Contraception and abortion in times of crisis: results from an online survey of Venezuelan women.

Introduction: In the last decade, Venezuela has experienced a complex humanitarian crisis that has limited access to healthcare. We set out to describe Venezuelan women's experiences accessing sexual and reproductive health services, including abortion, which is heavily restricted by law. Methods: We fielded an online survey in July of 2020 among Venezuelan women recruited through social media advertisements. We conducted descriptive statistical analyses using Excel and STATA SE Version 16.0. Results: We received 851 completed survey responses. Almost all respondents experienced significant hardship in the last year, including inflation (99%), worries about personal safety (86%), power outages (76%), and lack of access to clean water (74%) and medications (74%). Two thirds of respondents used contraception in the last two years, and almost half (44%) of respondents had difficulty accessing contraception during that same time period. About one fifth of respondents reported having had an abortion; of these, 63% used abortion pills, and 72% reported difficulties in the process. Half of those who had an abortion did it on their own, while the other half sought help - either from family members or friends (34%), from providers in the private health sector (14%), or from the Internet (12%). Conclusions: Venezuelan women who responded to our survey describe a harsh context with limited access to sexual and reproductive health services. However, they report relatively high rates of contraceptive use, and abortion seems to be common despite the restrictive legal setting.

Humanitarian crisis on the US-Mexico border: Mental health needs of refugees and asylum seekers.

Families and youth from the Northern Triangle of Central America seeking asylum in the U.S. report substantial trauma exposure and post-traumatic stress symptoms. Sexual and gender minorities of this population especially present unique circumstances and thus challenges and needs. However, with immigration along the southern U.S. border at a 21-year high, health and social resources for refugees and asylum seekers are being strained. Accordingly, the primary aim of this review is to raise awareness about migration-related trauma and the mental health needs among Central American and LGBTQ + refugees and asylum seekers in the U.S.-Mexico border. The authors also discuss practical, clinical, and advocacy implications to improve the mental health of refugees and asylum seekers entering the United States.

Feasibility and Effectiveness of a Preventive Care Program during the Compound Humanitarian Crisis and COVID-19 Pandemic in Venezuela.

Effective preventive care programs are urgently needed during humanitarian crises, as has been especially obvious during the COVID-19 pandemic. A pragmatic trial was designed: hybridized intervention (Diabetes Prevention Program [DPP] + medical nutrition therapy + liquid diet [LD]; LD group) vs. DPP only (DPP group). The participants were adults who were overweight/obese and at high risk of type 2 diabetes mellitus (T2DM). The LD consisted of a "homemade" milk- and fruit-juice-based beverage. Pandemic restrictions delayed the program by nine months, tripled the amount of time required for screening, and reduced the total sample to 60%. Eventually, 127 participants were randomized, and 94/127 participants (74.0%) completed the first phase. Participant dropout was influenced by migration, COVID-19 symptoms, education level, and socioeconomic status. In two months, the LD group lost 2.9 kg (p < 0.001) and the DPP group, 2.2 kg (p < 0.001) (between-group p = 0.170), with improvements in their cardiometabolic risk factors. At this stage, the DPP was shown to be feasible and effective, demonstrating weight loss with the improvement of cardiometabolic risk factors in a primary setting in Venezuela, a middle-income country with a chronic humanitarian crisis, during the COVID-19 pandemic.

Multimorbidity and Disability Among Venezuelan Migrants: A Population-Based Survey in Peru.

