Bioethical challenges in postwar development aid: The Rwandan case study

This article considers aspects of a development aid that provides medical support to strengthen pediatric orthopedics in Rwanda. We present part of the Afriquia foundation work, a nonprofit foundation from Poland involved in supporting the medical sector in Rwanda as a sign of global solidarity and the human right to health. The main foundation's activity is the treatment of orthopedic problems among Rwandan citizens. We present a case study of two children under the care of the Afiquia foundation. 11-year-old Seraphine treated due to the consequences of right tibia osteomyelitis and 11-year-old Lavi suffering from osteogenesis imperfecta. Both children were treated surgically in Poland due to Rwanda's lack of treatment possibilities. After the applied treatment, Seraphine walks correctly without crutches and can attend school and thrive among her peers. Lavi has not sustained any fragility fracture since the surgery in Poland. He is healthy and constantly ongoing his rehabilitation including gait training. The described cases initiated development aid in Rwanda, supplying hospitals with orthopedic implants and training medical staff. The growing number of humanitarian crises across the globe and the people affected requires increasing organizations involved in providing relief. The emphasis should be on global education, aiming to make the recipients reflect and prepare them to face humanitarian crises.

Nursing roles in disaster zones: Experiences and lessons from Turkey's 2023 earthquakes

BACKGROUND

Disasters affect human health and well-being globally. Nursing plays a vital role in disaster preparedness and response, ensuring efficient early care coordination and delivering effective field treatment.

AIM

This study investigates the challenges an Israeli humanitarian delegation encountered during their response to major earthquakes in Turkey in 2023. It explicitly focuses on difficulties in preparation, operations, and collaboration with local teams. The study further analyzes the findings and extracts valuable lessons from the mission.

METHODS

Using a qualitative descriptive design, 22 out of 32 nurses involved in delegation participated in three focus group discussions within two months of returning to Israel. The discussions were recorded, transcribed verbatim, and analyzed thematically. The study followed the COREQ guidelines, ensuring comprehensive reporting and methodological rigor in qualitative research.

FINDINGS

The study's main findings spanned predeparture preparation, mission challenges in the disaster zone, and postmission lessons, each highlighted by subthemes and participant quotations. A strong sense of mission was evident among the participants, along with frustration at inefficient time management prior to deployment. Many participants noted additional challenges, related to the difficulty of working in multiple languages and across cultures, and the opportunities for resolution. Finally, participants called for better psychological support following the mission.

CONCLUSION

Nurses in disaster zones offer valuable insights to enhance preparation, cross-cultural communication, and postmission implementation.

NURSING AND HEALTH POLICY IMPLICATIONS

Nurse managers and healthcare policymakers can utilize this study's findings to develop future nursing training programs in disaster-related skills. Additionally, it can help foster collaboration among international healthcare teams.

Challenges in humanitarian response implementation: a large-scale review of aid worker perspectives

Aid workers offer important perspectives for understanding better the most pervasive challenges that arise when implementing emergency response programming in humanitarian settings. This large sample study provides a global review of these perspectives, derived from 4,679 applications to the National NGO Program on Humanitarian Leadership, in which aid workers were asked to respond to the following question: 'What do you consider to be the biggest challenges in the implementation of emergency response programming in today's humanitarian settings?'. Through a qualitative coding process, the research team identified 14 major challenges that were prevalent across the applicants' responses and cross-tabulated these with their demographics. Coordination (30 per cent) and operating environment (29.5 per cent) were the most frequently reported. The study found a significant association between challenges identified and certain demographic variables. The results supplement a body of literature that is largely composed of small-scale, context-specific studies in which disaggre-gation of data by demographics is not possible.

The Urgent Call for Improved Healthcare for Children in Palestine Amidst Conflict

The ongoing conflict in Palestine has exacerbated an already dire healthcare situation for children, with hospitals and medical facilities struggling to function amidst targeted attacks and limited resources. This editorial highlights the urgent need for improved healthcare infrastructure and access to medical services for Palestinian children, who face disproportionate suffering and trauma. The blockade and restrictions on Gaza further compound the crisis, hindering access to specialized care and essential medications. The international community must prioritize humanitarian aid and support to address these challenges, safeguarding the health and well-being of Palestinian children amid conflict. Long-term solutions are imperative to build a sustainable healthcare system that ensures the rights of all children to access quality healthcare services, irrespective of geopolitical circumstances.

'I know you like the back of my hand': biometric practices of humanitarian organisations in international aid

Humanitarian organisations are increasingly utilising biometric data. However, we know little about the extent and scope of this practice, as its benefits and risks have attracted all the attention so far. This paper explores the biometric practices of the United Nations Refugee Agency, the United Nations World Food Programme, the International Committee of the Red Cross, Médecins Sans Frontières, and World Vision International. The study analysed relevant documents published over the past two decades and 17 semi-structured interviews with humanitarian workers conducted between June 2021 and June 2022. The findings reveal that humanitarian organisations use diverse types and functions of biometric data for different services, collaborate with many actors, and employ various data protection measures. Ultimately, challenging the straightforward generalisations about the use of such data, the paper argues that variational applications of biometrics in the humanitarian context require case-by-case analysis, as each instance will likely produce a different outcome.

Navigating the shift in Bangladeshi host community's perceptions towards the Rohingya refugees: a declining sympathy

Generosity and selflessness from the host community in Cox's Bazar were deemed to be instrumental in supporting Rohingyas who sought refuge in Bangladesh in 2017. Thousands of Rohingyas had to flee from their own country to save lives due to state-supported military violence. Initially, Bangladeshi media and civil society were largely supportive of the Rohingyas. However, the initial sympathy later withered away and may have turned into frustration and hostility. Based on 39 in-depth interviews with hot community members and humanitarian professionals, this paper argues that protraction of the crisis, inability to access natural resources due to the refugee camps, some Rohingyas' involvement in various unlawful activities, a perceived sense of neglect from the international community, and disruption in local labour market/trade affecting cost of living conditions for low-income people seem to have played important roles in creating widespread tensions between the host community and Rohingya refugees. We contend that findings of this study will add to the critical scholarship of humanitarian development in deepening the understanding of host and refugee communities' relationships. This paper will also have a positive impact on future policies toward harmonious coexistence between host communities and displaced refugees and potential sustainable solutions to the crisis.

