The importance of vision care for displaced populations: lessons from Israeli evacuees.

BACKGROUND: This study explores vision care priorities and coping mechanisms for Israeli evacuees and following the October 7th, 2023, attack by Hamas, which displaced 150,000 individuals, with about 15,000 being evacuated to the Dead Sea area. Faced with minimal health care infrastructure in the Dead Sea area and often lacking personal belongings, including eyeglasses and ocular medicine, these evacuees confronted significant vision care challenges. This context sets the stage for investigating the emergency vision care needs and solutions for populations affected by conflict and displacement. METHODS: In response to this crisis, a consortium led by Hadassah Academic College's Department of Optometry and the Dept. of Ophthalmology at Hadassah Medical Center established ophthalmic clinics in the Dead Sea region. These clinics offered comprehensive vision care services, including refractive and vision examinations, ophthalmological assessments, ocular imaging, and provision of free glasses. The setup included multiple stations for different vision tests, staffed by an interdisciplinary team of professionals. The study analyzes the effectiveness of these clinics, patient flow challenges, and the psychological impact of vision care in a crisis setting. RESULTS: Approximately 800 evacuees received examinations, with around 700 pairs of glasses distributed. Notable cases included emergency referrals for serious conditions and instances where glasses served as psychological support. The operation highlighted the necessity of vision care during crises and its potential psychological and social implications. The clinics successfully provided immediate vision care, but challenges in patient flow and insufficient electronic medical record integration were noted. The experience underscores the importance of prepared eye care interventions in crises. Recommendations for health policy decision-makers include establishing a national emergency vision care network, developing standardized treatment protocols, training local health workers, and raising public awareness about eye health in emergencies. CONCLUSIONS: The consortium's effort in providing urgent vision care to evacuees from the Hamas attack on Israel demonstrates the critical role of rapid, organized eye care in crisis situations. Vision care, along with hearing and mobility, is often overlooked during evacuations but is vital for the well-being and survival of evacuees, especially under trying circumstances. This project serves as a model for future humanitarian interventions, emphasizing the importance of addressing overlooked healthcare issues once the immediate crisis has passed, and the need for strategic planning in health care policy for similar emergency scenarios.

Examining the militarised hierarchy of Sierra Leone's Ebola response and implications for decision making during public health emergencies.

BACKGROUND: In September, 2014, Médecins Sans Frontières (MSF) called for militarised assistance in response to the rapidly escalating West Africa Ebola Epidemic. Soon after, the United Kingdom deployed its military to Sierra Leone, which (among other contributions) helped to support the establishment of novel and military-led Ebola Virus Disease (Ebola) response centres throughout the country. To examine these civil-military structures and their effects, 110 semi-structured interviews with civilian and military Ebola Response Workers (ERWs) were conducted and analysed using neo-Durkheimian theory. RESULTS: The hierarchical Ebola response centres were found to be spaces of 'conflict attenuation' for their use of 'rule-bound niches', 'neutral zones', 'co-dependence', and 'hybridity', thereby not only easing civil-military relationships (CMRel), but also increasing the efficiency of their application to Ebola response interventions. Furthermore, the hierarchical response centres were also found to be inclusive spaces that further increased efficiency through the decentralisation and localisation of these interventions and daily decision making, albeit for mostly privileged groups and in limited ways. CONCLUSIONS: This demonstrates how hierarchy and localisation can (and perhaps should) go hand-in-hand during future public health emergency responses as a strategy for more robustly including typically marginalised local actors, while also improving necessary efficiency-in other words, an 'inclusive hierarchical coordination' that is both operationally viable and an ethical imperative.

Time, space and health: using the life history calendar methodology applied to mobility in a medical-humanitarian organisation.