The political and economic crisis in Venezuela has originated an unprecedented migration. As of November 2020, 1.04 million Venezuelans have moved to Peru. Understanding their health profile is needed to identify their needs, provide care and secure resources without affecting the healthcare of nationals. We quantified the burden of multimorbidity and disability in the Venezuelan population in Peru. We analyzed the 2018 Survey of Venezuelan Population Living in Peru; population-based with random sampling survey in six cities in Peru. Participants were asked about the presence of 12 chronic conditions (self-reported); this information was grouped into 0, 1 and ≥ 2 conditions (i.e., multimorbidity). Disability was also ascertained with a self-reported questionnaire adapted from the short version of the Washington Group on Disability Statistics. Socioeconomic variables were analyzed as potential determinants. Variables were described with frequencies and 95% confidence interval (95% CI), compared with Chi2 test, and association estimates were derived with a Poisson regression reporting prevalence ratio and 95% CI. Results accounted for the complex survey design. The analysis included 7554 migrants, mean age 31.8 (SD: 10.2), 46.6% were women, 31.7% migrated alone and 5.6% had refugee status. The prevalence of multimorbidity was 0.6% (95% CI 0.4-0.9%), and was often present in women (p < 0.001), people ≥ 50 years (p < 0.001) and those without recent job (p < 0.001). The prevalence of disability was 2.0% (95% CI 1.5-2.7%), and was common among people ≥ 50 years (p < 0.001) and those without recent job (p < 0.001). Migration alone and refugee status were not associated with multimorbidity or disability. The self-reported prevalence of multimorbidity and disability in Venezuelan migrants in Peru was low, and were not strongly influenced by migration status. While these results could suggest a healthy migrant effect, the healthcare system should be prepared to deliver acute and preventive care for these migrants, while also securing primary prevention to delay the onset of chronic conditions in this population.

Research on aging during the Venezuelan humanitarian crisis: the experience of the Maracaibo aging study.

BACKGROUND: Venezuela is in the throes of a complex humanitarian crisis that is one of the worst in decades to impact any country outside of wartime. This case analysis describes the challenges faced by the ongoing Maracaibo Aging Study (MAS) during the deteriorating conditions in Venezuela. When the MAS began in 1997, it focused on memory-related disorders. Since then, strategic planning and proactive community participation allowed us to anticipate and address logistical, funding, and ethical challenges, and facilitated the enrollment and retention of more than 2500 subjects over 55 years of age. All participants, who are residents of the city of Maracaibo, Venezuela, underwent various assessments on several occasions. Here, we discuss how our approach to implementing a longitudinal, population-based study of age-related conditions has allowed our research program to continue throughout this period of political, economic, and social upheaval. DISCUSSION: As the social context in Venezuela became more complicated, new challenges emerged, and strategies to sustain the study and participation were refined. We identified five main mechanisms through which the evolving humanitarian crisis has affected implementation of the MAS: 1) community dynamics; 2) morale of researchers, staff, and participants; 3) financial feasibility; 4) components of the research process; and 5) impact on the health of staff, participants, and their families. Strategies to compensate for the impact on these components were implemented, based on inputs from community members and staff. Improved communication, greater involvement of stakeholders, broadening the scope of the project, and strengthening international collaboration have been the most useful strategies. Particular demands emerged, related to the increased mortality and comorbidities of participants and staff, and deterioration of basic services and safety. CONCLUSION: Although the MAS has faced numerous obstacles, it has been possible to continue a longitudinal research project throughout the humanitarian crisis, because our research team has engaged the community deeply and developed a sense of mutual commitment, and also because our project has provided funding to help keep researchers employed, somewhat attenuating the brain drain.

Invertendo o enfoque das "crises migratórias" para as "migrações de crise": uma revisão conceitual no campo das migrações / From "migration crisis" to "crisis migration": a conceptual review within the migration studies field / De "crisis migratoria" a "migraciones de crisis": una revisión conceptual en el campo de estudios de las migraciones

O presente artigo se propõe a debater um novo conceito no campo de estudos migratórios - as migrações de crise -, o qual traz à luz os processos, motivos e fatores vivenciados por populações afetadas por crises e que podem contribuir para processos migratórios de indivíduos, famílias e comunidades como um todo. Introduzindo diversas categorias correlatas - como a eventualidade, a imobilidade (ou enclausuramento) e a não escolha -, adota-se um direcionamento metodológico e conceitual que aponta para as crises como propulsoras das migrações. Dessa maneira, busca-se tensionar a ideia de que as migrações geram crises aos Estados-nação receptores de movimentos significativos de pessoas - a qual notavelmente se consolida pela disseminação do termo "crise migratória", em especial, nos discursos políticos e midiáticos correntes. A delimitação do novo conceito proposto e da sua metodologia de estudo pautou-se pela revisão bibliográfica da literatura especializada na área, com foco em pesquisas recentes sobre as migrações de crise e suas implicações tanto na esfera local como na internacional. Ao final do texto, levantamos os desafios e as contribuições de tal conceito, envolvendo debates centrais no campo das migrações, inobstante questões teórico-metodológicas