The multilevel correlates, contributions, and consequences of leader humility in humanitarian aid work

Objective

Leader humility has been linked to many positive outcomes but not examined in humanitarian aid work. Three studies examined the multilevel correlates, contributions, and consequences of leader humility in Medair-a large, multinational, faith-based aid organization. Study 1 examined correlates of leader humility in a sample of 308 workers and 167 leaders. Study 2 explored multilevel contributions of leader humility in 96 teams comprised of 189 workers. Study 3 utilized a subsample (50 workers, 34 leaders) to explore consequences of Time 1 leader and team humility on outcomes 6 months later.

Method

Participants completed measures of humility (general, relational, team), leader and team attributions (e.g., effectiveness, cohesion, and growth-mindedness), organizational outcomes (e.g., job engagement and satisfaction; worker and team performance), and psychological outcomes (e.g., depression, anxiety, compassion satisfaction, and flourishing).

Results

Leader and team humility contributed to multilevel positive attributions about leaders (as effective and impactful), teams (as cohesive, psychologically safe, and growth-minded), and oneself (as humble), and those attributions contributed to organizational and psychological outcomes. Teams' shared attributions of their leader's humility contributed to higher worker job satisfaction and team performance. Longitudinally, for workers and leaders, leader and team humility were associated with some positive organizational and psychological outcomes over time.

Conclusion

In humanitarian organizations, leader humility seems to act as an attributional and motivational social contagion that affects aid personnel's positive attributions about their leaders, teams, and themselves. In turn, these multilevel positive attributions contribute to several positive team, organizational, and psychological outcomes among workers and leaders.

Providing Remote Aid During a Humanitarian Crisis

Humanitarian crises create opportunities for both in-person and remote aid. Durable, complex, and team-based care may leverage a telemedicine approach for comprehensive support within a conflict zone. Barriers and enablers are detailed, as is the need for mission expansion due to initial program success. Adapting a telemedicine program initially designed for critical care during the severe acute respiratory syndrome coronavirus 2 pandemic offers a solution to data transfer and data analysis issues. Staffing efforts and grouped elements of patient care detail the kinds of remote aid that are achievable. A multiprofessional team-based approach (clinical, administrative, nongovernmental organization, government) can provide comprehensive consultation addressing surgical planning, critical care management, infection and infection control management, and patient transfer for complex care. Operational and network security create parallel concerns relevant to avoid geolocation and network intrusion during consultation. Deliberate approaches to address cultural differences that influence relational dynamics are also essential for mission success.

Fighting with words: humanitarian security and the changing role of law in contemporary armed conflict

Violence against humanitarians is a commonplace phenomenon in contemporary armed conflict. This paper examines how the manipulation of international legal principles for political or military purposes, a practice known as 'lawfare', impacts humanitarian security in conflict-affected areas. Drawing on a case study of the Syrian conflict (2011-), it finds that lawfare has been used to legitimate systematic civilian targeting by pro-government forces and to delegitimise the delivery of aid to opposition-held areas of the country. Efforts to use legal measures to promote civilian welfare-by way of sanctions or demands for cross-border humanitarian access-have been taken as evidence of Western attempts to politicise humanitarian considerations and international law. In practice, this has meant increased security risks for aid workers and impunity for those implicated in the violence. The paper concludes by calling for more critical research on lawfare and politicisation of international law as part and parcel of civilian protection in conflict-affected areas.

Reflections on the multi-sectoral response to COVID-19 in Bangladesh’s Rohingya refugee camps

While the COVID-19 pandemic continues to impact people globally, refugees comprise a vulnerable population, particularly those living in densely populated areas. In Bangladesh, Cox’s Bazar is currently home to almost a million Rohingya refugees. Because of the lack of healthcare, sanitation and water, as well as overcrowding, refugees were at high risk of becoming ill during the early phases of the COVID-19 pandemic in 2020. Moreover, superstitions and lack of trust in the healthcare system threaten to put the community at further risk. To prevent tragic consequences, national and international attention and action are required to strengthen the health system for Rohingya refugees. The community will require surveillance and testing, infection prevention and control measures, adequate food supplies, and access to improved healthcare services. This paper calls for a multi-sectoral approach to developing an action plan and implementation strategy to minimize the impact of COVID-19 on this vulnerable population.

Disaster Medicine Education for Israeli Medical Response Teams to the Ukrainian Refugee Crisis

INTRODUCTION

Disaster Medicine (DM) requires skills, knowledge, and prior experience that are rarely put to test by health care providers. Pediatric DM presents unique challenges in terms of both knowledge and practice.

METHODS

An anonymous survey consisting of demographic and five-point Likert scale questions was administered to physicians, nurses, and other medical personnel from Israel's major medical emergency teams who were deployed to respond to the refugee crisis in Ukraine. This included teams from the Hadassah and Tel Aviv Sourasky Medical Centers and the Israel Ministry of Health.

RESULTS

Of the 171 members of the medical teams deployed on the Ukraine border, a total of 105 responses were obtained (61.4%) from 61 physicians, 50 nurses, and 12 other health care providers. The teams were composed of pediatricians (31.6%), internal medicine physicians (21.6%), Emergency Medicine and intensive care physicians (18.0%), and 31.0% other specialties.For 60% of the participants, this was their first deployment, and 78% had received no training in DM. Members rated the need for DM training at 4/5 (IQR 3-5). Forty-nine (49) members (46.6%) were not briefed on situational awareness and 97 members (89.5%) were not trained in the recognition of acute stress reactions. The responders also rated their concerns about providing medical aid to children at 2/5 (IQR 1-3). A medical clown was part of the teams 42.8% of the time; the presence of clowns was rated at a median of 4/5 (IQR 4-5). The team members underscored the need for more targeted training in DM at 5/5 (IQR 3-5).

CONCLUSION

The findings highlight the need for the formulation of a disaster education model that includes pediatric DM.

Redefining shelter: humanitarian sheltering

Shelter is one of the most 'intractable problems' in humanitarian aid and yet there is little clarity on an overarching definition. Terminology for shelter and housing is often conflated, and the most prominent definition does not fully reflect recent progress in the Shelter and Settlements Sector. This paper explores the varying terminology utilised in definitions of shelter within humanitarian aid since 1990, reflecting on the concepts of 'shelter' and 'housing', alongside surrounding perceptions of 'house' versus 'home', and related measures of adequacy. The current, most prolific definition is also deconstructed, demonstrating ambiguity in some of terminology such as 'dignity' and 'privacy', and revealing that interpretation of this definition depends on the reader's knowledge. Lastly, a new definition of 'sheltering' is proposed, encompassing five key reflections: the concept of process over object; the inclusion of communities and individuals; the commonality of long-term sheltering; the wider effects of shelter; and the impacts on host communities and environment.

