Health sector recovery in early post‐conflict environments: experience from southern Sudan

Health sector recovery in post‐conflict settings presents an opportunity for reform: analysis of policy processes can provide useful lessons. 1 The case of southern Sudan is assessed through interviews, a literature review, and by drawing on the experience of former technical advisers to the Ministry of Health. In the immediate post‐conflict phase, the health system in southern Sudan was characterised by fragmentation, low coverage of health services, dismal health outcomes and limited government capacity. Health policy was extensively shaped by the interplay of context, actors and processes: the World Bank and the World Health Organization became the primary drivers of policy change. Lessons learned from the southern Sudan case include the need for: sustained investment in assessment and planning of recovery activities; building of procurement capacity early in the recovery process; support for funding instruments that can disburse resources rapidly; and streamlining the governance structures and procedures adopted by health recovery financing mechanisms and adapting them to the local context.     

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.     

Enhancing disaster management by mapping disaster proneness and preparedness

The focus of most disaster management programmes is to deploy resources-physical and human-from outside the disaster zone. This activity can produce a delay in disaster mitigation and recovery efforts, and a consequent loss of human lives and economic resources. It may be possible to expedite recovery and prevent loss of life by mapping out disaster proneness and the availability of resources in advance. This study proposes the development of two indices to do so. The Indian census data of 2001 is used to develop a methodology for creating one index on disaster proneness and one on resourcefulness for administrative units (tehsils). Findings reveal that tehsil residents face an elevated risk of disaster and that they are also grossly under-prepared for such events. The proposed indices can be used to map regional service provision facilities and to assist authorities in evaluating immediate, intermediate, and long-term disaster recovery needs and resource requirements.     

Providing health services during a civil war: the experience of a garrison town in South Sudan

The impact of conflict, particularly conflict arising during civil wars, on the provision of healthcare is a subject that has not been widely considered in conflict‐related research. Combatants often target health services to weaken or to defeat the enemy, while attempts to maintain or improve health systems also can comprise part of counter‐insurgency ‘hearts‐and‐minds’ strategies. This paper describes the dynamics associated with the provision of health services in Malakal, an important garrison town in South Sudan, during the second Sudanese civil war (1983–2005). Drawing on the concepts of opportunity hoarding and exploitation, it explores the social and political dynamics of service provision in and around the town during the war. These concepts provide a useful lens with which to understand better how health services are affected by conflict, while the empirical case study presented in the paper illustrates dynamics that may be repeated in other contexts. The concepts and case study set out in this paper should prove useful to healthcare providers working in conflict zones, including humanitarian aid agencies and their employees, increasing their understanding of the social and political dynamics that they are likely to face during future conflict‐related complex emergencies.     

Reducing post-disaster conflict: a cross-cultural test of four hypotheses using archaeological data

Four hypotheses concerning the relationship between climate-related disasters and conflict are tested using archaeological data in a controlled cross-cultural comparison. The four hypotheses are (1) Conflict increases following climate-related disasters because local economic conditions deprive polities of tax revenue so that they can no longer suppress conflict; (2) Conflict increases following climate-related disasters because existing social inequalities lead to conflicts over differential access to resources; (3) Conflict increases following climate-related disasters because migration forces population into condensed settlements ripe for conflict; and (4) Conflict increases following climate-related disasters in polities where leaders tightly control access to political authority because leaders may use violence to maintain control over the resources they use to secure support from other elites. Only the fourth hypothesis is supported. It is argued that understanding pre-disaster political strategies is key to understanding post-disaster conflict.     

The impact of Hurricane Rita on an academic institution: lessons learned

This paper examines the impact of Hurricane Rita on one of the many universities along the Gulf Coast of the United States: Lamar University in Beaumont, Texas. Hurricane Rita, which made landfall between Sabine Pass, Texas, and Johnson's Bayou, Louisiana, on 24 September 2005, is the fourth strongest Atlantic Ocean hurricane on record and the most intense tropical cyclone ever observed in the Gulf of Mexico. This paper assesses the tasks that confronted the administration, faculty, and students of Lamar University in the days and weeks after the event. It concludes that the one factor that will influence more than any other the degree of success after any disaster is whether all levels of the administrative command institutionalise, endorse, promote, and encourage the adopted recovery plan. The research seeks to share valuable insights on the vulnerabilities that academic institutions face during natural disasters and to highlight some of the many lessons learned.     

