Funding emergency response.

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

Sexual and reproductive health implementation research in humanitarian contexts: a scoping review.

BACKGROUND: Meeting the health needs of crisis-affected populations is a growing challenge, with 339 million people globally in need of humanitarian assistance in 2023. Given one in four people living in humanitarian contexts are women and girls of reproductive age, sexual and reproductive health care is considered as essential health service and minimum standard for humanitarian response. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on appropriate methods and analytical frameworks is limited. METHODS: A scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Peer-reviewed papers published from 2013 to 2022 were identified through relevant systematic reviews and a literature search of Pubmed, Embase, PsycInfo, CINAHL and Global Health databases. Papers that presented primary quantitative or qualitative data pertaining to a sexual and reproductive health intervention in a humanitarian setting were included. RESULTS: Seven thousand thirty-six unique records were screened for inclusion, and 69 papers met inclusion criteria. Of these, six papers explicitly described the use of an implementation research framework, three citing use of the Consolidated Framework for Implementation Research. Three additional papers referenced other types of frameworks used in their evaluation. Factors cited across all included studies as helping the intervention in their presence or hindering in their absence were synthesized into the following Consolidated Framework for Implementation Research domains: Characteristics of Systems, Outer Setting, Inner Setting, Characteristics of Individuals, Intervention Characteristics, and Process. CONCLUSION: This review found a wide range of methodologies and only six of 69 studies using an implementation research framework, highlighting an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization. Three hundred thirty-nine million people globally were in need of humanitarian assistance in 2023, and meeting the health needs of crisis-affected populations is a growing challenge. One in four people living in humanitarian contexts are women and girls of reproductive age, and provision of sexual and reproductive health care is considered to be essential within a humanitarian response. Implementation research can help to better understand how real-world contexts affect health improvement efforts. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on how best to do so is limited. This scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Of 69 papers that met inclusion criteria for the review, six of them explicitly described the use of an implementation research framework. Three used the Consolidated Framework for Implementation Research, a theory-based framework that can guide implementation research. Three additional papers referenced other types of frameworks used in their evaluation. This review summarizes how factors relevant to different aspects of implementation within the included papers could have been organized using the Consolidated Framework for Implementation Research. The findings from this review highlight an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization.

The dynamic space of aid relations in protracted internal displacement: the case of Sri Lanka's northern Muslims.

Aid relations in protracted displacement comprise a diversity of actors with different influence and involvement over time. Building on the case of Sri Lanka's northern Muslim's expulsion from the north of the country in 1990, this paper investigates the dynamic space of aid relations in their drawn-out internal displacement. The study draws on 38 key informant interviews and 10 focus-group discussions, conducted in Sri Lanka (Jaffna, Mannar, Puttalam, and Colombo) in 2022. The paper contributes new knowledge of the local dynamics of assistance in protracted displacement, by analysing the roles of a wide set of actors within this dynamic space of aid relations over time. The analysis incorporates angles and voices often overlooked in mainstream humanitarian studies, including internally displaced persons, hosts, and Middle Eastern aid funders. The study argues that a long-term perspective and a variety of voices provide foundations for more productive engagement with localisation in humanitarian action in protracted displacement crises.

Motivations, activities, timing, and employee engagement: three approaches to business involvement in disasters.

The alarming rise in occurrences of disasters, along with the positive development of corporate social responsibility (CSR), has led to the growing need for and involvement of businesses in disaster relief. However, this involvement differs greatly across organisations, and the fragmented research that exists has not offered an understanding of these differences and how they affect disaster relief. This study provides a comprehensive model of companies' involvement in disaster relief by integrating two disaster relief frameworks (activities and timing) into two CSR frameworks (motivation and employee engagement). The result is the MATE Model of four inextricably linked dimensions (motivation, activities, timing, and employee engagement), examined in a qualitative study with 57 interviewees across 34 organisations in Australia. The resulting Corporate Involvement in Disasters Model details the four MATE dimensions and categorises three approaches to corporate involvement in disaster relief: reactive, relational, and comprehensive. This model details a roadmap for effective business involvement in disaster relief.

Delivering health interventions to women, children, and adolescents in conflict settings: what have we learned from ten country case studies?

