Bioethical challenges in postwar development aid: The Rwandan case study.

This article considers aspects of a development aid that provides medical support to strengthen pediatric orthopedics in Rwanda. We present part of the Afriquia foundation work, a nonprofit foundation from Poland involved in supporting the medical sector in Rwanda as a sign of global solidarity and the human right to health. The main foundation's activity is the treatment of orthopedic problems among Rwandan citizens. We present a case study of two children under the care of the Afiquia foundation. 11-year-old Seraphine treated due to the consequences of right tibia osteomyelitis and 11-year-old Lavi suffering from osteogenesis imperfecta. Both children were treated surgically in Poland due to Rwanda's lack of treatment possibilities. After the applied treatment, Seraphine walks correctly without crutches and can attend school and thrive among her peers. Lavi has not sustained any fragility fracture since the surgery in Poland. He is healthy and constantly ongoing his rehabilitation including gait training. The described cases initiated development aid in Rwanda, supplying hospitals with orthopedic implants and training medical staff. The growing number of humanitarian crises across the globe and the people affected requires increasing organizations involved in providing relief. The emphasis should be on global education, aiming to make the recipients reflect and prepare them to face humanitarian crises.

'I know you like the back of my hand': biometric practices of humanitarian organisations in international aid.

Humanitarian organisations are increasingly utilising biometric data. However, we know little about the extent and scope of this practice, as its benefits and risks have attracted all the attention so far. This paper explores the biometric practices of the United Nations Refugee Agency, the United Nations World Food Programme, the International Committee of the Red Cross, Médecins Sans Frontières, and World Vision International. The study analysed relevant documents published over the past two decades and 17 semi-structured interviews with humanitarian workers conducted between June 2021 and June 2022. The findings reveal that humanitarian organisations use diverse types and functions of biometric data for different services, collaborate with many actors, and employ various data protection measures. Ultimately, challenging the straightforward generalisations about the use of such data, the paper argues that variational applications of biometrics in the humanitarian context require case-by-case analysis, as each instance will likely produce a different outcome.

Challenges in humanitarian response implementation: a large-scale review of aid worker perspectives.

Aid workers offer important perspectives for understanding better the most pervasive challenges that arise when implementing emergency response programming in humanitarian settings. This large sample study provides a global review of these perspectives, derived from 4,679 applications to the National NGO Program on Humanitarian Leadership, in which aid workers were asked to respond to the following question: 'What do you consider to be the biggest challenges in the implementation of emergency response programming in today's humanitarian settings?'. Through a qualitative coding process, the research team identified 14 major challenges that were prevalent across the applicants' responses and cross-tabulated these with their demographics. Coordination (30 per cent) and operating environment (29.5 per cent) were the most frequently reported. The study found a significant association between challenges identified and certain demographic variables. The results supplement a body of literature that is largely composed of small-scale, context-specific studies in which disaggre-gation of data by demographics is not possible.

Nursing roles in disaster zones: Experiences and lessons from Turkey's 2023 earthquakes.

BACKGROUND: Disasters affect human health and well-being globally. Nursing plays a vital role in disaster preparedness and response, ensuring efficient early care coordination and delivering effective field treatment. AIM: This study investigates the challenges an Israeli humanitarian delegation encountered during their response to major earthquakes in Turkey in 2023. It explicitly focuses on difficulties in preparation, operations, and collaboration with local teams. The study further analyzes the findings and extracts valuable lessons from the mission. METHODS: Using a qualitative descriptive design, 22 out of 32 nurses involved in delegation participated in three focus group discussions within two months of returning to Israel. The discussions were recorded, transcribed verbatim, and analyzed thematically. The study followed the COREQ guidelines, ensuring comprehensive reporting and methodological rigor in qualitative research. FINDINGS: The study's main findings spanned predeparture preparation, mission challenges in the disaster zone, and postmission lessons, each highlighted by subthemes and participant quotations. A strong sense of mission was evident among the participants, along with frustration at inefficient time management prior to deployment. Many participants noted additional challenges, related to the difficulty of working in multiple languages and across cultures, and the opportunities for resolution. Finally, participants called for better psychological support following the mission. CONCLUSION: Nurses in disaster zones offer valuable insights to enhance preparation, cross-cultural communication, and postmission implementation. NURSING AND HEALTH POLICY IMPLICATIONS: Nurse managers and healthcare policymakers can utilize this study's findings to develop future nursing training programs in disaster-related skills. Additionally, it can help foster collaboration among international healthcare teams.