Changing household responses to drought in Tharaka, Kenya: vulnerability, persistence and challenge

Drought is a recurring challenge to the livelihoods of those living in Tharaka District, Kenya, situated in the semi-arid zone to the east of Mount Kenya, from the lowest slopes of the mountain to the banks of the Tana River. This part of Kenya has been marginal to the economic and political life of Kenya from the colonial period until the present day. A study of more than 30 years of change in how people in Tharaka cope with drought reveals resilience in the face of major macro-level transformations, which include privatisation of landownership, population growth, political decentralisation, increased conflict over natural resources, different market conditions, and environmental shifts. However, the study also shows troubling signs of increased use of drought responses that are incompatible with long-term agrarian livelihoods. Government policy needs to address the challenge of drought under these new macro conditions if sustainable human development is to be achieved.     

Dividing disasters in Aceh, Indonesia: separatist conflict and tsunami, human rights and humanitarianism

This paper examines the interface between human rights and humanitarian action in the context of the conflict and tsunami in Aceh, Indonesia, between 1998 and 2007. It looks at the challenges international humanitarian non-governmental organisations (NGOs) faced as they engaged in human rights work in the conflict period and in conflict-related activities in the post-tsunami period. The paper argues that many large NGOs may have compromised what some would hold to be essential principles for humanitarian action because of domestic political concerns, donor restrictions and resistance among certain NGO chiefs. In contrast with the pre-tsunami period, in which NGOs worked for years amid military operations, in the post-tsunami period NGOs were decidedly apolitical, neglecting the conflict in their tsunami response--despite significant developments that permitted greater political engagement in Aceh's post-conflict transformation. The evidence suggests that NGOs are challenged in contextualising humanitarian responses and that there is a need to underscore donor flexibility and independence in humanitarian action.     

Women, Health and Humanitarian Aid in Conflict

The burden of political conflict on civilian populations has increased significantly over the last few decades. Increasingly, the provision of resources and services to these populations is coming under scrutiny; we highlight here the limited attention to gender in their provision. Women and men have different exposures to situations that affect health and access to health-care and have differential power to influence decisions regarding the provision of health services. We argue that the role of women in planning is central to the provision of effective, efficient and sensitive health-care to conflict-affected populations.     

GIS and local knowledge in disaster management: a case study of flood risk mapping in Viet Nam

Linking community knowledge with modern techniques to record and analyse risk related data is one way of engaging and mobilising community capacity. This paper discusses the use of the Geographic Information System (GIS) at the local level and the need for integrating modern technology and indigenous knowledge into disaster management. It suggests a way to mobilise available human and technical resources in order to strengthen a good partnership between local communities and local and national institutions. The paper also analyses the current vulnerability of two communes by correlating hazard risk and loss/damage caused by disasters and the contribution that domestic risk maps in the community can make to reduce this risk. The disadvantages, advantages and lessons learned from the GIS flood risk mapping project are presented through the case study of the Quang Tho Commune in Thua Thien Hue province, central Viet Nam.     

Social capital and the political economy of violence: a case study of Sri Lanka

This article examines the links between militarised violence and social capital (trans)formation. It first maps out emerging theoretical and policy debates on social capital and violent conflict and questions a number of the assumptions underpinning these debates. This is followed by an empirical analysis of several war-affected communities in Sri Lanka. The case studies illustrate that the links between militarised violence and social capital are complex, dynamic and context specific. It is argued that social capital cannot be understood in isolation from political and economic processes, and the belief that violent conflict inevitably erodes social capital is questioned. Finally, the implications for external agencies are highlighted. Rather than focusing on engineering social capital, external agencies need to focus on understanding better the preconditions for social capital formation and how they can contribute to the creation of an enabling environment. This requires as a starting-point a rigorous analysis of political and economic processes.     

