Conflict-related mortality: an analysis of 37 datasets

Mortality rates are among the main indicators of the human impact of armed conflict and many surveys have assessed this impact both for targeting and evaluating humanitarian aid programmes. Almost no epidemiological analysis such as calculating relative risk was performed nor were reference values clearly described. Here the aim is to review published mortality rates for a better understanding of age-specific mortality in armed conflict. Published mortality rates from conflict situations were collected and pre-conflict reference rates composed. We calculated the relative risk of dying in conflict compared to pre-conflict for children under 5 and people older than five years old. Although limited by reporting inadequacies, the results confirm the high vulnerability of children < 5 but identify a higher relative risk of dying among the > or = 5 year olds. Although not entirely new, this observation is not fully understood. Further systematic epidemiological research is needed to estimate and understand the impact of armed conflict on mortality.     

II Murahaleen Raids on the Dinka, 1985-89

Successive Sudanese governments have used proxy forces, so-called militias, as an integral part of their war with the rebel Sudan People's Liberation Army (SPLA). The Rizeiqat and Misseriya of South Darfur and South Kordofan created armed bands, known as Murahaleen, in order to raid cattle from the Dinka to their south. Massive raids have depopulated swathes of territory south of the Bahr al-Arab, killing tens of thousands of people and leading to the destruction and displacement of unknown numbers of others. Famine in western Sudan fuelled the early raids, but the scale of the devastation wrought from 1985 onwards was the result of government complicity and assistance. More recently, since the coming to power of the current military government in Khartoum in June 1989, the relationship between the army and the Murahleen has been formalized through the creation of Popular Defence Forces.     

Humanitarian emergencies and military help: some conceptual observations

In 1988 the International Peace Academy, New York, sponsored a study exploring the interface between security and the delivery of humanitarian aid. The aim was to evaluate the possible use of military help to support humanitarian relief workers during armed conflicts. As part of this pioneering work, the authors of this paper discuss the conceptual questions that must be raised before dealing with the associated practical difficulties. It examines those circumstances in which foreign military organizations might offer help in humanitarian emergencies; the nature of contemporary examples of humanitarian need that result in international responses; and the importance of factors which affect how these are perceived. The paper then analyses the pertinent functions that military units might undertake and finally examines the constraints that would apply if such forces were to become involved.     

Returning home: resettlement of formerly abducted children in Northern Uganda

This exploratory qualitative study considers the subjective resettlement experiences of children forced into armed conflict in Northern Uganda from the perspectives of 11 former child combatants and 11 adult community members. A thematic analysis was performed on the narrative data. The bioecological model was used to provide a conceptual framework for key themes. Major findings included the overarching impact of ongoing armed conflict on returnees' lives, the important role of the family in supporting children's resettlement, the harassment of former child soldiers by community members, and the community's inability to support systematically the returning children in tangible ways. This study recommends that humanitarian services at all levels strengthen the capacity of families to care for the material and psychoemotional needs of former child soldiers within their communities.     

Children and the Sphere standard on mental and social aspects of health

Most of the world's children live in resource-poor countries where people are at a relatively high risk of exposure to catastrophic situations arising from conflict and natural disasters.(6) Given the potential social, psychological and psychiatric consequences of exposure to disaster, mental health and psychosocial support programmes are increasingly part of humanitarian aid. A minimum standard on mental and social aspects of health is included in the recently revised Humanitarian Charter and Minimum Standards in Disaster Response (Sphere Handbook) (Sphere Project, 2004). Most recommendations for mental health and psychosocial interventions in guidance documents are based on expert opinion rather than research. Consequently, interventions are being implemented without full understanding of their potential benefit or harm. This paper offers a child-focused review of the evidence for each of the interventions described as indicators for the Sphere standard on mental and social aspects of health. It suggests some, but limited, support for each of them. However, the evidence base needs substantial strengthening.     

Post-conflict health reconstruction: search for a policy

Despite increasing experience in health reconstruction in societies emerging from conflict, the policy basis for investing in the development of equitable and effective health systems in the wake of war remains unsettled. Consideration of post-conflict health reconstruction is almost entirely absent in donor policies on global health. Practically by default, health programmes are seen increasingly as an element of stabilisation and security interventions in the aftermath of armed conflict. That perspective, however, lacks an evidence base and can skew health programmes towards short-term security and stabilisation goals that have a marginal impact and violate the principles of equity, non-discrimination, and quality, which are central to sound health systems and public acceptance of them. A better approach is to ground policy in legitimacy, viewing health both as a core social institution and one that, if developed according to human rights principles, including equity, non-discrimination, participation and accountability, can advance the effectiveness and the quality of governance in the emerging state.     