In the medical humanitarian context, the challenging task of collecting health information from people on the move constitutes a key element to identifying critical health care needs and gaps. Médecins Sans Frontières (MSF), during its long history of working with migrants, refugees and mobile populations in different contexts, has acknowledged how crucial it is to generate detailed context-related data on migrant and refugee populations in order to adapt the response interventions to their needs and circumstances. In 2019, the Brazilian Medical Unit/MSF developed the Migration History Tool (MHT), an application based on the life history method which was created in close dialogue with field teams in order to respond to information needs emerging from medical operations in mobile populations. The tool was piloted in two different contexts: firstly, among mobile populations transiting and living in Beitbridge and Musina, at the Zimbabwe-South Africa border; and, secondly, among Venezuelan migrants and refugees in Colombia. This article describes the implementation of this innovative method for collecting quantitative retrospective data on mobility and health in the context of two humanitarian interventions. The results have proven the flexibility of the methodology, which generated detailed information on mobility trajectories and on the temporalities of migration in two different contexts. It also revealed how health outcomes are not only associated with the spatial dimensions of movement, but also with the temporalities of mobility trajectories.

Humanitarian interventions and psychosocial training programs.

Humanitarian intervention is international endeavours often responding to a human induced crisis. Literature exists on the ethics, legalities and history of humanitarian intervention. Although, there are a great deal of publications on humanitarian intervention including guidelines and best practice, and evidence-based research and practice in the field, there is a paucity of work examining teaching and training of humanitarian professionals. The article discusses the need for specialist training aimed at developing humanitarian professionals and more specifically psychosocial practitioners in the field. A discussion of the role and the importance of decolonization within the sector and training programs is also presented. The paper then introduces a distance learning training delivered at the University of East London, informed by psychological theory and practice, aimed at supporting students with the development of multidisciplinary skills and competencies for working in the sector. The paper also examines various key components of the program.

Development of a patient rated scale for mental health global state for use during humanitarian interventions.

OBJECTIVE: We present the results of a cross-cultural validation of the Mental Health Global State (MHGS) scale for adults and adolescents (<14 years old). METHODS: We performed two independent studies using mixed methods among 103 patients in Hebron, Occupied Palestinian Territories and 106 in Cauca, Colombia. The MHGS was analyzed psychometrically, sensitivity and specificity, ability to detect clinically meaningful change, compared to the Clinical Global Impression-Severity scale (CGI-S). Principal component analysis was used to reduce the number of questions after data collection. RESULTS: The scale demonstrated good internal consistency, with a Cronbach alpha score of 0.80 in both settings. Test retest reliability was high, ICC 0.70 (95% CI [0.41-0.85]) in Hebron and 0.87 (95% CI [0.76-0.93]) in Cauca; inter-rater reliability was 0.70 (95% CI [0.42-0.85]) in Hebron and 0.76 (95% CI [0.57-0.88]) in Cauca. Psychometric properties were also good, and the tool demonstrated a sensitivity of 85% in Hebron and 100% in Cauca, with corresponding specificity of 80% and 79%, when compared to CGI-S. CONCLUSIONS: The MHGS showed promising results to assess global mental health thereby providing an additional easy to use tool in humanitarian interventions. Additional work should focus on validation in at least one more context, to adhere to best practices in transcultural validation.

Media influence on humanitarian interventions: analysis of the Rohingya refugee crisis and international media coverage.

In 2017, the long-festering discriminatory treatment to the Rohingyas in Myanmar, both in law and practice, resulted in the largest cross-border humanitarian crisis in Asia. During the 2016­2017 Rohingya refugee crisis, the aerial shots of burnt villages and images of people trudging toward the horizon in search of refuge in neighboring nations dominated the Western media. However, for humanitarians, the question of whether the media helps with humanitarian crises remains complicated and unclear. This study examines the effects of media coverage on the Rohingya refugee crisis based on articles from two liberal, elite newspaper sources, The New York Times and The Guardian between 2010 and 2020. The study reveals that the attempts of international pressure to stop the crisis have increased through media coverage and political pressures; however, the number of Rohingya refugees fleeing Myanmar intensified due to worsening violence and human rights violations committed by the Myanmar army. Findings are discussed using the lens of cultural and ideological context. The study suggests that in Myanmar, where authoritarian military culture is pervasive, there is a limited influence of the international press on the state-sponsored ethnic cleansing of the Rohingya population and questions whether consistent international pressure could have changed the outcome.

