The Program on Forced Migration and Health faculty lead and collaborate on research that influences policy and practice in complex emergencies, post-emergency recovery and development contexts. We work hand in hand with governments, international agencies and community-based organizations. As part of our commitment to building the next generation of leaders in the field, we regularly engage students in our research through mentorship in field engagements and research assistantships and through the application of applied case studies based on our research as part of our curriculum program.
Latent class analysis of violence against adolescents and psychosocial outcomes in refugee settings in Uganda and Rwanda
Program Faculty: Lindsay Stark
Abstract: Little is known about violence against children in refugee camps and settlements, and the evidence-base concerning mental health outcomes of youth in refugee settings in low and middle-income countries is similarly small. Evidence is needed to understand patterns of violence against children in refugee camps, and associations with adverse mental health outcomes. Surveys were conducted with adolescent refugees (aged 13–17) in two refugee contexts – Kiziba Camp, Rwanda (n = 129) (refugees from Democratic Republic of Congo) and Adjumani and Kiryandongo refugee settlements, Uganda (n = 471) (refugees from South Sudan). Latent Class Analysis was utilized to identify classes of violence exposure (including exposure to witnessing household violence, verbal abuse, physical violence and sexual violence). Logistic regressions explored the association between latent class of violence exposure and symptoms of depression and anxiety.In Rwanda, a two-class solution was identified, with Class 1 (n = 33) representing high levels of exposure to violence and Class 2 (n = 96) representing low levels of exposure. In Uganda, a three-class solution was identified: Class 1 (high violence; n = 53), Class 2 (low violence, n = 100) and Class 3 (no violence, n = 317). Logistic regression analyses indicated that latent violence class was associated with increased odds of high anxiety symptoms in Rwanda (AOR 3.56, 95% CI 1.16–0.95), and high v. no violence class was associated with depression (AOR 3.97, 95% CI 1.07–7.61) and anxiety symptoms (AOR 2.04, 95% CI 1.05–3.96) in Uganda.The present results support the existing evidence-base concerning the association between violence and adverse mental health outcomes, while identifying differences in patterns and associations between refugee youth in two different contexts.
The West and Central Africa Region
Program Faculty and Staff: Mark Canavera, Bree Akesson, Debbie Landis
The focus of this study is to better understand how social workers and related professionals are trained and educated—both formally and informally—to engage in social work practice, especially as it is related to child protection, in the West and Central Africa region. The study defined the social service workforce broadly, including not only professional social workers but paraprofessionals such as NGO and CBO workers who through their daily work attempt to support vulnerable children and families. Research occurred in two phases, an initial phase from November through December 2013 when documents were collated from 13 countries across the region and phone interviews were conducted with relevant individuals. A second phase included field visits to five West African countries in January and February 2014—Burkina Faso, Côte d’Ivoire, Ghana, Nigeria, and Senegal—during which the research team conducted 42 semi-structured interviews and 27 group discussions with 253 individuals.
DrPH Student: Zahirah McNatt
Decentralization through the establishment of hospital governing boards has been touted as an effective way to improve the quality and efficiency of hospitals in low-income countries. Although several studies have examined the process of decentralization, few have quantitatively assessed the implementation of hospital governing boards and their impact on hospital performance. Therefore, we sought to describe the functioning of governing boards and to determine the association between governing board functioning and hospital performance.
Determining Acceptable Customary Caregiving Arrangements with Congolese Refugees in Rwanda: Findings from Rapid Studies in Two Camps and A Toolkit for Moving Forward
Program Faculty and Staff: Lili Birnbaum, Liberata Muhorakeye, Nancy Gatete, and Mark Canavera
This report presents both the process and the findings from a recent attempt to better understand customary caregiving arrangements for refugee children living in two camp-based populations in Rwanda. The study emerged from UNHCR’s recognition that although the globally accepted definitions of unaccompanied and separated children (UASC) do include provisions about customary caregivers, this concept has only rarely been operationalized in field settings.
The Eric Garner case: Statewide survey of ny voters' response to proposed police accountability legislation
New York, NY USA
Program Faculty and Staff: Les Roberts and Sara A. Snyder, Saeed Rahman, Jamie K. Hamilton, Hana T. Hamdi, Columbia Epidemiology of Human Rights Study Group, Anjoli Anand, Anna Andel, Laurene Barlet, Juliana L. Bennington, Cyril Bennouna, Chris B. Boyer, Matthew Cato, Eric Cioe-Pena, Courtney A. Clark, Mary Crippen, Justine Dowden, Jennifer B. Fearon,
Lorraine Fei, Angie Hamouie, Ian R. Kurashige, Samina Lutfeali, Kathryn Martin, Ramón Millán, Adrienne Pizatella, Maria C. Quinn, Kate Ross-Hopley, Emily Wilkinson Salamea, Kaitlin Shaw, Mallory C. Sheff, Priyam Thind, Anaise M. Williams.
