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1.
Nature ; 603(7903): 864-870, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1747206

ABSTRACT

The COVID-19 pandemic has devastated many low- and middle-income countries, causing widespread food insecurity and a sharp decline in living standards1. In response to this crisis, governments and humanitarian organizations worldwide have distributed social assistance to more than 1.5 billion people2. Targeting is a central challenge in administering these programmes: it remains a difficult task to rapidly identify those with the greatest need given available data3,4. Here we show that data from mobile phone networks can improve the targeting of humanitarian assistance. Our approach uses traditional survey data to train machine-learning algorithms to recognize patterns of poverty in mobile phone data; the trained algorithms can then prioritize aid to the poorest mobile subscribers. We evaluate this approach by studying a flagship emergency cash transfer program in Togo, which used these algorithms to disburse millions of US dollars worth of COVID-19 relief aid. Our analysis compares outcomes-including exclusion errors, total social welfare and measures of fairness-under different targeting regimes. Relative to the geographic targeting options considered by the Government of Togo, the machine-learning approach reduces errors of exclusion by 4-21%. Relative to methods requiring a comprehensive social registry (a hypothetical exercise; no such registry exists in Togo), the machine-learning approach increases exclusion errors by 9-35%. These results highlight the potential for new data sources to complement traditional methods for targeting humanitarian assistance, particularly in crisis settings in which traditional data are missing or out of date.


Subject(s)
COVID-19 , Relief Work , COVID-19/epidemiology , Humans , Machine Learning , Pandemics , Poverty
3.
5.
BMC Med Educ ; 21(1): 610, 2021 Dec 10.
Article in English | MEDLINE | ID: covidwho-1566520

ABSTRACT

BACKGROUND: Disaster medicine is a component of the German medical education since 2003. Nevertheless, studies have shown some inconsistencies within the implementation of the national curriculum, and limits in the number of students trained over the years. Recently, the SARS-CoV-2 pandemic and other disasters have called attention to the importance of training medical students in disaster medicine on a coordinated basis. The aim of this study is to present and evaluate the disaster medicine and humanitarian assistance course, which was developed in the University of Tübingen, Germany. METHODS: The University Clinic for Anesthesiology and Intensive Care Medicine in Tübingen expanded the existing curriculum of undergraduate disaster medicine training with fundamentals of humanitarian medicine, integrating distance learning, interactive teaching and simulation sessions in a 40 h course for third-, fourth- and fifth- year medical students. This prospective and cross-sectional study evaluates the Disaster Medicine and Humanitarian Assistance course carried out over five semesters during the period between 2018 and 2020. Three survey tools were used to assess participants' previous experiences and interest in the field of disaster medicine, to compare the subjective and objective level of knowledge before and after training, and to evaluate the course quality. RESULTS: The total number of medical students attending the five courses was n = 102 of which n = 60 females (59%) and n = 42 males (41%). One hundred two students entered the mandatory knowledge assessment, with the rate of correct answers passing from 73.27% in the pre-test to 95.23% in the post-test (t [101] = 18.939, p < .001, d = 1.88). To determine the subjective perception of knowledge data were collected from 107 observations. Twenty-five did not complete the both questionnaires. Out of a remaining sample of 82 observations, the subjective perception of knowledge increased after the course (t [81] = 24.426, p < .001, d = 2.69), alongside with the interest in engaging in the field of disaster medicine (t [81] = 7.031, p < .001, d = .78). The 93.46% of the medical students (n = 100) graded the training received with an excellent overall score (1.01 out of 6). CONCLUSION: The study indicates a significant increase in students' understanding of disaster medicine using both subjective and objective measurements, as well as an increase interest in the field of disaster medicine and humanitarian assistance. Whereas former studies showed insufficient objective knowledge regarding disaster medical practices as well as subjective insecurities about their skills and knowledge to deal with disaster scenarios, the presented course seems to overcome these deficiencies preparing future physicians with the fundamentals of analysis and response to disasters. The development and successful implementation of this course is a first step towards fulfilling disaster medicine education requirements, appearing to address the deficiencies documented in previous studies. A possible adaptation with virtual reality approaches could expand access to a larger audience. Further effort must be made to develop also international training programs, which should be a mandatory component of medical schools' curricula.


