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International organisations (IOs) hold important governance functions and power. Yet, they are several steps detached from the constituencies that have entrusted them with functions and resources to carry them out, even as accountability expectations remain significant for their legitimacy. This article presents a broadly generalisable theoretical framework for understanding the variable accountability of IOs, seeking to advance the understanding of international accountability in three new ways. First, it elaborates on the concept of the scope of IO accountability, which can vary across organisations, over time, and across contexts. The idea of a scope of accountability moves beyond the dichotomy of accountable versus non-accountable power holders and advances an understanding of accountability as a multi-layered phenomenon, whereby both the expectations and practices of accountability can evolve over time and with respect to different audiences. Second, the article identifies three political factors – namely the formal and informal excercise of power, institutional structure, and public salience – that can shape, in important ways, the variable scope of IO accountability. Finally, it critically explores the tensions and contradictions between these political dynamics, and the implications for access to and the efficacy of accountability systems.
With the widespread democratic decline and the rise of autocratic regimes, global humanitarian assistance efforts have often fallen short of expectations. Historical humanitarian assistance efforts have changed, becoming less effective, or disappearing. Given the direction that global health crisis risks are taking today, it is crucial that diplomatic, structural, logistical, security, and operational questions be asked and appropriate global solutions sought for the future management of pandemics and climate change crises.
Conceptualizations of surge capacity are gaining traction in disaster preparedness and response, particularly in the context of critical and acute care during the pandemic as well as other disaster contexts. In most applications, the surge capacity domains describe the four types of assets required to ensure that surges in demand are addressed. Despite increasing interest and conceptual application, these constructs are yet to be considered or explored in relation to the profound resource scarcity and complex contexts of humanitarian health responses.
Objectives:
The aim of this research is to explore surge capacity domain constructs in the novel context of scarce health resource allocation in humanitarian health care response settings.
Methods:
This research was conducted according to an exploratory qualitative design. Clinicians and managers with relevant experiences were purposively recruited to include broad perspectives across humanitarian responses and clinical specialties. Interview transcripts were analyzed using a latent deductive pattern approach, using a deductive code book consisting of existing surge capacity domains to explore surge capacity constructs. Analysis of coded data for cross-cutting themes drove identification of new findings regarding surge capacity in the context of humanitarian health responses.
Results:
Seventeen participants completed semi-structured interviews. In addition to demonstrating the relevance of existing surge capacity domains (staff, stuff, space, and systems; 4Ss), four new themes emerged: (1) sponsorship; (2) suitability; (3) security; and (4) supply. These four themes informed the conceptualization of surge capacity dimensions which must be satisfied for an asset to render a positive impact with relevance to all four surge capacity domains (4S2 - cumulative 4S domains and the new dimensions).
Conclusions:
Although existing surge capacity domains have proven relevant to humanitarian health care response settings, this research produced a revised conceptualization of surge capacity constructs specific to this context. The identification of four surge capacity dimensions supported the conception and development of the Scarce Health Resource Allocation in Humanitarian Response Settings (SHARE-HRS) 4S2 model of surge capacity, thus offering a potential new tool to support humanitarian health response planning and evaluation.
Between 2022 and 2024, Somalia’s ongoing drought claimed more than 70 000 lives, with nearly 40% of these deaths among children under 5. This tragic loss highlights the urgent need for action to address the disproportionate impact of the drought on Somalia’s most vulnerable populations. The 2022 drought, which affected nearly half of the country’s population, brought Somalia to the brink of famine, leaving many families without essential resources and health care, particularly in the southern-central regions like Banadir, Bay, and Lower Shabelle. Despite narrowly avoiding famine through the efforts of the Somali government and international partners, the consequences of the drought continue to devastate communities. The study “From Insight to Action: An Update on Mortality Patterns in Somalia” reveals that most excess deaths were children, presenting not only a tragedy for families but also a long-term social and economic setback for the nation. WHO and UNICEF stress the need for a long-term approach to address Somalia’s vulnerabilities, emphasizing the importance of building resilient health systems, investing in climate-resilient agriculture, and empowering communities. The international community must also commit to supporting Somalia’s development to break the cycle of disaster and ensure a brighter future for the nation’s children.
The eastern Democratic Republic of Congo (DRC) has faced dual burdens of poor mental health and heightened levels of violence against women and children within the home. Interventions addressing family violence prevention may offer a path to mitigate mental distress within the eastern DRC. This exploratory analysis uses data from a pilot cluster randomized controlled trial conducted in North Kivu, DRC, assessing the impact of Safe at Home, a violence prevention intervention. Mental health was assessed at endline using the Patient Health Questionnaire-4. Statistical analyses employed multilevel linear regression.
