant gap in the evidence base around the effectiveness of GBV risk mitigation across all sectors. Understanding and strengthening measurement approaches in GBV risk mitigation remains a critical task for humanitarian response.

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

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

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

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

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

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

Luissa Vahedi, Jessica Anania, and Jocelyn Kelly. 8/2021. Gender-Based Violence and COVID-19 in Fragile Settings: A Syndemic Model. Read PublicationAbstract
The long-standing pandemic of gender-based violence has been worsened by COVID-19 and related containment measures, particularly in fragile settings marked by conflict, poverty, and weak infrastructure. At the same time, the implementation of gender-insensitive COVID-19 control policies can exacerbate the community transmission of COVID-19. These interactions form a syndemic—two or more pandemics whose interactions compound the severity of each. This report identifies the key avenues through which these two pandemics have synergistic effects and offers recommendations for mitigating their impact.
Sonny S. Patel, Oleksii Sukhovii, Oleksandr Zvinchuk, Julian H. Neylan, and Timothy Erickson. 2021. “Converging Impact of the Ongoing Conflict and COVID-19 Pandemic on Mental Health and Substance Use Disorders in Ukraine.” Journal of Emergency Management. Read PublicationAbstract

Since the Russian annexation of the Autonomous Republic of Crimea and the subsequent occupation of parts of the Donetsk and Luhansk regions, Ukraine has been facing increasing security and healthcare challenges. The seven-year war in East Ukraine has led to a rise in substance and alcohol use and increasing addiction rates among veterans, internally displaced persons, and civilian survivors. This article examines the combined impact of the ongoing Russo–Ukrainian conflict and COVID-19 pandemic on substance use in Ukraine. It also gives an overview of the institutions in place to monitor and improve mental health in the country. The article highlights the urgent need for further funding and research on substance and alcohol addiction, with vulnerable populations affected by the conflict during the COVID-19 pandemic. Frontline healthcare workers in this region should anticipate an increased burden of patients suffering from substance use disorders who are in need of emergency management intervention and proper behavioral health referrals.

Sonny S. Patel, Bernard McCaul, Gabriela Cáceres, Laura E.R. Peters, Ronak Patel, and Aaron Clark-Ginsberg. 4/2021. “Delivering the promise of the Sendai Framework for Disaster Risk Reduction in fragile and conflict-affected contexts (FCAC): A case study of the NGO GOAL's response to the Syria conflict.” Progress in Disaster Science. Read PublicationAbstract

The Sendai Framework for Disaster Risk Reduction (SFDRR) has helped to reduce global disaster risk, but there has been a lack of progress in disaster risk reduction (DRR) for people living in fragile and conflict affected contexts (FCAC). Given the mounting evidence that DRR cannot be implemented through conventional approaches in FCAC, serious efforts must be made to understand how to meet SFDRR's goals. This paper offers a case study of international non-governmental organization GOAL's programming that responds to the protracted crisis in Syria, with a critical discussion on SFDRR and how to adapt humanitarian relief and disaster resilience.

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

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

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

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

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

Amir Khorram-Manesh, Frederick M. Burkle Jr., Phatthranit Phattharapornjaroen, Milad Ahmadi Marzaleh, Mohammed Al Sultan, Matti Mantysaari, Eric Carlström, Krzysztof Goniewicz, Emelia Santamaria, John David Comandante, Robert Dobson, Boris Hreckovski, Glenn-Egil Torgersen, Luc J. Mortelmans, Mirjam de Jong, and Yohan Robinson. 11/2020. “The Development of Swedish Military Healthcare System: Part II-Re-evaluating the Military and Civilian Healthcare Systems in Crises Through a Dialogue and Study Among Practitioners.” Military Medicine.Abstract

Introduction: Historical changes have transformed Sweden from being an offensive to a defensive and collaborative nation with national and international engagement, allowing it to finally achieve the ground for the civilian–military collaboration and the concept of a total defense healthcare. At the same time, with the decreasing number of international and interstate conflicts, and the military’s involvement in national emergencies and humanitarian disaster relief, both the need and the role of the military healthcare system within the civilian society have been challenged. The recent impact of the COVID-19 in the USA and the necessity of military involvement have led health practitioners to anticipate and re-evaluate conditions that might exceed the civilian capacity of their own countries and the need to have collaboration with the military healthcare. This study investigated both these challenges and views from practitioners regarding the benefits of such collaboration and the manner in which it would be initiated.