Subject(s)
COVID-19 , Disaster Medicine , Relief Work , Students, Medical , Cross-Sectional Studies , Female , Humans , Male , Prospective Studies , SARS-CoV-2
6.
Disasters ; 45 Suppl 1: S216-S239, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1555668

ABSTRACT

The operational and socioeconomic consequences of Covid-19 have made cash assistance the global go-to relief modality, whether through humanitarian or social protection channels. Cash has proven to be an adaptable means of saving lives and supporting livelihoods and mitigating the pandemic's impacts on local economies while giving recipients the flexibility to decide what they require. Many humanitarian organisations have increased the scale of cash programmes, while government-administered social assistance mechanisms have been utilised on a huge scale. The crisis has bolstered attention on why linkages between social protection and humanitarian cash are important, including how to work together more effectively to enable better coverage of those in need. This paper has been developed with inputs from across the CALP Network. It explores how cash and voucher assistance-with a focus on humanitarian response-has been scaled up or adjusted in response to Covid-19, and how it is changing ways of working.


Subject(s)
COVID-19 , Relief Work , Humans , Public Policy , SARS-CoV-2
7.
Global Health ; 17(1): 83, 2021 07 22.
Article in English | MEDLINE | ID: covidwho-1388780

ABSTRACT

BACKGROUND: Yemen has been left in shambles and almost destroyed by its devastating civil war, and is now having to deal with the spread of coronavirus. The Yemeni people have been are left to fend for themselves and faced many problems such as hunger, the ongoing war, infections, diseases and lack of equipment even before the COVID-19 pandemic. All together it is a humanitarian crisis. Only around 50% of the hospitals and healthcare facilities are in full working condition, and even those that are functioning are operating at nowhere near full potential. Healthcare staff and facilities lack necessary essential equipment and money. CONCLUSION: As, sadly, is common in conflict-affected regions, the violence has brought with it a secondary disaster of infectious disease outbreaks. Yemen is not only battling COVID-19 amid a catastrophic war, but also has to deal with other diseases such as cholera, diphtheria and measles. A number of key measures are needed to support the current efforts against this deadly epidemic and its potential subsequent waves as well as to prevent further epidemics in Yemen.


Subject(s)
Armed Conflicts , COVID-19/epidemiology , Relief Work , Humans , Yemen/epidemiology
8.
Prehosp Disaster Med ; 36(5): 501-502, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1345519

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has caused the greatest global loss of life and economic impact due to a respiratory virus since the 1918 influenza pandemic. While health care systems around the world faced the enormous challenges of managing COVID-19 patients, health care workers in the Republic of Armenia were further tasked with caring for the surge of casualties from a concurrent, large-scale war. These compounding events put a much greater strain on the health care system, creating a complex humanitarian crisis that resulted in significant psychosocial consequences for health care workers in Armenia.


Subject(s)
COVID-19 , Disasters , Relief Work , Humans , Pandemics , SARS-CoV-2
11.
PLoS Med ; 18(6): e1003621, 2021 06.
Article in English | MEDLINE | ID: covidwho-1315878

