̽��ֱ�� of Cambridge - humanitarian

Syrian aid: lack of evidence for ‘interventions that work’, say researchers

fpjl2 — Thu, 04 Feb 2016 11:44:33 +0000

In the fifth year of the Syrian refugee crisis, donors and humanitarian agencies still remain unsure about which policies and interventions have been most effective, and continue to rely on a largely reactive response, say a group of researchers, aid workers and Syrian medical professionals.

Response approaches to date have often been short-termist, sometimes duplicating work and have very little evidence of effectiveness or impact, they say.

As national leaders and UN delegates gather in London today for the Support Syria Donor Conference, members of the Syrian Public Health Network warn that unless aid is provided on condition of evidence-gathering and transparency so funding can be directed to interventions that work, the health, education and livelihoods of refugees will continue to deteriorate.

They caution that Syrians in neighbouring countries such as Lebanon and Jordan – where services are stretched to breaking point – will suffer the most from ineffective interventions unless governments and NGOs of wealthy nations to do more to link allocation of donor funds to evidence, something that Network members have highlighted in a briefing for the UK's Department for International Development.

“A focus on health and health services is notably absent in the donor conference agenda yet it is a fundamental determinant on the success of education and livelihoods policies,” said Dr Adam Coutts, Cambridge ̽��ֱ�� researcher and member of the Syria Public Health Network.

“What funding there is for refugee healthcare risks disappearing unless governments insist on an evidence basis for aid allocation, similar to that expected in domestic policy-making.

“It is estimated that there are now over 4.3 million Syrian refugees in neighbouring frontline countries, and over half these people are under the age of 18. This level of displacement is unprecedented and given how short funds are, we need to be sure that programmes work,” said Coutts, from Cambridge's Department of Politics and International Studies.

“New ideas and approaches need to be adopted in order to reduce the massive burdens on neighbouring frontline states.”

Researchers say that the health response should do more to address the so-called ‘non-communicable diseases’ which ultimately cause more deaths: slow, silent killers such as diabetes, heart disease and, in particular, mental disorders. This means moving towards the development of universal health care systems in the region and building new public health services.

̽��ֱ��calls for more evidence come on the back of an article published last week in the Journal of the Royal Society of Medicine, in which members of the Syria Public Health Network (SPHN) address the response to mental disorders among displaced Syrians.

Clinics in some camps in Turkey and Lebanon report almost half of occupants suffering from high levels of psychological distress. However, many Syrians in neighbouring countries live outside the camps – up to 80% in Jordan, for example – which means cases are unreported.

In Lebanon, despite political commitment to mental health, there are just 71 psychiatrists, mostly in Beirut.

“ ̽��ֱ��implementation of short-term mental health interventions which often lack culturally relevant or practically feasible assessment tools risk diverting funds away from longer term, evidence based solutions,” said Coutts.

Moreover, a shortage of Syrian mental health professionals – less than 100 prior to the conflict has now fallen to less than 60 – is worsened by some neighbouring countries preventing Syrian doctors of any specialism from practising. Along with Physicians for Human Rights, SPHN members are calling for restrictions to be lifted on practising licenses for displaced Syrian health professionals.

“To date Syrian medical workers in Lebanon and Jordan are a largely untapped workforce who are ready to work and help with the response. However, due to labour laws and the dominance of private health service providers it is very difficult if not impossible for them to work legally,” said SPHN member Dr Aula Abbara.

Emerging evidence from the Syrian crisis, as well as evidence from previous conflicts, is pointing to psychological treatments which show some effectiveness:

Pilot studies with refugees in Turkish camps using ‘telemental’ projects, the delivery of psychiatric care through telecommunications, suggest that such techniques are effective in supporting healthcare professionals on the ground.

̽��ֱ��‘teaching recovery techniques’ method is designed to boost children’s capacity to cope with the psychological aftermath of war. These techniques have been used in communities in the aftermath of major natural disasters and conflicts, and have shown promise.

While SPHN members caution that adequate testing of these interventions is required, they argue that this is precisely the point: more evidence of what works.

Added Coutts: “A more scientific approach is needed so that precious and increasingly scarce financial aid is put to the most effective use possible. At the moment, NGOs and governments are not making sufficient reference to evidence in determining health, education and labour market policies for the largest displacement of people since World War Two.”