Theory of change and strategic priorities of the world federation of haemophilia.

The World Federation of Haemophilia (WFH) is a global network of national member organizations (NMOs) that advocate, collectively and individually, to improve lives of people with inherited bleeding disorders. The WFH vision of "Treatment for All" speaks to a future in which all people with an inherited bleeding disorder will have access to care, regardless of their gender or where they live. Over the last several years, initiatives including the WFH Humanitarian Aid program, the World Bleeding Disorders Registry, and Guidelines for the Management of Haemophilia and von Willebrand disease have significantly changed how the WFH and its partners work to improve and sustain care for people with bleeding disorders. Following an extensive consultation that included over 200 stakeholders from 70 countries, a Theory of Change was developed, and strategic priorities identified, to clearly define the WFH's intended impact and point of accountability to its stakeholders, and to determine how and through who those goals will be achieved. Both should help the WFH better support its NMOs and healthcare providers around the world in their efforts to improve access to diagnosis and care, as new therapies revolutionize the treatment landscape and the fallout of the global pandemic continues to challenge the ways in which we work and connect. Global collaboration of all stakeholders, based on their resources, objectives and skills, will be required to achieve these goals and to ensure more people have reliable access to safe treatment and care, regardless of their bleeding disorder, gender, or where they live.

Risk factors for clinical stages of COVID-19 amongst employees of the International Committee of the Red Cross (ICRC) worldwide over a period of 12 months.

BACKGROUND: Essential workers carry a higher risk of SARS-CoV-2 infection and COVID-19 mortality than individuals working in non-essential activities. Scientific studies on COVID-19 risk factors and clinical courses for humanitarian aid workers (HAW) specifically are lacking. The nature of their work brings HAW in proximity to various populations, therefore potentially exposing them to the virus. The objective of this study is to assess severity degrees of COVID-19 in relation to multiple risk factors in a cohort of HAW. METHODS: Retrospective cohort study of data collected by the Staff Health Unit of the International Committee of the Red Cross, over 12 months (February 2021 - January 2022). Prevalence of demographic and health risk factors and outcome events were calculated. Factors associated with disease severity were explored in univariable and multivariable logistic regression models. Resulting OR were reported with 95%CI and p-values from Wald Test. P-values < 0.05 were considered significant. RESULTS: We included 2377 patients. The mean age was 39.5y.o. Two thirds of the patients were males, and 3/4 were national staff. Most cases (3/4) were reported by three regions (Africa, Asia and Middle East). Over 95% of patients were either asymptomatic or presented mild symptoms, 9 died (CFR 0.38%). Fifty-two patients were hospitalised and 7 needed a medical evacuation outside the country of assignment. A minority (14.76%) of patients had at least one risk factor for severe disease; the most recorded one was high blood pressure (4.6%). Over 55% of cases occurred during the predominance of Delta Variant of Concern. All pre-existing risk factors were significantly associated with a moderate or higher severity of the disease (except pregnancy and immunosuppression). CONCLUSIONS: We found strong epidemiological evidence of associations between comorbidities, old age, and the severity of COVID-19. Increased occupational risks of moderate to severe forms of COVID-19 do not only depend on workplace safety but also on social contacts and context.

Mental health of people with limited access to health services: a retrospective study of patients attending a humanitarian clinic network in Germany in 2021.

