Institute for Global Health and Development

Integration has become both a key policy objective related to the resettlement of refugees and other migrants, and a matter of significant public discussion. Coherent policy development and productive public debate are, however, both threatened by the fact that the concept of integration is used with widely differing meanings. Based on review of attempted definitions of the term, related literature and primary fieldwork in settings of refugee settlement in the UK, the paper identifies elements central to perceptions of what constitutes 'successful' integration. Key domains of integration are proposed related to four overall themes: achievement and access across the sectors of employment, housing, education and health; assumptions and practice regarding citizenship and rights; processes of social connection within and between groups within the community; and structural barriers to such connection related to language, culture and the local environment. A framework linking these domains is presented as a tool to foster debate and definition regarding normative conceptions of integration in resettlement settings.

Current methods to estimate the incidence of gender-based violence in complex emergencies tend to rely on nonprobability samples. Population-based monitoring is undertaken relatively infrequently. This article provides a systematic review of published literature that represents attempts to quantify the magnitude of gender-based violence in emergency settings. Searches adopted a Boolean procedure, which led to initial selection of material that was then reviewed against set criteria. Only 10 studies met the final criteria for inclusion. Intimate partner violence, physical violence, and rape were the three categories of violence most frequently measured. Rates of intimate partner violence tended to be quite high across all of the studies-much higher than most of the rates of wartime rape and sexual violence perpetrated by individuals outside of the home. Direct comparisons of rates of violence were hindered by different case definitions, recall periods, and other methodological features. Recommendations for future studies are offered based on lessons learned from the studies reviewed.

It is 10 years since the adoption of the Cape Town Principles and Best Practices on the Prevention of Recruitment of Children into the Armed Forces and on Demobilization and Social Reintegration of Child Soldiers in Africa. The field of programming for the reintegration of children associated with armed forces and armed groups has made significant strides in this period. However, important gaps in the knowledge base remain. This paper examines empirical evidence that supports lessons learned from work with children formerly connected with fighting forces. It evaluates what is known, where promising practice exists, and lacunae in five programming areas: psychosocial support and care; community acceptance; education, training and livelihoods; inclusive programming for all war-affected children; and follow-up and monitoring. While the 2007 Paris Commitments to Protect Children from Unlawful Recruitment or Use by Armed Forces or Groups mark an emerging consensus on many issues, there is still a critical need for more systematic studies to develop the evidence base supporting intervention in this area.

This paper reports on an evaluation of a program in Sierra Leone that sought to support the community reintegration of young women and girls formerly associated with armed groups and forces. In the absence of baseline data, we used locally-derived indicators of reintegration and village timelines to conduct a retrospective cohort study of the progress of 142 girls and young women towards achievement of community reintegration following their experience of abduction. Although girls and young women in both intervention and comparison communities had made progress towards integration, the intervention was associated with improved mental health outcomes and higher ratings on some aspects of marriage quality. For those who had found the greatest challenges in reintegrating, the intervention additionally appeared to support community acceptance and inclusion in women's bondo activities.

This article describes a participative ranking methodology for identifying local understanding of reintegration and adjustment of potential value in programme planning and evaluation. It was applied in the specific context of girls formerly associated with ...

Despite emphasis on strengthening local health care provision, concern remains regarding the rates of utilization of state-provided services within Orissa. The reported study examined patterns of service utilization across the rural population of four districts of ...

A major humanitarian concern during the continuing crisis in Darfur, Sudan, has been the protection of children, although there has been little in the way of comprehensive analysis to guide intervention. Founded on a situational analysis conducted between October 2005 and March 2006, this paper documents the significant threats to children's well-being directly linked to the political conflict. It demonstrates the role of non-conflict factors in exacerbating these dangers and in promoting additional protection violations, and it uses the ‘protective environment’ framework (UNICEF Sudan, 2006a) to identify systematic features of the current environment that put children at risk. This framework is shown to provide a coherent basis for assessment and planning, prompting broad, multidisciplinary analysis, concentrating on preventive and protective action, and fostering a systemic approach (rather than placing an undue focus on the discrete needs of ‘vulnerable groups’). Constraints...

The present study examined levels of social integration for individuals resettling into community provision following the phased closure of Gogarburn Hospital, Edinburgh, UK, and the personal and service-related characteristics which were influential on such integration. The study ...

Mental health is becoming a central issue for public health complex emergencies. In this review we present a culturally valid mental health action plan based on scientific evidence that is capable of addressing the mental health effects of complex emergencies. A mental health system of primary care providers, traditional healers, and relief workers, if properly trained and supported, can provide cost-effective, good mental health care. This plan emphasises the need for standardised approaches to the assessment, monitoring, and outcome of all related activities. Crucial to the improvement of outcomes during crises and the availability to future emergencies of lessons learned from earlier crises is the regular dissemination of the results achieved with the action plan. A research agenda is included that should, in time, fill knowledge gaps and reduce the negative mental health effects of complex emergencies. Mass violence Economic Development Social capital Human rights Health and mental health services Health and mental health Impairment Action plan Figure: Macrolevel interactions and mental health during complex emergencies Search strategy and selection criteria We identified relevant studies for possible inclusion by searching standard computer databases including the US National Library of Medicine, Ecommons (Harvard Medical School), PubMed, and OVID. For psychosocial-related research, a review of grey literature (work that is not widely published; for example, theses, government reports, and dissertations) was compiled through bibliographic and documentation development associated with the Psychosocial Working Group (www.forcedmigration.org/psychosocial). Each author drew on his or her substantial expertise to contribute to this review. Keywords used were mental health, prevalence, trauma, traumatic event, refugee, war, mass violence, public health, complex emergency, complex humanitarian emergency, psychosocial, children, adolescents, Afghanistan,

