Search

Non-communicable diseases (NCDs) represent the primary cause of morbidity and mortality worldwide. Specific attention needs to be given in fragile and crisis-affected contexts, where health systems have even more difficulties in addressing and managing these diseases. Humanitarian actors intervening in crisis situations increasingly include NCD management in the services they support and provide. This review aims at presenting a series of questions that humanitarian agencies could consider when addressing NCDs in humanitarian crises. They include, among others, what conditions to address and for which target population, how to ensure continuity of care, which guidelines and medications to use, and what can be done beyond classical management of NCDs. Research and evidence are lacking on how to address care effectively for NCDs in emergencies. Therefore, advocacy is needed for NCD-oriented research so as to make interventions more effective and sustainable. No government or single agency can address NCDs in humanitarian crises alone. Strong leadership and partnerships between humanitarian actors, health providers, government bodies, research and academic institutions are required. Only a coordinated multidisciplinary and multi-stakeholder approach will achieve the required impact for affected populations.

INTRODUCTION\ud Understanding what enhances the motivation and performance of community health workers (CHWs) in humanitarian emergencies represents a key research gap within the field of human resources for health. This paper presents the research protocol for the Performance ImprovEment of CHWs in Emergency Settings (PIECES) research programme. Enhancing Learning and Research in Humanitarian Action (ELRHA) funded the development of this protocol as part of their Health in Humanitarian Crises (R2HC) call (No.19839). PIECES aims to understand what factors improve the performance of CHWs in level III humanitarian emergencies.\ud \ud METHODS AND ANALYSIS\ud The suggested protocol uses a realist evaluation with multiple cases across the 3 country sites: Turkey, Iraq and Lebanon. Working with International Medical Corps (IMC), an initial programme theory was elicited through literature and document reviews, semistructured interviews and focus groups with IMC programme managers and CHWs. Based on this initial theory, this protocol proposes a combination of semistructured interviews, life histories and critical incident narratives, surveys and latent variable modelling of key constructs to explain how contextual factors work to trigger mechanisms for specific outcomes relating to IMC's 300+ CHWs' performance. Participants will also include programme staff, CHWs and programme beneficiaries. Realist approaches will be used to better understand 'what works, for whom and under what conditions' for improving CHW performance within humanitarian contexts.\ud \ud ETHICS AND DISSEMINATION\ud Trinity College Dublin's Health Policy and Management/Centre for Global Health Research Ethics Committee gave ethical approval for the protocol development phase. For the full research project, additional ethical approval will be sought from: Université St. Joseph (Lebanon), the Ethics Committee of the Ministry of Health in Baghdad (Iraq) and the Middle East Technical University (Turkey). Dissemination activities will involve a mixture of research feedback, policy briefs, guidelines and recommendations, as well as open source academic articles.

This thesis concerns the history of humanitarian nutrition and its political implications. Drawing on aid agency archives and other historical sources, it examines how food has been delivered in emergencies, from the First World War to the present day. The approach is ethnographic: this is a study of the micro-level practices of relief, examining the objects distributed, the plans made, the techniques used. It is also historical: examining how such practices have changed over time. This thesis makes five interlocking arguments. First, I make a political point: that humanitarian action is always political, and that it is impossible to adhere to ‘classical’ humanitarian principles such as neutrality, impartiality and independence. Second, I make a sociological argument: that the activities of humanitarian nutrition have been shaped by a number of themes, which include militarism, medicine, modernity, and markets. Third, I make a historical argument: that the main features of humanitarian nutrition were solidified between the 1930s and the 1970s, and were largely in place by the time of the Biafran war. Fourth, I make a sociological argument: that these mid-century changes involved a profound redefinition of hunger and food (with hunger conceived as a biochemical deficiency, and food as a collection of nutrients). Finally, I make a normative argument, suggesting that this redefinition has not necessarily benefited the starving: the provision of food in emergencies, I argue, is often concerned with control and efficiency rather than the suffering individuals themselves.

Some 5 million people were classified as internally displaced in Colombia at the end of 2012, which represented about 10 per cent of the population and the highest number in the world at the time. Colombia differs from other countries with high levels of displacement in that it is comparatively politically stable, has effective national institutions, a relatively strong formal economy, and can by no means be described as a ‘failed’ or ‘failing’ state. The displacement literature tends to characterise the phenomenon as a humanitarian crisis and a side effect of the long-running civil war. But Colombians continue to be displaced in very large numbers despite the formal demobilization of the paramilitaries in 2006 and the diminished military capacity and engagement of the guerrillas since about the same period: the same groups that are widely regarded as being the main perpetrators of displacement. This thesis contends that displacement of the civilian population in Colombia is frequently not a consequence of violence, but rather the primary objective, where violence plays a facilitatory role. Moreover, the thesis asserts that these massive levels of displacement are substantively linked to predominantly economically-motivated logics and are regionally specific. By examining an agricultural commodity that has significantly expanded relatively recently in Colombia - African palm oil - this research examines if and how expanded cultivation may be linked to displacement. Using a political economy framework of analysis combined with empirical fieldwork, it explores the ‘localised displacement logics’ whereby land is coercively acquired by powerful local groups. The thesis concludes that the abandonment and dispossession of land from poor and marginalised groups constitutes part of an ongoing process of capitalist expansion and statebuilding in Colombia. Contrary to assertions that it is the intra-state conflict that constitutes the central obstacle to development, Colombia’s current trajectory of capitalist development may actually be a central obstacle to sustainable peace and not lead to an end to displacement.