BACKGROUND: Germany has a statutory health insurance system. However, a substantial part of the population still suffers from limited access to regular health services. While humanitarian organizations are partially filling this gap, people with limited access show a high prevalence of mental disorders. This study investigates the prevalence, and social determinants of mental disorders in patients attending the clinics of a humanitarian health network in three major cities in Germany, as well as perceived barriers to healthcare access in this population. METHODS: We performed a descriptive, retrospective study of individuals attending the outpatient clinics of the humanitarian organization Ärzte der Welt, in Berlin, Hamburg and Munich, in 2021. Medico-administrative data was collected using a digital questionnaire at first presentation to the clinics. We report the prevalence of both perceived altered mental health and diagnosed mental disorders, as well as the perceived barriers to healthcare access in this population. We performed a logistic regression analysis to identify the socio-demographic factors associated with mental disorders. RESULTS: Our study population consisted of 1,071 first presenters to the clinics in 2021. The median age at presentation was 32 years and 57.2% of the population were male. 81.8% experienced a form of homelessness, 40% originated from non-EU countries and only 12.4% had regular statutory health insurance. 101 (9.4%) patients had a diagnosed mental disorder. In addition, 128 (11.9%) patients reported feeling depressed, 99 (9.2%) reported a lack of interest in daily activities, and 134 (12.5%) lacked emotional support in situations of need on most days. The most reported barrier to accessing health services was high health expenses, reported by 61.3% of patients.In the bivariate logistic regression analysis age, insurance status and region of origin were significantly associated with mental disorders. In the multivariable analysis, only age groups 20-39 and 40-59 years remained significant. CONCLUSIONS: People with limited access to regular health services have a high need for mental health services. As a chronic condition, this is even more difficult to manage outside of regular services, where humanitarian clinics are only filling the gap in serving basic health needs.

Medicine donations: a review of policies and practices.

BACKGROUND: To help promote the effective delivery of drug donations, the World Health Organization (WHO) developed the Guidelines for Medicine Donations. The need for revisions is timely given the large-scale influx of medicine donations since the start of the COVID-19 pandemic. This study analyses current policies of donors and recipients that are commensurate with the recommendations in the Guidelines and examines current practices, challenges, and revision suggestions. RESULTS: A search for medicine donation policies of donors and recipients was conducted in May/June 2022 and repeated in January 2023. Potential donor countries were identified from the high-income countries on the United Nation's (UN) List of G20 Countries. Potential pharmaceutical company donors were selected from those with 2021 revenue of $30 billion or greater. Potential non-government organization donors came from the WHO list of non-governmental organizations (NGOs) and two other sources. Potential recipient countries were those on the UN List of Least Developed Countries. These four lists were supplemented with actual donors and recipients identified from the literature. All policies retrieved were screened to identify which of the 12 recommendations from the WHO Guidelines were incorporated. We identified 38 policies from 1 donor country, 6 brand-name multinational pharmaceutical companies, 6 NGOs and 25 recipient countries. Most policies incorporated all 12 recommendations. Twenty-five of the 38 policies were developed in 2010 or later. The majority of actual donors and recipients did not have policies that were publicly available. A rapid literature review for publications from 2010 onwards identified challenges in implementing the WHO Guidelines and suggested for revisions. Challenges included: (1) information management; (2) medication presentation; (3) influence from the pharmaceutical industry; (4) donation sustainability; and (5) the belief that donations are inherently good. CONCLUSIONS: Our findings suggest that both donors and recipients could further align their policies with the existing Guidelines and both groups should be consulted on any revisions to ensure that their experiences are reflected and their needs are addressed. While the current WHO Guidelines for Medicine Donations are a solid base for medical humanitarian efforts, evidence points to the need for an update to meet current challenges.

Health aid displacement during a decade of conflict (2011-19) in Syria: an exploratory analysis.

BACKGROUND: Syria has been in continuous conflict since 2011, resulting in more than 874,000 deaths and 13.7 million internally displaced people (IDPs) and refugees. The health and humanitarian sectors have been severely affected by the protracted, complex conflict and have relied heavily on donor aid in the last decade. This study examines the extent and implications of health aid displacement in Syria during acute humanitarian health crises from 2011 to 2019. METHODS: We conducted a trend analysis on data related to humanitarian and health aid for Syria between 2011 and 2019 from the OECD's Creditor Reporting System. We linked the data obtained for health aid displacement to four key dimensions of the Syrian conflict. The data were compared with other fragile states. We conducted a workshop in Turkey and key informants with experts, policy makers and aid practitioners involved in the humanitarian and health response in Syria between August and October 2021 to corroborate the quantitative data obtained by analysing aid repository data. RESULTS: The findings suggest that there was health aid displacement in Syria during key periods of crisis by a few key donors, such as the EU, Germany, Norway and Canada supporting responses to certain humanitarian crises. However, considering that the value of humanitarian aid is 50 times that of health aid, this displacement cannot be considered as critical. Also, there was insufficient evidence of health displacement across all donors. The results also showed that the value of health aid as a proportion of aggregate health and humanitarian aid is only 2% in Syria, compared to 22% for the combined average of fragile states, which further indicates the predominance of humanitarian aid over health aid in the Syrian crisis context. CONCLUSION: This study highlights that in very complex conflict-affected contexts such as Syria, it is difficult to suggest the use of health aid displacement as an effective tool for aid-effectiveness for donors as it does not reflect domestic needs and priorities. Yet there seems to be evidence of slight displacement for individual donors. However, we can suggest that donors vastly prefer to focus their investment in the humanitarian sector rather than the health sector in conflict-affected areas. There is an urgent need to increase donors' focus on Syria's health development aid and adopt the humanitarian-development-peace nexus to improve aid effectiveness that aligns with the increasing health needs of local communities, including IDPs, in this protracted conflict.