ABSTRACT

BACKGROUND: Globally, 235 million people are impacted by humanitarian emergencies worldwide, presenting increased risk of experiencing a mental disorder. Our objective was to test the effectiveness of a brief group psychological treatment delivered by trained facilitators without prior professional mental health training in a disaster-prone setting. METHODS AND FINDINGS: We conducted a cluster randomized controlled trial (cRCT) from November 25, 2018 through September 30, 2019. Participants in both arms were assessed at baseline, midline (7 weeks post-baseline, which was approximately 1 week after treatment in the experimental arm), and endline (20 weeks post-baseline, which was approximately 3 months posttreatment). The intervention was Group Problem Management Plus (PM+), a psychological treatment of 5 weekly sessions, which was compared with enhanced usual care (EUC) consisting of a family psychoeducation meeting with a referral option to primary care providers trained in mental healthcare. The setting was 72 wards (geographic unit of clustering) in eastern Nepal, with 1 PM+ group per ward in the treatment arm. Wards were eligible if they were in disaster-prone regions and residents spoke Nepali. Wards were assigned to study arms based on covariate constrained randomization. Eligible participants were adult women and men 18 years of age and older who met screening criteria for psychological distress and functional impairment. Outcomes were measured at the participant level, with assessors blinded to group assignment. The primary outcome was psychological distress assessed with the General Health Questionnaire (GHQ-12). Secondary outcomes included depression symptoms, posttraumatic stress disorder (PTSD) symptoms, "heart-mind" problems, social support, somatic symptoms, and functional impairment. The hypothesized mediator was skill use aligned with the treatment's mechanisms of action. A total of 324 participants were enrolled in the control arm (36 wards) and 319 in the Group PM+ arm (36 wards). The overall sample (N = 611) had a median age of 45 years (range 18-91 years), 82% of participants were female, 50% had recently experienced a natural disaster, and 31% had a chronic physical illness. Endline assessments were completed by 302 participants in the control arm (36 wards) and 303 participants in the Group PM+ arm (36 wards). At the midline assessment (immediately after Group PM+ in the experimental arm), mean GHQ-12 total score was 2.7 units lower in Group PM+ compared to control (95% CI: 1.7, 3.7, p < 0.001), with standardized mean difference (SMD) of -0.4 (95% CI: -0.5, -0.2). At 3 months posttreatment (primary endpoint), mean GHQ-12 total score was 1.4 units lower in Group PM+ compared to control (95% CI: 0.3, 2.5, p = 0.014), with SMD of -0.2 (95% CI: -0.4, 0.0). Among the secondary outcomes, Group PM+ was associated with endline with a larger proportion attaining more than 50% reduction in depression symptoms (29.9% of Group PM+ arm versus 17.3% of control arm, risk ratio = 1.7, 95% CI: 1.2, 2.4, p = 0.002). Fewer participants in the Group PM+ arm continued to have "heart-mind" problems at endline (58.8%) compared to the control arm (69.4%), risk ratio = 0.8 (95% CI, 0.7, 1.0, p = 0.042). Group PM+ was not associated with lower PTSD symptoms or functional impairment. Use of psychosocial skills at midline was estimated to explain 31% of the PM+ effect on endline GHQ-12 scores. Adverse events in the control arm included 1 suicide death and 1 reportable incidence of domestic violence; in the Group PM+ arm, there was 1 death due to physical illness. Study limitations include lack of power to evaluate gender-specific effects, lack of long-term outcomes (e.g., 12 months posttreatment), and lack of cost-effectiveness information. CONCLUSIONS: In this study, we found that a 5-session group psychological treatment delivered by nonspecialists modestly reduced psychological distress and depression symptoms in a setting prone to humanitarian emergencies. Benefits were partly explained by the degree of psychosocial skill use in daily life. To improve the treatment benefit, future implementation should focus on approaches to enhance skill use by PM+ participants. TRIAL REGISTRATION: ClinicalTrials.gov NCT03747055.


Subject(s)
Depression/therapy , Mental Health , Natural Disasters , Problem Solving , Psychotherapy, Brief , Psychotherapy, Group , Relief Work , Stress Disorders, Post-Traumatic/therapy , Stress, Psychological/therapy , Adaptation, Psychological , Adolescent , Adult , Aged , Aged, 80 and over , Depression/diagnosis , Depression/etiology , Depression/psychology , Female , Functional Status , Humans , Male , Middle Aged , Nepal , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/psychology , Stress, Psychological/diagnosis , Stress, Psychological/etiology , Stress, Psychological/psychology , Time Factors , Treatment Outcome , Young Adult
12.
Nutrients ; 13(7)2021 Jul 08.
Article in English | MEDLINE | ID: covidwho-1302429

ABSTRACT

Widespread food insecurity has emerged as a global humanitarian crisis during the coronavirus disease 2019 (COVID-19) pandemic. In response, international non-governmental organizations (INGOs) and United Nations (UN) agencies have mobilized to address the food security needs among different populations. The objective of this review was to identify and describe food security interventions implemented by INGOs and UN agencies during the early stages of the pandemic. Using a rapid review methodology, we reviewed food security interventions implemented by five INGOs and three UN agencies between 31 December 2019 and 31 May 2020. Descriptive statistical and content analyses were used to explore the extent, range, and nature of these interventions. In total, 416 interventions were identified across 107 low- and middle-income countries. Non-state actors have developed new interventions to directly respond to the food security needs created by the pandemic. In addition, these humanitarian organizations have adapted (e.g., new public health protocols, use of technology) and reframed existing initiatives to position their efforts in the context of the pandemic. These findings provide a useful baseline to monitor how non-state actors, in addition to the food security interventions these organizations implement, continue to be influenced by the pandemic. In addition, these findings provide insights into the different ways in which INGOs and UN agencies mobilized resources during the early and uncertain stages of the pandemic.