This thesis examines the role and relationship of standardization and advocacy in humanitarian aid planning processes within the emergent field of education and instability. Standardization refers to the aid industry’s increasing emphasis on establishing ‘universal’ principles and normative frameworks. Advocacy refers to transnational-policy-network activities that move forward the global standardization agenda. The study focuses on the purposes and practices of knowledge creation by an education-and-instability ‘epistemic community’: the Inter-Agency Network for Education in Emergencies (INEE). Drawing on global-level interviews with key figures, participant observations, and documentary analysis, the research explores how this epistemic community promotes its core tenets: that education is an inherent human right and that educational provision should be a frontline humanitarian response on par with food distribution and shelter construction. The thesis analyzes the consensus-making process that resulted in the publication of the 2004 INEE Minimum Standards handbook, the then-epitome of the epistemic community’s knowledge. Next, the thesis examines the local application and adaptation of such global standardization processes in post-conflict Uganda. The case study presents the relationships among international and local ‘development partner’ institutions concerned with educational planning as a complex and contradictory story of power dynamics and knowledge circulation. These ‘partnerships’ are characterized by a shared quest for adherence to the knowledge encapsulated within standardized global frameworks and their normative principles. For Ugandan institutions, fluency in this discourse is a powerful tool to appropriate for their own ends. For international institutions, the knowledge is at once a technical resource and a means to bring ever more stakeholders into the wider epistemic community concerned with humanitarian aid. I argue that, through judicious use of standardization and advocacy mechanisms, INEE seeks to legitimize the education sector’s existence within the humanitarian aid industry and expand support for (or ‘conversion’ to) the education-and-instability epistemic community’s core beliefs.

This thesis examines the policies, positions, and perspectives of developing countries on the emerging norm of humanitarian intervention after the Cold War, focusing on the period between 1991 and 2001. In doing so, it questions the role of opposition that conventional wisdom has allotted to them as parochial defenders of sovereignty. Instead, the thesis reveals variation and complexity, which militates against defining the South, or the issues that humanitarian intervention raises, in simplistic either-or terms.Part I draws on insights about ‘sovereignty as what states make of it’ to break the classic pluralism-solidarism impasse that has otherwise stymied the conversation on humanitarian intervention and confined the South as a whole to a ‘black box’ labelled rejectionism. It reconstructs the empirical record of developing countries at large on six cases of military intervention (northern Iraq, Somalia, Haiti, Sierra Leone, Kosovo, and East Timor), revealing variation that defies easy categorization. It also charts a cumulative and dynamic trend within the South towards a grey area between pluralism and solidarism that shows how these were not diametrically opposed positions. Following from that, Part II looks in-depth at India and Argentina. Whereas Argentina accepted the idea of humanitarian intervention, India remained reluctant to countenance it and persistently objected to the development of a new rule in its favour. Part II argues that the level of congruence between the emerging norm and the two countries’ prevailing values, aspirations, and historically constructed ways of thinking played a key role in determining the different levels of acceptance that the idea found with them. Part III delves deeper into the substance of their views. It shows how neither country constructed mutually exclusive choices between pluralism and solidarism, sovereignty and human rights, and intervention and non-intervention. Rather, both exhibited an acute awareness of the dilemmas of protecting human rights in a society of states, and a wariness of yes-no answers.Cumulatively, this thesis thus points away from thinking about the South itself as a given category with clear, shared or pre-determined ideas, and towards a more nuanced and inclusive conversation on humanitarian intervention.

In the last decade, scholars have recognized economic development and modernization as crucial themes in the history of the twentieth century and the ‘global Cold War.’ Yet while historians have written lucid histories of the role of the social sciences in American foreign policy in the Third World, far less is known on the Soviet Union’s ideological and material support during the same period for countries like Egypt, India, Ethiopia, Angola, or – most prominently – Afghanistan. This dissertation argues that the Soviet intervention in Afghanistan is best understood as the final and most costly of a series developmental interventions staged in that country during the latter half of the twentieth century by Afghans, Soviets, Americans, Germans and others. Cold War-era Afghanistan is best understood as a laboratory for ideas about the nation-state and the idea of a ‘national economy.’ One can best understand Afghanistan during that period less through a common but ahistorical ‘graveyard of empires’ narrative, and more in terms of the history of the social sciences, the state system in South and Central Asia, and the ideological changes in ideas about the state and the economy in 20th century economic thought. Four chapters explore this theme, looking at the history of the Soviet social sciences, developmental interventions in Afghanistan prior to 1978, a case study of Soviet advisors in eastern Afghanistan, and Soviet interventions to protect Afghan women. Making use of new materials from Soviet, German, and American archives, and dozens of interviews with former Soviet advisors, this dissertation makes a new and meaningful contribution to the historical literature on the Soviet Union, Central Asia, and international history.