Inclusive education for children with disabilities in a refugee camp

Children in refugee camps, and particularly those with disabilities, face unique challenges in accessing education and are at high risk of being marginalised. Best practices suggest that main-streaming is the optimal strategy for serving students with disabilities. This study examines the extent to which mainstreaming in a refugee camp helps to promote children's prosocial behaviours, taking into account their emotional and behavioural problems. In Kakuma Refugee Camp, Kenya, researchers collected data from the parents of children currently enrolled in special needs education centres (n=65) and from those formerly enrolled at these facilities who transitioned to mainstream classrooms (n=81). Children in mainstream schools functioned better in terms of prosocial behaviours, but this relationship disappeared when factoring in children's emotional and behavioural difficulties. In the context of a refugee camp, mainstreaming alone is not likely to help children's psychosocial and educational functioning, which requires dedicated supports, appropriate facilities and infrastructure, and a dual focus on disability-specific and disability-inclusive initiatives.     

Saving Children During the Depression: Britain's Silent Emergency, 1919–1939

The health of a large section of the British population was more adversely affected by the interwar Depression than was acknowledged by official sources. Particular concern was aroused by the condition of women and children. Many new charitable bodies were formed in response to this problem, and these included Save the Children Fund. This paper gives an indication of the scale of the health problem, which was particularly severe in the areas of heavy industry and high unemployment. It then considers the role of charitable organisations in drawing attention to the severity of deprivation and campaigning for appropriate responses on the part of government. Although these pressure groups were energetic and professional in their campaigning, it is conceded that in the short term they exercised only limited influence. However, it is argued that they won the intellectual contest. Finally, it is pointed out that their policies came to be accepted during World War II; thereby organisations like Save the Children Fund contributed to laying the foundations of the modern welfare state.     

Operation Child-ID: reunifying children with their legal guardians after Hurricane Katrina

Children constitute a vulnerable population and special considerations are necessary in order to provide proper care for them during disasters. After disasters such as Hurricane Katrina, the rapid identification and protection of separated children and their reunification with legal guardians is necessary in order to minimise secondary injuries (i.e. physical and sexual abuse, neglect and abduction). At Camp Gruber, an Oklahoma shelter for Louisianans displaced by Hurricane Katrina, a survey tool was used to identify children separated from their guardians. Of the 254 children at the camp, 36 (14.2 per cent) were separated from their legal guardians. Answering 'no' to the question of whether the accompanying adult was the guardian of the child prior to Hurricane Katrina was a strong predictor (27.8 per cent versus 3.2 per cent) of being listed as 'missing' by the National Center for Missing and Exploited Children (NCMEC). All the children at Camp Gruber who were listed as 'missing' by the NCMEC were subsequently reunited with their guardians.     

Displacement in urban areas: new challenges, new partnerships

Rapid urbanisation is a key characteristic of the modern world, interacting with and reinforcing other global mega trends, including armed conflict, climate change, crime, environmental degradation, financial and economic instability, food shortages, underemployment, volatile commodity prices, and weak governance. Displaced people also are affected by and engaged in the process of urbanisation. Increasingly, refugees, returnees, and internally displaced persons (IDPs) are to be found not in camps or among host communities in rural areas, but in the towns and cities of developing and middle-income countries. The arrival and long-term settlement of displaced populations in urban areas needs to be better anticipated, understood, and planned for, with a particular emphasis on the establishment of new partnerships. Humanitarian actors can no longer liaise only with national governments; they must also develop urgently closer working relationships with mayors and municipal authorities, service providers, urban police forces, and, most importantly, the representatives of both displaced and resident communities. This requires linking up with those development actors that have established such partnerships already.     

