Funding emergency response.

Protracted humanitarian emergencies are forcing donors and agencies to rethink their approaches to response. Gary Humphreys reports.

Supporting Migrant Children in Pediatric Settings: Lessons Learned from the US Migrant Humanitarian Crisis Response.

This article examines the influx of migrants to the United States and highlights current global and local immigration trends. The authors focus on migrant children-specifically the effect of migration trauma in the context of humanitarian responses to the intentional movement of migrants to Democrat-led cities across the US to humanize the compounded effects of migration trauma, restrictive immigration policies, and the current resettlement landscape for migrants. The authors are directly involved with supporting migrant arrivals who have relocated to Chicago from the southern border, and apply field knowledge to articulate current barriers to accessing health care and best practices within pediatric settings supporting migrant arrivals. Clinical and practice implications for medical providers in pediatric settings are included. The article also highlights the role of interdisciplinary collaboration in providing health care to asylum-seeking migrants and implications for transdisciplinary workforce development in this area. [Pediatr Ann. 2024;53(5):e171-e177.].

Rescue medical activities among sea migrants and refugees in the Mediterranean region: lessons to be learned from the 2014-2020 period.

BACKGROUND: Since 2014, the number of migrants and refugees crossing the Mediterranean towards Europe has risen significantly due to various reasons. Both state agencies and non-governmental organizations (NGOs) have launched rescue missions in the Central Mediterranean in accordance with international legal obligations for search and rescue (SAR) operations for those under distress at sea. Our aim is to summarise the specific qualifications needed for maritime SAR in the Mediterranean both in terms of the population at risk, the equipment and the medical support required, especially during the coronavirus disease 2019 (COVID-19) pandemic and the operational legal framework. MATERIALS AND METHODS: This article aims to summarise the key points of SAR efforts from a medical perspective as depicted in the relevant literature during a specific timeline period (2014-2020) in a specific part of the Mediterranean Sea (Central Mediterranean route). Only papers published in English and whose full text was available were included in this study. The inclusion criteria were: a) articles referring to sea rescue operations between 2014 and 2020, b) research that focused on medical preparedness and assistance during rescue operations in the Central Mediterranean route, c) studies concerning demographic and clinical features of the rescue population, d) guidelines on the rule of conduct of persons and states participating in rescue activities. The exclusion criteria were: a) studies describing SAR operations in different regions of the world and b) studies focusing on routes, demographics and medical support of migrants/refugees on land. RESULTS: Three major themes were identified: a) characteristics of the population in distress at sea: country of origin, age groups, presence of communicable and non-communicable diseases were identified in the relevant literature. Our research shows that dermatological and respiratory issues were the major concerns among sea migrants, coming from different countries of both Africa and Asia, being relatively young and mostly males; b) medical preparedness and equipment needed for rescue: according to current guidelines, revised during the COVID-19 pandemic, infrastructure needed during SAR operations includes both equipment for resuscitation, personal protective equipment, deck adjustments, medical personnel trained to function in an austere setting and able to handle vulnerable patient groups such as children and pregnant women; c) medico-legal implications of SAR operations: knowledge of the legal framework encompassing SAR operations seems necessary, as European Union and state led initiatives seem to withdraw from proactive SAR, while criminalising NGO led rescue efforts. Operating with the imperative to save lives seems to be the only way of respecting international law and human values, thus, a summary of what the law dictates was made in an effort to keep medical workers participating in such operations updated. CONCLUSIONS: Investigation aims to shed light on the special clinical features of sea migrants, the skills, equipment and organizational structure needed by medical workers participating in SAR operations as well as the legal framework under which they will be asked to operate. Special consideration will be given to the difficulties that emerged due to the COVD-19 pandemic.

A blockchain-enabled framework for sharing logistics resources during emergency operations.

This study presents conceptual research designed to assess how the sharing economy concept can be leveraged to increase the participation of commercial organisations, such as retailers and transporters, in disaster relief operations. Drawing on social exchange theory, the academic literature on the sharing economy and blockchain, as well as existing resource-sharing practices in commercial and humanitarian logistics, the study develops a theoretical framework for analysing the structure, benefits, and prerequisites of a logistics-sharing system in emergency response. In addition, it proposes to utilise the blockchain distributed ledger technology-a shared data platform that enables authenticated communication and the widespread sharing of real-time information-to facilitate interactions and enhance trust between emergency responders and commercial organisations. It is argued that using commercial logistics resources, including emergency supplies, transport capacity, and storage space, has the potential to improve the mobilisation and deployment of urgently needed relief items and augment the flexibility of emergency response.

