Center for Refugee and Disaster Response

Baltimore, MD, United States

Center for Refugee and Disaster Response

Baltimore, MD, United States
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Tappis H.,Center for Refugee and Disaster Response | Freeman J.,Johns Hopkins University | Glass N.,Johns Hopkins University
PLoS Currents | Year: 2016

Background: Gender based violence (GBV) remains one of the most serious threats to the health and safety of women and girls worldwide. The problem is even more pronounced in refugee populations where women and girls are at increased risk of violence. In 2015, UNHCR reported the highest number of forcibly displaced people in recorded history. Despite growing need, there have been few rigorous evaluations of interventions aimed at primary GBV prevention and no systematic reviews of GBV prevention efforts specifically focused on refugee populations; reviews to date have primarily examined prevention of conflict related sexual violence, with very limited focus on other forms of GBV such as intimate partner violence Methods: This study reviewed the scientific literature addressing strategies for primary prevention of GBV and their effectiveness among refugee populations over the past ten years (2006 to 2015). Narrative content analysis methods were used to extract findings related to prevention activities/programs recommended by the global humanitarian community, such as sociocultural norms change, rebuilding family and community support structures, improving accountability systems, designing effective services and facilities, working with formal and traditional legal systems, monitoring and documenting GBV, and/or engaging men and boys in GBV prevention and response. Results: Study findings indicate that a range of GBV prevention activities recommended by the global humanitarian community are currently being applied in a variety of settings. However, there remains a limited body of evidence on the effectiveness of GBV prevention programs, interventions, and strategies, especially among refugee populations. Conclusion: Commonly agreed upon standards or guidelines for evaluation of GBV prevention programming, and publication of evaluations conducted using these guidelines, could assist humanitarian stakeholders to build and disseminate an evidence base of effective GBV prevention interventions, programs and strategies. Evaluation of GBV prevention efforts, especially among refugee populations, must be given higher priority to justify continuation or revision of recommended GBV activities/programs being implemented in diverse humanitarian settings. © 2016 Public Library of Science. All rights reserved.

Delbiso T.D.,Catholic University of Louvain | Altare C.,Research and Analysis Unit | Rodriguez-Llanes J.M.,European Commission - Joint Research Center Ispra | Doocy S.,Center for Refugee and Disaster Response | Guha-Sapir D.,Catholic University of Louvain
Scientific Reports | Year: 2017

Despite the intuitive connection between drought and mortality, we still lack a sound quantitative synthesis of evidence drawn from the available data. In this study, we estimate the pooled under-five death rates (U5DR) and assess the effect of drought on child death in Ethiopia. Small-scale mortality surveys were searched from the Complex Emergency Database and then aggregated spatially and temporally with drought exposure data from the Global Drought Monitor and food insecurity data from the Famine Early Warning Systems Network. A Bayesian Poisson meta-analysis was performed on 88 surveys conducted in Ethiopia between 2009 and 2014, consisting of 55,219 under-five children. The pooled U5DR was estimated at 0.323/10,000/day (95% credible interval, CrI: 0.254-0.397), which is below both the emergency and the baseline death rate thresholds of sub-Saharan Africa. We failed to find a plausible association between drought and U5DR. However, minimal food insecure areas showed elevated U5DR compared to stressed food insecure areas. Furthermore, the U5DR increases as the prevalence of acute malnutrition increases. Targeted interventions to improve the underlying causes of child malnutrition are crucial. Further, revising and updating the existing mortality thresholds, both the baseline and the emergency, is recommended. © 2017 The Author(s).