This article aims to debate a new concept within the migration studies field which is named "crisis migration", shedding light on the processes, motives and factors that influence the movement of populations affected by crisis. Introducing other interrelated categories - such as eventuality, immobility and non-choice - , the article is guided by a methodological and conceptual perspective that understands crisis as a driver to migration. Therefore it seeks to defy the idea that migrations generate crisis to nation-states receiving large contingents of people. This idea has been consolidated by the term "migration crisis" especially disseminated in the midia and political discourses. Our discussion of the new concept was based on bibliographic review, focusing on recent researchs in respect to crisis migration and its unfoldings not only in the local but also in the international scenario. Finally, we bring about the challenges as well as the contributions of this concept, which involve unsolved central debates within the migration field.

Este artículo tiene como objetivo discutir un nuevo concepto en el campo de los estudios migratorios, las migraciones de crisis, que saca a la luz los procesos, los motivos y los factores experimentados por las poblaciones afectadas por las crisis y que pueden contribuir a los procesos migratorios de las personas, las familias y comunidades en su conjunto. Al introducir varias categorías relacionadas, como eventualidad, inmovilidad (o confinamiento) y no elección, se adopta una dirección metodológica y conceptual que apunta a las crisis como motores de la migración. De esta manera, buscamos tensionar la idea de que la migración genera crisis en los Estados-nación que reciben movimientos significativos de personas, lo que se consolida notablemente por la difusión del término crisis migratoria, especialmente en los discursos políticos y mediáticos actuales. La delimitación del nuevo concepto propuesto y su metodología de estudio fue guiada por la revisión bibliográfica de la literatura especializada en el área, con un enfoque en investigaciones recientes sobre migraciones de crisis y sus implicaciones tanto a nivel local como internacional. Al final del texto, planteamos los desafíos y las contribuciones de dicho concepto, involucrando debates centrales en el campo de las migraciones, a pesar de los problemas teóricos y metodológicos que aún no se han superado suficientemente dentro de este.

Analysis of the relationship between earthquake-related losses and the frequency of child-directed emotional, physical, and severe physical abuse in Haiti.

BACKGROUND: Child abuse is a public health and human rights issue that is prevalent worldwide. All forms of abuse against children can have negative physical and mental health consequences. Under post-disaster situations, where there is a potential for increased stress and decreased social support among caregivers, the risk of child abuse may be higher. OBJECTIVE: To explore the association between earthquake-related losses (family-related and property-related) and the experience of emotional, physical, and severe physical child abuse in the household for children aged 2-14 in Haiti. METHODS: A nationally representative sample of Haitian households from the 2012 Demographic and Health Survey (DHS) was used. Descriptive analyses were summarized using frequencies and measures of central tendency. Associations between earthquake-related loss and child abuse was assessed using log-binomial regression modelling. RESULTS: Two years following the earthquake, and after considering potentially confounding variables, death of a household member was associated with a higher likelihood of a child being victim to emotional (RR = 1.11, 95 % CI: 1.05-1.17) and severe physical abuse (RR = 1.50, 95 % CI: 1.15-1.96). Conversely, injury of a household member was associated with a lower likelihood of a child experiencing emotional abuse (RR = 0.93, 95 % CI: 0.87-0.99). CONCLUSIONS: There were associations between earthquake-related losses and some forms of child abuse; the results were not consistent across all exposures and outcomes. The high prevalence of reported child abuse indicates a need for interventions to reduce child abuse in homes overall. There is also need for further research into the aetiology and influences specific to different types of abuse.