Key issues for participatory research in the design and implementation of humanitarian assistance: a scoping review.

BACKGROUND: Participatory approaches that engage affected populations are increasingly applied in humanitarian health programs in concert with emerging accountability frameworks and the rapid growth of research in these settings. Participatory initiatives within this domain appear to be largely adopted at an operational level and are infrequently reported as a component of research efforts. Yet the evidence of the benefits of research involving community members is growing worldwide. This is the first review of participatory research (PR) in humanitarian settings. OBJECTIVES: This study sought to understand the extent to which PR values and practices have been adopted in humanitarian health programs and to explore key issues in applying PR in this context. METHODS: This scoping review was based on the approach developed by Arksey and O'Malley. The search for relevant peer-reviewed articles included scientific databases, a humanitarian database, targeted journals and online resources published since 2009. Eleven articles were retrieved and reviewed to identify practices and key issues related to conducting PR in humanitarian settings. RESULTS: Four key themes were identified: building trust with local research stakeholders and participants; the importance of contextual understanding; implications of collaborating with affected populations in PR, and neutrality of researchers and Non-Governmental Organizations (NGOs). Study teams considered PR as a valued approach where there was mistrust or a need for contextualized understanding. The studies described how adaptations made during the study optimized collaboration with affected populations and how the presence of NGOs influenced the approach and results of PR. CONCLUSIONS: One of the most important contributions of humanitarian health programs is to develop 'medical practices that are better adapted to the living conditions and priorities of patients who are generally ignored'. Participatory approaches, such as PR, support the development of health-related practices that are more relevant and sustainable for affected populations.

Iranian's healthcare system challenges during natural disasters: the qualitative case study of Kermanshah earthquake.

BACKGROUND: In order to the significance of lessons learned from the natural disasters for health care systems particularly in developing and under-developed countries, the main purpose of this study was to identify challenges and limitations in light of the earthquake experience in Kermanshah Province. METHODS: The present study was conducted in 2019 as a qualitative research using content analysis method. In this regard, 19 key informants were selected using snowball sampling. To enhance the accuracy of the study, the four validation criteria for qualitative studies in data coding developed by Guba and Lincoln including credibility, transferability, dependability and confirmability were used. Data was analyzed applying Graneheim and Lundman (2004) approach for analyzing the qualitative content of an interview text. RESULTS: Analysis of the data led to the identification of 2 main themes, 5 sub- themes and 17 main categories. The first main theme was health system oriented challenges containing challenges of medication supply and preparation, structural challenges, challenges in crisis-scene management and challenges of service delivery and the second main theme was non-health system oriented challenges including social and psychosocial challenges. CONCLUSION: According to the results, along with health system oriented challenges with the inter-sectoral or intra-sectoral nature, the non-health system oriented challenges the same as social, cultural and psychological factors can be considered as the major challenges of Iran's healthcare system in the face of crises. This complicated context can shed the light to policy makers that not only attention to the medicine and medical equipment supply chain, manpower preparation and service delivery system can be considered as an emergency, but also careful attention to the structural challenges and crisis-scene management should be planned and considered as a priority. Besides, the policy makers and the local managers should try to plan and act in a contingent situation according to the social and cultural characteristics of the region and the psychological condition and the mental needs of the people.

Quantifying the relationship between predisaster mitigation spending and major disaster declarations for US states and territories.

Since the Stafford Act of 1988, the process of obtaining a formal Major Disaster Declaration has been codified for national implementation, with tasks defined at the smallest levels of local government up to the President. The Disas-ter Mitigation Act of 2000 (DMA 2000) placed additional requirements on local government to plan for mitigation ac-tivities within their jurisdictions. The goal of DMA 2000 was to not only implement more mitigative actions at the local level, but also initiate a process by which local governments could set up ongoing conversations and collaborative efforts with neighboring jurisdictions to ensure continuous, proactive measures were taken against the impacts of disasters. Based on the increased attention paid to mitigation and planning activities, a reasonable expectation would be to see a decline in the number of major disaster declarations since DMA 2000. However, simple correlation analy-sis shows that since DMA 2000, the number of major disaster declarations continues to increase. This article is in-tended as a preliminary study to encourage more detailed analysis in the future of the impacts of federal policy on local-level disaster prevention.