What happens to the state in conflict?: political analysis as a tool for planning humanitarian assistance

It is now part of received wisdom that humanitarian assistance in conflict and post-conflict situations may be ineffective or even counterproductive in the absence of an informed understanding of the broader political context in which so-called 'complex political emergencies' (CPEs) occur. Though recognising that specific cases have to be understood in their own terms, this article offers a framework for incorporating political analysis in policy design. It is based on a programme of research on a number of countries in Africa and Asia over the last four years. It argues that the starting-point should be an analysis of crises of authority within contemporary nation-states which convert conflict (a feature of all political systems) into violent conflict; of how such conflict may in turn generate more problems for, or even destroy, the state; of the deep-rooted political, institutional and developmental legacies of political violence; and of the difficulties that complicate the restoration of legitimate and effective systems of governance after the 'termination' of conflict. It then lists a series of questions which such an analysis would need to ask--less in order to provide a comprehensive check-list than to uncover underlying political processes and links. It is hoped these may be used not only to understand the political dynamics of emergencies, but also to identify what kinds of policy action should and should not be given priority by practitioners.     

Mental health in South Sudan: a case for community‐based support

This paper² provides a snapshot of the mental health situation in South Sudan between 2013 and 2016, taking account of the personal reflections of both authors who were engaged in mental health and psychosocial support (MHPSS)³ programming in the country at this time.⁴ It begins by presenting an overview of MHPSS activities from this period, including governmental and non‐governmental organisation (NGO) services, and relevant research and coordination mechanisms. It goes on to illustrate the challenges to the provision of support, as well as the overarching structural, governance, and human resource constraints faced by the sector. Finally, recommendations are put forward for improving services and care for people suffering from psychosocial and mental health issues, as well as suggestions for areas of focus in the future. The importance of an integrated, community‐based model is emphasised, and opportunities for organisations engaged in reconciliation efforts and mental health service provision to collaborate are proposed.     

Barriers to the long‐term recovery of individuals with disabilities following a disaster

This study examines how pre‐existing disabling conditions influenced the recovery process of survivors of Hurricane Katrina. It focuses specifically on the barriers that hindered the recovery process in these individuals. Focus groups were convened in four Gulf Coast states with 31 individuals with disabilities who lived in or around New Orleans, Louisiana, prior to Hurricane Katrina in August 2005. Qualitative data were analysed using grounded theory methodology. Five themes emerged as the most significant barriers to recovery: housing; transportation; employment; physical and mental health; and accessing recovery services. While these barriers to recovery were probably common to most survivors of the disaster, the research results suggest that disability status enhanced the challenges that participants experienced in negotiating the recovery process and in acquiring resources that accommodated their disabilities. The findings indicate that, when disaster recovery services and resources did not accommodate the needs of individuals with disabilities, recovery was hindered. Recovery efforts should include building accessible infrastructure and services that will allow for participation by all.     

The Prevention and Mitigation of Famine: Policy Lessons from Botswana and Sudan

Botswana and Sudan experienced consecutive years of drought in the 1980s. Sudan faced a large decline in food entitlement and nutritional deterioration, which translated into famine in 1984/85. Botswana, on the other hand, nearly compensated income losses and averted nutritional deterioration and famine-related deaths. There are important lessons to learn from the famine prevention experience of Botswana. Its strategy for dealing with drought and famine combines policies of steady economic growth with supplementary poverty alleviation and drought relief programs. To provide continuity and stabilization of market operations in times of distress, the country channels sufficient food through market chains, provides price support to preempt market collapse and augments the income of consumers through public income transfer programs to prevent demand failure. In addition, it maintains a responsive and accountable political system and a decentralized participatory administrative structure. While Sudan should develop policies that are compatible with its own environment, it is crucial that it recognizes the critical role of public action in promoting growth, alleviating poverty, and providing timely relief responses in times of anticipated growth failure.     

