Evaluative research in a refugee cAMP: the effectiveness of community health workers in khao I dang holding center, Thailand

An evaluation of Khmer refugee public health services found a strong cultural preference for older females as Community Health Workers (CHWs), in contrast to the young males employed. Class conflicts were identified between educated, upper-class CHWs and the uneducated camp majority. Poor community acceptance of the CHWs impaired their effectiveness, and was attributed to age, sex and socioeconomic barriers. Based on these evaluation findings, the refugee health program was restructured to include a preponderance of female workers. A repeat survey demonstrated enhanced program effectiveness following this change.
Selection of refugee health workers should be based on intrinsic community roles, taking age, sex, socioeconomic and other group distinctions into account. Additional research is needed on the adaptation of community health principles to the refugee context.     

The impact of workplace exclusion on the humanitarian response to the refugee crisis in Lebanon

A contemporary issue of major concern is the millions of people fleeing homelands owing to political and socioeconomic challenges and seeking assistance elsewhere throughout the world. An effective response to this crisis includes support models that meet the various needs of refugee populations. In the complex system of humanitarian action, aid workers, among a multiplicity of actors, are the most important assets. This study utilised an inclusion–exclusion theoretical lens to examine the impact of their workplace experiences on activities in the context of the refugee crisis in Lebanon. In-depth interviews were held with 36 humanitarian practitioners, representing five international organisations that are involved in refugee aid programmes in the country. The study led to a new understanding of the link between inclusion and exclusion and the effectiveness of the humanitarian response to emergencies. In addition, it yielded new insights into apprehension about the national–international divide and its consequences for humanitarian assistance.     

Planning STI/HIV prevention among refugees and mobile populations: situation assessment of Sudanese refugees

This article reflects an investigation of knowledge, attitudes and behaviours and HIV/STI prevalence of Sudanese refugees and Ethiopian sex workers in 1992. It represents one of the earliest such investigations within an African refugee population. The investigation took place in the Dimma refugee settlement in south-western Ethiopia and study participants included Sudanese refugee men and women and Ethiopian female sex workers. Methods used for this investigation included focus group discussions, behavioural surveys and serologic testing. The main outcome measures of the investigation were HIV/STI knowledge, attitudes and behaviours and biological markers for HIV, syphilis and herpes simplex 2. The study findings indicate that in the early 1990s, knowledge about AIDS and condom use was low among Sudanese refugee women and not one reported having ever used a condom. Furthermore, sexual contact between refugee men and sex workers was frequent during the time of this study and the prevalence of HIV and other STIs was high. The results confirm a widely held assumption that highly mobile and transient populations in Africa are susceptible to STIs and HIV, in large part due to their knowledge, attitudes and behaviours.     

Living with transience in high-risk humanitarian spaces: the gendered experiences of international staff and policy implications for building resilience

Deployment in a crisis zone is a perilous undertaking. Little is known right now about how humanitarian workers relate social and professional goals to lived experiences of high-risk environments. In South Sudan, ranked as the most dangerous country globally for aid workers, 20 international humanitarian staff were interviewed to examine their sense of place, well-being, and vocation, using thematic and interpretative phenomenological analysis. Subjectivities of humanitarian space hinged upon negotiating physical hardships and social relationships: Juba, the capital, was described as a ‘prison’ and a ‘party hotspot’. For expatriate staff, making sense of spatial, social, and professional transience was sharply gendered and rooted in the subjectivities of risk-taking, crisis management, and career-building. Two policy measures are highlighted here to address the implications of transience for human well-being and organisational effectiveness. Efforts to support teams and structure work environments, altering the humanitarian and vocational bubble, will help to develop resilience at the heart of humanitarian systems.     

Jockeying for position in the humanitarian field: Iraqi refugees and faith-based organisations in Damascus

The rise in the number of interventions by faith-based organisations in the humanitarian field has reignited debate about the role of religion in the public sphere. This paper presents a nuanced examination of the part played by religious institutions and networks in the strategies of forced migrants in urban contexts. Furthermore, it considers how such organisations work to integrate displaced populations into their new surroundings. Drawing on two case studies and ethnographic fieldwork and in-depth interviews with Iraqi refugees and refugee service providers in Damascus, Syria, carried out between March 2010 and March 2011, it evaluates how Iraqi refugees, as active social agents, utilise religious institutions and networks in conjunction with established international humanitarian organisations to produce a distinctive geography of exile. In addition, it draws attention to how the Syrian state exerts influence over religious actors and how ultimately this affects the decision-making of forced migrants.     