Assuming successful randomization, impact of the Safe at Home intervention on mental health differed by participant gender. Women enrolled in the Safe at Home intervention reported statistically significant decreases in mental distress symptoms [β (95%CI) = −1.01 (−1.85, −0.17)], whereas men enrolled in Safe at Home had similar scores in mental distress to the control group [β (95%CI) = −0.12 (−1.32, 1.06)].
Ultimately, this exploratory analysis provides evidence of the potential for a family violence prevention model to improve women’s mental health in a low-resource, conflict-affected setting, although further research is needed to understand the impact on men’s mental health.
This field report presents the planning and execution of a large-scale aeromedical refugee retrieval operation amid the on-going Russia-Ukraine crisis. The retrieval was coordinated by the Italian Department of Civil Protection and led by the Centrale Remota Operazioni Soccorso Sanitario (CROSS), a governmental facility overseeing medical assistance. An Airbus A320 was chosen for its capacity of 165 passengers, with one emergency stretcher maintaining maximum seating. The aircraft was equipped with an Advanced Life Support kit, and specific considerations for medical equipment compliance were made. Special cases, including patients with on-going chemotherapy and end-stage kidney disease, underwent fit-to-fly screening. The boarding process in Lublin, Poland involved triage and arrangements for passengers with gastroenteric symptoms. Notably, 22 passengers with recent episodes of illness were isolated. The successful operation, demonstrating the viability of evacuating vulnerable individuals via commercial airlines, underscores the importance of precise planning and coordination in crisis situations.
Institutions are often reluctant to openly engage on controversies around the patriarchal underpinnings of the humanitarian sector, or the hard questions around implementing rights-based approaches in spaces where the dominant social norms run counter to an enabling environment for principled humanitarian and development assistance. A reluctance to engage on these issues can lead to unintended suppression of gender justice efforts under the urgency and scale of needs-based humanitarian response. Pre-crisis unequal power relations can be visible or invisible, difficult to measure and even more difficult to address through humanitarian action. Engaging on root causes and drivers of human suffering is often viewed as “political” in contexts of closing civic space and restricted humanitarian access. This article will explore tensions and synergies between the humanitarian principles and the gender justice agenda with a view to helping humanitarian actors contribute to long-term goals of transforming social norms. The article applies a critical feminist lens to the humanitarian principles of neutrality and impartiality, with a focus on the wider development agenda, the nature of the State in a State-centric global order, and the continuum of violence. Drawing on critical feminist theory and decolonization discourses, and building on gender analyses of international humanitarian law, this article looks to queer the humanitarian principles of neutrality and impartiality within the context of the shifting aid system in which they are applied. The objective is help address some of the gaps in literature, identify ways in which aid actors can reduce unintended harm to the gender justice agenda, and help contribute to the more transformative agendas of gender justice.
This chapter considers the impact of the sanctions in the short-term: both the economic impact on the Russian state and the Russian people, as well as sanctions’ failure to prevent further military action by Russia in Ukraine. Unintended knock-on or ripple effects of the sanctions are also discussed, as are the effects of the sanctions on world trading patterns and the economic health of other nations. The chapter also considers the potential long-term effects of sanctions on the Russian economy.
Crisis response operations are increasingly important due to the rising number and impact of crises. Frontline personnel of crisis organizations conduct this live-saving and risky work under conditions of uncertainty, threat, and time pressure. Some notable examples are emergency responders, military personnel, and humanitarian aid workers. Although their crisis response activities may vary considerably, they operate under similar circumstances and face the same operational dilemmas. This introduction presents eleven crisis response dilemmas that crisis responders face again and again. Still, little is known about how to deal with these dilemmas and dispersed research findings offer competing solutions. By integrating existing research on frontline crisis response, this book problematizes simple solutions to crisis response dilemmas and provides a basis for reflective thinking about possible improvements. As such, it gives an insight into the main theories and research topics on crisis response, and provides a comprehensive analysis of how frontline crisis responders organize and implement their activities amidst the chaos of crises.
This chapter examines eighteenth-century textual records about the Australian colonies, from the early British press reports of the establishment of the penal colony at Port Jackson to the accounts of religious personnel such as the first colonial chaplain Richard Johnson. It reveals how convicts and Indigenous people were represented in texts designed for metropolitan audiences. The isolated voices of evangelical reformers provided rich accounts of the problems and failures of the penal colony. They questioned the morality of the military governance of the penal colony and the dispossession of Indigenous peoples. Evangelical accounts from New South Wales became part of a global knowledge economy and a thriving print culture; they provided evidence that thickened, and at times contradicted, official accounts that circulated in the British media.