This thesis examines the approaches taken by the International Committee of the Red Cross (ICRC) and the Office of the High Commissioner for Refugees (UNHCR) to the protection of civilians during internal armed conflict, both at the level of global policy and at the level of implementation in the Colombian context. The thesis explains how the ICRC and UNHCR approach protection, why each has adopted its particular approach, and how and why the effectiveness of each approach is limited. In doing so, it offers a theoretical framework for explaining the approaches taken by international organizations (IOs) to new tasks within their mandates as well as policy implications for the ICRC, UNHCR and other humanitarian agencies. From a theoretical perspective, this research shows that factors internal to the IO carry greater explanatory power than external factors. Most significantly, when an IO expands into a new issue-area, it frames the new task in terms of the existing tasks within its mandate, replicating the specific goals and the means of pursuing those goals. The extent to which the approach is then adapted to the specificities of the new issue-area depends on the ‘bureaucratic personality’ of the IO, and specifically the extent to which decisions are informed by field-level experience. Internal conflicts by definition include armed non-state actors, and the analysis in this thesis emphasises both their significance in determining civilian security and their neglect in existing approaches to protection. While the ICRC seeks to reduce the threat posed by all armed actors (state and non-state) in its work at the field level, it relies heavily on an international legal framework which prioritises states and this partially undermines its attention to non-state actors at the field level. UNHCR retains a state-centric focus at both the field level and the level of global policy. From a policy perspective, therefore, the thesis advocates greater attention to armed non-state actors both at the level of practice and in the development of protection norms.

The legal humanitarian regime, set out in the Geneva Conventions and Additional Protocols, strives to alleviate human suffering through the provision of emergency goods and services, such as food supplies, water, temporary shelter, and medical treatment. This thesis examines how international non-government organizations (INGOs) contribute to the contestation of this regime in political emergencies, the effects of this contestation, and the factors driving INGO contestation. The thesis develops an analytical framework for understanding the nature and functioning of the legal humanitarian regime, and argues that INGO contestation occurs through the two processes of regime interpretation and regime implementation. It then goes on to identify the substantive content and effects of contestation, and the factors driving INGO contestation of the regime, through a detailed study of the policies and practices of CARE, Médecins Sans Frontiers, Oxfam, and World Vision, in Afghanistan and Sri Lanka, from 1990-2010. The thesis argues that contestation has constitutive effects, as it re-defines the meaning of the formal humanitarian regime, and the underlying rules and norms that specify the regime’s function, scope, and operating principles. Contestation also has causal effects, as it can make INGOs participants in the conflict, eroding thereby the basis on which they negotiate access and their ability to respond to humanitarian needs, and the security of their staff. It has also facilitated the subordination of humanitarian assistance by donor states and combatants to their political and security objectives. INGO identity - expressed in terms of the constituent rules and norms that define INGO membership, their mandate and goals, and the manner in which they distinguish themselves from other actors - is argued to be a necessary factor for explaining INGO contestation. The focus on identity highlights the agency of INGOs in shaping the humanitarian regime and demonstrates that INGOs are not simply at the mercy of more powerful actors or external constraints.

Over the last two decades, the international community has taken on the task of rebuilding societies in the aftermath of mass-atrocities. Through a combination of trial and error and vigorous academic research, a relatively clear (and semi-malleable) blueprint of post-atrocity peacebuilding has developed. This includes setting up a temporary international transitional authority, establishing democracy, facilitating economic development, and holding war crime trials. Though there are volumes of studies which address the pragmatic strengths and weaknesses of these key elements of peacebuilding, to date political theorists have not critically analyzed the moral legitimacy of these policies. My thesis aims to fill this gap. The overarching question of this thesis is this: What moral duties does the international community have to post-atrocity societies? To answer this question, I critically examine the normative issues involved in the four key aspects of peacebuilding (identified above). Using the framework of just war theory and a cosmopolitan theory of fundamental human rights, I argue that, in most post-atrocity cases, the international community has duties to remove atrocity-committing regimes from power, occupy the target-state and act as a transitional authority, help facilitate the creation of democracy and economic development, and hold war crimes trials. These duties, of course, are extremely complicated and limited and these qualifications are examined and developed throughout. Running through the construction of my theory of post-atrocity duties is a clear message: we – the international community – have obligations to the victims and survivors of atrocities. In other words, providing assistance in the wake of mass-atrocities is not a supererogatory act of charity, rather, it is a duty which we owe to the victims of these horrible crimes.