Humanitarian aid and local responses: the aftermath of the rebuilding effort on Tongoa island, Vanuatu

Cyclone Pam swept through the archipelago of Vanuatu on 13-14 March 2015, with wind speeds exceeding those recorded anywhere in the South Pacific since the 1980s. Southern and central parts of the country were particularly affected. Material damage on Tongoa, one of the most afflicted islands, was extensive, but no deaths were reported. During the storm, villagers found shelter in their kitchen, in what is considered locally as a 'lifeboat'. The aftermath was managed and mitigated by international aid organisations. On Tongoa, this included a 'Shelter Cluster' programme, under which villagers were given house rebuilding kits. Elaborating upon extensive ethnographic investigations on site between 2011 and 2018, this paper explores and reveals the ways in which this aid generated confusion among the local population. In a larger context of regular disasters triggered by natural hazards, locals have found endogenous ways of dealing with such extreme climatic events, for the most part without any external assistance.

Theory of change and strategic priorities of the world federation of haemophilia

The World Federation of Haemophilia (WFH) is a global network of national member organizations (NMOs) that advocate, collectively and individually, to improve lives of people with inherited bleeding disorders. The WFH vision of "Treatment for All" speaks to a future in which all people with an inherited bleeding disorder will have access to care, regardless of their gender or where they live. Over the last several years, initiatives including the WFH Humanitarian Aid program, the World Bleeding Disorders Registry, and Guidelines for the Management of Haemophilia and von Willebrand disease have significantly changed how the WFH and its partners work to improve and sustain care for people with bleeding disorders. Following an extensive consultation that included over 200 stakeholders from 70 countries, a Theory of Change was developed, and strategic priorities identified, to clearly define the WFH's intended impact and point of accountability to its stakeholders, and to determine how and through who those goals will be achieved. Both should help the WFH better support its NMOs and healthcare providers around the world in their efforts to improve access to diagnosis and care, as new therapies revolutionize the treatment landscape and the fallout of the global pandemic continues to challenge the ways in which we work and connect. Global collaboration of all stakeholders, based on their resources, objectives and skills, will be required to achieve these goals and to ensure more people have reliable access to safe treatment and care, regardless of their bleeding disorder, gender, or where they live.

Mobility Imaginaries of Humanitarian Intervention: Gender, Migration, and Violence along Mexico's Southern Border

Thousands of Central American women have been displaced from their countries of origin by violence. While the violence committed against them is often portrayed as isolated acts of aggression, women's suffering is also produced and perpetuated by humanitarian interventions that immobilize women in dangerous transit zones. Interventions are then justified by institutional logics that juxtapose women's vulnerability against the threat of their own mobility. This article draws on 14 months of ethnographic fieldwork along the southern Mexico border among migrant women who sought out humanitarian assistance following violent encounters. Central to my argument is the concept of mobility imaginaries, or widely shared social assumptions about how mobility should and can be accessed, by whom, and under what circumstances. Through this framework, I show how gendered mobility biases that underlie institutional logics compound other forms of institutional inequality, which often serves to reproduce, rather than mitigate, root causes of gender-based vulnerability.

The transition from development and disaster risk reduction to humanitarian relief: the case of Yemen during high-intensity conflict

Discussions on how humanitarian aid and disaster responses can link better with development and disaster risk reduction (DRR) have occurred for decades. However, the reverse transition, from development to relief, is still poorly understood. Using the case of Yemen, this study analyses whether and how development and DRR activities adapted to the emerging humanitarian crisis when conflict escalated in the country. It concentrates on governance strategies, actors, challenges, and opportunities at the nexus of development, disaster, and humanitarian responses. Semi-structured interviews and focus-group discussions with aid and societal actors were conducted remotely and in Jordan. The findings show gaps in knowledge and coordination in the movement from development and DRR to relief, but also reveal spaces and opportunities to advance towards enhanced integration of action before, during, and after an emergency. This paper contributes to the literature on this nexus and critically argues for a more integrated approach to conflicts and disasters.

Whose voices matter? Using participatory, feminist and anthropological approaches to centre power and positionality in research on gender-based violence in emergencies

An expansive view of 'rigorous' research is needed, particularly when studying complex health and human rights issues in settings where the imbalance of power between research participants, users and producers is heightened. This article examines how applying participatory, feminist and anthropological methods in gender-based violence research can hold researchers accountable to both acknowledging and explicitly addressing these power disparities. Applying these approaches throughout the research process takes time - to build trust and share stories rather than 'extract' data, to engage in collective meaning-making with those whose lived experiences are a form of expertise, and to consider how knowledge is represented and with whom it is shared. We provide examples and reflections from Empowered Aid, participatory action research that examines sexual exploitation and abuse in relation to humanitarian aid distributions, and tests ways for making aid safer. The study is grounded in ethnographic research by Syrian and South Sudanese women and girls living as refugees in Lebanon and Uganda, to safely take an active role in asking and answering questions about their own lives.

Addressing the mental health needs and burdens of children fleeing war: a field update from ongoing mental health and psychosocial support efforts at the Ukrainian border

Background: The ongoing horrors of the war in Ukraine have led to enormous consequences: loss of life, severe injuries, and mass movements of civilians. Exposure to war, living in conflict zones, and forced displacement increase the risk of experiencing a broad spectrum of direct and indirect burdens towards physical and mental health, in particular among children. Objective: This letter to the editor aims to provide multiple clinical and 'mental health and psychosocial support' (MHPSS) systems' perspectives by experts working in ongoing aid efforts to bridge and disseminate their current observations towards child and adolescent mental health services involved in the mental health response to the current war in Ukraine. Results and Discussion: The diverse perspectives from three mental health professionals involved in the MHPSS response highlight the different burdens and needs of children being confronted with situations of an existential nature. Children live through transformed social situations, deteriorated life conditions, general uncertainty, and encounter numerous losses. As such, war is the ultimate non-normative and existential stressor. The four perspectives highlight the need to: (1) adjust help toward the needs of the beneficiary, (2) understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters, (3) recognise losses and embrace finding ways to facilitate grief, and (4) continue to address these needs in a coordinated way that follows inter-agency guidelines. Conclusion: Better understanding the needs of refugee children underlines the importance of investing in their future by providing resources for humanitarian aid and psychosocial interventions during sustained emergencies. The perspectives presented in this letter emphasise that psychosocial care is deeply rooted in intersubjective help-encounters and, therefore, a professionalisation of interventions should co-occur with their humanisation and be adapted to subjective needs, varying sociocultural backgrounds, and the individuals themselves with the goal of reducing suffering and fostering well-being.