Armed conflict disproportionately affects the morbidity, mortality, and wellbeing of women, newborns, children, and adolescents. Our study presents insights from a collection of ten country case studies aiming to assess the provision of sexual, reproductive, maternal, newborn, child, and adolescent health and nutrition interventions in ten conflict-affected settings in Afghanistan, Colombia, Democratic Republic of the Congo, Mali, Nigeria, Pakistan, Somalia, South Sudan, Syria, and Yemen. We found that despite large variations in contexts and decision making processes, antenatal care, basic emergency obstetric and newborn care, comprehensive emergency obstetric and newborn care, immunisation, treatment of common childhood illnesses, infant and young child feeding, and malnutrition treatment and screening were prioritised in these ten conflict settings. Many lifesaving women's and children's health (WCH) services, including the majority of reproductive, newborn, and adolescent health services, are not reported as being delivered in the ten conflict settings, and interventions to address stillbirths are absent. International donors remain the primary drivers of influencing the what, where, and how of implementing WCH interventions. Interpretation of WCH outcomes in conflict settings are particularly context-dependent given the myriad of complex factors that constitute conflict and their interactions. Moreover, the comprehensiveness and quality of data remain limited in conflict settings. The dynamic nature of modern conflict and the expanding role of non-state armed groups in large geographic areas pose new challenges to delivering WCH services. However, the humanitarian system is creative and pluralistic and has developed some novel solutions to bring lifesaving WCH services closer to populations using new modes of delivery. These solutions, when rigorously evaluated, can represent concrete response to current implementation challenges to modern armed conflicts.

Delivering health and nutrition interventions for women and children in different conflict contexts: a framework for decision making on what, when, and how.

Existing global guidance for addressing women's and children's health and nutrition in humanitarian crises is not sufficiently contextualised for conflict settings specifically, reflecting the still-limited evidence that is available from such settings. As a preliminary step towards filling this guidance gap, we propose a conflict-specific framework that aims to guide decision makers focused on the health and nutrition of women and children affected by conflict to prioritise interventions that would address the major causes of mortality and morbidity among women and children in their particular settings and that could also be feasibly delivered in those settings. Assessing local needs, identifying relevant interventions from among those already recommended for humanitarian settings or universally, and assessing the contextual feasibility of delivery for each candidate intervention are key steps in the framework. We illustratively apply the proposed decision making framework to show what a framework-guided selection of priority interventions might look like in three hypothetical conflict contexts that differ in terms of levels of insecurity and patterns of population displacement. In doing so, we aim to catalyse further iteration and eventual field-testing of such a decision making framework by local, national, and international organisations and agencies involved in the humanitarian health response for women and children affected by conflict.

Coordinating non-established disaster relief groups: a case study of Hurricane Irma in Florida, United States.

This study examines the role of non-established relief groups (NERGs) and their involvement in the response to Hurricane Irma after it struck the state of Florida, United States, in September 2017. Its principal goal is to discover more about the engagement of NERGs in disaster response, as well as their motivations and their coordination with other emergency management agencies. The findings of a review of after-action reports and the outcomes of interviews with NERGs and other established organisations suggest that these groups often work with previously established networks. Many of the emergent type of NERGs have not worked with any established organisations prior to a disaster; frequently, therefore, they reach out to other emergent groups to acquire information and coordinate relief efforts. Given that emergent actors tend to lack a strict hierarchical structure for decision-making and coordination, there is a need to enhance communication between NERGs and established response bodies.

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.

Evaluator perceptions of NGO performance in disasters: meeting multiple institutional demands in humanitarian aid projects.

Providing aid in times of increasing humanitarian need, limited budgets, and mounting security risks is challenging. This paper explores in what organisational circumstances evaluators judge, positively and negatively, the performance of international non-governmental organisations (INGOs) in response to disasters triggered by natural hazards. It assesses whether and how, as perceived by expert evaluators, CARE and Oxfam successfully met multiple institutional requirements concerning beneficiary needs and organisational demands. It utilises the Competing Values Framework to analyse evaluator statements about project performance and organisational control and flexibility issues, using seven CARE and four Oxfam evaluation reports from 2005-11. The reports are compared using fuzzy-set Qualitative Comparative Analysis. The resulting configurations show that positive evaluations of an INGO's internal and external flexibility relate to satisfying beneficiary needs and organisational demands, whereas negative evaluations of external flexibility pertain to not meeting beneficiary needs and negative statements about internal control concerning not fulfilling organisational demands.

Gap or prehistoric monster? A history of the humanitarian-development nexus at UNICEF.