In recent history, the number and scale of natural disasters, one of the major causes of humanitarian emergencies, have increased markedly. From 2000 to 2009, compared with the period from 1980 to 1989, there were 3 times more natural disasters across the globe, with climate-related events accounting for nearly 80% of the increase. Since 2008, natural disasters such as floods, storms, and earthquakes have displaced an average of 26.4 million people per year. Even after adjusting for growth in population, the likelihood of being displaced by a disaster today is 60% higher than it was 40 years ago. In 2013 alone, 97 million people were affected by natural disasters. Man-made disasters, the other major cause of humanitarian emergencies (by means, for example, of violence and conflict), remain a leading driver of displacement as well. According to the UN High Commissioner of Refugees (UNHCR), mass displacement reached unprecedented levels in 2014: "59.5 million individuals were forcibly displaced worldwide as a result of persecution, conflict, generalized violence, or human rights violations." Particularly in fragile and conflict-affected states, a complex mix of overlapping hazards--both armed conflict and natural disasters--plays a role in creating humanitarian crises, one that climate change is expected only to exacerbate. The University College London-Lancet Commission, in its landmark 2009 report, said, "Climate change is the biggest global health threat of the 21st century. Effects of climate change on health will affect most populations in the next decades and put the lives and wellbeing of billions of people at increased risk." Among the billions of people at increased risk are adolescents (10- to 19-year-olds), who account for 1 in 5 people in the world, or about 1.2 billion. The vast majority--90%--of adolescents live in developing countries (including China), and approximately 510 million of this group are girls. The poorest adolescent girls living in the poorest communities--roughly more than 200 million girls living in households in the bottom 2 wealth quintiles--are at special risk for being deleteriously affected by climate change. Nonetheless, adolescent girls are not currently a specifically targeted, high-risk group in humanitarian relief efforts during emergencies, nor are they specifically engaged as a population whose involvement could advance national adaptation plans to mitigate the effects of climate change. In 2011, Plan Internationali published a valuable monograph entitled "Weathering the Storm: Adolescent Girls and Climate Change," that called attention to the particular vulnerability of adolescent girls to the effects of climate change. It was a prescient analysis. In the intervening 4 years, the effect of climate change has become more pronounced, and there is a clearer vision of its consequences. The human rights community has more urgently addressed the effect of climate change, especially on socially excluded groups, and practitioners have begun to organize an increasingly accelerated response to the plight of adolescent girls in humanitarian emergencies, both those caused by natural disasters and armed conflicts. The overall reaction to the cataclysm suffered by adolescent girls, however, has been slower than the data warrant. Language: en

This paper evaluates how the Philippines utilize social protection systems and programs to help households better manage disaster risk. Exposure and vulnerability to natural disasters and the effects of climate change are particularly high in the Philippines. At the same time, the Philippines has developed one of the most advanced social protection systems in the East Asia Pacific region. The Department of Social Welfare and Development is prominently integrated into the national disaster risk management framework of the Philippines, taking the lead coordinating role in disaster response activities. Consequently, social protection programs are on the frontlines of disaster response in the Philippines. This paper focuses specifically on the devastating impact of Typhoon Yolanda, which struck the country in November 2013, as a case study against which the Philippines’ social protection response can be assessed.

The Pacific island countries (PICs) are some of the most exposed to frequent natural disasters and climate shocks, and their vulnerability is increasing due to mounting effects of climate change as well as demographic and economic forces. Natural disasters hit the poorest hardest and have long-term consequences for human development. Social protection programs and systems have an important role in helping poor and vulnerable populations cope with the impacts of shocks as well as build long-term resilience. This paper discusses the potential role of social protection for disaster and climate risk reduction and management in PICs. It presents evidence and lessons from other regions, providing examples of tools and entry points for the development of climate, and disaster, responsive social protection interventions and context-specific recommendations for PICs.

Many countries have used social protection to achieve broader development goals, particularly on poverty reduction and inclusive growth. A wide range of social protection programs allows countries to tackle specific development constraints at national, community, and household levels; provide support to particular population groups; and enhance growth-promoting opportunities.For instance, public works programs and cash transfers are important and flexible social assistance programs that can be tailored to achieve specific objectives and adjusted to various levels of institutional capacity. They can also be implemented as national and centralized programs or delivered in a more decentralized fashion through community-driven development platforms.