Quality design: a planning methodology for the integration of refugee and local health services,West Nile,Uganda

In an emergency, the international community responds to the immediate health needs of refugees through the establishment of action-oriented, life-saving services. Healthcare delivery is often managed with limited, if any, coordination with local health management structures. In situations where refugees remain in the host country for many years, sustainability issues inevitably arise. Refugee-hosting governments may ultimately be called upon to assume the management and funding of refugee services. Planning for service integration, while protecting against declines in service quality, is a challenge in the typically resource-poor host environments. This paper discusses these issues by presenting the experience of the West Nile districts in northern Uganda, and describes quality design as a relevant planning methodology. Quality design is a systematic planning approach that documents and directly incorporates the service users' self-defined expectations and needs.     

Risk factors for long‐term post‐traumatic stress disorder among medical rescue workers appointed to the 2008 Wenchuan earthquake response in China

This study aims to determine the risk factors for clinically‐significant post‐traumatic stress disorder (PTSD) among Chinese medical rescue workers one year after the response to the Wenchuan earthquake on 12 May 2008. A sample of 337 medical workers who performed response work within the first three months of the event completed an online questionnaire, which included information on demographics, social support, the management and organisation of the disaster response, and an assessment of PTSD. Symptoms consistent with PTSD were prevalent in 17 per cent of the rescue workers. Those who developed PTSD symptoms were more likely to have been injured, experienced a water shortage, been disconnected from family and friends during the response, and have passive coping styles and neurotic personalities. Factors that cannot be changed easily, such as personality traits, should be evaluated prior to deployment to ensure that rescue workers at higher risk of PTSD are provided with adequate support before and during deployment.     

Health and social impacts of a flood disaster: responding to needs and implications for practice

Carlisle in northwest England suffered its worse floods for more than 180 years in 2005. A study, reported here, was undertaken to assess the health and social impacts of these floods via in‐depth, taped individual and focus‐group interviews with people whose homes had been flooded and with agency workers who helped them. Respondents spoke of physical health ailments, psychological stress, water health‐and‐safety issues related to the floods, and disputes with insurance and construction companies, which they felt had caused and exacerbated psychological health problems. Support workers also suffered from psychological stress. Furthermore, it was found that people had low expectations of a flood and were not prepared. The findings are presented in five sections covering flood risk awareness, water contamination issues, physical health, mental health, and impact on frontline support workers. The discussion focuses on the implications of the findings for policy and practice vis‐à‐vis psychological health provision, contamination issues, training and support for frontline support workers, matters relating to restoration, and preparation for flooding.     

Rapid Assessment of Population Size by Area Sampling in Disaster Situations

In the initial phase of a complex emergency, an immediate population size assessment method, based on area sampling, is vital to provide relief workers with a rapid population estimate in refugee camps. In the past decade, the method has been progressively improved; six examples are presented in this paper and questions raised about its statistical validity as well as important issues for further research. There are two stages. The first is to map the camp by registering all of its co-ordinates. In the second stage, the total camp population is estimated by counting the population living in a limited number of square blocks of known surface area, and by extrapolating average population calculated per block to the total camp surface. In six camps selected in Asia and Africa, between 1992 and 1994, population figures were estimated within one to two days. After measuring all external limits, surfaces were calculated and ranged between 121,300 and 2,770,000 square metres. In five camps, the mean average population per square was obtained using blocks 25 by 25 meters (625 m2), and for another camp with blocks 100 by 100 m2. In three camps, different population density zones were defined. Total camp populations obtained were 16,800 to 113,600. Although this method is a valuable public health tool in emergency situations, it has several limitations. Issues related to population density and number and size of blocks to be selected require further research for the method to be better validated.     