Betancourt T.S.,Harvard University | Betancourt T.S.,Francois Xavier Bagnoud Center for Health and Human Rights | Newnham E.A.,Francois Xavier Bagnoud Center for Health and Human Rights | Newnham E.A.,University of Western Australia | And 5 more authors.
Journal of Adolescent Health | Year: 2012

Purpose: As we build the evidence base of interventions for depression among war-affected youth, it is critical to understand factors moderating treatment outcomes. The current study investigated how gender and history of abduction by Lord's Resistance Army rebels moderated treatment outcomes for war-affected youth. Methods: The study - a three-armed, randomized, controlled trial - was conducted with internally displaced war-affected adolescents in northern Uganda. Participants with significant depression symptoms (N = 304; 57% female; 14-17 years of age) were randomly assigned to an interpersonal psychotherapy group (IPT-G), a creative play/recreation group, or a wait-list control condition. Secondary analyses were conducted on data from this randomized controlled trial. Results: A history of abduction by Lord's Resistance Army rebels was reported by 42% of the sample. Gender and abduction history interacted to moderate the effectiveness of IPT-G for the treatment of depression. In the IPT-G intervention arm, treatment effectiveness was greatest among female subjects without an abduction history, with effect size = 1.06. IPT-G was effective for the treatment of depression for both male and female subjects with a history of abduction (effect size =.92 and.50, respectively). Male subjects with no abduction history in IPT-G showed no significant improvement compared with those in the control conditions. Conclusions: Abduction history and gender are potentially important moderators of treatment effects, suggesting that these factors need to be considered when providing interventions for war-affected youth. IPT-G may be an effective intervention for female subjects without an abduction history, as well as for both male and female former child soldiers, but less so for male subjects without an abduction history. © 2012 Society for Adolescent Health and Medicine.

Betancourt T.S.,Harvard University | Yang F.,Harvard University | Yang F.,Georgia Regents University | Bolton P.,Center for Refugee and Disaster Response
International Journal of Methods in Psychiatric Research | Year: 2014

This study aimed to refine a dimensional scale for measuring psychosocial adjustment in African youth using item response theory (IRT). A 60-item scale derived from qualitative data was administered to 667 war-affected adolescents (55% female). Exploratory factor analysis (EFA) determined the dimensionality of items based on goodness-of-fit indices. Items with loadings less than 0.4 were dropped. Confirmatory factor analysis (CFA) was used to confirm the scale's dimensionality found under the EFA. Item discrimination and difficulty were estimated using a graded response model for each subscale using weighted least squares means and variances. Predictive validity was examined through correlations between IRT scores (θ) for each subscale and ratings of functional impairment. All models were assessed using goodness-of-fit and comparative fit indices. Fisher's Information curves examined item precision at different underlying ranges of each trait. Original scale items were optimized and reconfigured into an empirically-robust 41-item scale, the African Youth Psychosocial Assessment (AYPA). Refined subscales assess internalizing and externalizing problems, prosocial attitudes/behaviors and somatic complaints without medical cause. The AYPA is a refined dimensional assessment of emotional and behavioral problems in African youth with good psychometric properties. Validation studies in other cultures are recommended. © 2014 John Wiley & Sons, Ltd.

Tierney D.,St John Of God Frankston Rehabilitation Hospital | Bolton P.,Center for Refugee and Disaster Response | Matanu B.,Buka Hospital | Garasu L.,Nazareth Treatment Center | And 2 more authors.
International Journal of Mental Health Systems | Year: 2016

Background: The Bougainville Crisis (1988-1997) was the largest armed conflict in the Pacific since WW-II. Despite this, there has been no assessment of the Mental Health and Psychosocial (MHPS) impact of the war. The aim of this paper is to summarize the available data regarding the longer-term MHPS impact of the Bougainville Crisis. Methods: A literature review and a sequence of consultations in Bougainville were conducted to identify the MHPS impact of the Bougainville Crisis and the capacity within Bougainville to address these issues. Results: The Bougainville Crisis resulted in violence-related deaths; the displacement of more than half of the population; widespread human rights abuses; far-reaching societal impacts including undermining of the traditional authority of elders and women and damage to cultural values and relationships; property damage and significant impacts on education and the economy. Conflict-related experiences continue to impact on mental health in the form of trauma-related symptoms, anger, complicated grief, alcohol and substance abuse, domestic violence including sexual assault, excessive alcohol use and a lack of engagement in purposeful activities. Other impacts include an increase in other forms of gender-based violence (including sexual assault), population displacement, and adverse trans-generational effects on children exposed to disturbed parental behaviours attributable to conflict exposure. In spite of the evident needs, there is limited capacity within Bougainville to address these pressing MHPS issues. Conclusions: The Bougainville Crisis has had a significant MHPS impact at multiple levels in the society. There is a strong interest within Bougainville to draw on external expertise to build local capacity to address MHPS issues. Preliminary recommendations are made to assist the process of building the capacity in Bougainville to address MHPS needs. © 2016 Tierney et al.