Background Diarrheal disease is a common cause of morbidity and mortality. Displaced populations are especially vulnerable due to overcrowded camps and limited access to water and sanitation facilities, increasing the risk for outbreaks. Hand washing with soap is effective against disease transmission, and studies suggest access to a convenient hand washing station may be the key to increasing hand washing behavior. This pilot study evaluated the acceptability, durability and use of a novel hand washing bag (HWB) at the household level among Sudanese refugees immediately following an acute emergency. Methods We distributed one HWB to every household (n = 874) in Adamazin Transit Center in western Ethiopia. The evaluation consisted of baseline and endline surveys, three monthly monitoring visits and focus group discussions (FGDs) over a six month period. FGD data were analyzed using the Risk, Attitudes, Norms, Abilities, and Self-Regulatory model. Survey and monitoring data were analyzed using SPSS. Note: Residents were resettled to Bambasi Refugee Camp during the study period where the endline survey was conducted. Results Baseline data suggested water quantity and availability of soap were below SPHERE standards, however participants responded positively to the HWB. At the end of the monitoring period, 73.9 % of the same households retained their original HWBs and 66.7 % of bags had water at the time of the visit. The mean lifespan of the HWB during the monitoring period was 2.73 months. From a new sample of households selected for the endline evaluation, 93.0 % had an original HWB, but only 39.4 % had water in the bag. Endline FGD participants felt the HWB was useful, but reported insufficient soap and hygiene messaging. Conclusion The HWB performed well during the early phases of the emergency, however longer term results in this setting are unclear. The low levels of reported use measured by proxy indicators at six months indicated decreasing acceptability over time or a reflection of potential differences between the two sites. It is also unknown whether the HWB influenced hand washing behavior. Study findings were shared with the manufacturer in an effort to improve the bag’s acceptability, utility, and durability.

Master's thesis in Risk management and societal safety The evolving possibilities of using new types of technology in emergency settings have made both the UN agencies and International Non-Governmental Organizations (INGO) open their eyes for the potential benefits this can present for them in humanitarian emergencies. Especially information and communication technology (ICT) systems have been applied to ensure that the needs of the people at risk are being meet, through a reliable and efficient information management system across organizations. This explorative thesis will present, discuss and conclude the findings from our two fieldworks conducted in Lebanon in 2014/2015. The empirical material has been collected from relevant governmental and humanitarian actors at field and national level as well as beneficiaries. Our study focuses on how ICT systems can contribute to reliable information management in the humanitarian response. Descriptive and normative theoretical perspectives within information processing have been applied to be able to describe how information management across levels in a hierarchical system either should be reliable, or how the organizational errors may lead the information processing to fail. In addition a theoretical perspective on how technological systems are diffused and adopted in the hierarchical system is used; this will shape the theoretical framework and guide the findings when answering the research questions and problem. The key findings in this thesis suggests that the official ICT systems in Lebanon are innovated and implemented in ways that do not make these compatible with the needs of all users across levels within the organizations. This is especially the case for the users at field level, who have identified different technological needs than what has been developed at national level. Findings also illuminate that when the ICT systems are not covering the existing needs it creates challenges for cross-organizational information processing as users starts to develop their own internal ICT systems to cover their needs, creating a fragmented information picture over needs and gaps across organizations. Further, the findings indicate that a lack of standardized ways of both sharing information, as well as organizations operate with their own set of information, further hampers the possibility for reliable information management. Lacking a holistic approach when performing assessments, the implementation of further interventions may not be according to the actual needs. The lack of a common approach, when handling information therefore limits the possibility, of having reliable information management through ICT systems in the humanitarian response in Lebanon.

This paper describes how socio-ecological theory and a syndemic health systems and public health approach may help address the plight of youth in situations of political violence and humanitarian emergencies. We describe the treatment gap caused by discrepancies in epidemiological prevalence rates, individual and family needs, and available human and material resources. We propose four strategies to develop a participatory public health approach for these youth, based on principles of equity, feasibility, and a balance between prevention and treatment. The first strategy uses ecological and transgenerational resilience as a theoretical framework to facilitate a systems approach to the plight of youth and families. This theoretical base helps to engage health care professionals in a multisectoral analysis and a collaborative public health strategy. The second strategy is to translate pre-program assessment into mental health and psychosocial support (MHPSS) priorities. Defining priorities helps to develop programs and policies that align with preventive and curative interventions in multiple tiers of the public health system. The third is a realistic budgetary framework as a condition for the development of sustainable institutional capacity including a monitoring system. The fourth strategy is to direct research to address the knowledge gap about effective practices for youth mental health in humanitarian settings.KeywordsPublic health Youth Humanitarian emergencies Resilience Mental health Syndemics