The Eric Garner case was unique because this police-induced death was caught on video from before the moment of physical confrontation. A mixed-methods representative household survey and Garner’s arrest video were used to determine NYS voters’ opinions (n=119) about police indictment and Governor Cuomo’s request for expanded authority. Respondents were asked the officers should face indictment, shown the arrest video, and then asked again about indictment. Prior to the video (n=86), a majority of respondents (57.4%) believed involved officers should have been indicted. After viewing, the proportion increased by 13.7%. A majority support Cuomo’s call for expanded authority to appoint a special prosecutor in cases where police are involved in civilian deaths. Study limitations include: prior exposure to the footage and a low response rate. NYS voters generally support Cuomo’s proposal for appointing special prosecutors; however, a quarter of respondents disagreed with the method of reform and expressed either a: preference for every case to go to trial, preference for a case-by-case basis, and distrust in stateappointed special prosecutors. This research could inform discussions regarding proposed system reforms. Future research with a less well-circulated video is needed to determine the extent to which videos of police-induced deaths affect public opinion.
TRANSFORMING HOUSEHOLDS: REDUCING INCIDENCE OF VIOLENCE IN EMERGENCIES (THRIVE)
Lebanon, Haiti and Colombia
Program Faculty and Staff: Lindsay Stark, Beth Rubenstein, Khudejha Asghar
There is an urgent need for programs that reduce violence in the home in emergencies, including intimate partner violence (IPV), emotional abuse, physical and sexual abuse, and child maltreatment and neglect. However, there is limited evidence on what works to prevent violence in the home in these settings. Co-led by the UN Children’s Fund (UNICEF) and the CPC Learning Network, THRIVE uses a theory-driven, action-focused approach to determine drivers of violence, and select effective interventions to address violence in the home across humanitarian emergency contexts. The program will develop a grounded theory of change (TOC), explore innovative approaches to primary prevention, devise a measurement approach to document drivers of violence and evaluate programs seeking to reduce its frequency, and help strengthen the capacity of the humanitarian community to conduct rigorous evaluation research on violence in the home interventions that bridge the gaps between the GBV and CP sectors. The research has three stages: 1) Literature and PracticeReview, 2) Formative Research & Tool Development, and 3) Implement, Monitor and Evaluate Interventions.
Program Faculty and Staff: Lindsay Stark, Sarah Meyer, Beth Charpentier (also 2013 alumna)
UNHCR’s 2012 Framework for the Protection of Children articulates the centrality of child protection formulated around six goals. Strategies to achieve the goals of the Framework are being rolled out in 11 pilot countries. In recognition of the importance of measurement and assessment of UNHCR’s child protection activities, including protection from sexual and gender-based violence (SGBV), UNHCR, the CPC Network and AVSI collaborated on this pilot study as a first step towards developing tools that can measure change in key child protection indicators. Researchers developed a Child Protection Index (CPI), based on UNHCR’s Framework for the Protection of Children, to measure the strength of the child protection system and conducted a first assessment in December 2013 in Kiziba Camp, Rwanda. This initial report presents the methodology, findings and key learnings of the pilot study. In 2015, UNHCR, the CPC Learning Network, and TPO-Uganda released another report, revising and adding the CPI, survey methods, and focus groups for adolescents based on a study conducted from December 2014-February 2015 in Kiryandongo and Adjumani refugee settlements, Uganda.
Community-based child protection mechanisms in refugee camps in rwanda: An ethnogrpahic study in RwandA
Program Faculty and Staff: Lindsay Stark, Mike Wessells, Mark Canavera
The purpose of this research is to learn about community-based child protection processes and mechanisms (CBCPMs) in two refugee camps in Rwanda – Gihembe and Kiziba. In particular, the research seeks to identify what refugees see as the main harms or risks to children, what CBCPMs exist and how they are used, what protective factors enable children’s positive coping and resilience, and whether and how the CBCPMs link with elements of the formal aspects of the child protection system, led by the Rwandan government and Office of the United Nations High Commissioner for Refugees (UNHCR). This study places special emphasis on the linkages between CBCPMs and education-sector groups and structures in order to assess modalities of interaction and collaboration between the two sectors for the strengthening of children’s protective environment.