Humanitarians' ethics: the role of face-to-face experiences in humanitarian aid workers' motivation.

This paper analyses the significance of specific ethical experiences for humanitarian aid workers' motivation. Following Emmanuel Levinas's understanding of ethics as arising from intersubjective face-to-face encounters, the study illuminates the experiential origins of the humanitarian commitment by analysing James Orbinski's memoir entitled An Imperfect Offering: Dispatches from the Medical Frontline. Orbinski, a former International Council President at Médecins Sans Frontières, was directly involved in humanitarian responses to several major crises during the 1990s, including those in Somalia, Afghanistan, Rwanda, and what was then Zaire. This paper explores three formative experiences from Orbinski's childhood and teenage years to analyse the personal ethics of humanitarian aid workers and to illuminate the intersection of the personal and professional level of humanitarian aid work. Illustrating that Orbinski's humanitarian commitment is a surrendering to the other's call, the paper argues for stronger inclusion of aid workers' lives and experiences to achieve a comprehensive understanding of humanitarian work.

Fighting with words: humanitarian security and the changing role of law in contemporary armed conflict.

Violence against humanitarians is a commonplace phenomenon in contemporary armed conflict. This paper examines how the manipulation of international legal principles for political or military purposes, a practice known as 'lawfare', impacts humanitarian security in conflict-affected areas. Drawing on a case study of the Syrian conflict (2011-), it finds that lawfare has been used to legitimate systematic civilian targeting by pro-government forces and to delegitimise the delivery of aid to opposition-held areas of the country. Efforts to use legal measures to promote civilian welfare-by way of sanctions or demands for cross-border humanitarian access-have been taken as evidence of Western attempts to politicise humanitarian considerations and international law. In practice, this has meant increased security risks for aid workers and impunity for those implicated in the violence. The paper concludes by calling for more critical research on lawfare and politicisation of international law as part and parcel of civilian protection in conflict-affected areas.

Humanitarian aid and local responses: the aftermath of the rebuilding effort on Tongoa island, Vanuatu.

Cyclone Pam swept through the archipelago of Vanuatu on 13-14 March 2015, with wind speeds exceeding those recorded anywhere in the South Pacific since the 1980s. Southern and central parts of the country were particularly affected. Material damage on Tongoa, one of the most afflicted islands, was extensive, but no deaths were reported. During the storm, villagers found shelter in their kitchen, in what is considered locally as a 'lifeboat'. The aftermath was managed and mitigated by international aid organisations. On Tongoa, this included a 'Shelter Cluster' programme, under which villagers were given house rebuilding kits. Elaborating upon extensive ethnographic investigations on site between 2011 and 2018, this paper explores and reveals the ways in which this aid generated confusion among the local population. In a larger context of regular disasters triggered by natural hazards, locals have found endogenous ways of dealing with such extreme climatic events, for the most part without any external assistance.

Redefining shelter: humanitarian sheltering.

Shelter is one of the most 'intractable problems' in humanitarian aid and yet there is little clarity on an overarching definition. Terminology for shelter and housing is often conflated, and the most prominent definition does not fully reflect recent progress in the Shelter and Settlements Sector. This paper explores the varying terminology utilised in definitions of shelter within humanitarian aid since 1990, reflecting on the concepts of 'shelter' and 'housing', alongside surrounding perceptions of 'house' versus 'home', and related measures of adequacy. The current, most prolific definition is also deconstructed, demonstrating ambiguity in some of terminology such as 'dignity' and 'privacy', and revealing that interpretation of this definition depends on the reader's knowledge. Lastly, a new definition of 'sheltering' is proposed, encompassing five key reflections: the concept of process over object; the inclusion of communities and individuals; the commonality of long-term sheltering; the wider effects of shelter; and the impacts on host communities and environment.