̽��ֱ��lack of an evidence base in the donor-funded response to Syrian migrant crisis means funds may be allocated to ineffective interventions, say researchers, who call on funders and policymakers in London for this week’s Syrian Donor Conference to insist on evaluation as a condition of aid.

A focus on health and health services is notably absent in the donor conference agenda yet it is a fundamental determinant on the success of education and livelihoods policies

Adam Coutts

UNHCR Photo Unit

Lebanese Town Opens its Doors to Newly Arrived Syrian Refugees

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Ounce of prevention, pound of cure

lw355 — Tue, 09 Oct 2012 12:34:13 +0000

Benjamin Franklin famously advised fire-threatened Philadelphians in 1736 that “An ounce of prevention is worth a pound of cure.” Clearly, preventing fires is better than fighting them, but to what extent can we protect ourselves from natural disasters? Hazards such as earthquakes, tsunamis, floods, hurricanes and volcanic eruptions are not in themselves preventable, but some of their devastating effects could be reduced through forward planning.

“It’s important to be able to recover resiliently from disasters and, as part of this, it’s vital to identify the vulnerabilities of communities living in hazard-prone regions,” explained Michael Ramage from the Centre for Risk in the Built Environment (CURBE). By putting resources into resilience and building back better, communities can reduce the risk of disastrous consequences should a similar event reoccur.”

Now, thanks to an information system that Cambridge researchers developed originally for tracking how regions recover from disasters, communities could soon have the means to understand how best to protect themselves from future catastrophes.

̽��ֱ��story begins in Haiti, where CURBE researcher Daniel Brown has been working over the past year with the British Red Cross and the United Nations following the devastating earthquake in 2010, which killed 316,000, displaced 1.3 million and destroyed almost 100,000 houses. In a country that was deeply impoverished before the earthquake, people continue to live under tarpaulins exposed to safety and security risks, with limited access to water, livelihoods and key services.

Brown travelled to the country to field-test a system that he and colleagues at Cambridge Architectural Research (CAR) and ImageCat had developed during the previous four years as a mapping technique for tracking post-disaster recovery.

With funding from the Engineering and Physical Sciences Research Council (EPSRC), Brown had identified a suite of 12 ‘performance indicators’ spanning core recovery sectors extracted from high-resolution satellite imagery. He used these to map the recovery process in Ban Nam Khem, Thailand, after the 2004 Indian Ocean tsunami, and Muzaffarabad, Pakistan, after the 2005 Kashmir earthquake, by looking at aspects such as the movement of populations, the construction of dwellings, the accessibility of roads, and the loss and rebuilding of livelihoods.

In Thailand and Pakistan, the system had already proved to be extremely useful. Brown’s work provided data and results that assisted decision making and had the potential to ensure the recovery process was both transparent and accountable.

In Haiti, the EPSRC-funded follow-on project aimed to fine-tune the performance indicators within operational situations to suit the workflow of aid agencies.

What Brown found, however, was that in the complex and dynamic situation that follows a disaster, agencies desperately needed a real-time system to help them decide where to put resources. “Many of the hundreds of maps produced within the first week of the Haiti earthquake were soon out of date because of the changeability of the situation,” he explained. “There was also a massive duplication of effort, with agencies often lacking trained staff to ensure the right information about buildings and people was acquired at the right time.”

Dr Stephen Platt, Chairman of CAR, who has also been working on the project, described how these findings confirmed the results of a survey the team had previously carried out: “Agencies told us that they lack coordinated mapping information on where displaced populations have gone and where they have begun to return to, as well as damage to livelihoods, and rehabilitation of homes and infrastructure. It’s very hard for them to decide where to put funds to the best effect for positive and resilient change.”

Brown’s first task was a remote analysis of the affected area from his office in Cambridge, using pre-disaster satellite imagery together with a new technique based on high-resolution oblique aerial photographs that capture views of the façade of buildings, and Lidar, which measures building height. On his arrival in Haiti, he identified which of the performance indicators was relevant for planning and used these to gather field information on the state of buildings, the socioeconomic impact on people, the safest places to rebuild and the community’s views. All data were integrated into a single database to aid the design of a rebuilding programme.