community-based child protection mechanisms amongst urban refugees in kampala, uganda: an ethnographic study in Uganda
Program Faculty and Staff: Lindsay Stark, Mike Wessells, Mark Canavera
The purpose of the study reported here was to learn about community-based child protection processes and mechanisms in three urban refugee communities in Kampala, Uganda. In particular, the research sought to identify what urban refugees see as the main harms or risks to children, what CBCPMs exist and how they are used, what protective factors enable children’s positive coping and resilience, and whether and how the CBCPMs link with elements of the formal, government led aspects of the national child protection system. This study had a special focus on the protective effects of education. By learning about child protection amongst urban refugee communities, the research aimed to contribute to new knowledge that will be useful in strengthening both the child protection system and services provided to refugees in Uganda.
child protection systems strengthening and disaster risk reductioN
Haiti, Cote d'lvoire, South Sudan, Palestine and the Philippines
Program Staff: Mark Canavera
Students: Kiryn Lanning 2012, Kristen White 2013
The CPC Learning Network Secretariat in collaboration with UNICEF is also completing a series of studies that examine perceptions of efforts to strengthen national child protection systems in a variety of humanitarian settings: the 2010 earthquake in Haiti; the 2011 post-electoral violence in Côte d’Ivoire; the protracted emergences in South Sudan and Palestine; and Typhoon Yolanda/Haiyan in 2014 in the Philippines.
Middle East and North Africa
Program Faculty: Neil Boothby; Students: Shatha El-Nakib '15
The project aims to influence policy by providing a compelling evidence-based argument that current frameworks for refugee health are not optimally configured for 21st century needs, and that there is an opportunity to enhance health services for the millions of displaced Syrians in the Middle East and Turkey and tens of millions of additional displaced persons worldwide.
Ethiopia, DRC, Pakistan
Lindsay Stark and Marni Sommer have been working with the International Rescue Committee to evaluate the COMPASS program, which identifies and responds to the vulnerabilities of adolescent girls by establishing a foundation for their healthy transition into adulthood in humanitarian crises.
Ghana, Nigeria, Mali, Liberia, Ethiopia, DRC, Kenya, Tanzania, Malawi, Madagascar, Mozambique, Zambia, Burma, Cambodia
Program Faculty: James Eliades
Jamie Eliades works with PATH and Ministries of Health on the MalariaCare program. In this, MalariaCare is analyzing data from across all its countries to identify factors that are most associated with improvement in health care worker performance in improving the provision of quality care management. These include core competencies such as recognizing the need for a diagnostic test, accurately performing that test, adhering to the results and providing proper treatment.
Program Faculty: Les Roberts
Les Roberts has received a CDC grant to use non-traditional methods to monitor birth and deaths among displaced people in urban areas. This main approach will involve organizing community monitors to keep track of births, deaths and migrations from a fixed number of households in their neighborhoods. The first site for this project will be in the city of Goma in North Kivu Province, Democratic Republic of Congo.
The objective of the research, which is supported by USAID and JSI, is to develop a set of methods and tools for establishing a nationally representative estimate of the number, distribution and basic characteristics of children outside of households. The aim is that inclusive data can guide policy makers and service providers in recognizing and protecting these children.
This study seeks to identify the key attitudes, behaviors and supportive elements of resilient households: those that provide their children with positive and supportive care and protection. The study employs a range of qualitative methodologies, including ethnography, in depth interviews, and direct observation of parent-child interactions.
Democratic Republic of Congo, Sudan
Program Faculty: Lindsay Stark; Students: Eva Noble '15
This project used two tools, a household survey and a mobile phone-based community surveillance tool, together and separately in both chronic and rapid-onset emergencies in the Democratic Republic of Congo in 2014, and will soon expand to new contexts in South Sudan.
Research is now underway in the Democratic Republic of Congo and Somalia to examine various methodologies used to monitor attacks on education in these conflict affected countries, measures to protect schools and their personnel, and ways to increase national capacity to monitor this violation of attacks on schools.
Program Faculty: Rachel Moresky
The CPAP Survival study is designed to measure the impact of continuous positive airway pressure (CPAP) on mortality in children ages 1-59 months. A randomized controlled clinical trial is being used to evaluate this low-cost, low-technology medical device in two district hospitals in the Brong-Ahafo and Ashanti regions of Ghana.
Ethnographic study of child protection threats in post-ebola sierra leone
The project aims to evaluate child protection threats in Sierra Leone after the Ebola crisis.
Democratic Republic of Congo, Chad, Pakistan, Myanmar, Yemen and Somalia
Program Faculty: Therese McGinn
Therese McGinn and Sara Casey have been working with CARE, the International Rescue Committee and Save the Children to improve the sexual and reproductive health of women and girls in countries affected by war or natural disaster.