HIGHLIGHTS

The three expert humanitarian aid perspectives highlight the need to: adjust help toward the needs of the beneficiary,understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters,recognise losses and embrace finding ways to facilitate grief, andcontinue to address these needs in a coordinated way that follows inter-agency guidelines.

Post-conflict disaster governance in Nepal: one-door policy, multiple-window practice

The response to the earthquakes in Nepal on 25 April and 12 May 2015 was as overwhelming as the magnitude of the events themselves. Tensions between the humanitarian imperative and the post-conflict state-building agenda soon became evident. Many actors offered support by creatively complying with the state's approach, whereas others bypassed official channels completely. In post-conflict settings such as Nepal, the situation is especially complicated because of the contradiction between policies underscoring the importance of the state in the response and the reality of the fragility of the state, which often leads to the significant involvement of aid organisations. The post-conflict political landscape of Nepal shaped the contours of the response, as well as how actors decided to operate within them. This paper, based on empirical findings from four months of research, contributes to a better understanding of the intricacies of the post-conflict and post-disaster nexus in the context of a state-led response.

The Impact of Climate-Change-Related Disasters on Africa's Economic Growth, Agriculture, and Conflicts: Can Humanitarian Aid and Food Assistance Offset the Damage?

This study analyzed the impact of climate-related natural disasters (droughts, floods, storms/rainstorms) on economic and social variables. As the Africa-specific empirical literature is limited, this study used panel data from 1961–2011 on Africa. The study used a panel data regression model analysis. The results showed that climate change-related natural disasters affected Africa’s economic growth, agriculture, and poverty and caused armed conflicts. Among the disasters, droughts are the main cause of negative impact, severely affecting crops such as maize and coffee and resulting in increased urban poverty and armed conflicts. In contrast, international aid has a positive effect but the impact is insignificant compared to the negative consequences of climate-related natural disasters. Cereal food assistance has a negative crowding-out effect on cereal production. International donors should review their interventions to support Africa’s adaptative capacity to disasters. Government efficiency has reduced the number of deaths, and this is an area that supports Africa’s adaptative efforts.

European Countries Step-up Humanitarian and Medical Assistance to Ukraine as the Conflict Continues

On the 24th of February 2022, the Russian Federation began an unprovoked invasion of Ukraine, marking the biggest military attack in Europe since the second world war. Over 4 million people have fled their homeland within the first month of the war and have triggered a large refugee crisis with impacts far beyond the Ukrainian border. People in the neighboring countries have shown tremendous support by stepping forward to donate food, clothes, medications, money, and other essential supplies. The governments and other regional stakeholders have also been supportive in accommodating and easing regulations for the incoming refugees. Herein, we summarize the humanitarian measures and medical donations that have been made by European countries as they stepped up their efforts to provide refugees with all necessary basic services. We further highlight potential oncoming challenges in Ukraine and the host countries along with relevant solutions to these challenges. The current scenario highlights the need for multi-party and multi-level collaborations (both public and private) to tackle the emerging situation.

Gender-Based Violence Risk Mitigation by Non-GBV Specialists Prior to and during COVID-19: A Global Survey of Knowledge, Attitudes and Practices of Humanitarian Practitioners

Available evidence indicates that the COVID-19 pandemic and response measures may lead to increased risk of gender-based violence (GBV), including in humanitarian contexts. This study examined the knowledge, attitudes, and practices of humanitarian practitioners related to GBV risk mitigation approaches during COVID-19 in order to refine current guidance and inform future materials. A global, online cross-sectional survey of humanitarian practitioners was conducted between November 2020 and April 2021. We calculated descriptive statistics and used Chi-square or Fisher’s exact tests to compare knowledge, attitudes, and practices among GBV specialists and non-specialists. Of 170 respondents, 58% were female and 44% were GBV specialists. Almost all (95%) of the respondents agreed or strongly agreed that they have a role to play in GBV risk mitigation. Compared to GBV specialists, a higher proportion of non-specialists reported little to no knowledge on GBV risk mitigation global guidance (38% vs. 7%, p < 0.001) and on how to respond to a disclosure of GBV (18% vs. 3%, p < 0.001). Respondents reported several barriers to integrating GBV risk mitigation into their work during COVID-19, including insufficient funding, capacity, knowledge, and guidance. Efforts to mainstream GBV risk mitigation actions should continue and intensify, leveraging the lessons and experiences generated thus far.

Anxiety and Perceived Risk in Red Cross Volunteer Personnel Facing the Coronavirus Disease 2019 Pandemic

In the current situation of sanitary emergencies, humanitarian organizations and their volunteers are playing an important role in the coronavirus disease 2019 (COVID-19) pandemic. A study is proposed that includes a network of volunteers who perform humanitarian activities during the COVID-19 pandemic to assess anxiety, perceived risk, and response behaviors and to explore their relationship with sociodemographic variables. For data collection, an online questionnaire was developed through the Google Forms® platform, where the perceived risk, anxiety, and behavioral responses of the general population to the Influenza A (H1N1) pandemic were assessed. The survey presented is a modified version of that survey adapted for COVID-19. This adaptation was endorsed by an experts committee made up of the health chief of the Ecuadorian Red Cross, the focus point of operations from the International Federation of the Red Cross in Ecuador, and a member from the Health Unit of the Americas Regional Office of the International Federation of the Red Cross. A significant relationship has been shown between the job situation and perceived risk and anxiety, being the staff who worked full time away from home, which was exposed to greater risk and anxiety. Both perceived risk and perceived anxiety are very high (according to a 5-point Likert scale). Knowing these data from this first-line personnel will allow adopting measures that could be beneficial for stress management and, therefore, contribute to the well-being and support of these humanitarian and volunteer organizations in the worldwide response to COVID-1 9.

Why humility is vital to effective humanitarian aid leadership: a review of the literature

Organisational scientists are paying increasing attention to humility, following a larger trend in scholarship highlighting the relational and interdependent nature of leadership and business. A growing body of evidence identifies humility as vital to effective organisational leadership, facilitating positive organisational outcomes, such as lower voluntary turnover and greater follower job satisfaction. To date, research on the subject has focused on certain specific organisational contexts, including businesses, hospitals, and schools. This paper reviews the existing literature and explores why humility may be an especially important leader trait in international humanitarian aid organisations and relief work-a context that is not only uniquely challenging, but also one that would seemingly stand to benefit keenly from the quality. It argues that humility is essential for effective leadership because it is normative of good character, it is predictive of positive outcomes, and it corresponds to a genuine representation of the nature of humanitarian aid.