Background The burden of neuropsychiatric disorders in refugees is likely high, but little has been reported on the neuropsychiatric disorders that affect Syrian and Iraqi refugees in a country of first asylum. This analysis aimed to study the cost and burden of neuropsychiatric disorders among refugees from Syria and Iraq requiring exceptional, United Nations-funded care in a country of first asylum. Methods The United Nations High Commissioner for Refugees works with multi-disciplinary, in-country exceptional care committees to review refugees’ applications for emergency or exceptional medical care. Neuropsychiatric diagnoses among refugee applicants were identified through a retrospective review of applications to the Jordanian Exceptional Care Committee (2012–2013). Diagnoses were made using International Classification of Disease-10th edition codes rendered by treating physicians. Results Neuropsychiatric applications accounted for 11% (264/2526) of all Exceptional Care Committee applications, representing 223 refugees (40% female; median age 35 years; 57% Syrian, 36% Iraqi, 7% other countries of origin). Two-thirds of neuropsychiatric cases were for emergency care. The total amount requested for neuropsychiatric disorders was 925,674 USD. Syrian refugees were significantly more likely to request neurotrauma care than Iraqis (18/128 vs. 3/80, p = 0.03). The most expensive care per person was for brain tumor (7,905 USD), multiple sclerosis (7,502 USD), and nervous system trauma (6,466 USD), although stroke was the most frequent diagnosis. Schizophrenia was the most costly and frequent diagnosis among the psychiatric disorders (2,269 USD per person, 27,226 USD total). Conclusions Neuropsychiatric disorders, including those traditionally considered outside the purview of refugee health, are an important burden to health among Iraqi and Syrian refugees. Possible interventions could include stroke risk factor reduction and targeted medication donations for multiple sclerosis, epilepsy, and schizophrenia. Electronic supplementary material The online version of this article (doi:10.1186/s13031-015-0038-5) contains supplementary material, which is available to authorized users.

Recurrent, large, waterborne epidemics of hepatitis E virus (HEV) occur regularly after monsoon rains contaminate water supplies in Asia or during humanitarian crises in Africa. These epidemics commonly affect thousands of persons, and it has a high mortality in pregnant women who become infected. Although a subunit HEV vaccine has been developed by Chinese investigators and was found to be highly effective and safe in a large clinical trial, this vaccine is only available in China. Until it is prequalified by the World Health Organization, the vaccine may not be available for use outside of China in low-income countries that lack national vaccine regulatory agencies. In this manuscript, we explore possible strategies for providing access to this potentially important vaccine for international use in responding to epidemics of HEV in low-resource countries.

Some 5 million people were classified as internally displaced in Colombia at the end of 2012, which represented about 10 per cent of the population and the highest number in the world at the time. Colombia differs from other countries with high levels of displacement in that it is comparatively politically stable, has effective national institutions, a relatively strong formal economy, and can by no means be described as a ‘failed’ or ‘failing’ state. The displacement literature tends to characterise the phenomenon as a humanitarian crisis and a side effect of the long-running civil war. But Colombians continue to be displaced in very large numbers despite the formal demobilization of the paramilitaries in 2006 and the diminished military capacity and engagement of the guerrillas since about the same period: the same groups that are widely regarded as being the main perpetrators of displacement. This thesis contends that displacement of the civilian population in Colombia is frequently not a consequence of violence, but rather the primary objective, where violence plays a facilitatory role. Moreover, the thesis asserts that these massive levels of displacement are substantively linked to predominantly economically-motivated logics and are regionally specific. By examining an agricultural commodity that has significantly expanded relatively recently in Colombia - African palm oil - this research examines if and how expanded cultivation may be linked to displacement. Using a political economy framework of analysis combined with empirical fieldwork, it explores the ‘localised displacement logics’ whereby land is coercively acquired by powerful local groups. The thesis concludes that the abandonment and dispossession of land from poor and marginalised groups constitutes part of an ongoing process of capitalist expansion and statebuilding in Colombia. Contrary to assertions that it is the intra-state conflict that constitutes the central obstacle to development, Colombia’s current trajectory of capitalist development may actually be a central obstacle to sustainable peace and not lead to an end to displacement.

In the last decade, scholars have recognized economic development and modernization as crucial themes in the history of the twentieth century and the ‘global Cold War.’ Yet while historians have written lucid histories of the role of the social sciences in American foreign policy in the Third World, far less is known on the Soviet Union’s ideological and material support during the same period for countries like Egypt, India, Ethiopia, Angola, or – most prominently – Afghanistan. This dissertation argues that the Soviet intervention in Afghanistan is best understood as the final and most costly of a series developmental interventions staged in that country during the latter half of the twentieth century by Afghans, Soviets, Americans, Germans and others. Cold War-era Afghanistan is best understood as a laboratory for ideas about the nation-state and the idea of a ‘national economy.’ One can best understand Afghanistan during that period less through a common but ahistorical ‘graveyard of empires’ narrative, and more in terms of the history of the social sciences, the state system in South and Central Asia, and the ideological changes in ideas about the state and the economy in 20th century economic thought. Four chapters explore this theme, looking at the history of the Soviet social sciences, developmental interventions in Afghanistan prior to 1978, a case study of Soviet advisors in eastern Afghanistan, and Soviet interventions to protect Afghan women. Making use of new materials from Soviet, German, and American archives, and dozens of interviews with former Soviet advisors, this dissertation makes a new and meaningful contribution to the historical literature on the Soviet Union, Central Asia, and international history.

