̽��ֱ�� of Cambridge - aid

Opinion: Aid workers get a bad rap – but too often they’re thrown in at the deep end

cjb250 — Tue, 21 Mar 2017 13:56:11 +0000

Acute famine in the Horn of Africa, an impending food crisis in Yemen and ongoing civil war in Syria are among the main causes of today’s global refugee crisis. Currently there are more than 65.3m people displaced across the globe and over 5,000 refugees died or went missing in the Mediterranean in 2016 on their way to Europe, making it the deadliest year on record.

While humanitarian organisations struggle to cope, it seems to be standard and accepted practice for the media to bash them for their work. Criticism is varied and extensive, but what the media seems to agree on is that humanitarian NGOs, charities and UN organisations are all inefficient and expensive. They are accused of disappointing efforts to come up with better aid programmes and ultimately failing to provide any results for their work.

Dangerous work and constant rotations

But it is a risky job to deliver aid in crises environments. In 2015, the Guardian reported that it has rarely ever been more dangerous to be an aid worker. And the statistics speak for themselves. In 2015, 148 attacks on aid workers were recorded with 109 people killed, 110 injured and 68 kidnapped.

In order to protect their staff, many organisations operate a strict rotation policy, which means that staff members have to leave an acute emergency operation after every three to six months or every second year. Such policies ensure that people can alternate between more and less dangerous posts, allowing them to rest and recover. OCHA, the UN Office for the Coordination of Humanitarian Affairs, for instance, has an emergency response roster with staff deployed to crises outbreaks usually for six to eight weeks.

Other organisations such as UNHCR, the UN Refugee Agency, works with roving positions. To respond immediately to crises and subsequent displacement, roving staff can be deployed to any emergency operation within 72 hours to assist local offices. A roving staff member whom I met during my research told me she sleeps next to her suitcase packed and ready, always on the move.

Little long-term memory

Such rotation policies are necessary, but they obviously present a challenge to the efficiency and effectiveness of humanitarian work. Emergency relief needs to be extremely fast paced, setting up camps, providing food, water and health services to thousands of displaced people in a matter of a few days.

In such context, staff should ideally rely on lessons learned and a good institutional memory of the local operation, but constant turnover makes information sharing difficult and the development of a long-term institutional memory is hard to achieve. And while new staff members in other organisations learn from colleagues who have been doing the same job for a few years, frequent staff rotations between Rwanda, Syria or Yemen make personal handovers almost impossible. So humanitarian workers often find themselves thrown in at the deep end.

Passing on knowledge

In order to deal with these challenges, humanitarian organisations need to be creative. ̽��ֱ��UN Refugee Agency, for instance, is currently piloting a global platform on good practices for staff assisting urban refugees, highlighting ways of addressing sexual violence or employment assistance that proved successful in other countries. ̽��ֱ��aim is to disseminate lessons learnt and best practices online. Humanitarian workers can proactively search for examples that might work in their own contexts by searching and filtering the database, instead of relying on personal handovers.

Lessons need to be learnt. EU Civil Protection and Humanitarian Aid., CC BY-NC-ND

Another charity, Engineers without Borders, often working in the aftermath of a first emergency response, publicly celebrates failures through its annual Failure Report. Its purpose is to give others the chance to learn from failures faster. Meanwhile, Save the Children is investing heavily in online learning courses. Staff members are trained on general operational systems or security procedures online before being sent to an emergency. Other training courses are designed to foster a better understanding of the organisation’s values and ways of doing things in order to develop a more global institutional memory.

Humanitarian organisations can easily be dismissed as inefficient and not effective, but they are operating in a challenging environment, constantly on the move to tackle global emergency and refugee crises.

Corinna Frey, PhD Candidate, Cambridge Judge Business School

This article was originally published on ̽��ֱ��Conversation. Read the original article.

̽��ֱ��media are quick to criticise humanitarian organisations as inefficient and expensive, writes Corinna Frey (Cambridge Judge Business School), in ̽��ֱ��Conversation, but we should remember the extremely challenging work they do.

DFID - UK Department for International Development

Action Against Hunger team deliver hygiene kits to Iraqi refugees

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Targeting of Syrian healthcare as ‘weapon of war’ sets dangerous precedent, say researchers

fpjl2 — Wed, 15 Mar 2017 11:42:36 +0000

̽��ֱ��strategy of using people’s need for healthcare against them by violently denying access sets a dangerous precedent that the global health community must urgently address, say an international team of researchers.

