Social Networks and Support to Older People in Refugee Situation in Western Countries

Background: Forced migration of humans as a result of conflict continues to be a global problem. Many of the refugees displaced and made vulnerable by conflict induced forced migration are older adults. These older adults may lose their social networks and support as a result of the conflicts leading to migration and be unable to recreate them, making them more vulnerable. This review aims to describe the social network and support situation of older adults in refugee situation as presented in global literature. Methods/Design: The five steps of Arksey and O’Malley’s (2005) framework to search multiple databases from inception till June 2021 will be followed. MeSH terms and keywords, e.g., “older refugees”, “refugees”, and “social network”, “social support”, will be adopted for the following databases: SocINDEX, PsychINFO, Social Work Abstracts, Sociology Abstracts, Social Services Abstracts, Web of Science and/or Scopus, Canadian electronic library. Citations will be screened (title/abstract and full text) using predefined inclusion and exclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) will be used to describe the process of data inclusion and exclusion. Discussion: This review will reveal gaps in the provision of social support to older refugees and inform policy development for the improvement of support to older refugees

How are the health needs of internally displaced persons adressed by international actors?

The number of internal displacements has doubled over the last decade, as conflicts and climate related disasters have increasingly triggered movement within countries borders. Due to the lack of a legally binding framework and international agency dedicated for the protection of internally displaced persons (IDPs), the needs of IDPs are underprioritized by international actors. Evidence suggests that IDPs face worse health outcomes than any other crisis-affected population group. This leads to a policy analysis on the involvement of international actors on addressing the health needs of IDPs. The concept of humanitarianism will be utilized as the theoretical foundation and is the underlying motive of humanitarian action worldwide. As an altruistic desire to reduce suffering, humanitarianism aims to provide relief to victims of conflicts or disasters while adhering to the humanitarian principles. Assessing the humanitarian concept helps to conceptualize the role of international actors in the humanitarian assistance of IDPs. For the methodology, a description of the literature search and the selection of certain material has been provided. It also examined why documents by international organizations like the UNHCR, the OCHA, the WHO and the IASC were used for this policy analysis. The first part of the findings identified the legal protection frameworks for IDPs. International law and the Guiding Principles on Internal Displacement represent the most suitable legal tools for IDPs. Guiding concepts regarding the realization of health rights have also been developed by international organizations and national authorities. The second part of the results concentrated on the humanitarian coordination mechanisms for IDPs. Although the UNHCR does not hold an exclusive mandate for IDPs, the protection and assistance of IDPs relies mainly on the UNHCR. The humanitarian coordination mechanism applicable in internal displacement settings is the IASC Cluster approach. The Cluster approach spreads accountability of UN agencies across various sectors, including shelter, food security or health. Despite individual interventions of NGOs on the health of IDPs, the Health Cluster remains the most suitable tool for coordinating an emergency health response. Health cluster country operations have targeted the health needs of IDPs through provision of essential health care. The country cluster operations have contributed to an effective humanitarian relief coordination for IDPs. Due to the lack of an international legally binding framework, the lack of health funding for IDPs and limited accountabilities for IDPs, the issue of internal displacement will remain. Strengthening humanitarian engagement in all sectors concerning the well-being of IDPs can be achieved through a holistic approach

What the eye does not see : a critical interpretive synthesis of European Union policies addressing sexual violence in vulnerable migrants

AbstractIn Europe, refugees, asylum seekers and undocumented migrants are more vulnerable to sexual victimisation than European citizens. They face more challenges when seeking care. This literature review examines how legal and policy frameworks at national, European and international levels condition the prevention of and response to sexual violence affecting these vulnerable migrant communities living in the European Union (EU). Applying the Critical Interpretive Synthesis method, we reviewed 187 legal and policy documents and 80 peer-reviewed articles on migrant sexual health for elements on sexual violence and further analysed the 37 legal and 12 peer-reviewed articles among them that specifically focused on sexual violence in vulnerable migrants in the EU-27 States. Legal and policy documents dealing with sexual violence, particularly but not exclusively in vulnerable migrants, apply ‘tunnel vision’. They ignore: a) frequently occurring types of sexual violence, b) victimisation rates across genders and c) specific risk factors within the EU such as migrants’ legal status, gender orientation and living conditions. The current EU policy-making paradigm relegates sexual violence in vulnerable migrants as an ‘outsider’ and ‘female only’ issue while EU migration and asylum policies reinforce its invisibility. Effective response must be guided by participatory rights- and evidence-based policies and a public health approach, acknowledging the occurrence and multiplicity of sexual victimisation of vulnerable migrants of all genders within EU borders

What is the evidence on availability and integration of refugee and migrant health data in health information systems in the WHO European Region?