Veenema T.G.,Center for Refugee and Disaster Response | Thornton C.P.,Center for Refugee and Disaster Response
Journal of Radiology Nursing | Year: 2015

Guidance for the optimal management of patient surge after a radiologic disaster is limited and rarely taught in schools of nursing or staff development/continuing education programs. To prepare and respond to this low-frequency, high-impact event, nurses require a substantive body of knowledge and skill set on which to base both public health and acute care preparedness and response efforts. Hospital and public health emergency management response plans may be insufficient to accommodate the patient surge, health system burden, and the fear and uncertainty that characterize these types of events. Lessons learned from Chernobyl, Three Mile Island, and the Fukushima Daiichi nuclear power plant accidents can inform nurse preparedness efforts by providing information on what can be expected throughout the disaster life cycle of these catastrophic events. Nurse involvement may potentially include site response; the establishment of community reception centers for population screening and monitoring; decontamination; shelter management; and the psychosocial support of victims, families, co-workers, and the community impacted by the event. Copyright © 2015 by the Association for Radiologic & Imaging Nursing.

Strong J.,Center for Refugee and Disaster Response | Varady C.,Caritas Lebanon Migrant Center | Chahda N.,Caritas Lebanon Migrant Center | Doocy S.,Center for Refugee and Disaster Response | Burnham G.,Center for Refugee and Disaster Response
Conflict and Health | Year: 2015

Background: The flight of Syrian and Palestinian families into Lebanon from Syria included a number of older refugees. This study sought to characterize the physical and emotional conditions, dietary habits, coping practices, and living conditions of this elderly population arriving in Lebanon between March 2011 and March 2013. Methods: A systematic selection of 210 older refugees from Syria was drawn from a listing of 1800 refugees over age 60 receiving assistance from the Caritas Lebanon Migrant Center (CLMC) or the Palestinian Women's Humanitarian Organization (PALWHO). CLMC and PALWHO social workers collected qualitative and quantitative information during 2013. Results: Two-thirds of older refugees described their health status as poor or very poor. Most reported at least one non-communicable disease, with 60% having hypertension, 47% reporting diabetes, and 30% indicating some form of heart disease. Difficulties in affording medicines were reported by 87%. Physicial limitations were common: 47% reported difficulty walking and 24% reported vision loss. About 10% were physically unable to leave their homes and 4% were bedridden. Most required medical aids such as walking canes and eyeglasses. Diet was inadequate with older refugees reporting regularly reducing portion sizes, skipping meals, and limiting intake of fruits, vegetables, and meats. Often this was done to provide more food to younger family members. Some 61% of refugees reported feeling anxious, and significant proportions of older persons reported feelings of depression, loneliness, and believing they were a burden to their families. 74% of older refugees indicated varying degrees of dependency on humanitarian assistance. Conclusion: The study concluded older refugees from Syria are a highly vulnerable population needing health surveillance and targeted assistance. Programs assisting vulnerable populations may concentrate services on women and children leaving the elderly overlooked. © 2015 Strong et al.