Why has bridging the humanitarian-development divide been such a long-running endeavour, and why have so many frameworks to do so been proposed and picked apart over the years? Rather than contributing yet another 'mind the gap' approach, this paper seeks to articulate why such a lacuna emerged in the first place, and to explore how to exit a debate that has grown increasingly circular. To provide one possible answer to the questions above, the paper draws on the history of UNICEF (United Nations Children's Fund) in working across the 'humanitarian-development' nexus. Suggesting that the gap is more artefact than fact, derived from the institutionalisation of aid, the paper argues that focusing on the challenges and the concepts that inherently transcend humanitarian-development silos may enhance understanding of what it means-and what is needed-to operate at the intersection of humanitarian and development action on behalf of children.

Purpose-driven improvisation during organisational shocks: case narrative of three critical organisations and Typhoon Haiyan.

Disasters often produce elements of shock that may render pre-established plans for action limited or otherwise inapplicable to the current situation. Improvisation is considered to be a common response among organisations that operate in such turbulent environments. Despite the prevalence of such plans for action, existing research is reticent with regard to the processes concerning how improvisation relates to pre-established organisational goals. This study explores how improvisation can be employed by organisations to attain specific objectives, amidst the emergent nature of the initiative. Using case study narratives of three small organisations that were critical to the response after Typhoon Haiyan struck Leyte, Philippines, in November 2013, the paper demonstrates that improvisation can be absorbed as a conscious mechanism that can aid the attainment of pre-established goals. Furthermore, it conceptualises the buffering effect of improvisation to elucidate the process via which it purposefully directs an organisation to preserve and fulfil its aims.

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.

Low-dose surgical prophylaxis: Optimization of use of World Federation of Hemophilia Humanitarian Aid donated clotting factor concentrates to developing countries.

BACKGROUND: Patients with hemophilia (PWH) might need surgical interventions during the course of their lives. Such medical interventions pose hemostatic challenges and requests infusion of clotting factor concentrates (CFCs) during peri and postoperative for variable periods to prevent bleeding and until complete wound healing. Access to CFCs to PWH living in resource limited settings is usually a challenge which makes surgical interventions either risky or not practical. Recently World Federation of Hemophilia (WFH) started a humanitarian aid program to channel CFCs into resource limited countries and which allowed the possibility to perform surgical interventions for PWH in these countries. AIM OF WORK: To study safety and efficacy of using lower doses of CFCs for surgical prophylaxis. METHODS: Review of literature and our center experience to demonstrate safety and efficacy of low dose surgical prophylaxis using CFCs RESULTS: Several elements can help using lower doses of CFCs for surgical prophylaxis in resource limited setting. These elements include severity of hemophilia, type of surgical procedure, the use of hemostatic surgical techniques, the type of CFCs, the mode of infusion of CFCs and finally the use of adjunctive therapies CONCLUSION: Management of surgical procedures for PWH in a multidisciplinary specialized hemophilia treatment centers with proper understanding of hemostatic and surgical challenges of the procedure can allow for safe and effective use of lower doses of CFCs for surgical prophylaxis.

Caring for Critically Ill Patients in Humanitarian Settings.

Critical care medicine is far from the first medical field to come to mind when humanitarian action is mentioned, yet both critical care and humanitarian action share a fundamental purpose to save the lives and ease the suffering of people caught in acute crises. Critically ill children and adults will be present regardless of resource limitations and irrespective of geography, regional or cultural contexts, insecurity, or socioeconomic status, and they may be even more prevalent in a humanitarian crisis. Critical care is not limited to the walls of a hospital, and all hospitals will have critically ill patients regardless of designating a specific ward an ICU. Regular and consistent consideration of critical care principles in humanitarian settings provides crucial guidance to intensivists and nonintensivists alike. A multidisciplinary, systematic approach to patient care that encourages critical thinking, checklists that encourage communication among team members, and context-specific critical care rapid response teams are examples of critical care constructs that can provide high-quality critical care in all environments. Promoting critical care principles conveys the message that critical care is an integral part of health care and should be accessible to all, no matter the setting. These principles can be effectively adopted in humanitarian settings by normalizing them to everyday clinical practice. Equally, core humanitarian principles-dignity, accountability, impartiality, neutrality-can be applied to critical care. Applying principles of critical care in a context-specific manner and applying humanitarian principles to critical care can improve the quality of patient care and transcend barriers to resource limitations.

Challenges and barriers of humanitarian aid management in 2017 Kermanshah earthquake: a qualitative study.