Subasta de vidas y humanitarismo estratégico: la Unión Europea y la crisis de refugiados desde una óptica crítica / Auctioning of lives and strategic humanitarianism: the European Union and the refugee crisis from a critical perspective / Leilão de vidas e humanitarismo estratégico: a União Europeia e a crise dos refugiados sob uma perspectiva crítica

RESUMEN Este artículo tiene como propósito analizar las consecuencias de la crisis de refugiados que experimentó la Unión Europea en el 2015. A través de un marco teórico denominado «realismo crítico¼, se pudo establecer que la crisis de refugiados en Europa no fue abordada con base en los principios humanitarios que inspiran los fundamentos de la Unión, sino más bien a través de diversas medidas soberanistas que tienen como fin poner freno a la entrada de más refugiados; la crisis también puso en evidencia la relativa fragilidad institucional de esa institución, reflejada en su incapacidad para crear un sistema centralizado dirigido a distribuir proporcionalmente la población refugiada a lo largo de Europa. Sin embargo, la Unión Europea sí cumplió con una función básica: a través de diversas medidas sustentadas en los intereses individuales de "seguridad", detuvo la entrada y de hecho rechazó a centenares de miles de refugiados que esperaban entrar a Europa. El presente trabajo sostendrá que esas medidas son producto de cierto atavismo identitario (racista), así como una estrategia de diversos actores que instrumentalizaron la crisis para avanzar en sus agendas políticas.

ABSTRACT This article aims to analyze the consequences of the refugee crisis experienced by the European Union in 2015. Through a specific theoretical framework called "critical realism", it was established that the refugee crisis in Europe was not addressed on the basis of the humanitarian principles that inspire the foundations of the Union, but rather through various sovereign measures that aim to curb the entry of more refugees; the crisis also highlighted the relative institutional fragility of that institution, reflected in its inability to create a centralized system aimed at distributing proportionally the refugee population throughout Europe. However; the European Union did fulfill a basic function: through various measures based on the individual interests of "security" stopped entry and in fact rejected hundreds of miles of refugees waiting to enter Europe. This paper will argue that these measures are the product of a certain (racist) identity atavism, as well as a strategy of various actors that who instrumentalized the crisis to advance their political agendas.

RESUMO O objetivo deste artigo é analisar as consequências da crise de refugiados vivenciada pela União Europeia em 2015. Por meio de um referencial teórico chamado "realismo crítico", foi estabelecido que a crise de refugiados na Europa não era tratada com base nos princípios humanitários que inspiram as fundações da União, mas através de várias medidas soberanas que visam coibir a entrada de mais refugiados; A crise também destacou a relativa fragilidade institucional dessa instituição, refletida em sua incapacidade de criar um sistema centralizado destinado a distribuir proporcionalmente a população de refugiados em toda a Europa. No entanto, a União Europeia cumpriu uma função básica: através de várias medidas baseadas nos interesses individuais da "segurança", interrompeu a entrada e, de fato, rejeitou centenas de milhares de refugiados que esperavam para entrar na Europa. O presente trabalho sustentará que essas medidas são o produto de um certo atavismo de identidade (racista), bem como uma estratégia de vários atores que instrumentalizaram a crise para avançar em suas agendas políticas.

Responsabilidad de Proteger: entre el realismo clásico y la ética internacional, una aproximación al caso de Siria / The responsability to protect: between classical realism and international ethics, an approach to the case of Syria / Responsabilidade de Proteger: entre o realismo clássico e a ética internacional, uma abordagem para o caso da Síria

RESUMEN El concepto de Responsabilidad de Proteger (R2P) ha generado diversas posturas siendo un principio implementado como herramienta de las Naciones Unidas. Para lograr entender la aplicación de esta medida de intervención humanitaria, se realiza una revisión de sus antecedentes, seguido del análisis realista según los pilares en que se encuentra fundamentada. Posteriormente y por medio del análisis del caso de Siria se identificarán fortalezas y debilidades de este compromiso político caracterizado por la prevención, respuesta oportuna y reconstrucción de comunidades en crisis, en donde se ve amenazada la sociedad civil por genocidio, crímenes de guerra, depuración étnica y crímenes de lesa humanidad.