Over the last two decades, the international community has taken on the task of rebuilding societies in the aftermath of mass-atrocities. Through a combination of trial and error and vigorous academic research, a relatively clear (and semi-malleable) blueprint of post-atrocity peacebuilding has developed. This includes setting up a temporary international transitional authority, establishing democracy, facilitating economic development, and holding war crime trials. Though there are volumes of studies which address the pragmatic strengths and weaknesses of these key elements of peacebuilding, to date political theorists have not critically analyzed the moral legitimacy of these policies. My thesis aims to fill this gap. The overarching question of this thesis is this: What moral duties does the international community have to post-atrocity societies? To answer this question, I critically examine the normative issues involved in the four key aspects of peacebuilding (identified above). Using the framework of just war theory and a cosmopolitan theory of fundamental human rights, I argue that, in most post-atrocity cases, the international community has duties to remove atrocity-committing regimes from power, occupy the target-state and act as a transitional authority, help facilitate the creation of democracy and economic development, and hold war crimes trials. These duties, of course, are extremely complicated and limited and these qualifications are examined and developed throughout. Running through the construction of my theory of post-atrocity duties is a clear message: we – the international community – have obligations to the victims and survivors of atrocities. In other words, providing assistance in the wake of mass-atrocities is not a supererogatory act of charity, rather, it is a duty which we owe to the victims of these horrible crimes.

The project received start-up funding in the form of a University of St Andrews FILTA award The importance of specialist intervention in the form of humanitarian aid from governments, NGOs and other aid agencies during a humanitarian emergency cannot be over-emphasised. Humanitarian aid is the assistance provided in response to a humanitarian crisis. Humanitarian aid may be logistical, financial or material and its central aim is to alleviate human suffering and save lives. This paper describes an inter-disciplinary project that created the Virtual Humanitarian Disaster learning and teaching resource (VHD) that is centred on the events occurring in the aftermath of an earthquake. To facilitate learning, scenarios with integrated task dilemmas have been modelled which will provide the opportunity for users of the resource to explore the inter-relationships between the key areas of activities which are important to the NGOs and other bodies which deliver humanitarian aid. Such areas include geo-political relationships, legal and regulatory requirements, information management, logistic, financial and human resource management imperatives. The VHD is primarily aimed at students. It creates a more flexible learning and teaching environment when compared with traditional classroom methods. The resource enables students to make decisions concerning critical situations within the controlled environment of a virtual world, where the consequences of any wrong decisions, will not directly impact on lives and property. The VHD has been embedded within an undergraduate module of the School of Management as it specifically relates to the final thematic area within which the module engages, namely the strategic and operational challenges faced by NGOs operating in the “humanitarian relief industry”. We demonstrate that virtual worlds can be used to enhance learning and make it more engaging. The VHD affords students the opportunity to explore given scenarios in accordance with a specified budget and in so doing, they realise module outcomes in a more active and authentic learning environment. Postprint

This thesis examines the approaches taken by the International Committee of the Red Cross (ICRC) and the Office of the High Commissioner for Refugees (UNHCR) to the protection of civilians during internal armed conflict, both at the level of global policy and at the level of implementation in the Colombian context. The thesis explains how the ICRC and UNHCR approach protection, why each has adopted its particular approach, and how and why the effectiveness of each approach is limited. In doing so, it offers a theoretical framework for explaining the approaches taken by international organizations (IOs) to new tasks within their mandates as well as policy implications for the ICRC, UNHCR and other humanitarian agencies. From a theoretical perspective, this research shows that factors internal to the IO carry greater explanatory power than external factors. Most significantly, when an IO expands into a new issue-area, it frames the new task in terms of the existing tasks within its mandate, replicating the specific goals and the means of pursuing those goals. The extent to which the approach is then adapted to the specificities of the new issue-area depends on the ‘bureaucratic personality’ of the IO, and specifically the extent to which decisions are informed by field-level experience. Internal conflicts by definition include armed non-state actors, and the analysis in this thesis emphasises both their significance in determining civilian security and their neglect in existing approaches to protection. While the ICRC seeks to reduce the threat posed by all armed actors (state and non-state) in its work at the field level, it relies heavily on an international legal framework which prioritises states and this partially undermines its attention to non-state actors at the field level. UNHCR retains a state-centric focus at both the field level and the level of global policy. From a policy perspective, therefore, the thesis advocates greater attention to armed non-state actors both at the level of practice and in the development of protection norms.