Bozorgmehr K, Biddle LR, Rohleder S, Puthoopparambil S, Jahn R. What is the evidence on availability and integration of refugee and migrant health data in health information systems in the WHO European Region?. Health Evidence Network synthesis report. Vol 66. Copenhagen: World Health Organization. Regional Office for Europe; 2019.Nachnutzbar entsprechend den Bedingungen der Lizenz [CC BY-NC-SA 3.0 IGO](https://creativecommons.org/licenses/by-nc-sa/3.0/igo/

The burden of acute respiratory infections in crisis-affected populations: a systematic review

Crises due to armed conflict, forced displacement and natural disasters result in excess morbidity and mortality due to infectious diseases. Historically, acute respiratory infections (ARIs) have received relatively little attention in the humanitarian sector. We performed a systematic review to generate evidence on the burden of ARI in crises, and inform prioritisation of relief interventions. We identified 36 studies published since 1980 reporting data on the burden (incidence, prevalence, proportional morbidity or mortality, case-fatality, attributable mortality rate) of ARI, as defined by the International Classification of Diseases, version 10 and as diagnosed by a clinician, in populations who at the time of the study were affected by natural disasters, armed conflict, forced displacement, and nutritional emergencies. We described studies and stratified data by age group, but did not do pooled analyses due to heterogeneity in case definitions. The published evidence, mainly from refugee camps and surveillance or patient record review studies, suggests very high excess morbidity and mortality (20-35% proportional mortality) and case-fatality (up to 30-35%) due to ARI. However, ARI disease burden comparisons with non-crisis settings are difficult because of non-comparability of data. Better epidemiological studies with clearer case definitions are needed to provide the evidence base for priority setting and programme impact assessments. Humanitarian agencies should include ARI prevention and control among infants, children and adults as priority activities in crises. Improved data collection, case management and vaccine strategies will help to reduce disease burden

Effectiveness of Mechanisms and Models of Coordination between Organizations, Agencies and Bodies Providing or Financing Health Services in Humanitarian Crises: A Systematic Review.

BACKGROUND: Effective coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises is required to ensure efficiency of services, avoid duplication, and improve equity. The objective of this review was to assess how, during and after humanitarian crises, different mechanisms and models of coordination between organizations, agencies and bodies providing or financing health services compare in terms of access to health services and health outcomes. METHODS: We registered a protocol for this review in PROSPERO International prospective register of systematic reviews under number PROSPERO2014:CRD42014009267. Eligible studies included randomized and nonrandomized designs, process evaluations and qualitative methods. We electronically searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library and websites of relevant organizations. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. We assessed the quality of evidence using the GRADE approach. RESULTS: Of 14,309 identified citations from databases and organizations' websites, we identified four eligible studies. Two studies used mixed-methods, one used quantitative methods, and one used qualitative methods. The available evidence suggests that information coordination between bodies providing health services in humanitarian crises settings may be effective in improving health systems inputs. There is additional evidence suggesting that management/directive coordination such as the cluster model may improve health system inputs in addition to access to health services. None of the included studies assessed coordination through common representation and framework coordination. The evidence was judged to be of very low quality. CONCLUSION: This systematic review provides evidence of possible effectiveness of information coordination and management/directive coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises. Our findings can inform the research agenda and highlight the need for improving conduct and reporting of research in this field

A Systematic Review Of Sexual Violence And Hiv In The Post-Disaster Context: Latin America And The Caribbean

ABSTRACT INTRODUCTION: In the last decade, over 800 disasters struck Latin America and the Caribbean, cumulatively affecting an estimated 64 million people. Three quarters of the region’s population lives in disaster risk areas. There is widespread consensus that sexual violence increases in the aftermath of disasters, however historically its prevention has not been prioritized, and in general it remains a vastly understudied phenomenon at the intersection of health and human rights. The linkage between sexual violence and Human Immunodeficiency Virus (HIV) in the post-disaster context is similarly unrepresented in the literature. OBJECTIVES: This systematic review aims to assess the extent to which sexual violence in the post-disaster context has been studied in the region of Latin America and the Caribbean. The primary objectives of the review include (1) to identify and assess the quality of existing literature on sexual violence in the post-disaster context in Latin America and the Caribbean; (2) to assess whether ostensible increases in incidence of sexual violence and HIV infection in the post-disaster context are supported by the existing literature; and (3) to describe contextual factors of the post-disaster context that exacerbate sexual violence vulnerabilities. METHODS: A systematic review of the literature was conducted by searching PubMed, Ovid Global Health, Web of Science and LILACS databases for relevant publications on sexual violence in post-disaster Latin America and the Caribbean (n=147). Exclusion criteria were applied and 10 articles investigating the 2010 earthquake in Haiti (n=7), the 2007 earthquake in Peru (n=1), Hurricane Noel (2007) in the Dominican Republic (n=1), and Hurricane Mitch (1998) in Honduras and Nicaragua (n=1) were ultimately reviewed. RESULTS: The results of this systematic review indicate that sexual violence increases in the aftermath of natural disasters and that women and girls are the most vulnerable populations. Sexual violence may also increase risk of HIV, however there is insufficient evidence to support an association between sexual violence and HIV at the population level. Structural and social factors, most notably gender inequality, exacerbate sexual violence vulnerabilities in the post-disaster context. CONCLUSIONS: There is an urgent need for additional research investigating sexual violence in the global post-disaster context in order to inform prevention efforts and disaster preparedness and to uphold human rights

