Roundtable on the Demography of Forced Migration – författare

Fertility and reproductive health issues more broadly have tended to be of low priority in humanitarian crises. Public attention is drawn by information concerning the magnitude of refugee flows, of death tolls, and of numbers of injuries. Reproductive health has been regarded as a longer term issue that could safely be put on the back burner during the crisis phase of an emergency, when issues of providing adequate food, clean water, and shelter, plus treating acute infectiousdiseases of crowding, take priority. This report reviews what evidence there is concerning the effects of humanitarian crisis on fertility, with a view to identifying common patterns that may exist across settings and be of value in guiding responses to future crises.

In May 2002 Timor Leste (East Timor) emerged as a new nation after centuries of foreign rule and decades of struggle for independence. Its birth was a painful one; a United Nations-brokered Popular Consultation in August 1999, in which an overwhelming majority of the people opted for independence, was followed by several weeks of vengeful violence, looting, and destruction by pro-Indonesia militias. It left the territory and all of its essential services devastated. In this context, the United Nations Transitional Administration in East Timor (UNTAET), with the country''s leaders and people and many other partners, set about restoring order and services, building a government structure, and preparing for independence. This paper summarizes the rehabilitation and development of the health sector from early 2000 to the end of 2001.

This report is concerned with reviewing psychosocial concepts in research related to humanitarian work, with particular emphasis on research related to children affected by prolonged violence and armed conflict.

Admittedly, the world and the nature of forced migration have changed a great deal over the last two decades. The relevance of data accumulated during that time period can now be called into question. The roundtable and the Program on Forced Migration at the Mailman School of Public Health of Columbia University have commissioned a series of epidemiological reviews on priority public health problems for forced migrants that will update the state of knowledge. Malaria Control During Mass Population Movements and Natural Disasters— the first in the series, provides a basic overview of the state of knowledge of epidemiology of malaria and public health interventions and practices for controlling the disease in situations involving forced migration and conflict.

The Roundtable on the Demography of Forced Migration was established by the Committee on Population of the National Research Council in 1999. The roundtable is composed of experts from academia, government, philanthropy, and international organizations. The roundtable''s purpose is to serve as an interdisciplinary, nonpartisan focal point for taking stock of what is known about demographic patterns in refugee situations, to apply this knowledge base to assist both policy makers and relief workers, and to stimulate new directions for innovation and scientific inquiry in this growing field of study.

Situations involving conflict and forced migration have become increasingly commonplace in today''s world. The need to understand the causes, consequences, and characteristics of these situations is creating a burgeoning field of research. But given the nature of complex emergency settings, traditional research guidelines may be inappropriate. The research and policy community has recognized this problem and has begun to address issues surrounding the ethics of doing research in emergency settings and among conflict-affected and displaced populations. The Roundtable on the Demography of Forced Migration, under the aegis of the Committee on Population of the National Research Council, held a workshop to examine some of these issues. This report to the roundtable summarizes the workshop presentations and discussion.

In recent years the number of complex humanitarian emergencies around the world has been steadily increasing. War and political, ethnic, racial, and religious strife continually force people to migrate against their will. These forced migrants create a stream of new challenges for relief workers and policy makers. A better understanding of the characteristics of refugee populations and of the population dynamics of these situations is vital. Improved research and insights can enhance disaster management, refugee camp administration, and repatriation or resettlement programs.Forced Migration and Mortality examines mortality patterns in complex human- itarian emergencies, reviewing the state of knowledge, as well as how patterns may change in the new century. It contains four case studies of mortality in recent emergencies: Rwanda, North Korea, Kosovo, and Cambodia. Because refugees and internally displaced persons are likely to continue to be a significant humanitarian concern for many years, research in this field is critical. This is the first book to comprehensively explore forced migration and mortality and it provides useful material for researchers, policy makers, and relief workers.

Providing medical support to the local population during a chronic crisis is difficult. The crisis in the Democratic Republic of the Congo (DRC), which is characterized by high excess mortality, ongoing armed violence, mass forced displacement, interference by neighboring countries, resource exploitation, asset stripping, and the virtual absence of the state, has led to great poverty and a dearth of funds for the support of the health system.International nongovernmental organizations (NGOs) have stepped in to address the dire humanitarian situation. This study looks at four organizations that support local health care in the eastern DRC: the International Rescue Committee (IRC), Malteser, Medical Emergency Relief International (Merlin), and the Association Régionale d''Approvisionnement en Médicaments Essentiels (ASRAMES). The study makes a comparison of the management and financing approaches of these four organizations by collecting and comparing qualitative and quantitative data on their interaction with the (remaining) local health providers and the local population.Specific objectives of the study are:1. To identify which management and financing approaches, including the setting of fees, are used by the four NGOs supporting healthcare in the eastern DRC.2. To determine how these financing approaches affect utilization rates in the health zones supported by the four NGOs.3. To assess how these utilization rates compare with donor and humanitarian standards.4. To determine at what level fees must be set to allow for cost recovery or cost sharing in health facilities.5. To identify the managerial problems confronting the four NGOs.Many epidemiological and public health studies focus on the interaction between health providers and target groups. Supporting Local Health Care in a Chronic Crisis: Management and Financing Approaches in the Eastern Democratic Republic of the Congo concentrates more on how the relationship between the supporting NGOs and the local health system actually develops. In addition, a common aspect of many of the epidemiological and public health studies is the search for an optimal, or at least appropriate, management and financing approach.