The devastating Venezuelan crisis.

The Venezuelan crisis is filling the headlines and truly deserves the world's attention. It is a wake-up call to all as it holds relevant lessons for both developing and developed countries. The country suffers a severe humanitarian crisis. Its economy has declined at a faster pace than any other peacetime economy worldwide. Hardship and repression have led millions to flee the country creating a refugee crisis in Colombia and other neighboring countries, and millions more are expected to flee unless conditions improve. It raises serious security concerns in the whole Western Hemisphere. The country of Venezuela sits on and owns the largest oil reserves in the world. Oil helps explain the "rent-seeking" behavior that is at the root of this crisis. ("Rent-seeking" is simply getting money from the government for the oil it sells and giving little or nothing back to the government in return. -EEd) However, oil cannot be blamed for this crisis - it helped Venezuela get out of the poverty trap and become a modern democratic society in the 20th century. This crisis comes from the perverse combination of bad politics, bad policy, and corruption that besieged the country over the last 20 years. Since he was elected in 1998, Hugo Chávez paved the way to authoritarianism while making the economy more vulnerable to the ups and downs of oil prices. Chávez died in early 2013. When Nicolás Maduro, his anointed heir, was elected to succeed him, the economy was in bad shape and institutions were already weak, but problems had been papered over thanks to high oil prices and the money the government made from its sale. When oil prices were high worldwide, Venezuelan governments did not save money for possible future economic losses. When oil prices began falling in 2014 and threatened the money from "rent-seeking" by many Venezuelans, Maduro chose the road to overt authoritarianism instead of seeking to restore the basics of an open society and a prosperous economy: the rule of law, property rights, transparency, prudent fiscal and monetary policy, and essential public goods such as education, health, housing, transportation, and infrastructure. This paper is a brief history of how the present Crisis in Venezuela developed and how it can be reasonably resolved. The Venezuelan people are suffering. There are lessons here for everyone in the world (A Venezuelan and James Ausman).

Conducting a desk review to inform the mental health and psychosocial support response to the 2016 Ecuador earthquake.

Following the 7.8 magnitude earthquake that struck Ecuador on 16 April 2016, multiple salient public health concerns were raised, including the need to provide mental health and psychosocial support for individual survivors and their communities. The World Health Organization and the United Nations High Commissioner for Refugees recommend conducting a desk review to summarize existing information, specific to the affected communities, that will support timely, culturally-attuned assessment and delivery of mental health and psychosocial support shortly after the onset of a disaster or humanitarian emergency. The desk review is one component of a comprehensive toolkit designed to inform and support humanitarian actors and their responders in the field. This commentary provides a case example of the development of a desk review that was used to inform personnel responding to the 2016 earthquake in Ecuador. The desk review process is described in addition to several innovations that were introduced to the process during this iteration. Strengths and limitations are discussed, as well as lessons learned and recommendations for future applications.

Internal displacement in Colombia: Fifteen distinguishing features.

This commentary aims to delineate the distinguishing features of conflict-induced internal displacement in the nation of Colombia, South America. Even as Colombia is currently implementing a spectrum of legal, social, economic, and health programs for "victims of armed conflict," with particular focus on internally displaced persons (IDPs), the dynamics of forced migration on a mass scale within this country are little known beyond national borders.   The authors of this commentary are embarking on a global mental health research program in Bogota, Colombia to define best practices for reaching the displaced population and implementing sustainable, evidence-based screening and intervention for common mental disorders. Presenting the defining characteristics of internal displacement in Colombia provides the context for our work and, more importantly, conveys the compelling and complex nature of this humanitarian crisis. We attempt to demonstrate Colombia's unique position within the global patterning of internal displacement.

Outreach to internally displaced persons in Bogotá, Colombia: challenges and potential solutions.

Programs that provide services for internally displaced persons (IDPs) in Colombia, South America face challenges when attempting to engage and enroll the target population of forced migrants they intend to serve. Innovative multi-strategy outreach approaches must be used in order to effectively seek, recruit, provide services, monitor, and retain IDPs.