The effect of research on COVID-19 and PM2.5 on the localization of humanitarian aid.

The spatiotemporal variation of the death and tested positive cases is poorly understood during the respiratory coronavirus disease 2019 (COVID-19) pandemic. On the other hand, COVID-19's spread was not significantly slowed by pandemic maps. The aim of this study is to investigate the connection between COVID-19 distribution and airborne PM2.5 (particulate matter with an aerodynamic diameter less than 2.5 µm). Long-term exposure to high levels of PM2.5 is significantly connected to respiratory diseases in addition to being a potential carrier of viruses. Between April 2020 and March 2021, data on COVID-19-related cases were gathered for all prefectures in Japan. There were 9159, 109,078, and 451,913 cases of COVID-19 that resulted in death, severe illness, and positive tests, respectively. Additionally, we gathered information on PM2.5 from 1119 air quality monitoring stations that were deployed across the 47 prefectures. By using the statistical analysis tools in the Geographical Information System (GIS) software, it was found that the residents of prefectures with high PM2.5 concentrations were the most susceptible to COVID-19. Additionally, the World Health Organization-Air Quality Guidelines (WHO-AQG) relative risk (RR) of 1.04 (95% CI: 1.01-1.08), which was used to compute the PM2.5-caused deaths, was employed as well. Approximately 1716 (95% CI: 429-3,432) cases of PM2.5-related deaths were thought to have occurred throughout the study period. Despite the possibility that the actual numbers of both COVID19 and PM2.5-caused deaths are higher, humanitarian actors could use PM2.5 data to localize the efforts to minimize the spread of COVID-19.

The Geneva Global Hub for Education in Emergencies: A new ally for education in emergencies.

This article provides an overview of the current landscape and needs for education in emergencies, as well as challenges and opportunities in today's critical juncture, in particular with the creation of a new ally for education in emergencies: the Geneva Global Hub for Education in Emergencies. It covers the disruption of education by the Covid-19 pandemic and the associated exacerbation of child-protection risks, as well as the pandemic's impact on the realization of the right to education of displaced children and youth and those living in humanitarian crises. While there is ample recognition at the international policy level of the importance of education in emergencies, major obstacles still prevail, such as continued underfunding and the underprioritization of education in humanitarian situations. As the world faces unparalleled needs, in particular during crises, and grapples to accelerate progress toward Sustainable Development Goal 4 and meet the commitments set out in the Global Compact for Refugees, new opportunities promise to tap opportune alliances, to inspire commitment, and to boost country-level impact.

Chronic diseases and multi-morbidity in persons experiencing homelessness: results from a cross-sectional study conducted at three humanitarian clinics in Germany in 2020.

BACKGROUND: Persons experiencing homelessness (PEH) suffer a high burden of chronic diseases and multi-morbidity, yet face significant barriers in accessing healthcare services. These health inequalities were further aggravated during the COVID-19 pandemic. While there is a lack of comprehensive health data on PEH, even less is known about populations experiencing housing exclusion, a hidden form of homelessness. This study examines and compares chronic diseases and multi-morbidity in PEH, persons experiencing housing exclusion, and persons with secure housing who lacked access to regular healthcare services in the wake of the COVID-19 pandemic in Germany. METHODS: Study participants were adults who sought medical care at clinics of the humanitarian organisation "Ärzte der Welt" in Munich, Hamburg and Berlin in 2020. The patients were categorised into three housing groups according to the ETHOS classification of homelessness and housing exclusion. Socio-demographic characteristics, self-rated health, chronic diseases and multi-morbidity were described in each group. Logistic regression analysis was used to identify socio-demographic factors associated with higher odds of chronic diseases and multi-morbidity in each housing group. RESULTS: Of the 695 study participants, 333 experienced homelessness, 292 experienced housing exclusion and 70 had secure housing. 92.3% of all patients had either no or limited health coverage, and 96.7% were below the poverty line. Males and EU/EEA citizens were highly represented among PEH (74.2% and 56.8% respectively). PEH had lower self-rated health (47.8%, p = 0.04), and a higher prevalence of psychiatric illness (20.9%, p = 0.04). In adjusted analyses, belonging to the age group 35-49 and ≥ 50 years were associated with greater odds of chronic disease (AOR = 2.33, 95% CI = 1.68-3.24; AOR = 3.57, 95% CI = 2.55-5.01, respectively) while being ≥ 50 years old was associated with multi-morbidity (AOR = 2.01, 95% CI = 1.21, 3.33). Of the 18 participants tested for SARS-COV-2, 15 were PEH, 1 of whom tested positive. CONCLUSIONS: Housing status was not an independent risk factor for chronic disease and multi-morbidity in our study population. However, PEH reported poorer self-rated and psychiatric health. Strategies to improve access to healthcare services amongst persons experiencing homelessness and housing exclusion are needed in Germany.