Material and Method: A primary study was conducted among responsive countries using a questionnaire created using the Nominal Group Technique. Relevant search subjects and keywords were extracted for a systematic review of the literature, according to the PRISMA model.

Results: The 14 countries responding to the questionnaire had either a well-developed military healthcare system or units created in collaboration with the civilian healthcare. The results from the questionnaire and the literature review indicated a need for transfer of military medical knowledge and resources in emergencies to the civilian health components, which in return, facilitated training opportunities for the military staff to maintain their skills and competencies.

Conclusions: As the world witnesses a rapid change in the etiology of disasters and various crises, neither the military nor the civilian healthcare systems can address or manage the outcomes independently. There is an opportunity for both systems to develop future healthcare in collaboration. Rethinking education and training in war and conflict is indisputable. Collaborative educational initiatives in disaster medicine, public health and complex humanitarian emergencies, international humanitarian law, and the Geneva Convention, along with advanced training in competency-based skill sets, should be included in the undergraduate education of health professionals for the benefit of humanity.

Robert I.S. Macpherson and Frederick M. Burkle Jr. 11/2020. “Humanitarian Aid Workers: The Forgotten First Responders.” Prehospital and Disaster Medicine. Read PublicationAbstract

Humanitarian aid workers are an overlooked population within the structure of posttraumatic stress disorder (PTSD) research and assistance. This negligence is an industry-wide failure to address aid workers’ psychological health issues. The suspected numbers of death by suicide, diagnosed PTSD, depression, anxiety disorders, hazardous alcohol and drug consumption, emotional exhaustion, and other stress-related problems are impossible to quantify but are considered endemic. Tools for establishing organizational frameworks for mental health and psychosocial support are readily available. However, the capacity to implement this assistance requires the creation and practice of an open and non-judgmental culture, based on the realistic acceptance that aid work has become inherently dangerous. The possibility of developing a psychological problem because of aid work has increased along with the rise in levels of disease, injury, kidnapping, and assault. As a result, expressions of traumatic stress have become the norm rather than an exception. This commentary outlines the essential steps and components necessary to meet these requirements.

Adrienne Fricke and Rahaf Safi. 3/2021. Window of Hope: Sustaining education of health professionals in northwest Syria.Abstract
This report is based on a comprehensive needs assessment carried out remotely by the HHI team in Syria in 2019. The OSF HESP grant was awarded to a larger project to understand the impact of humanitarian emergencies, including armed conflict, on students enrolled in medical and nursing programs. The goal is to produce a needs assessment toolkit to help support professional health care education programs during conflict. In addition to Syria, where the conflict is ongoing, the project examines Colombia, a recent post-conflict setting, and Rwanda, a developed post-conflict setting.
Frederick M. Burkle Jr. 3/2020. “Opportunities Lost: Political Interference in the Systematic Collection of Population Health Data During and After the 2003 War in Iraq.” Disaster Medicine and Public Health Preparedness.Abstract

The review of the article, “Developing a Public Health Monitoring System in a War-torn Region: A Field Report from Iraqi Kurdistan,” prompted the writing of this commentary. Decisions to implement health data systems within Iraq require exploration of many otherwise undisclosed or unknown historical facts that led to the politicization of and ultimate demise of the pre-2003 Iraq war systematic health data monitoring system designed to mitigate both direct and indirect mortality and morbidity. Absent from the field report’s otherwise accurate history leading up to and following the war is the politically led process by which the original surveillance system planned for the war and its aftermath was destroyed. The successful politicization of the otherwise extensively planned for public health monitoring in 2003 and its legacy harmed any future attempts to implement similar monitoring systems in succeeding wars and conflicts. Warring factions only collect military casualty data. The field report outlines current attempts to begin again in building a systematic health monitoring system emphasizing it is the “only way to manage the complex post-war events that continue to lead to disproportionate preventable mortality and morbidity.”