Evaluator perceptions of NGO performance in disasters: meeting multiple institutional demands in humanitarian aid projects

Providing aid in times of increasing humanitarian need, limited budgets, and mounting security risks is challenging. This paper explores in what organisational circumstances evaluators judge, positively and negatively, the performance of international non-governmental organisations (INGOs) in response to disasters triggered by natural hazards. It assesses whether and how, as perceived by expert evaluators, CARE and Oxfam successfully met multiple institutional requirements concerning beneficiary needs and organisational demands. It utilises the Competing Values Framework to analyse evaluator statements about project performance and organisational control and flexibility issues, using seven CARE and four Oxfam evaluation reports from 2005-11. The reports are compared using fuzzy-set Qualitative Comparative Analysis. The resulting configurations show that positive evaluations of an INGO's internal and external flexibility relate to satisfying beneficiary needs and organisational demands, whereas negative evaluations of external flexibility pertain to not meeting beneficiary needs and negative statements about internal control concerning not fulfilling organisational demands.

Training Package for Emergency Medical Teams Deployed to Disaster Stricken Areas: Has 'TEAMS' Achieved its Goals?

In spite of their good intentions, Emergency Medical Teams (EMTs) were relatively disorganized for many years. To enhance the efficient provision of EMT's field team work, the Training for Emergency Medical Teams and European Medical Corps (TEAMS) project was established. The purpose of this study was to assess the effectiveness and quality of the TEAMS training package in 2 pilot training programs in Germany and Turkey. A total of 19 German and 29 Turkish participants completed the TEAMS training package. Participants were asked to complete a set of questionnaires designed to assess self-efficacy, team work, and quality of training. The results suggest an improvement for both teams' self-efficacy and team work. The self-efficacy scale improved from 3.912 (± 0.655 SD) prior to training to 4.580 (± 0.369 SD) after training (out of 5). Team work improved from 3.085 (± 0.591 SD) to 3.556 (± 0.339 SD) (out of 4). The overall mean score of the quality of the training scale was 4.443 (± 0.671 SD) (out of 5). In conclusion, The TEAMS Training Package for Emergency Medical Teams has been demonstrated to be effective in promoting EMT team work capacities, and it is considered by its users to be a useful and appropriate tool for addressing their perceived needs.

Beyond performance and protocols: early responders' experiences of multiple accountability demands in the response to the 2015 Nepal earthquake

Critics have long questioned the push for professionalised and performance-driven accountability in the humanitarian sector, yet the matter is largely treated as a 'back office' issue of standards, guidelines, and processes. Scant attention is paid to the accountability demands experienced by early responders to disasters. Set in the contested climate of the emergency response to the earthquake in Nepal on 25 April 2015, and drawing on interviews with 15 early responders, this paper reveals three forms of accountability demands: (i) accountability as compliance; (ii) accountability as the object of government regulation; and (iii) accountability as public opposition and interrogation. Beyond the performance-centric, non-governmental organisation-driven understanding of accountability, early responders to the earthquake experienced multidirectional accountability demands, not only from donors and beneficiaries, but also from the national government and wider public. Engaging with public criticism is a significant feature of early responders' responsibility that warrants further consideration by the humanitarian community.

An Analysis of Essential Pediatric Surgical Cases Encountered During a Decade of Large-Scale Military Humanitarian Aid Missions

INTRODUCTION

Disease Control Priorities, 3rd Edition (DCP3) is an evidence-based, published resource that outlines essential procedures recommended for developing health care systems. These systems must consider various populations and the incidence of certain surgical conditions that require treatment. In relation to pediatric patients, the prevalence of certain surgical conditions encountered remains unclear in several low- and middle-income countries. Over the past 15 years, the USNS Mercy, one of the U.S. Navy's large hospital ships, has led the Pacific Partnership missions, which provide large-scale humanitarian aid throughout Southeast Asia. The data collected during these missions provide an opportunity to analyze the scope of pediatric operations performed in resource-limited countries. This analysis may assist in future planning for specific needs during military humanitarian missions.

MATERIALS AND METHODS

Surgical case data were prospectively collected during the six Pacific Partnership missions from 2006 to 2018. Demographic data were analyzed for all patients ≤8 years of age who underwent an operation. These data were retrospectively reviewed and all case logs were categorized by mission year, procedure-type, and host nation. Operations were classified based on 44 essential operations delineated in DCP3. Primary outcome was incidence of DCP3 essential operations. Secondary outcomes were perioperative complications. Standard statistical methods were performed for descriptive analysis.

RESULTS

A total of 3,209 major and minor operations were performed during 24 port visits in nine countries. Pediatric cases represented 1,117 (38%) of these procedures. Pediatric surgeons performed 291 (26%) of these cases. Based on DCP3 criteria, 789 pediatric operations (71%) were considered essential procedures. The most common DCP3-aligned procedures were cleft lip repair (432, 57%), hernia repair (207, 27%), and hydrocelectomy (60, 8%). Operative volume for pediatric surgery was highest during the 2008 mission (522 cases), when two pediatric surgeons were deployed, and lowest during the 2018 mission (five cases), when the mission focus was on education rather than surgical procedures and lack of pediatric cases referred by the host nation. Overall complication rate for pediatric cases was 1%.

CONCLUSIONS

This study represents the largest known analysis of military humanitarian assistance. Pediatric operations represented over one-third of the surgical volume during Pacific Partnership missions from 2006 to 2018. The majority of cases were DCP3-aligned and associated with a low complication rate. Future humanitarian aid missions and host nations should allocate appropriate medical and educational resources to treat DCP3 pediatric surgical diseases in low- and middle-income countries to support long-term capacity building while maintaining optimal surgical outcomes.

The internal brain drain: foreign aid, hiring practices, and international migration

Building on empirical material gathered in Haiti, this paper advances a new and innovative understanding of the internal brain drain phenomenon-the poaching of local skilled workers by international organisations (IOs) or international non-governmental organisations (INGOs)- by conceptualising it as an equilibrium. This equilibrium is composed of two sets of tensions: (i) those between the salary conditions in the public sector and those on offer to local personnel working for IOs and INGOs; and (ii) those inherent in the dual salary scale used by IOs and INGOs for local and international staff. These two sets of tensions contribute in their specific ways to international migration, and, as such, the internal brain drain has a bearing on external brain drain dynamics. In addition, the paper addresses the difficult policy choices facing development and humanitarian organisations, since every set of policies that impacts on one side of the equilibrium is bound to affect its other side.