The functions of social service workers at a time of war against a civilian population

This article identifies the nature of functions that social service workers employed by municipal organisations have to perform during a community disaster and subsequent reorganisation at a time of war. The article also explores to what extent the functions of workers change as a result of the transition from a peacetime routine to a war situation. Using focus groups the study assesses the knowledge of social service workers and ordinary citizens who had direct experience of the second Lebanese war in Israel (2006). Eight major functions needed at a time of disaster are distinguished among various employees. The article discusses the significance of these functions, and the need to make changes in the network of functions at a time of disaster.     

Practical experience with the management of a cholera outbreak in a refugee cAMP in eastern Sudan, 1985

From May to November 1985 most refugee camps in Eastern Sudan were affected by cholera. This article summarizes the experience from the refugee camp Wad Sherife with the emphasis on the practical aspects of management of cholera in a refugee context. Paramedical personnel from the refugee community were used to a great extent both in curative and preventive measures. The home visitors played an important role in the early detection of the cases and in trying to prevent the spread of cholera in the camp. A total of 1793 cases were admitted during a three month period. The results show a case fatality rate of 1.8%. A significantly higher number of women were affected in the age group 15–44. As seen in other refugee camps in Eastern Sudan, there was a relatively high intravenous fluid consumption with an average of about 6 litres in adults.     

Tuberculosis in a Refugee Camp: A campaign to reduce transmission

In November 1985, tuberculosis was highly prevalent among the 6,250 Tigrayan refugees ofFau I camp in Eastern Sudan. It was therefore decided to launch an active case-finding campaign aimed at decreasing transmission, to be carried out by primary health care workers. The entire population of the camp was screened for symptoms of pulmonary tuberculosis and the sputum of people with productive cough was examined by direct microscopy. However, it was considered that this examination was insufficiently sensitive in the camp situation. For this reason, people with non-productive cough or sputum-negative were enrolled in a follow-up program whose length was determined by the severity of their symptoms.
The campaign was interrupted by circumstances that are typical of refugee situations. On the basis of results obtained a few conclusions can nonetheless be made on the appropriateness of introducing an active screening program in situations where a stable refugee population has good access to basic health care of good quality.     

Cholera in Sudan: An account of an epidemic in a refugee camp in eastern Sudan, May-June 1985

In 1985 cholera has been a serious problem in the horn of Africa, particularly affecting the many famine victims and refugees in that region. In this paper the history of cholera in Africa is briefly summarized, as is the background to the current refugee situation in eastern Sudan. A cholera epidemic involving 1,175 cases in two adjacent refugee camps in eastern Sudan is described. In this epidemic there were thirteen inpatient deaths and thirty-eight known home deaths from cholera. The management of the epidemic is described in detail. Overall an average of 8 1. of intravenous fluid was used per case, a higher figure than was anticipated, probably because of the unexpected degree of vomiting and the shortage of trained nursing staff.
The relationship between cholera and malnutrition is explored and hypochlorhydria is suggested as the main reason for the increased susceptibility to cholera among malnourished populations. It was observed that severely malnourished adults and children appeared to nave less severe diarrhoea with their cholera, presumably because of reduced mucosal surface area and poor enterocyte function. Finally possible means of aborting cholera epidemics are discussed.     

Training refugees as primary health care workers: Past imperfect, future conditional

Many problems have been encountered in the planning and implementation of health care in refugee camps, and more specifically in the training of refugees as primary health care workers. A review of the published literature and a "survey" of the opinions and experiences of refugee, national and international health personnel regarding training has therefore been undertaken to provide an overview of what has been done and to make recommendations for future work.
The review highlights the need to reallocate resources away from high visibility emergency aid to development activities, such as training, that will create an infrastructure for primary health care and promote self-reliance.     

Refugee Density and Dependence: Practical Implications of Camp Size

Different refugee camps may have widely differing morbidity and mortality rates. Some of these differences are ascribed to environmental factors. This paper reviews the key issues relating to one environmental factor: the size of the refugee camp, and provides a tentative theoretical framework for examining the effect of camp size on refugees. This effect may not be considered because aid workers chronically underestimate the value of the refugees' contribution to their own survival. Large camps settle great numbers of refugees to the hinterland of the camp and limit their access to resources available there. This may increase refugee dependency and vulnerability. There is some slight evidence from the analysis of data provided by Mercer (1992) that child mortality rates (aged 0–4 years) are positively correlated with camp size (as inferred from child populations). If other factors allow, it might be wise for camp planners to try to limit camps to a size which allows refugees reasonable access to local resources.     