“We were delighted to find that the information system can be used for all phases of the disaster cycle, from preparedness through to damage assessment, then planning and finally recovery monitoring. You could think of each phase comprising a single module in the database. All these phases are effectively interrelated with each other – data produced during one phase can be used in another phase. So when we collected damage data, these could be used as a baseline to inform planning, and so on,” explained Brown.

Ramage, Principal Investigator for the follow-on project, added: “You can see how a system that can be used to predict where future vulnerabilities might be in a community is so important. And, through Steve’s work in New Zealand, Chile and Italy, we have learnt more about how governments and agencies in developed countries are currently responding to disasters, which has allowed us to learn more about how our system and ideas might be adapted for different contexts.”

Echoing this, Dr Emily So, Director of CURBE, explained how the project fitted into what’s been called the disaster management cycle: “Governments and agencies think in terms of mitigation, preparedness, response and recovery.

What we are trying to do in our research – which builds on 25 years of work in this area in the Department of Architecture under the leadership of Professor Robin Spence – is to make sure that we not only do reactive groundwork after the disaster but also proactive work, to mitigate and prepare ahead of the event and reduce the risk of disaster.”

̽��ֱ��team has recently been awarded funding for a two-year project involving eight global institutions with the remit of using satellite remote sensing to understand risk and vulnerabilities in communities around the world, under the European Commission’s Seventh Framework Programme.

“ ̽��ֱ��hazard itself is not what creates the disaster,” added So. “It’s the quality of the housing and the social fabric. This is where CURBE can help in terms of assessing exposure and proposing methods of evaluating it. Better information means better ideas, means better protection.”

For more information, please contact Louise Walsh (louise.walsh@admin.cam.ac.uk) at the ̽��ֱ�� of Cambridge Office of External Affairs and Communications.

Working with humanitarian organisations in Haiti, Cambridge researchers have found that an information system they designed to track how regions recovered from disasters can also be used to support preparedness, planning and project management.

Better information means better ideas, means better protection.

Dr Emily So

Colin Crowley on flickr

Haiti after the January 2010 earthquake

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Safe water solutions

lw355 — Mon, 01 Nov 2010 15:38:27 +0000

Almost 900 million people worldwide lack access to safe water; polluted lakes and waterways diminish livelihoods and health; and 2.6 billion people (almost half the population of the developing world) lack access to adequate sanitation¹ .

In Cambridge, research groups from several disciplines are working in regions worldwide where dirty, polluted and inadequate supplies of water make drinking, cooking and cleaning an everyday challenge for the communities who live there. We take a look here at some of their solutions.

Water cleaning with mussel power

Zoologist Dr David Aldridge is a keen advocate for the amazing abilities of mussels to clean up water. His work in China is using these remarkable organisms as cheap and sustainable water filters to improve water quality and, as a result, it is hoped that a local industry will develop to farm them.

China’s Lake Dianchi was once a rich haven of aquatic species but increasing levels of pollution from a cocktail of fertilizer run-off, sewage and the effluent from factories has caused a huge deterioration in water quality. ̽��ֱ��water is undrinkable and a hazard to those using it for washing, and the native aquatic wildlife has all but died off. Where once underwater visibility was over 10 metres, on a good day it’s now a mere 30 cm.

Using a set-up that could be replicated in many of the world’s polluted freshwaters, Dr Aldridge from Cambridge’s Department of Zoology and colleagues at the Chinese Academy of Sciences have deployed specially bred giant mussels – once native to the lake – in experimental enclosures along the lakeside.

̽��ֱ��mussels filter 50 litres of water a day, removing algae and suspended particles. ‘In just a few months,’ he explains, ‘not only did the water become clearer but native plants suddenly began to emerge from seeds buried for decades on the lake bed. These, in turn, provide habitat for insects, and then fish, and the system stabilises back to clearer water.’

One challenge has been the tendency of people living locally to eat the mussels. ̽��ֱ��team’s solution has been to turn to pearl farming to encourage the community to sustain the mussels in the lake. Chopsticks are used to insert a tiny bead of shell into the mussel, around which a pearl is formed. Recognising the potential impact of this idea on bolstering local industries, the World Bank awarded Dr Aldridge a Development Market Place Award to continue the work.