Review of Policies and Guidelines on Infant Feeding in Emergencies: Common Ground and Gaps

Recent crises in regions where exclusive breastfeeding is not the norm have highlighted the importance of effective policies and guidelines on infant feeding in emergencies. In 1993, UNICEF compiled a collection of policy and guideline documents relating to the feeding of infants in emergency situations. In June 2000 Save the Children, UK, UNICEF and the Institute of Child Health undertook a review of those documents, updating the list and identifying the common ground that exists among the different policies. The review also analysed the consistency of the policy framework, and highlighted important areas where guidelines are missing or unclear. This article is an attempt to share more widely the main issues arising from this review. The key conclusions were that, in general, there is consensus on what constitutes best practice in infant feeding, however, the lack of clarity in the respective responsibilities of key UN agencies (in particular UNICEF, UNHCR and WFP) over issues relating to co-ordination of activities which affect infant-feeding interventions constrains the implementation of systems to support best practice. Furthermore, the weak evidence base on effective and appropriate intervention strategies for supporting optimal infant feeding in emergencies means that there is poor understanding of the practical tasks needed to support mothers and minimise infant morbidity and mortality. We, therefore, have two key recommendations: first that the operational UN agencies, primarily UNICEF, examine the options for improving co-ordination on a range of activities to uphold best practice of infant feeding in emergencies; second, that urgent attention be given to developing and supporting operational research on the promotion of optimal infant-feeding interventions.     

A Research Note about Military-Civilian Humanitarianism: More Questions than Answers

'Military-civilian humanitarianism'— or the coming together of military forces and civilian aid agencies to deal with the human suffering from complex emergencies — has numerous forms, but disenchantment has resulted from the Somalia and Bosnia syndromes. There is little political will at present, but evidence from the immediate post-Cold War era suggests how multilateral military operations could expand or contract in future to the benefit or peril of war victims. Partly a literature review but more importantly a framework for interpreting recent publications, this essay seeks to move beyond exchanging assertions. There is a contextualisation of recent literature; a definition of military-civilian humanitarianism; a discussion of possible military contributions to humanitarian action; a framework to assess the effectiveness of military-civilian humanitarianism; and a preliminary analysis of experience from northern Iraq, Somalia, Bosnia, Rwanda and Haiti. Caveat lector : At this point in time, there are still 'more questions than answers'.     

Putting Children First

Save the Children Fund in 1923 and UNICEF in 1990 both declared that children must come first in receiving relief. Whereas SCF's call was a corporate credo for the world, for use whenever disaster struck, UNICEF's was offered as a strategic policy document applicable at all times. In contrast, the 1989 UN Convention on the Rights of the Child, as a legally-binding document in the field of human rights, omitted all reference to giving such priority to children. The reason for transforming the original credo is that the principle of 'children first', if it includes every child and is to be applied literally in the field, is not only impracticable but unacceptable in many cultures. The social value of a particular child's life — or of human life generally — is simply not an absolute, in all circumstances, in all cultures.     

Influencing resilience: the role of policy entrepreneurs in mainstreaming climate adaptation

One way to make development pathways more resilient in the face of a changing climate has been through mainstreaming adaptation into government policies, planning and sectoral decision‐making. To date, many of the transferable lessons have taken the form of technical approaches such as risk assessments and toolkits. This article instead draws on evidence from South Asia to emphasise some of the more tacit and informal approaches used to influence adaptation policy. Despite their apparent significance in policy processes, such tactics are often neither planned for nor well reported in resilience‐building projects and programme documents. Using evidence to populate a typology of influencing strategies, this article looks particularly at the role of policy entrepreneurs who navigate the political complexity of both formal and informal governance systems to promote successful adaptation mainstreaming. It concludes with recommendations for adaptation and resilience programming that can more effectively harness the breadth of influencing strategies.     

Rehabilitation: strategic, proactive, flexible, risky?

Rehabilitation after armed conflict is a direct intellectual descendant of thinking about rehabilitation after natural calamity. It is related, generally, to poverty reduction and, operationally, to associated action at the micro level. This history has limited its strategic conceptualisation and, in particular, its links with reconciliation and state re-legitimation and also with macro-economic stabilisation and renewed growth. In post-war--or more generally, a lull in conflict with the potential to become permanent--a country's rapid, focused, prioritised action within a strategic framework is urgent. It is not risk-free for political and natural disasters as well as for those with economic and social bases. Flexibility, learning from initial experience and asking intended household beneficiaries about their needs in advance can reduce risk as can pre-positioning of contingency or standby resources to avert post-war calamities (for example, drought, flood) and catastrophes (renewed violence) from delaying and discrediting rehabilitation efforts.     

