Children's experience of conflict related emergencies: some implications for relief policy and practice

Nutrition and Care of Young Children during Emergencies

Emergencies are not only sudden events with natural causes that can be ameliorated with resources from outside. The causes and consequences of emergencies with sudden or slow onset, those that are complex and involve conflict, or are permanent emergencies are all deeply rooted in the vulnerability of people to hazards and their incapacity to recover. This will have implications for care behaviours and practices in the feeding, health, hygiene, and psychosocial areas. Families react to slow-onset emergencies by managing a declining resource with inevitable negative impacts on child care. Food intake declines. At the extreme of destitution, families may migrate to refugee camps where children face health crises as large displaced populations congregate around contaminated water sources. Breastfeeding may cease. In war situations, children face extreme psychosocial stresses. The importance of care for young children is given insufficient attention by those providing assistance from outside. Care interventions should improve the effectiveness of health, food, and psychosocial support

Evaluation of Nutrition Interventions in Children in Conflict Zones: A Narrative Review

Food and nutrition insecurity becomes increasingly worse in areas affected by armed conflict. Children affected by conflict, or in war-torn settings, face a disproportionate burden of malnutrition and poor health outcomes. As noted by humanitarian response reviews, there is a need for a stronger evidence-based response to humanitarian crises. To achieve this, we systematically searched and evaluated existing nutrition interventions carried out in conflict settings that assessed their impact on children's nutrition status. To evaluate the impact of nutrition interventions on children's nutrition and growth status, we identified published literature through EMBASE, PubMed, and Global Health by using a combination of relevant text words and Medical Subject Heading terms. Studies for this review must have included children (aged ≤18 y), been conducted in conflict or postconflict settings, and assessed a nutrition intervention that measured ≥1 outcome for nutrition status (i.e., stunting, wasting, or underweight). Eleven studies met the inclusion and exclusion criteria for this review. Five different nutrition interventions were identified and showed modest results in decreasing the prevalence of stunting, wasting, underweight, reduction in severe or moderate acute malnutrition or both, mortality, anemia, and diarrhea. Overall, nutrition interventions in conflict settings were associated with improved children's nutrition or growth status. Emergency nutrition programs should continue to follow recent recommendations to expand coverage and access (beyond refugee camps to rural areas) and ensure that aid and nutrition interventions are distributed equitably in all conflict-affected populations.

Mental and social health in disasters: Relating qualitative social science research and the Sphere standard

Increasingly, social scientists interested in mental and social health conduct qualitative research to chronicle the experiences of and humanitarian responses to disaster We reviewed the qualitative social science research literature in relation to a significant policy document, the Sphere Handbook, which includes a minimum standard in disaster response addressing "mental and social aspects of health", involving 12 interventions indicators. The reviewed literature in general supports the relevance of the Sphere social health intervention indicators. However, social scientists' chronicles of the diversity and complexity of communities and responses to disaster illustrate that these social interventions cannot be assumed helpful in all settings and times. With respect to Sphere mental health intervention indicators, the research largely ignores the existence and well-being of persons with pre-existing, severe mental disorders in disasters, whose well-being is addressed by the relevant Sphere standard. Instead, many social scientists focus on and question the relevance of posttraumatic stress disorder-focused interventions, which are common after some disasters and which are not specifically covered by the Sphere standard. Overall, social scientists appear to call for a social response that more actively engages the political, social, and economic causes of suffering, and that recognizes the social complexities and flux that accompany disaster. By relating social science research to the Sphere standard for mental and social health, this review informs and illustrates the standard and identifies areas of needed research.

Ideological commitment and posttraumatic stress in former Tamil child soldiers

This study focuses on the impact of present ideological commitment on posttraumatic stress symptoms in former child soldiers living in exile. Eighteen men and two women (aged 25-37), who had joined different Tamil armed groups in Sri Lanka between the ages of 13 and 17 years, participated. The Impact of Event Scale was used to measure posttraumatic symptoms. Qualitative methods were used to investigate the participants' ideological commitment. Participants reported being exposed to many potentially traumatizing events, and had high scores on the Impact of Event Scale. Twenty-five percent of the sample showed strong ideological commitment to the "cause". Ideological commitment at the present seemed to predict better mental health when exposure was less intense and overwhelming. Time had a negative impact on ideological commitment.

Family environment and emotional and behavioural symptoms in adolescent Cambodian Refugees: influence of time, gender, and acculturation

For young refugees, the turmoil of adolescence is exacerbated by the acculturation process that sometimes places them at odds with the traditional culture of their ethnic group. The family environment can affect how adolescents cross that pivotal period. This paper focuses on the influence of family environment, gender and acculturation on the mental health of young refugees from early to mid-adolescence. Sixty-seven Cambodian adolescents were followed up from early to mid-adolescence. The effects of the youths' acculturation level, gender, and family environment and structure on internalising and externalising symptoms were analysed through linear regression analyses. Family conflict tends to increase from early to mid-adolescence. The association between family environment and mental health changes over time and, overall, family environment is associated with externalisation whereas gender, acculturation level, and family structure influence internalisation. Cambodian girls and boys cope differently with the challenges of adolescence in the host country, adopting traditional strategies and borrowing new ones from the host culture. Family therapy may help the parents and their adolescents address this process of change, which is both a source of vulnerability and of fulfilment, and enhances the ability of the family to negotiate between the cultural worlds of the home and of the host countries.

Community based rehabilitation: a strategy for peace-building

BACKGROUND: Certain features of peace-building distinguish it from peacekeeping, and make it an appropriate strategy in dealing with vertical conflict and low intensity conflict. However, some theorists suggest that attempts, through peace-building, to impose liberal values upon non-democratic cultures are misguided and lack an ethical basis. DISCUSSION: We have been investigating the peace-building properties of community based approaches to disability in a number of countries. This paper describes the practice and impact of peace-building through Community Based Rehabilitation (CBR) strategies in the context of armed conflict. The ethical basis for peace-building through practical community initiatives is explored. A number of benefits and challenges to using CBR strategies for peace-building purposes are identified. SUMMARY: During post-conflict reconstruction, disability is a powerful emotive lever that can be used to mobilize cooperation between factions. We suggest that civil society, in contrast to state-level intervention, has a valuable role in reducing the risks of conflict through community initiatives.

Providing health care for refugee children and unaccompanied minors

The health of refugee children must be considered beyond ensuring access to health care to include issues such as housing and education. Refugees require support in using services, and their culture and religious background must be taken into account. Asylum seeking children have the same rights to health as any other children, yet non-eligibility for welfare foods may have implications for their nutrition. Providing for 15-18 year olds presents particular problems. It is important to arrange access to appropriate care for unfamiliar diseases and to recognize emotional health problems, particularly when they are related to past experiences of violence.