Dr Aldridge is also developing a means by which local authorities and managers of waterways can check the health of freshwater in their region, reducing the need for difficult and costly chemical testing. ‘We’re using the biology of the lake as an indicator of water quality. ̽��ֱ��number and type of organisms, or biotic index, provides a useful indication of the state of the water they live in. ̽��ֱ��guide book we are creating will enable users armed with only a hand net to monitor the condition of water in their province.’

Healthy water for households

Many people who lack access to safe water live in regions where conventional methods for supplying drinking water through water pipes are simply not possible or cost-effective. For these people, the alternative is to use household water treatment and safe storage systems (HWTS) based on chlorination, solar disinfection, ceramic filters or biosand filters.

As part of Dr Douglas Crawford-Brown’s wide research interests in water policy, he has been examining the effectiveness of reducing microbes in drinking water using low-cost HWTS in the developing world. As Executive Director of the Cambridge Centre for Climate Change Mitigation Research, in the Department of Land Economy, his research interests have an environmental perspective: ‘ ̽��ֱ��problem of ensuring safe water provision in the face of environmental change is a global one. But for developing countries, where large investments in infrastructure are not possible, it’s a massive concern.’

His work has been in collaboration with colleagues Dr Mark Sobsey and Dr Linda Venzcel at the ̽��ֱ�� of North Carolina, from which he moved two years ago, and Dr Christine Stauber at Georgia State ̽��ֱ��. Dr Crawford-Brown’s role in the long-term project has been to model the predicted human health impacts so that they can be compared against field epidemiological data in the Dominican Republic, Ghana, Honduras and Cambodia.

‘Our results show clearly that there is significant reduction in microbes, but also a residual concentration that can be quite difficult to remove,’ he explains. ‘In one project funded by the International Rotarians, we found that a simple sand filtration HWTS in the Dominican Republic halved the incidence of diarrhoeal disease, a major cause of death among infants in poor communities worldwide.’

Given that affordability of water systems is a critical regulatory issue, his research has also looked more widely at health–health trade-offs. ‘Trade-offs occur when the costs of water treatment in poor communities cause them to re-allocate limited finances, often away from buying medicine, unless public programmes are brought in to provide healthcare. Our goal is to provide policy makers with the evidence on which to base decisions on risk and in allocating budgets.’

Improving outcomes

Having worked for several years in rural Nepal trying to implement the use of water filtration units, Tommy Ngai from the Department of Engineering knows only too well that, despite their benefits, the adoption and continued use of HWTS is not always straightforward.

For the past four years he has been investigating how to scale up the dissemination of HWTS. Working with Dr Dick Fenner in the Centre for Sustainable Development in the Department of Engineering, his research has taken him to Nepal, southern India and Ghana, where he has carried out extensive interviews with project management staff, community workers, government officials, shopkeepers and household end users.

‘It’s not uncommon for communities either to not take up HWTS or for the equipment to be found lying abandoned a year or so later,’ he explains. ‘There may be a lack of awareness among potential users, or the devices may be too expensive to operate and maintain, or the supply chain unavailable, or there may be technical difficulties and ineffective post-implementation support.’

Ngai’s research has, for the first time, captured the big picture of the many competing factors at play – from the technical and financial, to the social and institutional. ̽��ֱ��outcomes are three programme-specific computer simulation models linking over 300 different variables. ̽��ֱ��models can help implementing organisations to appreciate the complexity of project management, to understand the interactions and consequences of any policy strategy and, crucially, to make recommendations for increasing the success of an HWTS programme.

‘Literally thousands of scenarios can be simulated in the model, whereas in the real world you can only try one strategy at a time,’ he says. ‘Comprehensive analysis showed that no single strategy will always work in all situations, and that some measures that have long-term benefits may at first appear counter-intuitive.’

One of the models has also been designed as an easy-to-use simulation game that can be run on a PC, allowing agencies and government officials to explore the effects of different potential intervention strategies concerning programme expansion, promotion, training, pricing and capacity building, and to predict adoption and sustained use of HWTS.