Assessing the impact of microfinance programming on children: an evaluation from post‐tsunami Aceh

This paper presents an evaluation of the long‐term impact of microfinance programmes on Acehnese children during the post‐tsunami recovery. The study, conducted from June to August 2010, examined the impact of microfinance programming six years after the tsunami. The sample consisted of 185 microfinance participants, with a comparison group of 192 individuals who did not participate in microfinance programmes. All respondents were parents, interviewed through a structured survey. The study used four child protection indicators—diet, health, childcare and education—in contrast to traditional repayment rate indicators. The primary results were insignificant with respect to all four child protection indicators, suggesting that, with respect to these indicators, there was no long‐term difference between the impact of microfinance on beneficiaries' children and non‐beneficiaries' children. These findings signify a need for microfinance actors to move beyond traditional indicators of economic success to evaluate the social changes microfinance programmes are presumed to effect.     

Conflict, the Continuum and Chronic Emergencies: A Critical Analysis of the Scope for Linking Relief, Rehabilitation and Development Planning in Sudan

The concept of the ‘relief-to-development continuum’ has been the subject of renewed interest in recent years. Concerned by the rise in relief budgets over the past decade and the absolute fall in development aid resources, support has been growing for the concept of developmental relief. In the context of complex political emergencies, it has been argued further that as effective development aid can reduce vulnerability to the impact of natural hazards, so it might also be used to contribute to a process of conflict prevention. In this way, the concept of the relief-development continuum has become entwined with broader discussions about the contribution of official development assistance to conflict management. Drawing on a Review of Operation Lifeline Sudan (OLS), this paper cautions against uncritical application of the concept of the continuum in complex political emergencies, and of rehabilitation in particular, in the current Sudanese context. It argues that in order to move legitimately from relief aid programming to development aid programming, three fundamental conditions must be in place: first, a minimum level of security, respect for human rights and humanitarian access. Second, empirical evidence from the field needs to demonstrate that the emergency is over. Finally, moving from relief to development aid programming is contingent on donor governments accepting the legitimacy of national governmental structures and of the rebel movements. In other words, for donor governments, moving along the continuum is in significant part determined by foreign policy considerations, not only technical ones. Consideration needs to be given to the actual and perceived legitimation of the different movements that a move to rehabilitation might be seen to imply. The paper argues that none of these conditions had been satisfied in Sudan by mid-1997. Instead of a process of normalisation paving the way to long-term development, the current situation in Sudan is better described as a chronic political emergency. In such a context, uncritical pursuit of developmental strategies may negatively affect the welfare of conflict-affected populations.     

Zimbabwe's Child Supplementary Feeding Programme: a re-assessment using household survey data

In 1992-3 and 1995-6, Zimbabwe used a Child Supplementary Feeding Programme (CSFP) to combat child malnutrition during drought-induced emergencies. Previous evaluations of the CSFP relied on routine administrative data and key informant interviews and made only cursory use of available household survey data. These evaluations concluded that the CSFP was effective in preventing an increase in malnutrition among children under five, especially in 1992-3. The more-detailed analysis of household surveys provided in this article suggests that CSFP coverage was generally patchy and disappointingly low, especially in 1995-6. There is little evidence that children from poor or nutritionally vulnerable households got preferential access to supplementary feeding. The CSFP failed to feed many malnourished and nutritionally vulnerable children even in areas where the programme was operating. Household survey evidence suggests that the CSFP's impact on nutritional status was likely marginal, especially in 1995-6.     

The ethical contours of research in crisis settings: five practical considerations for academic institutional review boards and researchers

The number of research studies in the humanitarian field is rising. It is imperative, therefore, that institutional review boards (IRBs) consider carefully the additional risks present in crisis contexts to ensure that the highest ethical standards are upheld. Ethical guidelines should represent better the specific issues inherent to research among populations grappling with armed conflict, disasters triggered by natural hazards, or health‐related emergencies. This paper seeks to describe five issues particular to humanitarian settings that IRBs should deliberate and on which they should provide recommendations to overcome associated challenges: staged reviews of protocols in acute emergencies; flexible reviews of modification requests; addressing violence and the traumatic experiences of participants; difficulties in attaining meaningful informed consent among populations dependent on aid; and ensuring reviews are knowledgeable of populations' needs. Considering these matters when reviewing protocols will yield more ethically sound research in humanitarian settings and hold researchers accountable to appropriate ethical standards.