Humanitarian aid and local power structures: lessons from Haiti's 'shadow disaster'

This paper investigates the confluence of humanitarian aid, centralisation, and politics. The 7.0 magnitude earthquake in Haiti on 12 January 2010 led to more than USD 16 billion in pledges. By contrast, Hurricane Matthew, which made landfall in Haiti on 4 October 2016, stayed in the shadows, attracting about one per cent of the amount. While the earthquake exhibited one face of centralisation, the Category 4 storm laid bare rural vulnerabilities shaped by postcolonial state neglect, and reinforced by the influx of non-governmental organisations in the 'Republic of Port-au-Prince'. The study draws on data from four case studies in two departments to illuminate the legacies of hyper-centralisation in Haiti. Compounding matters, Matthew struck in the middle of an extended election that the international community attempted to control again. The paper argues that disaster assistance and politics are uncomfortably close, while reflecting on the momentary decentralisation of aid after the hurricane and its effectiveness.

"Making Patients" in Postwar and Resource-scarce Settings. Diagnosing and Treating Mental Illness in Postwar Kosovo

Postwar development contexts are increasingly sites of mental health and psychosocial interventions in which local health providers are trained by foreign experts in evidence-based diagnostic and treatment strategies. Underlying this course of action is a well-accepted biomedical logic that assumes symptoms can be identified and translated into mental disorders, and disorders into forms of treatment. I question this logic by investigating how patients are actually "made" in postwar and resource-scarce settings. Specifically, I focus on the tensions and ethical dilemmas with which practitioners in Kosovo grapple as they navigate requirements of international standards, their own perception of good care, and the limited resources at their disposal. The resultant practice of "making patients" to fit diagnostic repertoires is a product of health practitioners' structural power, but also an ethical response to the materially untenable conditions that practitioners and their patients are confronting.

Trust in Humanitarian Aid From the Earthquake in 2017 to COVID-19 in Iran: A Policy Analysis

The earthquake of November 2017, the great flood of April 2019, and the COVID-19 outbreak in 2020 are 3 major emergencies in Iran during the last 3 years. A common issue in all of these crises seems to be the issue of "trust." Official authorities, including the Iranian President, ministers, and the judiciary system, tried to gain people's trust by either changing policies or developing new ones. In August 2019, the new law on crisis management in Iran went into effect and the issue of public donation has been considered, too. Also, in their response to the COVID-19 outbreak, Iranian officials ordered all sectors to cooperate with the Ministry of Health and provide it with all necessary facilities. Therefore, it seems that new policies are still needed to overcome mistrust in Iran at times of emergency. Developing a policy on donation management was the first step, and there are several factors that could have contributed to the perception of the mistrust and failure in emergency missions. Mistrust can be the result of different causes, including but not limited to lack of knowledge on capabilities and efficiencies of humanitarian organizations, engagement of a wide range of organizations from different categories, extension of mistrust of an organization to other emergency organizations in the area or all of operation, lack of unity in emergency response, and poor public relations.

The futility of rights-based humanitarian aid to the Occupied Palestinian Territories

A rights-based approach (RBA) to humanitarian aid is intrinsic to Norwegian policy and should inform Norwegian aid to the Occupied Palestinian Territories, one of the main receivers of Norwegian aid. However, this is the case only to a limited extent. While Norwegian humanitarian non-governmental organisations (NGOs) take RBA seriously, and design their projects in accordance with its principles, they are unable to pursue a programme of long-term structural change. This is because the main duty-bearer, Israel, is indifferent or hostile to their work, while Norway's foreign policy is given higher priority than following through a rights-based agenda. The result of this situation is a large, long-standing aid effort that is unable to provide more than temporary relief in a steadily deteriorating situation. The Palestinian case suggests that RBA in humanitarianism may lead to frustration rather than human liberation when not backed up by political power.

"Lost Generation" in South Sudan: A Broader Approach Toward Peace Urgently Needed

What began in 2013 as the eruption of a political struggle between forces loyal to President Salva Kiir, a member of the Dinka ethnic group, and then-vice president Riek Machar, a Nuer, has splintered into a multifaction conflict. A dizzying array of armed groups have entered the fray, many unmotivated by political leverage that conventionally brings parties to a conflict to the negotiating table. Two years and tens of thousands of deaths after the 2015 signing of the Agreement on the Resolution of the Conflict in South Sudan, with no substantive progress toward meetings its terms, it is unrealistic to think that Intergovernmental Authority on Development's recently announced High-Level Revitalization Forum will be sufficient to address the drivers of this conflict. Current policy proposals are poorly designed to address escalating intercommunal conflict and cattle raiding, both devastating forms of violence. As measures at the international level continue to be pursued, the conflict resolution strategy should also include a more comprehensive approach incorporating local actors in order to build momentum toward long-term stability. In this article, we highlight gaps in the current dialogue around a political solution in South Sudan, as well as domains that must be part of the next push for peace. (Disaster Med Public Health Preparedness. 2019;13:663-671).

"It's Not Always Possible to Live Your Life Openly or Honestly in the Same Way" - Workplace Inclusion of Lesbian and Gay Humanitarian Aid Workers in Doctors Without Borders

In this exploratory study, we present findings from semi-structured interviews with 11 self-identified lesbian and gay (LG) humanitarian aid workers of Doctors without Borders (MSF). We investigate their perceptions of workplace inclusion in terms of perceived satisfaction of their needs for authenticity and belonging within two organizational settings, namely office and field. Through our combined deductive and inductive approach, based on grounded theory, we find that perceptions of their colleagues' and supervisors' attitudes and behaviors, as well as organizational inclusiveness practices play a role in LGs' perceived authenticity, but not belonging, in the workplace. However, these organization-level characteristics do not account for between-participant differences in perceived authenticity. Therefore, we inductively construct a typology of three groups, which we coined conscious first-missioners, authentic realists, and idealistic activists, based on how LG humanitarian aid workers assess and deal with not being able to be their authentic selves when they are in the field, because homosexuality is illegal in many project countries. Conscious first-missioners are separated from the other two groups based on having gone to the field once, whereby they felt in control over the decision on how to manage their sexuality. Alternatively, authentic realists and idealistic activists alike felt they did not really have a choice in how to manage their sexuality, but handled that differently. We find the importance of one's sexuality as well as adherence to the overarching organizational mission relevant individual-level factors herein. Furthermore, we find disclosure of sexual identity to be strongly context-dependent, as participants are 'out of the closet' in the office, but go back into the closet when they enter the field, with different country contexts even leading to different decisions concerning self-disclosure, thus demonstrating the importance of careful sexual identity management. This so-called disclosure dilemma, we find, may not be merely an individual choice, but rather a shared dilemma involving multiple stakeholders, such as the organization and fellow team members. We discuss the findings' contributions to existing literature on LGs' workplace experiences and implications for future research on inclusion of sexual and other invisible minorities in the workplace.