Bass J.,Applied Mental Health Research Group | Poudyal B.,Rehabilitation Action for Torture Victims in Aceh RATA | Tol W.,Yale University | Murray L.,Applied Mental Health Research Group | And 2 more authors.
Social Psychiatry and Psychiatric Epidemiology | Year: 2012

Purpose War and conflict have consequences on the mental health of individuals and entire communities and the communities in Aceh, Indonesia, having experienced more than 30 years of armed conflict, are no exception. This study presents results from an evaluation of a nonspecific mental health group counseling program among adults affected by conflict. Interventions such as these need to be evaluated to further the limited empirical evidence base for efficacious community-based treatments for improving the mental health and psychosocial problems in humanitarian settings. Methods A total of 589 adults were screened using a locally validated measure of mental health and functioning. Of all, 420 (71%) met the study inclusion criteria of elevated symptom levels and functional impairment: 214 and 206 in three intervention and three control villages, respectively. Intervention participants met weekly for eight sessions in groups of eight to ten adults. Following completion of treatment, 175 (85%) controls and 158 (74%) intervention participants were re-assessed. Regression analyses compared pre- and post-intervention scale scores. Results We did not find an intervention effect for reducing the burden of depression and anxiety symptoms when compared with the control sample. Impact on functioning was mixed and there was an increase in use of positive coping strategies. Conclusions The lack of mental health impact may be because the mental health problems and dysfunction were not due to disorder, but were normal responses to struggles of daily living experienced by this community and not addressed by the intervention. © Springer-Verlag 2011.

Morton M.,Johns Hopkins University | Morton M.,Center for Refugee and Disaster Response | Levy J.L.,Johns Hopkins University | Levy J.L.,Center for Refugee and Disaster Response
Prehospital and Disaster Medicine | Year: 2011

Gathering essential health data to provide rapid and effective medical relief to populations devastated by the effects of a disaster-producing event involves challenges. These challenges include response to environmental hazards, security of personnel and resources, political and economic issues, cultural barriers, and difficulties in communication, particularly between aid agencies. These barriers often impede the timely collection of key health data such as morbidity and mortality, rapid health and sheltering needs assessments, key infrastructure assessments, and nutritional needs assessments. Examples of these challenges following three recent events: (1) the Indian Ocean tsunami; (2) Hurricane Katrina; and (3) the 2010 earthquake in Haiti are reviewed. Some of the innovative and cutting-edge approaches for surmounting many of these challenges include: (1) the establishment of geographical information systems (GIS) mapping disaster databases; (2) establishing internet surveillance networks and data repositories; (3) utilization of personal digital assistant-based platforms for data collection; (4) involving key community stakeholders in the data collection process; (5) use of pre-established, local, collaborative networks to coordinate disaster efforts; and (6) exploring potential civil-military collaborative efforts. The application of these and other innovative techniques shows promise for surmounting formidable challenges to disaster data collection. © Copyright Morton © 2011 World Association for Disaster and Emergency Medicine.

Gorokhovich Y.,City University of New York | Doocy S.,Center for Refugee and Disaster Response | Walyawula F.,Makerere University | Muwanga A.,Makerere University | Nardi F.,University of Rome La Sapienza
Landslide Science and Practice: Global Environmental Change | Year: 2013

Severe rains at the beginning of March in eastern Uganda caused fatal landslide in village Nametsi, district Bududa. On March 1st 300 people were missing or dead as the result of this event. More than 8,000 people from nearby villages were evacuated in UN funded temporary camp in Bulucheke. Results of preliminary assessment of the landslide situation showed development of new scarp within 300 m from the head of the Nametsi landslide. Absence of drainage systems, steep slopes and changes of the land cover exacerbate the potential for new landslides and will lead to new disasters in the future. Bududa area is known for Arabica coffee plantations that provide cash and jobs to local residents. Establishment of a simple monitoring system and education of local population regarding mitigation measures will reduce the risk of future disasters and provide better and safe environment for the coffee production. This will also lead to the reduction of poverty in the area and creating a potential for the future economic growth. © Springer-Verlag Berlin Heidelberg 2013.

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