Selling displaced people? A multi‐method study of the public communication strategies of international refugee organisations

The world has seen a major increase in forced displacement since 2011. As a growing number of states implement restrictive refugee policies, public communication has become essential for refugee organisations. This study analysed, therefore, three international refugee organisations’ discursive strategies towards the recent Syrian crisis, as well as their production and the social context. A critical discourse analysis of international press releases (N=122) and six semi‐structured interviews with press and regional officers revealed that the observed actors largely dehumanise displaced people and subordinate them to the ‘Western self’ and state interests; displaced people hardly ever acquire their own voice. The study found that the medium characteristics of press releases and the importance of media attention result in a depersonalising humanitarian discourse. In addition, there were indications of a post‐humanitarian discourse that reproduced the humanitarian sector's ‘marketisation’. Finally, the examined organisations use the political realist cross‐issue persuasion strategy, displaying displaced people as resettlement objects.     

Why Aid Agencies Need Better Understanding of the Communities They Assist: The Experience of Food Aid in Rwandan Refugee Camps

Refugee views on food aid reveal the ignorance of the international community regarding Rwandan culture, economy and politics. This ignorance carries a number of costs. On one level, the main cost is that a professional service is not carried out to the best of one's ability. Ignorance of Rwanda's North–South divide, for instance, has caused agencies to be insensitive to in-camp discrimination based upon regional identity and its impact on programme activities. On a deeper level, agency ignorance about Rwandan culture, economy and the dynamics of camp politics, reduces refugee confidence in humanitarian agencies and workers. Better information would not only result in the greater likelihood of appropriate responses to specific needs, but would also encourage greater credibility in the political arena where the ultimate stake is to see lasting peace and a dignified return of refugees to their homes.     

The parameters of refugeeism and flight: the case of laos

The circumstances of the flight of four ethnic groups from Laos are described and cornpared. It is found that different ethnic groups defined the fall of the Laotian government in 1975 differently. This affected why, how and when they fled. It is stressed that any explanation of refugee behavior must be in terms not only of individual motivation but also of group behavior. Conclusions are drawn about the role that social networks, sanctuary opportunities, perceptions of family unity, class, clanship, patron-client relationships and traditions of mobility can play in making the decision to flee.     

Training Community Health Workers in refugee camps: A case study from Pakistan

In October 1983 a training programme for refugee community health workers was begun as the major part of a primary health care programme for Afghan refugees in Pakistan. The programme began with a pilot period in Badaber camp, situated near to Peshawar. The general issues involved in training auxiliary health personnel were answered by the use of a "knowledge, attitudes and practices survey" and involvement of the refugees from the beginning of the programme. The development of the training programme is discussed with reference to these issues and the constraints arising from the special circumstances of the refugees, in addition to those common to most national training programmes, are reviewed.     

基于中美10所高校的应急管理核心知识体系的解释结构模型研究

应急管理涉及多学科、多领域,明确其核心知识体系可以为应急管理相关学科融合和发展提供基础。本文收集了中美两国10所高校15个本科专业225门专业课程,构建解释结构模型进行研究。结果显示：应急管理核心知识体系包括8大类：应急类、防灾减灾类、公共服务和社会管理类、安全生产类、国家安全类、法律类、公共卫生类和综合类。这8大类又分为18个小类,应急类包括为理论、技术方法和应用;防灾减灾类包括理论、过程和单灾种防范;公共服务和社会管理类包括理论与应用;安全生产类包括安全、健康和环境;国家安全类包括国土安全、恐怖主义和国际关系;公共卫生类包括心理和医疗救助;而法律类重在应急相关法律,综合类则表现为多个领域相结合。该体系的构建可以为应急管理相关学科研究提供知识基础,促进各学科领域在应急研究方面融合发展。