Food Security in Protracted Crises: Building More Effective Policy Frameworks

This paper considers the principal elements that underpin policy frameworks for supporting food security in protracted crisis contexts. It argues that maintaining the food entitlements of crisis-affected populations must extend beyond interventions to ensure immediate human survival. A 'policy gap' exists in that capacities for formulating policy responses to tackle the different dimensions of food insecurity in complex, fluid crisis situations tend to be weak. As a result, standardised, short-term intervention designs are created that fall short of meeting the priority needs of affected populations in the short and long term and only partially exploit the range of policy options available. The paper discusses key attributes of agency frameworks that could support more effective policy processes to address longer term as well as immediate food security needs. Additionally, it points to some main challenges likely to be encountered in developing such frameworks and, with the participation of beneficiaries, translating them into effective action.     

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.     

The Northridge Earthquake: Community-based Approaches to Unmet Recovery Needs

The 1994 Northridge, California earthquake has proven to be one of the most costly disasters in United States history. Federal and state assistance programmes received some 681,000 applications from victims for various forms of relief. In spite of the flow of US$11 billion in federal assistance into Los Angeles and Ventura counties, many victims have failed to obtain adequate relief. These unmet needs relate to the vulnerability of particular class and ethnic groups. In response to unmet needs, a number of non-governmental organisations (NGOs) have become involved in the recovery process. This paper, based on evidence collected from hundreds of in-depth interviews with the people involved, examines the activities of several community-based organisations (CBOs) and other NGOs as they have attempted to assist vulnerable people with unmet post-disaster needs. We discuss two small ethnically diverse communities in Ventura County, on the periphery of the Los Angeles metropolitan region. The earthquake and resultant disaster declaration provided an opportunity for local government and NGOs to acquire federal resources not normally available for economic development. At the same time the earthquake created political openings in which longer-term issues of community development could be addressed by various local stakeholders. A key issue in recovery has been the availability of affordable housing for those on low incomes, particularly Latinos, the elderly and farm workers. We discuss the successes and limitations of CBOs and NGOs as mechanisms for dealing with vulnerable populations, unmet needs and recovery issues in the two communities.     

Reproductive health services for refugees by refugees: an example from Guinea

The need to involve refugees in their own reproductive health (RH) services has long been recognised, but there is a lack of published examples describing how this can be achieved collaboratively between refugee initiatives, UNHCR, bilateral development organisations and international relief agencies. This paper outlines the work, outputs and lessons learnt of the Reproductive Health Group (RHG), an organisation of Liberian and Sierra Leonean refugee midwives and laywomen providing RH services to fellow refugees in Guinea's Forest Region between 1996 and 2000. Working as part of the Guinean health system, RHG midwives and community facilitators helped make the RH services in their region the most effective in Guinea at the time. Looking at RHG's achievements, the challenges it faced and partly overcame, it is argued that refugee organisations can plan and implement RH services for refugees where UNHCR and its international partners ensure that they receive funding and technical assistance.     

Reconciling reintegration: the complexity of economic and social reintegration of ex‐combatants in Burundi

The extent to which disarmament, demobilisation and reintegration (DDR) programmes initiated by state or multilateral agencies can realise the reintegration of ex‐combatants remains debated. While some consider that DDR should have the ambition to result in long‐term reintegration, others argue that DDR should focus on short‐term goals. This paper explores experiences with the reintegration of ex‐combatants in Burundi. It shows the interconnectedness of economic and social reintegration processes, and demonstrates that the reintegration of ex‐combatants cannot be seen in isolation from the wider recovery and development context in which DDR is taking place. Moreover, the case demonstrates that reconciliation and social reintegration are deeply interconnected, to the extent that social reintegration may fail if reconciliation is not taken into account. Rather than a debate between long‐ and short‐term goals, the focus should therefore be on increasing the understanding of reintegration processes and finding ways in which programmes can contribute to those.