ABSTRACT The concept of Responsibility to Protect (R2P) has generated various positions being a principle implemented as a tool of the United Nations. In order to understand the application of this humanitarian intervention measure, carry out a review of its background, follow the realistic analysis according to the pillars on which it is based. Later and through the analysis of the case of Syria, strengths and weaknesses of this specific political commitment will be identified for the prevention, timely response and reconstruction of communities in crisis, where civil society is threatened by genocide, war crimes, ethnic cleansing and crimes against humanity.

RESUMO O conceito de Responsabilidade de Proteger (R2P) tem gerado diversas posições sendo um princípio implementado como uma ferramenta das Nações Unidas. A fim de compreender a aplicação desta medida de intervenção humanitária, é feita uma revisão dos seus antecedentes, seguida de uma análise realista de acordo com os pilares em que se baseia. Posteriormente, e através da análise do caso sírio, serão identificados os pontos fortes e fracos deste compromisso político caracterizado pela prevenção, resposta atempada e reconstrução das comunidades em crise, onde a sociedade civil está ameaçada por genocídio, crimes de guerra, limpeza étnica e crimes contra a humanidade.

Forensic archaeology and anthropology sensitization in post-conflict Uganda.

The renowned work of Clyde Snow and the development of the Equipo Argentino de Anthropología Forense (EAAF) team has inspired the use of forensic anthropological and archaeological skills in human rights interventions around the world. Whether for medico-legal intervention and acquisition of evidence or humanitarian repatriation and identification of human remains, forensic expertise has garnered attention in the global arena. Arguably fulfilling evidentiary and psychosocial needs, there has been growing interest in this post-conflict redress. However, as part of the critique of these interventions, scholars and practitioners have pointed out - primarily in medico-legal investigations - a lack of sensitization of local communities regarding forensic work, increasing the potential for re-traumatization, unrealistic expectations, or an unintentional increase in political tensions. Research regarding forensic intervention and human remains have permeated social sciences, peace and conflict studies, and science and technology studies, revealing both intentional and unintentional impacts of forensic sciences after mass violence. In an effort to mitigate negative impacts of medico-legal or humanitarian interventions, the research described here sought to sensitize communities in Uganda about forensic methods. Findings from this study suggest that sensitization is necessary and desired, and that a multi-step approach can assist in managing expectations.

Políticas de atendimento a migrantes e refugiados no Brasil e aproximações da psicologia / Policies of assistance to migrants and refugees in Brazil and psychology approaches / Políticas de atención a migrantes y refugiados en Brasil y aproximaciones de la psicología / Politiques d'accueil des migrants et des réfugiés au Brésil et approches de la psychologie

Temos assistido em todo o mundo a intensificação dos deslocamentos de pessoas que deixam seus locais de origem em virtude de ameaças à vida em busca de acolhida em outros países, enfrentando situações extremas tanto antes do processo migratório, como durante e após a chegada em novo território. O Brasil conta com políticas públicas de acolhimento e integração previstas em leis e acordos internacionais, que são aqui explanadas. Propõe-se discutir as aproximações da Psicologia enquanto área que atua nesse campo, a partir de bibliografias disponíveis sobre o tema, tecendo reflexões acerca das formas de compreensão das condições de saúde de imigrantes e refugiados e as modalidades de intervenção que têm sido desenhadas, evidenciando as dimensões sociopolíticas que envolvem o trabalho humanitário. Entende-se que as intervenções devem mobilizar suporte socioassistencial, acionar os recursos materiais e simbólicos dos sujeitos e grupos para enfrentamento da situação e construção de um novo cotidiano, considerando a complexidade das experiências de deslocamentos.