In his next post, as Director of Research Learnings at the Centre for Affordable Water and Sanitation Technology in Canada (www.cawst.org/), Ngai will be using his research to help NGOs and government policy makers to understand quickly how best to encourage sustained adoption of HWTS in their region.

^{1 www.unep.org/pdf/SickWater_screen.pdf}

For more information about these projects, please contact Dr David Aldridge (da113@cam.ac.uk) at the Department of Zoology; Dr Douglas Crawford-Brown (djc77@cam.ac.uk) at the Department of Land Economy; Tommy Ngai (tommyngai@yahoo.ca) and Dr Dick Fenner (raf37@cam.ac.uk) at the Department of Engineering.

Research across the ̽��ֱ�� is helping to clean up water in regions around the world.

̽��ֱ��problem of ensuring safe water provision in the face of environmental change is a global one. But for developing countries, where large investments in infrastructure are not possible, it’s a massive concern.

Dr Douglas Crawford-Brown

Tommy Ngai

Water clarity improvement after filtration

Sanitation innovation

Ensuring access to safe water isn’t the only challenge; it’s also what you do with waste. An innovative study has come up with a prototype system that could improve sanitation in urban slums.

̽��ֱ��realities of high-density living in urban slums have made conventional approaches to improved sanitation practically impossible, with low-income families renting living space in tightly packed, unplanned settlements serviced by pit latrines.
Nate Sharpe’s research in the Centre for Sustainable Development has come up with a solution for emptying pit latrines in the slums of Dar es Salaam, Tanzania, although his findings should be applicable to many other similar cities around the world. ‘Pit latrines are filling up faster than ever and people are often forced to rely on unhygienic emptying methods,’ he explains. ‘If smaller amounts of the sludge could be removed more often, it becomes easy to transport – even on the back of a bicycle.’

Sharpe has designed a prototype bicycle-powered vacuum pump/tank system and a business model for small businesses to run a latrine-emptying service at a low enough price that even the poorest might be able to afford to make their latrine usable again. ̽��ֱ��next stage is to test the device in Tanzania and to put the device into production.

His research was completed as part of an MPhil in Engineering for Sustainable Development with Dr Heather Cruickshank, and is just one of around 35 similar projects annually that are finding innovative engineering solutions to a host of sustainability problems. Many focus on developing countries where, as Sharpe has highlighted, sometimes the solution lies not in the development of new technology but in the creation of a new business angle that works in the local community.

For more information about these and other projects, please contact Dr Heather Cruickshank (hjc34 AT cam DOT ac DOT uk).

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Out of poverty

bjb42 — Mon, 01 Nov 2010 14:04:57 +0000

Bangladesh is a country beset by seasonal cycles of poverty and hunger. Almost 20 million people in the country are extremely poor and are vulnerable to natural disasters such as flooding. ̽��ֱ��UK Department for International Development (DFID) has invested a combined £120 million in two projects aimed at overcoming the poverty cycle by providing people who have almost no assets with the resources to build and secure a sustainable livelihood.

Professor Nick Mascie-Taylor and Dr Rie Goto, together with other members of the Human Epidemiology, Nutrition, Growth and Ecology (HENGE) group in the Department of Biological Anthropology, are supporting the projects by conducting in-depth nutritional and health surveys, as well as looking for ways of improving the nutritional status of the very poor.

Small steps to stability

Under the £65 million DFID-funded ‘shiree’/ Economic Empowerment of the Poorest programme, which runs until 2015, a consortium of NGOs is helping 750,000 of the poorest individuals across Bangladesh to generate assets and improve their income. ̽��ֱ��idea is that, by stimulating economic improvements, individuals can take iterative steps (shiree is the Bengali word for steps) out of poverty.

̽��ֱ��HENGE team will be carrying out annual surveys throughout the project, providing a measure of how nutrition and health changes as a result of the development programmes. ̽��ֱ��baseline assessment survey has just been completed and the results provide a stark illustration of why the intervention is needed: as many as 80% of individuals are undernourished, compared with 40% across the Bangladesh population. For children, this rises to 85%, and one in seven children is stunted, wasted and underweight.