This study provides an overview of Arab official development assistance (ODA) over the past four decades. Trends in volume, composition, and direction are discussed in chapter two and the institutional framework is discussed in chapter three. Over 90 percent of Arab development assistance is provided by three countries: the Kingdom of Saudi Arabia (KSA), Kuwait, and the United Arab Emirates (UAE).

This thesis examines the policies, positions, and perspectives of developing countries on the emerging norm of humanitarian intervention after the Cold War, focusing on the period between 1991 and 2001. In doing so, it questions the role of opposition that conventional wisdom has allotted to them as parochial defenders of sovereignty. Instead, the thesis reveals variation and complexity, which militates against defining the South, or the issues that humanitarian intervention raises, in simplistic either-or terms.Part I draws on insights about ‘sovereignty as what states make of it’ to break the classic pluralism-solidarism impasse that has otherwise stymied the conversation on humanitarian intervention and confined the South as a whole to a ‘black box’ labelled rejectionism. It reconstructs the empirical record of developing countries at large on six cases of military intervention (northern Iraq, Somalia, Haiti, Sierra Leone, Kosovo, and East Timor), revealing variation that defies easy categorization. It also charts a cumulative and dynamic trend within the South towards a grey area between pluralism and solidarism that shows how these were not diametrically opposed positions. Following from that, Part II looks in-depth at India and Argentina. Whereas Argentina accepted the idea of humanitarian intervention, India remained reluctant to countenance it and persistently objected to the development of a new rule in its favour. Part II argues that the level of congruence between the emerging norm and the two countries’ prevailing values, aspirations, and historically constructed ways of thinking played a key role in determining the different levels of acceptance that the idea found with them. Part III delves deeper into the substance of their views. It shows how neither country constructed mutually exclusive choices between pluralism and solidarism, sovereignty and human rights, and intervention and non-intervention. Rather, both exhibited an acute awareness of the dilemmas of protecting human rights in a society of states, and a wariness of yes-no answers.Cumulatively, this thesis thus points away from thinking about the South itself as a given category with clear, shared or pre-determined ideas, and towards a more nuanced and inclusive conversation on humanitarian intervention.

The emergence of regional security organisations during the 1990s in Africa proved to be of great significance for the lives of many Africans, including those living in conflict-torn countries such as Liberia, Sierra Leone, Côte d’Ivoire or the Democratic Republic of Congo, but, at the same time, this phenomenon has been understudied. This dissertation explores why regional security organisations with an agenda of democratic governance emerged in Africa in the 1990s. This question is answered with two in-depth case studies on the Economic Community of West African States (ECOWAS) and the Southern African Development Community (SADC). Driven by an empirical puzzle, this study is both hypothesis-testing and hypothesis generating. The study starts by laying out the different possible factors put forward by several bodies of theory in international relations to explain the emergence of ECOWAS and SADC as security organisations. These hypotheses are then tested throughout the history and the evolution of ECOWAS and SADC in order to highlight the circumstances of their creation and their qualified failure as economic communities. This is followed by a comparative analysis of the security and democracy mandates entrusted to ECOWAS and SADC by its member states based on the study of the legal texts that outline the specific objectives of each regional security organisation and the tools they were given to implement their mandates. The study finally analyses the implementation records of ECOWAS and SADC in order to assess the commitment of their member states to their new democracy and security mandate. The research concludes with the two following hypotheses: 1) A security agenda cannot emerge without the involvement of the regional hegemon. 2) What the regional hegemon can do, including affecting the speed of the transformation, is constrained by the acceptance of its leadership by its neighbours (legitimacy) and by state weakness (capability).

Managing non-communicable diseases (NCDs) in crisis-affected and fragile humanitarian contexts requires special attention because primary health care systems often collapse or become compromised in such settings. As a result, addressing and managing these diseases become more challenging. Humanitarian organizations that intervene in crisis situations are increasingly including NCD management in the services they support and provide; however, they encounter a range of issues such as ensuring the quality of care, sustainability of programs, and the possibility of unintended harms. This case study explores ethical considerations raised by a mobile NCD program run by an international humanitarian organization in a country affected by a protracted civil war., La gestion des maladies non transmissibles (MNT) dans les contextes humanitaires fragiles et touchés par des crises requiert une attention particulière car les systèmes de soins de santé primaires s’effondrent souvent ou sont compromis dans de tels contextes. Par conséquent, le traitement et la gestion de ces maladies deviennent plus difficiles. Les organisations humanitaires qui interviennent dans les situations de crise intègrent de plus en plus la gestion des MNT dans les services qu’elles soutiennent et fournissent ; cependant, elles se heurtent à une série de problèmes tels que la garantie de la qualité des soins, la durabilité des programmes et la possibilité de dommages involontaires. Cette étude de cas explore les considérations éthiques soulevées par un programme mobile de lutte contre les MNT géré par une organisation humanitaire internationale dans un pays touché par une guerre civile prolongée.