̽��ֱ��authors of a new report published today (15 March) in ̽��ֱ��Lancet – marking six years since the conflict began – have “triangulated” various data sources to provide new estimates for the number of medical personnel killed so far: 814 from March 2011 to February 2017.

However, they also say this is likely to be a “gross underestimate” due to limitations of evidence-gathering and corroboration in the conflict areas.

There were 199 attacks on health facilities in 2016 alone – an increase from 91 in 2012, when the Syrian government effectively criminalised medical aid for the opposition. ̽��ֱ��government and its allies, including Russia, have been responsible for at least 94% of attacks, say the experts – threatening the foundation of medical neutrality.

Besieged areas are denied medicine, and remaining medics are delivering what care they can in brutal conditions. Despite explicit protections under International Humanitarian Law, attacks on health workers have included imprisonment, abduction, torture and execution.

̽��ֱ��authors of the latest report, including researchers from Cambridge’s departments of sociology and politics, say the conflict has exposed serious shortcomings in global governance.

They call for the systematic documentation of attacks on health workers and, critically, the perpetrators via the WHO, allowing for greater accountability. UN policies and practices should also be reviewed and strengthened, including operational capacity to deliver support to health workers across conflict lines.

̽��ֱ��research team also calls for global solidarity with health workers in the Syrian conflict, including support to increase awareness among donors and politicians.

“Syria has become one of the most dangerous places on earth to be a healthcare worker,” says Dr Adam Coutts, report co-author from Cambridge’s Department of Sociology.

“Thousands of health workers have left and relocated to neighbouring countries and further afield such as Europe. This poses significant challenges for current healthcare provision in Syria but also for future health system rebuilding in a post conflict situation.”

Between 2011 and 2015, it is estimated that 15000 doctors, or half of the pre-war numbers, left the country. In Eastern Aleppo, approximately 1 doctor remained for every 7000 residents, compared with 1 in 800 in 2010.

̽��ֱ��exodus of older, experienced doctors has left critical gaps. Younger, less experienced physicians – many of whom are students with no experience in trauma management or emergency medicine – have become indispensable. However, this increases risk for patients and warns of a serious shortage of skilled doctors in future.

In non-government controlled areas, the few health workers left face massive numbers of trauma victims, shortages of medicines, epidemics of infectious disease and chemical attacks. In areas under siege, surgical supplies and essential medicines are seldom allowed in, patients rarely evacuated, and public health measures such as water chlorination and measles vaccination are sometimes blocked.

̽��ֱ��bulk of Syria’s remaining health workers are in government-controlled areas, where they also face mortar attacks from rebel areas and travel restrictions. Some report being forced to breach ethical principles under pressure.

Sophie Roborgh, one of the report’s authors from the Department of Politics and International Studies, conducts research on violence against health workers and medical infrastructure in conflict, and how health workers deal with it – professionally and personally.

“Healthcare workers that remain have been forced to adjust their entire lives around the threats and pressures they face,” she says. “There is such a shortage of staff that some physicians and other medical staff actually live full-time in hospitals.

“One medic showed me pictures on his phone of his colleague’s young children, who spend much time with their father, helping to mop up blood in operation rooms. Another told me how he celebrated his wedding in the hospital.

“We are trying to uncover which measures of support for these health workers are actually effective, in the hope that we can eventually move beyond a one-size-fits-all approach to a more specific, evidence-based model for conflict situations.”

Coutts says that practical policy options to assist displaced Syrian healthcare workers require evidence of where they are and what skills and training capacities they have. This information is not currently available and is badly needed.

“It is vital that the international community design policies and interventions to help displaced healthcare workers find and sustain employment in neighbouring host countries,” says Coutts.

“Due to visa and right-to-work issues, Syrian doctors and allied health professionals are unable to practice in countries such as Lebanon and Jordan. This is currently an untapped and essential workforce that could be used to support the already overstretched humanitarian response and public services in host communities.”

As new estimates of death toll for health workers are published, experts say the deliberate and systematic attacks on the healthcare infrastructure in Syria – primarily by government forces – expose shortcomings in international responses to health needs in conflict.

It is vital that the international community design policies and interventions to help displaced healthcare workers find and sustain employment in neighbouring host countries

Adam Coutts

European Commission DG ECHO

Syrian refugee in a hospital in Lebanon

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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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