Addressing the health needs of children in complex emergencies is critical to the success of relief efforts and requires coordinated and effective interventions. However, little systematic work has been undertaken to evaluate such care. To address this need, this monograph presents a review of the published literature in this area, providing background on the burden of disease, the major causes of morbidity and mortality, and the evidence base for effective interventions. It also describes surveys of nongovernmental organizations (NGOs) and international agencies providing care to children in complex emergencies, which were conducted to identify guidelines commonly used to provide such care and assesses the content and limitations of these guidelines. A more in-depth survey of several organizations was also conducted to assess obstacles to this kind of care.On the basis of the survey findings and the review of the published literature, the working group recommended that evidence-based, locally adapted guidelines to address the curative and preventive care of children in complex emergencies and health systems planning should be adopted by ministries of health and supported by the World Health Organization (WHO) and UNICEF. The guidelines should target, as much as possible, the different levels of health care workers providing care to children to ensure appropriate, effective, and uniform care in a variety of situations. Child Health in Complex Emergencies presents specific examples of areas for further research and guideline development. This report is not intended to be an exhaustive and definitive assessment of child health in complex emergencies. The topic is much too vast and complex, and different individuals and institutions will have incompatible perspectives. Rather, we aim to provide a starting point for discussion and debate on how to improve the care of children in these settings.

In Africa many of the refugee flows in recent years have had a strong ethnic dimension; interethnic conflict or conflict between politically powerful groups with minority populations is often an important aspect of whois forced to flee. In most cases the origins of conflict occur in a multiethnic environment, and repatriation (if it happens) occurs in that multiethnic context, with implications for subsequent relationships between the groups in terms of political, economic, and numeric power. As the primary source of recruitment to a population, fertility is an essential component ofpostconflict restructuring. The disruption of fertility during the disorder of forced migration can itself be seen as part of the disintegration of society and identity; the impact of conflict and flight on reproduction may be an important indicator of the degree of crisis faced by the population. Postcrisis fertility and changes from the reproductive regime prior to the forced migration indicate not only how the population has responded to the multiplicity of changes and traumas, but also its ability to adapt and manipulate its new sociopolitical position. This report focuses onthe specific experience of a single persecuted population whose sociopolitical history, along with their underlying marital and fertility regimes, will inevitably condition responses to conflict.

Situations involving conflict and forced migration have become increasingly commonplace in today''s world. The need to understand the causes, consequences, and characteristics of these situations is creating a burgeoning field of research. But given the nature of complex emergency settings, traditional research guidelines may be inappropriate. The research and policy community has recognized this problem and has begun to address issues surrounding the ethics of doing research in emergency settings and among conflict-affected and displaced populations. The Roundtable on the Demography of Forced Migration, under the aegis of the Committee on Population of the National Research Council, held a workshop to examine some of these issues. This report to the roundtable summarizes the workshop presentations and discussion.

The Roundtable on the Demography of Forced Migration was established by the Committee on Population of the National Research Council in 1999. The roundtable is composed of experts from academia, government, philanthropy, and international organizations. The roundtable''s purpose is to serve as an interdisciplinary, nonpartisan focal point for taking stock of what is known about demographic patterns in refugee situations, to apply this knowledge base to assist both policy makers and relief workers, and to stimulate new directions for innovation and scientific inquiry in this growing field of study.

In recent years the number of complex humanitarian emergencies around the world has been steadily increasing. War and political, ethnic, racial, and religious strife continually force people to migrate against their will. These forced migrants create a stream of new challenges for relief workers and policy makers. A better understanding of the characteristics of refugee populations and of the population dynamics of these situations is vital. Improved research and insights can enhance disaster management, refugee camp administration, and repatriation or resettlement programs.Forced Migration and Mortality examines mortality patterns in complex human- itarian emergencies, reviewing the state of knowledge, as well as how patterns may change in the new century. It contains four case studies of mortality in recent emergencies: Rwanda, North Korea, Kosovo, and Cambodia. Because refugees and internally displaced persons are likely to continue to be a significant humanitarian concern for many years, research in this field is critical. This is the first book to comprehensively explore forced migration and mortality and it provides useful material for researchers, policy makers, and relief workers.

Admittedly, the world and the nature of forced migration have changed a great deal over the last two decades. The relevance of data accumulated during that time period can now be called into question. The roundtable and the Program on Forced Migration at the Mailman School of Public Health of Columbia University have commissioned a series of epidemiological reviews on priority public health problems for forced migrants that will update the state of knowledge. Malaria Control During Mass Population Movements and Natural Disasters— the first in the series, provides a basic overview of the state of knowledge of epidemiology of malaria and public health interventions and practices for controlling the disease in situations involving forced migration and conflict.