Community-based psychosocial interventions are key elements of mental health and psychosocial support; yet evidence regarding their effectiveness and implementation in humanitarian settings is limited. This study aimed to assess the appropriateness, acceptability, feasibility and safety of conducting a cluster randomized trial evaluating two versions of a group psychosocial intervention. Nine community clusters in Ecuador and Panamá were randomized to receive the standard version of the Entre Nosotras intervention, a community-based group psychosocial intervention co-designed with community members, or an enhanced version of Entre Nosotras that integrated a stress management component. In a sample of 225 refugees, migrants and host community women, we found that both versions were safe, acceptable and appropriate. Training lay facilitators to deliver the intervention was feasible. Challenges included slow recruitment related to delays caused by the COVID-19 pandemic, high attrition due to population mobility and other competing priorities, and mixed psychometric performance of psychosocial outcome measures. Although the intervention appeared promising, a definitive cluster randomized comparative effectiveness trial requires further adaptations to the research protocol. Within this pilot study we identified strategies to overcome these challenges that may inform adaptations. This comparative effectiveness design may be a model for identifying effective components of psychosocial interventions.
The International Organization for Migration (IOM) is yet another international organization created in the years following World War II. It was designed to cope with a specific situation: displacement and perceived “surplus population” in post-war Europe. Over the years, its role has expanded, especially in terms of emergency responses to conflicts and disasters, creating a multi-mandate organisation. International human rights law binds states, either through treaty or custom; the international law of armed conflict is binding on parties to the conflict, states or non-state armed groups (NSAGs), and all high contracting parties. International organizations operating in the humanitarian sphere have accepted to uphold the humanitarian principles of humanity, neutrality, impartiality and independence, that draw on both sub-disciplines of international law. This chapter explores IOM’s role and obligations in humanitarian operations, particularly towards individuals caught up in the humanitarian crisis and to other humanitarian actors. In that regard, in the light of its 2015 Humanitarian Policy and its related organization status with the UN since 2016, how far do the abovementioned humanitarian principles, international human rights law norms, international rule of law, and even the Guiding Principles on Internal Displacement, govern IOM’s work in humanitarian settings?
The different dynamics created by ceasefires discussed throughout this book challenge many of the basic, frequently unstated assumptions about how ceasefires are used as part of a particular political process that supposedly moves violence towards peace. This book argued that ceasefires are often not the humanitarian, purely positive or beneficial tools they have long been considered to be. In many cases, ceasefires are not simply a “cease fire’ but rather interject into complex contestations for control of the state. As such, this final chapter presents actionable recommendations for practitioners about how ceasefires interject into much broader and more complex processes. Ceasefires are not only used as military tools to stop violence but political tools actors in civil wars use for their own statebuilding ends. These ends are invariably much broader than winning or losing militarily and need to be considered when making decisions relating to, for example, mediation, foreign aid, humanitarian access, development, reconstruction, migration and refugee intakes.
By 1837 the British government had been sending convicts, soldiers, and livestock entrepreneurs to Australia for almost fifty years. A committee of its own House of Commons, inspired by humanitarian principles, now reported the devastating effects on the indigenous inhabitants. Evidence of ‘extermination’ and ‘extirpation’ meant that the best minds of the Colonial Office were already exercised by the devastation of indigenous peoples inflicted by settlers who might have no clear aim of damaging them. When British government was extended to New Zealand, it was soon evident that Māori, for centuries sharing a largely common language and history, had a more effective capacity to resist than Aboriginal Australians, for millennia divided into hundreds of separate peoples and languages. In all Australian colonies and New Zealand, the determination of immigrants to ‘make productive’ land they knew belonged to others created disaster. Within twenty years of settlement, the Aboriginal population of Victoria declined by eighty percent. As the British spread over the whole continent, countless nations were extinguished. Across the Tasman the indigenous population was halved and the ‘passing of the Māori’ was still openly discussed even as adaptation, intermarriage and parliamentary representation saved it from genocide.
Mental health and psychosocial support (MHPSS) staff in humanitarian settings have limited access to clinical supervision and are at high risk of experiencing burnout. We previously piloted an online, peer-supervision program for MHPSS professionals working with displaced Rohingya (Bangladesh) and Syrian (Turkey and Northwest Syria) communities. Pilot evaluations demonstrated that online, peer-supervision is feasible, low-cost, and acceptable to MHPSS practitioners in humanitarian settings.
Objectives
This project will determine the impact of online supervision on i) the wellbeing and burnout levels of local MHPSS practitioners, and ii) practitioner technical skills to improve beneficiary perceived service satisfaction, acceptability, and appropriateness.