Humanitarian medical aid to the Syrian people: Ethical implications and dilemmas

Medical professionals providing humanitarian aid in times of crisis face complicated ethical and clinical challenges. Today, humanitarian aid is given in accordance with existing guidelines developed by international humanitarian organizations and defined by international law. This paper considers the ethical aspects and frameworks of an atypical humanitarian project, namely one that provides medical support through an Israeli civilian hospital to Syrian Civil War casualties. We explore new ethical questions in this unique situation that pose a serious challenge for the medical community and conventional ethical norms, a challenge Israeli medical staff meet on a daily basis. Before discussing the ethical challenges, we give a description of the project and its unique status.

Difficulties faced by Korean disaster relief workers while providing humanitarian aid: A descriptive study

The aim of the present study was to identify difficulties experienced by Korean disaster relief workers during humanitarian aid deployment. A convenience sample of disaster relief workers aged >18 years, who had been dispatched to an overseas disaster site, were recruited; 107 relief workers completed the Humanitarian Aid Difficulty Scale that consists of 23 items comprising five factors. The average difficulty rating was 2.64 on a five point scale. By item, participants gave the highest scores for bathroom use and the lowest scores for cooperation among team members. By factor, infrastructure was rated as the greatest difficulty, followed by health conditions, goods and equipment, culture and customs, and cooperation. Considering sociodemographic characteristics, there were significant age differences in the culture and customs factor, as well as significant occupation differences in the cooperation, culture and customs, and goods and equipment factors. These findings highlight the need to improve the welfare of workers. It is recommended that further research be conducted according to occupation and with repeated measurement prior to, in the middle of, and after deployment of relief workers.

Humanitarian applications of machine learning with remote-sensing data: review and case study in refugee settlement mapping

The coordination of humanitarian relief, e.g. in a natural disaster or a conflict situation, is often complicated by a scarcity of data to inform planning. Remote sensing imagery, from satellites or drones, can give important insights into conditions on the ground, including in areas which are difficult to access. Applications include situation awareness after natural disasters, structural damage assessment in conflict, monitoring human rights violations or population estimation in settlements. We review machine learning approaches for automating these problems, and discuss their potential and limitations. We also provide a case study of experiments using deep learning methods to count the numbers of structures in multiple refugee settlements in Africa and the Middle East. We find that while high levels of accuracy are possible, there is considerable variation in the characteristics of imagery collected from different sensors and regions. In this, as in the other applications discussed in the paper, critical inferences must be made from a relatively small amount of pixel data. We, therefore, consider that using machine learning systems as an augmentation of human analysts is a reasonable strategy to transition from current fully manual operational pipelines to ones which are both more efficient and have the necessary levels of quality control.This article is part of a discussion meeting issue 'The growing ubiquity of algorithms in society: implications, impacts and innovations'.

Enhancing Global Health Security: US Africa Command's Disaster Preparedness Program

US Africa Command's Disaster Preparedness Program (DPP), implemented by the Center for Disaster and Humanitarian Assistance Medicine, partnered with US Government agencies and international organizations to promote stability and security on the African continent by engaging with African Partner Nations' (PN) civil and military authorities to improve disaster management capabilities. From 2008 to 2015, DPP conducted disaster preparedness and response programming with 17 PNs. DPP held a series of engagements with each, including workshops, strategic planning, developing preparedness and response plans, tabletop exercises, and prioritizing disaster management capability gaps identified through the engagements. DPP partners collected data for each PN to further capacity building efforts. Thus far, 9 countries have completed military pandemic plans, 10 have developed national pandemic influenza plans, 9 have developed military support to civil authorities plans, and 11 have developed disaster management strategic work plans. There have been 20 national exercises conducted since 2009. DPP was cited as key in implementation of Ebola response plans in PNs, facilitated development of disaster management agencies in DPP PNs, and trained nearly 800 individuals. DPP enhanced PNs' ability to prepare and respond to crises, fostering relationships between international agencies, and improving civil-military coordination through both national and regional capacity building. (Disaster Med Public Health Preparedness. 2019;13:319-329).

Kinship, nomadism, and humanitarian aid among Somalis in Ethiopia

This paper draws on extended ethnographic and health policy research in eastern Ethiopia to reconsider kinship and nomadism among Somalis, as both of these cultural features transform in the contexts of recurrent humanitarian crises and episodic relief operations. The emergence and importance of new patterns of travel and migration among Somalis in Ethiopia reveal significant changes in the configurations and enactments of Somali kinship, on which many Somalis' mobility depends. Conversely, an analysis of Somalis' dynamic sub-clan groupings and geographically dispersed kinship networks also highlights emergent patterns of mobility and migration that enable access to training opportunities and employment with relief organisations, as well as to distributions of humanitarian aid. Based on these findings, this paper argues that kinship and nomadism-both long central to Somalis' identities in Ethiopia-remain interdependent, coevolved, and key to their resilience and livelihoods in the face of recurrent crises and intermittent humanitarian responses.

Sea-change in reproductive health in emergencies: how systemic improvements to address the MISP were achieved

The Minimum Initial Services Package (MISP) for reproductive health has been the minimum standard for reproductive health service provision in humanitarian emergencies since 1995. Assessments of acute humanitarian settings in 2004 and 2005 revealed few MISP services in place and low knowledge of the MISP among humanitarian responders. Just 10 years later, assessments of humanitarian settings in 2013 and 2015 found largely consistent availability of MISP services and high awareness of the MISP as a standard among responders. We describe the multi-pronged strategy undertaken by the Women's Refugee Commission and other Inter-agency Working Group on Reproductive Health in Crises (IAWG) member agencies to effect systemic improvements in the availability of the MISP at the onset of humanitarian responses. We find that investments in fact-finding missions, awareness-raising, capacity development, policy harmonisation, targeted funding, emergency risk management, and community resilience-building have been critical to facilitating a sea-change in reproductive health responses in acute, large-scale emergencies. Efforts were underpinned by collaborative, inter-agency partnerships in which organisations were committed to working together to achieve shared goals. The strategies, activities, and achievements contain valuable lessons for the health sector, including reproductive health, and other sectors seeking to better integrate emerging or marginalised issues into humanitarian action.