The transition from development and disaster risk reduction to humanitarian relief: the case of Yemen during high-intensity conflict.

Discussions on how humanitarian aid and disaster responses can link better with development and disaster risk reduction (DRR) have occurred for decades. However, the reverse transition, from development to relief, is still poorly understood. Using the case of Yemen, this study analyses whether and how development and DRR activities adapted to the emerging humanitarian crisis when conflict escalated in the country. It concentrates on governance strategies, actors, challenges, and opportunities at the nexus of development, disaster, and humanitarian responses. Semi-structured interviews and focus-group discussions with aid and societal actors were conducted remotely and in Jordan. The findings show gaps in knowledge and coordination in the movement from development and DRR to relief, but also reveal spaces and opportunities to advance towards enhanced integration of action before, during, and after an emergency. This paper contributes to the literature on this nexus and critically argues for a more integrated approach to conflicts and disasters.

Post-conflict disaster governance in Nepal: one-door policy, multiple-window practice.

The response to the earthquakes in Nepal on 25 April and 12 May 2015 was as overwhelming as the magnitude of the events themselves. Tensions between the humanitarian imperative and the post-conflict state-building agenda soon became evident. Many actors offered support by creatively complying with the state's approach, whereas others bypassed official channels completely. In post-conflict settings such as Nepal, the situation is especially complicated because of the contradiction between policies underscoring the importance of the state in the response and the reality of the fragility of the state, which often leads to the significant involvement of aid organisations. The post-conflict political landscape of Nepal shaped the contours of the response, as well as how actors decided to operate within them. This paper, based on empirical findings from four months of research, contributes to a better understanding of the intricacies of the post-conflict and post-disaster nexus in the context of a state-led response.

Mobility Imaginaries of Humanitarian Intervention: Gender, Migration, and Violence along Mexico's Southern Border.

Thousands of Central American women have been displaced from their countries of origin by violence. While the violence committed against them is often portrayed as isolated acts of aggression, women's suffering is also produced and perpetuated by humanitarian interventions that immobilize women in dangerous transit zones. Interventions are then justified by institutional logics that juxtapose women's vulnerability against the threat of their own mobility. This article draws on 14 months of ethnographic fieldwork along the southern Mexico border among migrant women who sought out humanitarian assistance following violent encounters. Central to my argument is the concept of mobility imaginaries, or widely shared social assumptions about how mobility should and can be accessed, by whom, and under what circumstances. Through this framework, I show how gendered mobility biases that underlie institutional logics compound other forms of institutional inequality, which often serves to reproduce, rather than mitigate, root causes of gender-based vulnerability.

Why humility is vital to effective humanitarian aid leadership: a review of the literature.

Organisational scientists are paying increasing attention to humility, following a larger trend in scholarship highlighting the relational and interdependent nature of leadership and business. A growing body of evidence identifies humility as vital to effective organisational leadership, facilitating positive organisational outcomes, such as lower voluntary turnover and greater follower job satisfaction. To date, research on the subject has focused on certain specific organisational contexts, including businesses, hospitals, and schools. This paper reviews the existing literature and explores why humility may be an especially important leader trait in international humanitarian aid organisations and relief work-a context that is not only uniquely challenging, but also one that would seemingly stand to benefit keenly from the quality. It argues that humility is essential for effective leadership because it is normative of good character, it is predictive of positive outcomes, and it corresponds to a genuine representation of the nature of humanitarian aid.