Cooperação internacional e deslocamento interno na Colômbia: Desafios à maior crise humanitária da América do Sul / International Cooperation and Internal displacement in Colombia: facing the challenges of the largest humanitarian crisis in South America / Cooperacion internacional y desplazamiento interno en Colombia: Desafíos a la mayor crisis humanitaria de América del Sur

O objetivo deste artigo é compreender a interação entre o Alto Comissariado das Nações Unidas para os Refugiados (ACNUR) e o governo colombiano nos esforços de mitigação do deslocamento interno forçado, bem como os principais desafios enfrentados na abordagem do problema. Este artigo privilegia a leitura adotada pelos atores mencionados acima, a qual vincula o deslocamento ao conflito armado vivenciado pelo país há mais de quarenta anos. Embora se trate de um problema observado há décadas, as formulações políticas nacionais com vistas à sua mitigação surgiram tardiamente, mais precisamente, em meados da década de 1990. Da mesma forma, a atenção do ACNUR ao problema somente foi intensificada em finais dessa mesma década. O artigo conclui que existe uma grande assimetria entre o desenvolvimento normativo de atenção aos deslocados observado na Colômbia e a execução de tais normas. Por exemplo, falta coordenação entre entidades nacionais e sub-nacionais, assim como entre as nacionais e as internacionais. No que diz respeito à prevenção do deslocamento interno e avaliação do impacto das políticas, o desafio é ainda maior, na medida em que são embrionários os esforços neste sentido. Sustenta-se que o ACNUR tem empregado os mesmos critérios que o governo na execução de suas tarefas, quando estes poderiam ser repensados e redefinidos à luz da experiência do Alto Comissariado.

The objective of this article is to understand the interaction between the United Nations High Commissioner for Refugees (UNHCR) and the Colombian government in their attempts to mitigate forced internal displacement, as well as the main challenges faced in addressing this problem. This article focuses on the interpretation adopted by the forementioned actors, who link this displacement to the armed conflict the country that has endured for more than forty years. Although this issue has been discussed for decades, the formulation of national policies intended to mitigate its effects came late, in the mid-1990s. Similarly, the UNHCR began paying more attention only in the late 1990s. The article concludes that there is a significant disparity between the development of norms regarding the internally displaced and the execution of such norms. For example, there needs to be greater coordination between national and local organizations, and national and international organizations. With respect to the prevention of internal displacement and the evaluation of the impact of these policies, the challenge is even greater; as such efforts are in the beginning stages. The UNHCR has used the same criteria as the Colombian government in executing its tasks; these criteria should be rethought and redefined in light of the High Commissioner's experience.

El objetivo de este artículo es comprender la interacción entre el Alto Comisionado de las Naciones Unidas para los Refugiados (ACNUR) y el gobierno colombiano en los esfuerzos para mitigar los efectos del desplazamiento interno forzado. Este artículo privilegia la lectura adoptada por los actores antes mencionados, la cual vincula el desplazamiento al conflicto armado por el que atraviesa el país hace más de cuarenta años. Aunque se trate de un problema observado hace décadas, las formulaciones políticas nacionales con miras a su mitigación surgieron tardíamente, más precisamente, a mediados de la década de 1990. De la misma forma, la atención del ACNUR al problema no se intensificó hasta fines de esa misma década. El artículo concluye que existe una gran asimetría entre el desarrollo normativo de atención a los desplazados observado en Colombia y la ejecución de tales normas. Por ejemplo, falta coordinación entre entidades nacionales y subnacionales, así como también entre las nacionales y las internacionales. En lo que atañe a la prevención del desplazamiento interno y a la evaluación del impacto de las políticas, el desafío es todavía mayor en la medida en que son embrionarios los esfuerzos en este sentido. Se sostiene que el ACNUR ha empleado los mismos criterios que el gobierno en la ejecución de sus tareas, cuando estos podrían ser repensados y redefinidos a la luz de la experiencia del Alto Comisionado.