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.

HPCR. 9/2003. Roundtable Report on Human Rights and Rule of Law: Constitutional and Legal Reform.Abstract

The opportunities for engaging the Afghan public in the process of constitution building and legal reform are quickly disappearing. Decades of war have left the legal system, and its legal culture, in ruins. The project of constitutional and legal reform will be central to the success of reconstruction efforts. For the first time, Afghan legal professionals, civil society leaders, and other groups have the chance to engage in the rebuilding of their country’s legal foundations: both to stabilize a still-insecure country, and to transform their society in more long-lasting ways. However, as the Constitutional Loya Jirga approaches, many key questions regarding the nature of the new Afghan legal order remain, and many Afghans are beginning to feel that they have been left out of the process. The Afghan Independent Human Rights Commission (AIHRC) is in an ideal position to engage civil society groups and legal professionals in wider debate about the protection and integration of human rights standards in the new legal system. Its mandate includes the harmonization of international human rights standards with national law, and perhaps more importantly, the Commission enjoys access to a nation-wide constituency of individuals and groups who support the central government and the modernization of Afghan law. This roundtable report, which presents topics and analysis from a roundtable co-hosted by AIHRC and the Program on Humanitarian Policy and Conflict Research (HPCR) at Harvard University and entitled Human Rights and Rule of Law: Constitutional and Legal Reform, attempts to capture the outcomes of one such effort at engagement and discussion. This Roundtable was one of the first such meetings in Kabul to engage a broad representation of civil society leaders, legal professionals, and Loya Jirga delegates from provinces outside Kabul. In total, there were about forty participants, with half of the group from Kabul and half from other cities and towns. The Roundtable was led by members of the AIHRC, with attendance and participation by members of the Judicial Reform Commission. A series of background papers in Dari was drafted by HPCR (in close consultation with members of the AIHRC) prior to the Roundtable, and made available to the participants along with a copy of President Hamid Karzai’s most recent decree on the Constitutional Loya Jirga and a paper on legal reform in Afghanistan.

International Humanitarian Law Research Initiative. 5/2004. Rules of IHL Applicable to the Conduct of Military Operations in Urban Areas.Abstract

Urban warfare constitutes one of the most serious threats to the security and integrity of civilians in times of war. It represents, consequently, one of the most challenging areas of International Humanitarian Law (IHL) in practice. This note reviews the rules of IHL applicable to the conduct of hostilities in urban environments, and identifies key legal provisions desgned to enhance the protection of civilians in these areas.

HPCR. 5/2002. Securing Communities for Reconstruction in Afghanistan: Final Report of the Conflict Prevention Initiative E-Conference.Abstract

For two weeks in April and May 2002, the Conflict Prevention Initiative (CPI) of the Harvard Program on Humanitarian Policy and Conflict Research (HPCR) hosted the first ever international e-conference on “Securing Communities for Reconstruction in Afghanistan,” attracting over 90 participants. The majority of the participants were Afghan NGO and civil society leaders working in Pakistan and Afghanistan. Others included representatives of various inter-governmental organizations, INGOs, academic institutions and donor governments. This report summarizes the principal themes of the discussion and concludes with a series of recommendations for various actors involved in the process of reconstruction in Afghanistan. These recommendations include both those specifically formulated by participants as well as those drawn more generally from the conference discussion. In addition, actual quotes from the participants are interspersed throughout the report in shaded boxes to suggest the richness and depth of the discussion. The e-conference was preceded by conversations with NGO leaders in Kabul, as well as roundtables with Afghan civil society leaders in Peshawar, Pakistan and Mashad and Zahedan, Iran. The roundtables were designed both to produce substantive inputs for the e-conference as well as to gather perspectives from those who may not have regular internet access. In this way, both the roundtables and the e-conference were designed to engage participants from their separate localities and yet still connect them with broader discussions and analysis. 

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