We have witnessed the intensification of displacements of people who have left their hometown because of threats to life, searching for refuge in other countries, facing extreme situations before the migratory process, during and after arrival in new territory. Brazil has public policies of reception and integration provided for laws and international agreements, which are explained here. This article discusses the approaches of Psychology as an area that acts directly in this field, based on bibliographical references, reflecting on ways of understanding the health conditions of immigrants and refugees and how interventions have been designed, highlighting the sociopolitical dimensions of humanitarian work. Interventions should mobilize socio-assistance support, trigger the material and symbolic resources of the individuals and groups to face the situation and build a new daily life, considering the complexity of the displacement experiences.

Hemos visto en todo el mundo una intensificación de desplazamientos de personas que dejan sus lugares de origen en virtud de amenazas a su vida en busca de acogida en otros países, enfrentando situaciones extremas tanto antes delproceso migratorio, como durante y después de la llegada al nuevo territorio. El Brasil cuenta con políticas públicas de acogida e integración previstas en leyes y acuerdos internacionales, que serán explicadas en el presente texto. Proponemos discutir las aproximaciones de la Psicología como área que actúa en ese campo, a partir de bibliografias disponibles sobre el tema, elaborando reflexiones acerca de las formas de comprensión de las condiciones de salud de inmigrantes y refugiados y las modalidades de intervención que han sido disenadas, evidenciando las dimensiones sociopolíticas implicadas en el trabajo humanitario. Las intervenciones deben movilizar apoyo socio-asistencial, accionar los recursos materiales y simbólicos de los sujetos y grupos para enfrentar la situación y construir un nuevo cotidiano, considerando la complejidad de las experiencias de desplazamientos.

Nous avons assisté à l'intensification des déplacements de personnes qui ont quitté leur ville d'origine en raison de menaces de mort, qui cherchaient refuge dans d'autres pays et faisaient face à des situations extrêmes avant le processus de migration, pendant etaprès leur arrivée sur un nouveau territoire. Le Brésil a des politiquespubliques d'accueil et d'intégration prévoyant des lois et des accords internationaux, qui sont expliqués ici. Cet article traite des approches de la psychologie en tant que domaine agissant directement dans ce champ, en se basant sur des bibliographies disponibles sur le sujet, sur des moyens de comprendre les conditions de santé des immigrants et des réfugiés et sur la manière dont les interventions ont été conçues, en soulignant les dimensions sociopolitiques du travail humanitaire. Les interventions doivent mobiliser un mouvement socio-assistance, mobiliser les ressources matérielles et symboliques des individus et des groupes pour faire face à la situation et construire un nouveau quoti-dien, en tenant compte de la complexité des expériences de déplacement.

Beyond a politics of recrimination: Scandal, ethics and the rehabilitation of violence.

The practice of contemporary warfare seems to be plagued by scandal. It is often assumed that the act of bearing witness to these moments of ethical failure, in which the relationship between the martial and the ethical breaks down, plays an important role in holding powerful actors to account for their conduct. Considerable faith has been placed in the role of transparency and truth-telling as foundations for normative engagements with war. This article argues that we must be cautious about this investment. Drawing on the work of Jean Baudrillard, this article offers a method for critically reading scandals as a series of line-drawing manoeuvres. Taken together, these manoeuvres demonstrate how scandals function to enable, excuse and obscure the complex landscapes of violence that define the spectacular and mundane sites of contemporary war. Reducing critical engagements with violent practices to a logic of recrimination, scandals often function to revitalise the very principles they appear to contest. Focusing upon the socio-political implications of wartime scandals, this article demonstrates that the performative force of scandals is therefore the reproduction of a violent status quo rather than opening up new spaces for imagining less violent futures. Offering a critical reading of controversies relating to the provision of humanitarian assistance and education in Afghanistan, this article reflects on the ambiguities and anxieties of critiquing violence.

Mental and social health in disasters: the Sphere standards and post-tsunami psychosocial interventions in Asia.