Expatriate aid workers (n = 214) representing 19 nongovernmental organizations (NGOs) completed a predeployment survey, including measures of mental health (depression, anxiety, and posttraumatic stress disorder [PTSD]); risk factors (childhood trauma, family risk, and adult trauma exposure); and resilience factors (coping, social support, and healthy lifestyle) to assess their baseline mental health during preparation for deployment. Multiple regression analysis indicated that childhood trauma/family risk was not significantly related to depression, anxiety, or PTSD symptoms when controlling for report of prior mental illness; yet, adult trauma exposure was significantly related to all three. Social support contributed significant variance to depression and PTSD. NGOs can help applicants recognize the effects of recent trauma and the resilience provided by a healthy social network.

Background: International humanitarian aid workers providing care in emergencies are subjected to numerous chronic and traumatic stressors. Objectives: To examine consequences of such experiences on aid workers' mental health and how the impact is influenced by moderating variables. Methodology: We conducted a longitudinal study in a sample of international non-governmental organizations. Study outcomes included anxiety, depression, burnout, and life and job satisfaction. We performed bivariate regression analyses at three time points. We fitted generalized estimating equation multivariable regression models for the longitudinal analyses. Results: Study participants from 19 NGOs were assessed at three time points: 212 participated at pre-deployment; 169 (80%) post-deployment; and 154 (73%) within 3-6 months after deployment. Prior to deployment, 12 (3.8%) participants reported anxiety symptoms, compared to 20 (11.8%) at post-deployment (p = 0?0027); 22 (10.4%) reported depression symptoms, compared to 33 (19.5%) at post-deployment (p = 0?0117) and 31 (20.1%) at follow-up (p = .00083). History of mental illness (adjusted odds ratio [AOR] 4.2; 95% confidence interval [CI] 1?45-12?50) contributed to an increased risk for anxiety. The experience of extraordinary stress was a contributor to increased risk for burnout depersonalization (AOR 1.5; 95% CI 1.17-1.83). Higher levels of chronic stress exposure during deployment were contributors to an increased risk for depression (AOR 1?1; 95% CI 1?02-1.20) comparing post-versus pre-deployment, and increased risk for burnout emotional exhaustion (AOR 1.1; 95% CI 1.04-1.19). Social support was associated with lower levels of depression (AOR 0?9; 95% CI 0?84-0?95), psychological distress (AOR = 0.9; [CI] 0.85-0.97), burnout lack of personal accomplishment (AOR 0?95; 95% CI 0?91-0?98), and greater life satisfaction (p = 0.0213). Conclusions: When recruiting and preparing aid workers for deployment, organizations should consider history of mental illness and take steps to decrease chronic stressors, and strengthen social support networks.

Cognitive behavioural treatment manuals have increased in frequency, purpose and impact over the last 40 years. Despite numerous papers on the topic, few empirical studies regarding the constitution of treatment manuals have been conducted. A Delphi study examining the factors that constitute a good cognitive behavioural treatment manual is presented. This study generated a consensus of opinion of factors that therapists and researchers should consider when developing and appraising treatment manuals for cognitive behavioural interventions. Limitations of the study and the potential relevance of the research are discussed.

Background This paper reports on the use of a “neighborhood method” to measure the nature and incidence of violence against women and girls in post-conflict Liberia. Methods The study population comprised females in Montserrado and Nimba counties. Study participants were randomly selected for interviews using multi-stage cluster sampling. 30 clusters of households were sampled in each county. Information on incidents of domestic violence and rape within the preceding 18 months was collected with regard to females of all ages in the respondent’s household, and those of her four closest neighbors to make up the full sample. Findings Households in the sample contained 7015 females (1687 girls, 4586 women, 742 age missing) in Montserrado and 6632 (2070 girls, 4167 women, 95 age missing) in Nimba. In the previous 18 months 54.1% (CI 53.1-55.1) and 55.8% (CI 54.8-56.8) of females in Montserrado and Nimba respectively were indicated to have experienced non-sexual domestic abuse; 19.4% (CI ...

The ever-growing range of approaches to psychosocial intervention in areas of armed conflict reflects a wide diversity in underlying perspective. Practitioners are faced with questions of effectiveness and appropriateness of interventions. The author presents a conceptual framework formulated by the Psychosocial Working Group that offers a way of understanding psychosocial well being that embraces the breadth of the field. This framework is used to explore the assessment of the impact of events, by directing attention towards both the depletion and accretion of human, social and cultural resources as a result of armed conflict. Issues of effective, appropriate and ethical interventions are discussed in relation to the fundamental importance of facilitation of community engagement.

It is 10 years since the adoption of the Cape Town Principles and Best Practices on the Prevention of Recruitment of Children into the Armed Forces and on Demobilization and Social Reintegration of Child Soldiers in Africa. The field of programming for the reintegration of children associated with armed forces and armed groups has made significant strides in this period. However, important gaps in the knowledge base remain. This paper examines empirical evidence that supports lessons learned from work with children formerly connected with fighting forces. It evaluates what is known, where promising practice exists, and lacunae in five programming areas: psychosocial support and care; community acceptance; education, training and livelihoods; inclusive programming for all war-affected children; and follow-up and monitoring. While the 2007 Paris Commitments to Protect Children from Unlawful Recruitment or Use by Armed Forces or Groups mark an emerging consensus on many issues, there is still a critical need for more systematic studies to develop the evidence base supporting intervention in this area.