Cancer in Syrian refugees in Jordan and Lebanon between 2015 and 2017.

Protracted conflicts in the Middle East have led to successive waves of refugees crossing borders. Chronic, non-communicable diseases are now recognised as diseases that need to be addressed in such crises. Cancer, in particular, with its costly, multidisciplinary care, poses considerable financial and ethical challenges for policy makers. In 2014 and with funding from the United Nations High Commissioner for Refugees, we reported on cancer cases among Iraqi refugees in Jordan (2010-12) and Syria (2009-11). In this Policy Review, we provide data on 733 refugees referred to the United Nations High Commissioner for Refugees in Lebanon (2015-17) and Jordan (2016-17), analysed by cancer type, demographic risk factors, treatment coverage status, and cost. Results show the need for increased funding and evidence-based standard operating procedures across countries to ensure that patients have equitable access to care. We recommend a holistic response to humanitarian crises that includes education, screening, treatment, and palliative care for refugees and nationals and prioritises breast cancer and childhood cancers.

Return migration after the Fukushima Daiichi nuclear disaster: the impact of institutional and individual factors.

This paper explores two groups of factors, individual and institutional, that have influenced return migration since the Fukushima Daiichi nuclear accident in Japan on 11 March 2011. Based on an analysis of statistical data on evacuees, a questionnaire completed by 289 people who migrated, and 19 semi-structured interviews with disaster-affected people, the research found (apropos of institutional factors) that while the lifting of the government's evacuation order has had no immediate effect on return decisions, the termination of monetary compensation and housing subsidies has had a significant bearing on them. As for individual factors, a strong sense of attachment to home and the possession of property, job obligations, and having family members in the home location are key determinants of return decisions. Moreover, the paper suggests that there could be differing opinions among Japanese government officials and evacuees regarding radiation exposure risk and the degree to which infrastructure and social services have been rehabilitated.

Returning to normalcy in the short term: a preliminary examination of recovery from Hurricane Harvey among individuals with home damage.

This study focuses on coastal counties in Texas, United States, affected by Hurricane Harvey in 2017 to gauge the influence of individual and contextual characteristics on people's ability to return to normalcy in the short term. Data from a survey conducted by the Kaiser Family Foundation and the Episcopal Health Foundation between October and November 2017 were utilised in the analysis. The paper observes, based on the results of an ordered logistic regression, and contrary to previous work, that age, gender, levels of poverty, and social capital are not significant predictors of a return to normalcy. However, indicators such as whether a person evacuated, if he/she identified as Hispanic/Latino, the extent of damage sustained to one's home, and if one's automobile was damaged or destroyed are shown to affect recovery. A discussion of the potential reasons for these findings is provided as a means of informing future research on disaster recovery.

Equity in aid allocation and distribution: A qualitative study of key stakeholders in Northern Uganda.

The Sustainable Development Goals have spurred a growing interest in and focus on equitable development. In theory, donors can play an important role in promoting equity within a country by providing services, influencing government policies and incorporating equity into decision-making. However, we know little about whether this actually happens on the ground. We conduct what we believe is the first study to explore the extent to which equity is prioritised in the allocation and distribution of aid, based on in-depth interviews with government officials, bilateral and international donors, and implementing partners operating in Northern Uganda. We find that a broad category of people are perceived to be marginalised/vulnerable, with a substantial segment largely untargeted by major donor programmes. Various stakeholders employ a wide range of strategies to identify the most vulnerable individuals and groups, including the use of available data and statistics, consultation and engagement with relevant stakeholders, and undertaking primary data collection. The strategies used to incorporate equity in aid allocation and distribution include: targeting the regions of Northern Uganda and Karamoja in particular, targeting both refugees and host populations in refugee-hosting districts, prioritising the critically vulnerable in any aid distribution process, and using specific tools and consultants to ensure that major equity issues are addressed in proposals. Challenges undermining the process include poor understanding of the concept of equity among some implementing partners, lack of comprehensively disaggregated data, corruption, and political interference in choice of aid location from government officials and donors.