BACKGROUND: Examining various problems after disasters is important for the affected people. Managing humanitarian aid and donations among the affected people is considered as one of the most important problems after disasters. Therefore, the present study aimed to evaluate the challenges and barriers of humanitarian aid management in 2017 Kermanshah Earthquake. METHODS: This study was conducted from November 2017 to January 2018, with qualitative case study design. The population included 21 people including 6 humanitarian aid manager, 6 volunteers, 4 aid workers, and 5 affected people. The data were collected through semi-structured interviews and purposeful sampling, which continued until saturating the data. The strategies recommended by Guba were used for evaluating the trustworthiness of the data. The data was analyzed with conventional content analysis method according to method suggested by Graneheim and Lundman. RESULTS: Based on the results, two themes, nine categories, and 19 sub-categories were identified considering the challenges and barriers of humanitarian aid and donors' management during the 2017 Kermanshah Earthquake. The categories included education, command and coordination, communication and information, rules, security, traffic and overcrowding, assessment, providing system, and cultural setting. Also, two themes including managerial and structural barriers were extracted. CONCLUSION: Adopting an effective management and appropriate policies with respect to humanitarian aid and modifying structural and managerial barriers can improve the performance and management of humanitarian aid.

Hygiene programming during outbreaks: a qualitative case study of the humanitarian response during the Ebola outbreak in Liberia.

BACKGROUND: Hygiene promotion is a cornerstone of humanitarian response during infectious disease outbreaks. Despite this, we know little about how humanitarian organisations design, deliver or monitor hygiene programmes, or about what works to change hygiene behaviours in outbreak settings. This study describes humanitarian perspectives on changing behaviours in crises, through a case study of hygiene promotion during the 2014-2016 Liberian Ebola outbreak. Our aim was to aid better understanding of decision making in high-stress situations where there is little precedent or evidence, and to prompt reflection within the sector around how to improve and support this. METHODS: We conducted in-depth, semi-structured interviews with fourteen purposively-sampled individuals (key informants) from international organisations involved in hygiene behaviour change during the outbreak. Through thematic analysis we identified the decisions that were made and processes that were followed to design, deliver and monitor interventions. We compared our findings with theory-driven processes used to design behaviour change interventions in non-outbreak situations. RESULTS: Humanitarians predominantly focussed on providing hygiene products (e.g. buckets, soap, gloves) and delivering messages through posters, radio and community meetings. They faced challenges in defining which hygiene behaviours to promote. Assessments focused on understanding infrastructural needs, but omitted systematic assessments of hygiene behaviours or their determinants. Humanitarians assumed that fear and disease awareness would be the most powerful motivators for behaviour change. They thought that behaviour change techniques used in non-emergency settings were too 'experimental', and were beyond the skillset of most humanitarian actors. Monitoring focussed on inputs and outputs rather than behavioural impact. CONCLUSIONS: The experiences of humanitarians allowed us to identify areas that could be strengthened when designing hygiene programmes in future outbreaks. Specifically, we identified a need for rapid research methods to explore behavioural determinants; increased skills training for frontline staff, and increased operational research to explore behaviour change strategies that are suited to outbreak situations.

The impact of the Gulf crisis on Qatar's humanitarian sector.

The 2017 Gulf crisis is one of the most challenging episodes faced by Qatar since its independence in 1971, with major economic, social, and political impacts on the Arab Gulf nation. Its economic prognosis has been brought into doubt, the map of regional alliances has been redrawn, and any prospects of deeper regional integration have been dashed. This paper analyses the little-documented impact of the crisis on Qatar's humanitarian sector, which has unfolded as the small, gas-rich emirate has striven to become a major humanitarian donor. It concludes that while there have been disruptions to humanitarian operations and regional coordination, the Gulf crisis has triggered and in some cases accelerated already intended reforms across the Qatari humanitarian sector. In the long term, the reorganisation and adaptation implemented to weather the storm of the crisis may help Qatar to emerge from the crisis with a more sustainable and resilient humanitarian sector.

Putting affected people at the centre of humanitarian action: an argument for the principle of humanitarian subsidiarity.

The humanitarian system has grown organically over the course of a generation to become a complex system bound by a common primary mandate. Its guiding principles provide it with a unique identity and separate humanitarian actors from other aid-related stakeholders. However, all of the evidence suggests that humanitarian actors will extend their reach and engage in new and unprecedented ways with an expanded mandate in years to come. Now, more than ever, they are challenged to retain the moral high ground and to put disaster-affected people at the centre of humanitarian action. Consequently, this paper proposes that the humanitarian system introduce a new principle: humanitarian subsidiarity. It moves the conception of subsidiarity beyond meanings ascribed by the Catholic Church and the European Union and links it instead to the attributes of agency, accountability, and trust to find accommodation with the core humanitarian principles of humanity, impartiality, neutrality, and independence.