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.

Ethical Considerations of Triage Following Natural Disasters: The IDF Experience in Haiti as a Case Study

Natural disasters in populated areas may result in massive casualties and extensive destruction of infrastructure. Humanitarian aid delegations may have to cope with the complicated issue of patient prioritization under conditions of severe resource scarcity. A triage model, consisting of five principles, is proposed for the prioritization of patients, and it is argued that rational and reasonable agents would agree upon them. The Israel Defense Force's humanitarian mission to Haiti following the 2010 earthquake serves as a case study for the various considerations taken into account when designing the ethical-clinical policy of field hospitals. The discussion focuses on three applications: the decision to include an intensive care unit, the decision to include obstetrics and neonatal units, and the treatment policy for compound fractures.

Effects of disease salience and xenophobia on support for humanitarian aid

This article examines how disease salience influences attitudes toward two types of humanitarian aid: sending foreign aid and housing refugees. Some have argued that disease salience increases levels of out-group prejudice through what is referred to as the behavioral immune system (BIS), and this increase in out-group prejudice works to shape policy attitudes. However, an alternative mechanism that may explain the effects of disease salience is contamination fear, which would suggest there is no group bias in the effects of disease threat. Existing work largely interprets opposition to policies that assist out-groups as evidence of out-group prejudice. We suggest it is necessary to separate measures of out-group animosity from opinions toward specific policies to determine whether increased out-group prejudice rather than fear of contamination is the mechanism by which disease salience impacts policy attitudes. Across two experiments, disease salience is shown to significantly decrease support for humanitarian aid, but only in the form of refugee support. Furthermore, there is converging evidence to suggest that any influence of disease salience on aid attitudes is not caused by a corresponding increase in xenophobia. We suggest that the mechanism by which disease threat influences policy attitudes is a general fear of contamination rather than xenophobia. These findings go against an important hypothesized mechanism of the BIS and have critical implications for the relationship between disease salience and attitudes toward transnational policies involving humanitarian aid.

[The health of migrants at the Greece-Macedonia border]

At the border between Greece and Macedonia, a transit camp for refugees is turning into a permanent camp. The management of the health emergency is assured by international teams from several humanitarian organisations, including the French Red Cross. The organisation of the care team, the cultural differences and the lack of resources are just some of the factors to be considered.

Republic of Senegal Disaster Preparedness and Response Exercise: Lessons Learned and Progress Toward Key Goals

OBJECTIVE

The Republic of Senegal Disaster Preparedness and Response Exercise was held from June 2-6, 2014, in Dakar, Senegal. The goal was to assist in familiarizing roles and responsibilities within 3 existing plans and to update the National Disaster Management Strategic Work Plan.

METHODS

There were 60 participants in the exercise, which was driven by a series of evolving disaster scenarios. During the separate Disaster Management Strategic Work Plan review, participants refined a list of projects, including specific tasks to provide a "road map" for completing each project, project timelines, and estimated resource requirements. Project staff administered a survey to conference participants.

RESULTS

A total of 86% of respondents had improved knowledge of Senegal disaster plans as a result of the exercise. A total of 89% of respondents had a better understanding of their ministry's role in disaster response, and 92% had a better understanding of the role of the military during a pandemic. Participants also generated ideas for disaster management system improvement in Senegal through a formal "gap analysis."

CONCLUSIONS

Participants were in strong agreement that the exercise helped them to better understand the contents of their disaster response plans, build relationships across ministerial lines, and effectively enhance future disaster response efforts. (Disaster Med Public Health Preparedness. 2017;11:183-189).

Development and validation of the Humanitarian Aid Difficulty Scale for Japanese healthcare workers

Few studies have investigated deployment-related experiences of healthcare workers dispatched for medical humanitarian aid or attempted to assess their difficult living and working environments. This is the first study to develop and validate a scale to measure these kinds of difficulties, in 264 Japanese healthcare workers. The Humanitarian Aid Difficulty Scale was developed in three stages. First, an item pool was generated based on literature and expert reviews. The scale was then tested in a pilot study. Reliability and validity were identified through exploratory and confirmatory factor analysis and Cronbach's alpha. The scale consisted of 23 items across five factors based on exploratory factor analysis (cooperation, health status, infrastructure, culture and customs, and supplies and equipment). The total variance explained was 60.7%. Reliability of the five factors was acceptable and validity was supported by confirmatory factor analysis. Cronbach's alpha for the scale was 0.87. The scale may enable evaluation of the level of difficulty of the living and working environments of Japanese healthcare workers in medical humanitarian aid who are at a greater risk of distress.

Characteristics of an Effective International Humanitarian Assistance: A Systematic Review

INTRODUCTION

The objective of this study is to identify the effectiveness characteristics, review the definition of them, and develop a conceptual mapping of existing domains in the field of International Humanitarian Assistance (IHA).

METHODS

We conducted a systematic review and searched the major databases (Science Direct, Scopus, Springer and Pubmed) and grey literature, including references of potentially eligible articles and conference proceedings through March 2015. Articles were included if they focused on IHA effectiveness. Reviewers independently identified the eligible studies and extracted data.

RESULTS

10 studies were included and 48 characteristics were identified. There is a lack of scientific studies and agreement on the characteristics of IHA effectiveness. 

CONCLUSION

This study could be the step toward an understanding of IHA effectiveness characteristics and its definitions with the findings making a base line for more research in this area.

The Development of a Humanitarian Health Ethics Analysis Tool

Introduction Health care workers (HCWs) who participate in humanitarian aid work experience a range of ethical challenges in providing care and assistance to communities affected by war, disaster, or extreme poverty. Although there is increasing discussion of ethics in humanitarian health care practice and policy, there are very few resources available for humanitarian workers seeking ethical guidance in the field. To address this knowledge gap, a Humanitarian Health Ethics Analysis Tool (HHEAT) was developed and tested as an action-oriented resource to support humanitarian workers in ethical decision making. While ethical analysis tools increasingly have become prevalent in a variety of practice contexts over the past two decades, very few of these tools have undergone a process of empirical validation to assess their usefulness for practitioners.

METHODS

A qualitative study consisting of a series of six case-analysis sessions with 16 humanitarian HCWs was conducted to evaluate and refine the HHEAT.

RESULTS

Participant feedback inspired the creation of a simplified and shortened version of the tool and prompted the development of an accompanying handbook.

CONCLUSION

The study generated preliminary insight into the ethical deliberation processes of humanitarian health workers and highlighted different types of ethics support that humanitarian workers might find helpful in supporting the decision-making process.