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.

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.

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.

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.

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.

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.

VII Jornada quirúrgica de labio y paladar hendido: Residencia Nacional de Cirugía Plástica, Reconstructiva y Estética, Santo Domingo, Republica Dominicana / VII Surgical operative for cleft lip and palate: National Plastic Surgery Residency, Santo Domingo, Dominican Republic

El labio y paladar hendido es la malformación craneofacial más frecuente; una problemática nacional e internacional muy conocida, pero tratada por pocos. Dadas las recientes experiencias negativas de la COVID-19, el Departamento de Cirugía Plástica del Hospital Dr. Salvador Bienvenido Gautier de Santo Domingo (República Dominicana), quiso concederle a la sociedad algo positivo devolviendo sonrisas. Nuestra jornada pretendió, mediante procedimientos quirúrgicos, restaurar la alegría y esperanza a nuestra población, afectada grandemente por esta pandemia. La VII Jornada Quirúrgica de Labio y Paladar Hendido se realizó del 5 al 8 de noviembre del 2020 con participación multidisciplinaria que incluyó: cirujanos plásticos, pediatras, anestesiólogos, enfermería, equipo de coordinadores y organizadores, el equipo de gerencia del Hospital Dr. Salvador B. Gautier, Ministerio de Salud, Servicio Nacional de Salud, Sociedad Dominicana de Cirugía Plástica, Reconstructiva y Estética y Colegio Médico Dominicano. Contamos con 5 cirujanos plásticos invitados desde México, 1 cirujano plástico invitado nacional, 14 médicos ayudantes del Departamento de Cirugía Plástica y Reconstructiva y 12 residentes de la Residencia Nacional de Cirugía Plástica, Reconstructiva y Estética. Se evaluaron 53 pacientes y fueron operados 37, predominando la patología de labio y paladar hendido con 15 pacientes, labio hendido con 13 pacientes y paladar hendido con 9 pacientes

Cleft lip and palate is the most common craniofacial deformity, representing an international and national problematic well known, but treated by few surgeons. Due to recent negative experiences due to COVID-19, the Plastic Surgery medical staff of the Dr. Salvador Bienvenido Gautier in Santo Domingo (Dominican Republic), made it its task to return hope and positivity by returning smiles. Our main duty was to restore happiness and hope through surgical procedures to our population, greatly affected by the recent pandemic. The VII Surgical Operative for Cleft and Palate took place during November 5th -8th, 2020 with a multidisciplinary team conformed by: plastic surgeons, pediatricians, anesthesiologist, nurses, an organization and coordinating team, the administrative hospital staff, the public health department, the Dominican Plastic Surgery National Society, and the Dominican Medical College. We had 5 international surgeons from Mexico, 1 national invited surgeon, 14 staff members form the Plastic and Reconstructive Surgery Department, 12 residents from the Plastic and Reconstructive Surgery Department. Fifty three patients were evaluated and 37 were operated. The most common pathology was the combination of cleft lip and palate with a total of 15 patients, followed by cleft lip with 13 patients and cleft palate with 9 patients

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.