Cash-for-work

̽��ֱ��DFID-funded Chars Livelihoods Programme is focused on an area in north-western Bangladesh where people living on large flat islands (chars) in river channels live with the frequent risk of losing their homes and crops to flooding. ̽��ֱ��project is providing 55,000 of the poorest households with a raised earthen plinth to lift their homes above the flood plain, plus income-generating assets – livestock or a vegetable garden – to help them not slip back into poverty.

A cash-for-work plinth building programme during the Monga (hungry) season gave local people approximately 2.6 million person-days of paid work. Although cash-for-work schemes are a familiar feature of development programmes, no research has looked at their impact on nutritional status. A concern levelled at such schemes has been that the increased physical work might cause weight loss. Results of the first such investigation have just been published by the HENGE team. Working with chars dwellers engaged in cash-for-work during a particularly severe Monga, they found no evidence to back up the concerns. By contrast, the scheme led to greater food expenditure and consumption, and a significant increase in the nutritional status of families.

Health package

̽��ֱ��team is also investigating how they can translate their research into tangible health benefits. They have been looking at the perennial problem among the extreme poor of gut parasites like hookworm (picked up through the soles of bare feet), which damages the lining of the gut, contributing to nutrient loss and anaemia.

Professor Mascie-Taylor has trialled a combination of deworming and dietary supplementation with vitamins, supplied in powdered form so that they can be sprinkled onto food. In only three months, the results were dramatic; the children, in particular, showed a 54% reduction in wasting.

With innovation funding from the shiree project, work has already begun on putting together a combined health package comprising regular deworming, micronutrients in sachets and flip-flops to prevent hookworm infection. ‘Our aim,’ he explains, ‘is to provide a cost-effective means of helping people back to the health needed to sustain graduation out of poverty.’

For more information, please contact Professor Nick Mascie-Taylor (nmt1@cam.ac.uk) at the Department of Biological Anthropology or visit http://henge.bioanth.cam.ac.uk/

Cambridge researchers are contributing to projects in Bangladesh that aim to lift 1 million people out of poverty by 2015.

Our aim is to provide a cost-effective means of helping people back to the health needed to sustain graduation out of poverty.

Professor Nick Mascie-Taylor

Nick Mascie-Taylor

Chars dwellers building plinths as part of the cash-for-work scheme

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Humanitarian focus on ICTs for international development

lw355 — Mon, 01 Nov 2010 09:49:39 +0000

A recently launched initiative of the Humanitarian Centre will focus activities on information and communications technologies for international development (ICT4D). Networking opportunities, learning events, training courses and an online directory will bring together academic, private sector and development practitioner audiences around the topic of ICT4D.

̽��ֱ��Humanitarian Centre is a Cambridge networking organisation for international relief and development, and a registered society of the ̽��ֱ��. During the year-long focus on ICT4D, the Centre will be working in partnership with Cambridge-based ARM, a globally recognised company that designs the technology that lies at the heart of advanced digital products.

Ian Steed, Humanitarian Centre Manager, explains the importance of the new focus: ‘ICT4D is a research growth area with exciting potential for creating innovative ways to alleviate global poverty and inequality. Our aim is to facilitate valuable and productive collaborations between groups that would not otherwise have the chance to connect.’

A number of research areas led by the ̽��ֱ�� are already highlighting the potential of ICT4D. Among these, a scoping project with China Mobile is examining the benefits of mobile phones for medical care in China and beyond, the Centre for Commonwealth Education has been introducing open educational resources into Zambian primary schools, and a new project by the Centre of Governance and Human Rights working with FrontlineSMS will examine the impact of mobile technology on citizen-led governance in Africa.

̽��ֱ��2010–2011 focus on ICT4D will be reflected in the second of the Humanitarian Centre’s Cambridge and International Development reports late in 2011. ̽��ֱ��first report, focusing on Cambridge innovation in international development, was published in November 2010.

For more information, please contact Ian Steed, Humanitarian Centre Manager (ian.steed@humanitariancentre.org; Tel: +44 (0)1223 760885) or visit www.humanitariancentre.org/

New networking activities will help academic expertise in information and communications technology to benefit developing countries.

ICT4D is a research growth area with exciting potential for creating innovative ways to alleviate global poverty and inequality

Ian Steed

Kiwanja

kiwanja

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