In May 2002 Timor Leste (East Timor) emerged as a new nation after centuries of foreign rule and decades of struggle for independence. Its birth was a painful one; a United Nations-brokered Popular Consultation in August 1999, in which an overwhelming majority of the people opted for independence, was followed by several weeks of vengeful violence, looting, and destruction by pro-Indonesia militias. It left the territory and all of its essential services devastated. In this context, the United Nations Transitional Administration in East Timor (UNTAET), with the country''s leaders and people and many other partners, set about restoring order and services, building a government structure, and preparing for independence. This paper summarizes the rehabilitation and development of the health sector from early 2000 to the end of 2001.

This report is concerned with reviewing psychosocial concepts in research related to humanitarian work, with particular emphasis on research related to children affected by prolonged violence and armed conflict.

In Africa many of the refugee flows in recent years have had a strong ethnic dimension; interethnic conflict or conflict between politically powerful groups with minority populations is often an important aspect of whois forced to flee. In most cases the origins of conflict occur in a multiethnic environment, and repatriation (if it happens) occurs in that multiethnic context, with implications for subsequent relationships between the groups in terms of political, economic, and numeric power. As the primary source of recruitment to a population, fertility is an essential component ofpostconflict restructuring. The disruption of fertility during the disorder of forced migration can itself be seen as part of the disintegration of society and identity; the impact of conflict and flight on reproduction may be an important indicator of the degree of crisis faced by the population. Postcrisis fertility and changes from the reproductive regime prior to the forced migration indicate not only how the population has responded to the multiplicity of changes and traumas, but also its ability to adapt and manipulate its new sociopolitical position. This report focuses onthe specific experience of a single persecuted population whose sociopolitical history, along with their underlying marital and fertility regimes, will inevitably condition responses to conflict.

Fertility and reproductive health issues more broadly have tended to be of low priority in humanitarian crises. Public attention is drawn by information concerning the magnitude of refugee flows, of death tolls, and of numbers of injuries. Reproductive health has been regarded as a longer term issue that could safely be put on the back burner during the crisis phase of an emergency, when issues of providing adequate food, clean water, and shelter, plus treating acute infectiousdiseases of crowding, take priority. This report reviews what evidence there is concerning the effects of humanitarian crisis on fertility, with a view to identifying common patterns that may exist across settings and be of value in guiding responses to future crises.

Providing medical support to the local population during a chronic crisis is difficult. The crisis in the Democratic Republic of the Congo (DRC), which is characterized by high excess mortality, ongoing armed violence, mass forced displacement, interference by neighboring countries, resource exploitation, asset stripping, and the virtual absence of the state, has led to great poverty and a dearth of funds for the support of the health system.International nongovernmental organizations (NGOs) have stepped in to address the dire humanitarian situation. This study looks at four organizations that support local health care in the eastern DRC: the International Rescue Committee (IRC), Malteser, Medical Emergency Relief International (Merlin), and the Association Régionale d''Approvisionnement en Médicaments Essentiels (ASRAMES). The study makes a comparison of the management and financing approaches of these four organizations by collecting and comparing qualitative and quantitative data on their interaction with the (remaining) local health providers and the local population.Specific objectives of the study are:1. To identify which management and financing approaches, including the setting of fees, are used by the four NGOs supporting healthcare in the eastern DRC.2. To determine how these financing approaches affect utilization rates in the health zones supported by the four NGOs.3. To assess how these utilization rates compare with donor and humanitarian standards.4. To determine at what level fees must be set to allow for cost recovery or cost sharing in health facilities.5. To identify the managerial problems confronting the four NGOs.Many epidemiological and public health studies focus on the interaction between health providers and target groups. Supporting Local Health Care in a Chronic Crisis: Management and Financing Approaches in the Eastern Democratic Republic of the Congo concentrates more on how the relationship between the supporting NGOs and the local health system actually develops. In addition, a common aspect of many of the epidemiological and public health studies is the search for an optimal, or at least appropriate, management and financing approach.

Addressing the health needs of children in complex emergencies is critical to the success of relief efforts and requires coordinated and effective interventions. However, little systematic work has been undertaken to evaluate such care. To address this need, this monograph presents a review of the published literature in this area, providing background on the burden of disease, the major causes of morbidity and mortality, and the evidence base for effective interventions. It also describes surveys of nongovernmental organizations (NGOs) and international agencies providing care to children in complex emergencies, which were conducted to identify guidelines commonly used to provide such care and assesses the content and limitations of these guidelines. A more in-depth survey of several organizations was also conducted to assess obstacles to this kind of care.On the basis of the survey findings and the review of the published literature, the working group recommended that evidence-based, locally adapted guidelines to address the curative and preventive care of children in complex emergencies and health systems planning should be adopted by ministries of health and supported by the World Health Organization (WHO) and UNICEF. The guidelines should target, as much as possible, the different levels of health care workers providing care to children to ensure appropriate, effective, and uniform care in a variety of situations. Child Health in Complex Emergencies presents specific examples of areas for further research and guideline development. This report is not intended to be an exhaustive and definitive assessment of child health in complex emergencies. The topic is much too vast and complex, and different individuals and institutions will have incompatible perspectives. Rather, we aim to provide a starting point for discussion and debate on how to improve the care of children in these settings.