Subject(s)
COVID-19/epidemiology , Developing Countries , Food Security , Relief Work , Food Security/methods , Food Supply , Humans , Organizations , United Nations
13.
Int Marit Health ; 72(2): 99-109, 2021.
Article in English | MEDLINE | ID: covidwho-1296140

ABSTRACT

BACKGROUND: Since 2014, the number of migrants and refugees crossing the Mediterranean towards Europe has risen significantly due to various reasons. Both state agencies and non-governmental organizations (NGOs) have launched rescue missions in the Central Mediterranean in accordance with international legal obligations for search and rescue (SAR) operations for those under distress at sea. Our aim is to summarise the specific qualifications needed for maritime SAR in the Mediterranean both in terms of the population at risk, the equipment and the medical support required, especially during the coronavirus disease 2019 (COVID-19) pandemic and the operational legal framework. MATERIALS AND METHODS: This article aims to summarise the key points of SAR efforts from a medical perspective as depicted in the relevant literature during a specific timeline period (2014-2020) in a specific part of the Mediterranean Sea (Central Mediterranean route). Only papers published in English and whose full text was available were included in this study. The inclusion criteria were: a) articles referring to sea rescue operations between 2014 and 2020, b) research that focused on medical preparedness and assistance during rescue operations in the Central Mediterranean route, c) studies concerning demographic and clinical features of the rescue population, d) guidelines on the rule of conduct of persons and states participating in rescue activities. The exclusion criteria were: a) studies describing SAR operations in different regions of the world and b) studies focusing on routes, demographics and medical support of migrants/refugees on land. RESULTS: Three major themes were identified: a) characteristics of the population in distress at sea: country of origin, age groups, presence of communicable and non-communicable diseases were identified in the relevant literature. Our research shows that dermatological and respiratory issues were the major concerns among sea migrants, coming from different countries of both Africa and Asia, being relatively young and mostly males; b) medical preparedness and equipment needed for rescue: according to current guidelines, revised during the COVID-19 pandemic, infrastructure needed during SAR operations includes both equipment for resuscitation, personal protective equipment, deck adjustments, medical personnel trained to function in an austere setting and able to handle vulnerable patient groups such as children and pregnant women; c) medico-legal implications of SAR operations: knowledge of the legal framework encompassing SAR operations seems necessary, as European Union and state led initiatives seem to withdraw from proactive SAR, while criminalising NGO led rescue efforts. Operating with the imperative to save lives seems to be the only way of respecting international law and human values, thus, a summary of what the law dictates was made in an effort to keep medical workers participating in such operations updated. CONCLUSIONS: Investigation aims to shed light on the special clinical features of sea migrants, the skills, equipment and organizational structure needed by medical workers participating in SAR operations as well as the legal framework under which they will be asked to operate. Special consideration will be given to the difficulties that emerged due to the COVD-19 pandemic.


Subject(s)
Emergency Medical Services/statistics & numerical data , Refugees/statistics & numerical data , Relief Work/organization & administration , Transients and Migrants/statistics & numerical data , Female , Humans , Male , Mediterranean Sea , Security Measures/organization & administration , Socioeconomic Factors
17.
BMJ Glob Health ; 5(7)2020 07.
Article in English | MEDLINE | ID: covidwho-838959

Subject(s)
Refugees , Relief Work , Humans , Syria
19.
J Glob Health ; 11: 05003, 2021 Jan 16.
Article in English | MEDLINE | ID: covidwho-1110684

ABSTRACT

BACKGROUND: The COVID-19 pandemic is a global phenomenon that is spreading at an alarmingly high rate, increasing morbidity, mortality as well as affecting the global economy, education sector and psychological well-being of the public. Measures, taken to mitigate the spread of the virus during this pandemic, created challenges to humanitarian communities preventing them from carrying out their responsibilities towards vulnerable populations. The aim of this study is to assess the burden of COVID-19 by looking at the current living conditions, examining available services provided, and identifying the economic and health challenges of Syrian refugee families living in Lebanon. METHODS: This is a cross-sectional study conducted on 129 Syrian refugee families living in Lebanon during the COVID-19 pandemic. All participants provided consent prior to completion of the standardized questionnaire. RESULTS: During the pandemic, 79% of breadwinners lost their jobs; of those who kept their jobs, 68% had their wages reduced. None of the families was capable of affording all of their basic needs with 55% only partially affording and 45% not able to afford. Thirty percent of Syrian refugee families did not receive support from organizations during the pandemic reflecting the impact of this crisis on humanitarian organizations. Education was also affected as 70% of children did not continue their education at home. Stress and anxiety were the most commonly reported behavioral changes among both children and adults. CONCLUSIONS: The impact of this crisis is multidimensional affecting the economy, global health and education level of the public. Measures should be taken to lessen the detrimental effect of this crisis on the community as a whole and on vulnerable populations in particular.


Subject(s)
COVID-19/epidemiology , Refugees/statistics & numerical data , Relief Work/statistics & numerical data , Adult , Child , Cross-Sectional Studies , Female , Humans , Lebanon/epidemiology , Male , Socioeconomic Factors , Surveys and Questionnaires , Syria/ethnology , Vulnerable Populations
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