Building referral mechanisms for neonatal care in humanitarian emergency settings: A systematic review

AIM: During humanitarian emergencies, women and children are particularly vulnerable to health complications and neonatal mortality rates have been shown to rise. Additionally, health cluster partners face challenges in coordinating referrals, both between communities and camps to health facilities and across different levels of health facilities. The purpose of this review was to identify the primary referral needs of neonates during humanitarian emergencies, current gaps and barriers, and effective mechanisms for overcoming these barriers. METHODS: A systematic review was performed using four electronic databases (CINAHL, EMBASE, Medline, and Scopus) between June and August 2019 (PROSPERO registration number CRD42019127705). Title, abstract, and full text screening were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The target population was neonates born during humanitarian emergencies. Studies from high-income countries and prior to 1991 were excluded. The STROBE checklist was used to assess for risk of bias. RESULTS: A total of 11 articles were included in the analysis; these were mainly cross-sectional, field-based studies. The primary needs identified were referrals from homes to health facilities before and during labour, and inter-facility referrals after labour to more specialised services. Some of the main barriers included a lack of roads and infrastructure for transport, staff shortages-especially among more specialised services, and a lack of knowledge among patients for self-referral. Mechanisms for addressing these needs and gaps included providing training for community healthcare workers (CHWs) or traditional birth attendants to identify and address antenatal and post-natal complications; education programmes for pregnant women during the antenatal period; and establishing ambulance services in partnership with local Non-Governmental Organizations. CONCLUSION: This review benefited from a strong consensus among selected studies but was limited in the quality of data and types of data that were reported. Based on the above findings, the following recommendations were compiled: Focus on local capacity-building programmes to address programmes acutely. Recruit CHWs to raise awareness of neonatal complications among pregnant women. Upskill CHWs to provide timely, appropriate and quality care during humanitarian emergencies

Interventions to improve latent and active tuberculosis treatment completion rates in underserved groups in low incidence countries:a scoping review

BACKGROUND: People in underserved groups have higher rates of tuberculosis (TB) and poorer treatment outcomes compared with people with no social risk factors.OBJECTIVES: This scoping review aimed to identify interventions that improve TB treatment adherence or completion rates.ELIGIBILITY CRITERIA: Studies of any design focusing on interventions to improve adherence or completion of TB treatment in underserved populations in low incidence countries.SOURCES OF EVIDENCE: MEDLINE, Embase and Cochrane CENTRAL were searched (January 2015 to December 2023).CHARTING METHODS: Piloted data extraction forms were used. Findings were tabulated and reported narratively. Formal risk of bias assessment or synthesis was not undertaken.RESULTS: 47 studies were identified. There was substantial heterogeneity in study design, population, intervention components, usual care and definition of completion rates. Most studies were in migrants or refugees, with fewer in populations with other risk factors (eg, homelessness, imprisonment or substance abuse). Based on controlled studies, there was limited evidence to suggest that shorter treatment regimens, video-observed therapy (compared with directly observed therapy), directly observed therapy (compared with self-administered treatment) and approaches that include tailored health or social support beyond TB treatment may lead to improved outcomes. This evidence is mostly observational and subject to confounding. There were no studies in Gypsy, Roma and Traveller populations, or individuals with mental health disorders and only one in sex workers. Barriers to treatment adherence included a lack of knowledge around TB, lack of general health or social support and side effects. Facilitators included health education, trusted relationships between patients and healthcare staff, social support and reduced treatment duration.CONCLUSIONS: The evidence base is limited, and few controlled studies exist. Further high-quality research in well-defined underserved populations is needed to confirm the limited findings and inform policy and practice in TB management. Further qualitative research should include more people from underserved groups.</p