Methods
MHPSS practitioners in two contexts (Bangladesh and Turkey/Northwest Syria) will participate in 90-minute group-based online supervision, fortnightly for six months. Sessions will be run on zoom and will be co-facilitated by MHPSS practitioners and in-country research assistants. A quasi-experimental multiple-baseline design will enable a quantitative comparison of practitioner and beneficiary outcomes between control periods (12-months) and the intervention. Outcomes to be assessed include the Kessler-6, Harvard Trauma Questionnaire and Copenhagen Burnout Inventory and Client Satisfaction Questionnaire-8.
Results
A total of 80 MHPSS practitioners will complete 24 monthly online assessments from May 2022. Concurrently, 1920 people receiving MHPSS services will be randomly selected for post-session interviews (24 per practitioner).
Conclusions
This study will determine the impact of an online, peer-supervision program for MHPSS practitioners in humanitarian settings. Results from the baseline assessments, pilot evaluation, and theory of change model will be presented.
Chapter 1 immerses the reader into the Za'atari refugee camp. Situated in Jordan just seven and a half miles south of the Syrian border, the camp – a two-square-mile rectangle divided into twelve districts – is nestled in the very heart of the Middle East. Here, in the desert heat, a community was born in the swell of crisis. The reader is immediately introduced to the book's three featured Syrian women entrepreneurs – Yasmina, Asma, and Malak – in their elements. Yasmina, a salon and wedding dress shop owner, is relaxing in the salon with her family as her client celebrates a beautiful wedding a couple of districts away. Asma, a social entrepreneur and teacher, is reading a story to a group of children – including three of her own – in her trailer, which she has converted into a magical hideout for the children. Malak, an artist, is putting the finishing touches on a series of drawings for an event at a youth center that is meant to encourage the girls in Za'atari to push against the harmful practice of child marriage.
Chapter 12 features the three entrepreneurs discussing their hopes for the future. Despite its progress, Za'atari still faces significant challenges in terms of basic resources and opportunities. So each entrepreneur represents a different hope. Yasmina, as the oldest of the group, discusses the ultimate hope within residents: that there will be lasting peace in Syria and they can return home. Asma considers another hope many have: resettlement to new communities. She talks about her potential resettlement to Canada after recently being interviewed at the embassy in Amman, and what it would mean for her children to have more consistent, higher quality education. Malak discusses the hope that, even if she is to remain in Za'atari for long, it will be better resourced so all children will have the opportunity to realize their God-given gifts. Her most recent painting of a woman, covered in vibrant colors and looking upward, represents this hope – as she accepts her life in Za'atari for now and sees her purpose as living out her gifts boldly as a role model for the children around her. In this spirit, the book ends with a poem by Asma about the hopes and dreams of Za'atari.
Chapter 4 provides an overview of today’s global refugee crisis, driven by perspectives of refugees around the world. The Syrian war has displaced a stunning half of Syria’s prewar population, with nearly 80,000 of those Syrians having fled to nearby Za'atari; the UN calls it “the biggest humanitarian and refugee crisis of our time.” But it is only a part of a broader global crisis: today, more people than at any other time in history have been forcibly displaced from their homes. More than twenty-six million refugees, over half of whom are children, have fled their home countries entirely. This chapter provides a brief exploration of the major crises causing displacement, from instability in Central America and Afghanistan, to the Rohingya genocide in Myanmar, to wars in South Sudan and Yemen. And it considers where most refugees end up: in host cities, in refugee camps, and – unfortunately only on rare occurences – resettled permanently in adoptive cities. It discusses how, due to continuing conflicts and tightening restrictions on acceptance of refugees, refugee camps are increasingly becoming like permanent settlements, despite their intended role as temporary safe havens.
Chapter 9 is about the present impact of the three entrepreneurs’ ventures, alongside many others, on the Za'atari community. A far cry from its makeshift origins, Za'atari is now much like a city. The Shams-Élysées, the Saudi Market, and other areas are buzzing as more than 3,000 businesses generate about $13 million in revenue a month and serve community members. These include bird shops, a cinema, sustainable farming solutions, and, of course, the ventures launched by Yasmina, Asma, and Malak. Yasmina is bringing profound joy into the lives of women across Za'atari. She helps brides feel special, valued, and beautiful, sometimes after a long period of feeling forgotten. Asma is uplifting Za'atari's children to reach for their highest aspirations. Much to her delight, her apprentice Nawara creates her own version of the storytelling initiative that is widely attended. In addition to running her studio with Treza, Malak repeatedly uses her art to empower the children around her, especially on the issue of child marriage. She designs twenty powerful drawings that are presented to girls during a workshop, empowering them to push back against such arrangements.