The primary objective of this paper is to examine and inform the mental health and psychosocial support standards of the 2011 edition of the Sphere Project's Humanitarian Charter and Minimum Standards in Humanitarian Response. This is done through a qualitative analysis of internal evaluation documents, reflecting four long-term humanitarian psychosocial programmes in different countries in post-tsunami Asia. The analysis yielded three overall conclusions. First, the Sphere standards on mental health and psychosocial support generally are highly relevant to long-term psychosocial interventions after disasters such as the Indian Ocean tsunami of 26 December 2004, and their application in such settings may improve the quality of the response. Second, some of the standards in the current Sphere handbook may lack sufficient guidance to ensure the quality of humanitarian response required. Third, the long-term intervention approach poses specific challenges to programming, a problem that could be addressed by including additional guidance in the publication.

Introducing Jus ante Bellum as a cosmopolitan approach to humanitarian intervention.

Cosmopolitans often argue that the international community has a humanitarian responsibility to intervene militarily in order to protect vulnerable individuals from violent threats and to pursue the establishment of a condition of cosmopolitan justice based on the notion of a 'global rule of law'. The purpose of this article is to argue that many of these cosmopolitan claims are incomplete and untenable on cosmopolitan grounds because they ignore the systemic and chronic structural factors that underwrite the root causes of these humanitarian threats. By way of examining cosmopolitan arguments for humanitarian military intervention and how systemic problems are further ignored in iterations of the Responsibility to Protect, this article suggests that many contemporary cosmopolitan arguments are guilty of focusing too narrowly on justifying a responsibility to respond to the symptoms of crisis versus demanding a similarly robust justification for a responsibility to alleviate persistent structural causes. Although this article recognizes that immediate principles of humanitarian intervention will, at times, be necessary, the article seeks to draw attention to what we are calling principles of Jus ante Bellum (right before war) and to stress that current cosmopolitan arguments about humanitarian intervention will remain insufficient without the incorporation of robust principles of distributive global justice that can provide secure foundations for a more thoroughgoing cosmopolitan condition of public right.

Posttraumatic stress in emergency settings outside North America and Europe: a review of the emic literature.

Mental health professionals from North America and Europe have become common participants in postconflict and disaster relief efforts outside of North America and Europe. Consistent with their training, these practitioners focus primarily on posttraumatic stress disorder (PTSD) as their primary diagnostic concern. Most research that has accompanied humanitarian aid efforts has likewise originated in North America and Europe, has focused on PTSD, and in turn has reinforced practitioners' assumptions about the universality of the diagnosis. In contrast, studies that have attempted to identify how local populations conceptualize posttrauma reactions portray a wide range of psychological states. We review this emic literature in order to examine differences and commonalities across local posttraumatic cultural concepts of distress (CCDs). We focus on symptoms to describe these constructs - i.e., using the dominant neo-Kraepelinian approach used in North American and European psychiatry - as opposed to focusing on explanatory models in order to examine whether positive comparisons of PTSD to CCDs meet criteria for face validity. Hierarchical clustering (Ward's method) of symptoms within CCDs provides a portrait of the emic literature characterized by traumatic multifinality with several common themes. Global variety within the literature suggests that few disaster-affected populations have mental health nosologies that include PTSD-like syndromes. One reason for this seems to be the almost complete absence of avoidance as pathology. Many nosologies contain depression-like disorders. Relief efforts would benefit from mental health practitioners getting specific training in culture-bound posttrauma constructs when entering settings beyond the boundaries of the culture of their training and practice.

The analytical framework of water and armed conflict: a focus on the 2006 Summer War between Israel and Lebanon.

This paper develops an analytical framework to investigate the relationship between water and armed conflict, and applies it to the 'Summer War' of 2006 between Israel and Lebanon (Hezbollah). The framework broadens and deepens existing classifications by assessing the impact of acts of war as indiscriminate or targeted, and evaluating them in terms of international norms and law, in particular International Humanitarian Law (IHL). In the case at hand, the relationship is characterised by extensive damage in Lebanon to drinking water infrastructure and resources. This is seen as a clear violation of the letter and the spirit of IHL, while the partial destruction of more than 50 public water towers compromises water rights and national development goals. The absence of pre-war environmental baselines makes it difficult to gauge the impact on water resources, suggesting a role for those with first-hand knowledge of the hostilities to develop a more effective response before, during, and after armed conflict.