Culturally informed resilience in conflict settings: A literature review of Sumud in the occupied Palestinian territories

Investigating culturally specific views and experiences of trauma and resilience can offer new insights that can aid distress management, meaning making, coping and resilience in adverse conditions, and inform emergency and disaster responses. Sumud is a Palestinian cultural construct and component of resilience in the occupied Palestinian territories (oPt). Sumud in Arabic refers to steadfastness or perseverance. This literature review focuses on research studies on Sumud in the oPt, with particular attention on the meaning and manifestations of Sumud, the role of non-violent resistance, and how Sumud and non-violent resistance informs resilience and coping in the context of a military occupation, protracted political conflict, and chronic adversity. The peer-reviewed literature was surveyed using the PubMed and PsycINFO databases. The findings indicate how Sumud is a central component of resilience and provides a meta-cognitive framework which Palestinians use to interpret, cope and respond to ongoing injustice and traumatic experiences, engendering a sense of purpose and meaning. It is both a value and an action that manifests via individual and collective action to protect family and community survival, wellbeing, dignity, Palestinian identity and culture, and a determination to remain on the land. The implications of this study and the relevance of the findings to mental health and disaster relief are considered

Adaptive Coping During Protracted Political Conflict, War and Military Blockade in Gaza

Identifying culturally-relevant concepts and coping mechanisms can help protect civilian wellbeing. This study explores how seven professional Palestinian university graduates in the Gaza Strip (occupied Palestinian territories) cope with war, military occupation, military blockade and the challenges of living in a conflict-affected area. Participants were interviewed to determine whether culturally specific modes of coping were used. Thematic analysis was applied. The use of resistance and more specifically, sumud , being steadfast and persevering, were identified alongside the motivation to persevere and other adaptive responses to living conditions. Coping strategies identified in this study include adapting, problem-solving, accepting reality, exercising patience, utilising social support, and faith in God (iman) and religion. The implications of this study and the relevance of the findings to mental health and disaster relief are considered

“It was touching”: Experiences and views of students in the June 3 flood and fire disaster relief response volunteerism in Accra, Ghana

Evidence from Africa on the motivations and experiences of student volunteers in community disaster relief response programs are rare. This study explores the experiences and views of the students who volunteered at the emergency mental health relief response site after the June 3, 2015, flood and fire disaster in Accra, and the implications for future professional response work in Ghana. Thematic analysis of 15 qualitative in-depth interviews showed that, overall, the student volunteers were both self-oriented and other-oriented. The students viewed work at the emergency response site as a touching experience and a call of duty. The response work provided the students with practical pathways to linking their clinical and community learning experiences. This study recommends that, rather than an ad hoc response team, the Ghana Psychological Association should consider setting up a standing disaster relief response network to provide mental health relief and recovery response in community emergency situations in Ghana

Social suffering and the psychological impact of structural violence and economic oppression in an ongoing conflict setting: The Gaza Strip

Structural violence and economic oppression (e.g. control over resources, politically engineered poverty and unemployment) are common features of warfare, yet there is a lack of research exploring the impact this has on civilian wellbeing in conflict‐affected areas. This study, embedded within a human rights and community liberation psychology framework, aims to address this need by studying young Palestinian university graduates living under military blockade and occupation in the Gaza Strip. Semi‐structured interviews were conducted. Thematic analysis indicated that economic and political domains adversely affected multiple aspects of civilian life and wellbeing. The findings revealed the deleterious effects of structural violence and economic oppression which created: human insecurity; poor psychological wellbeing and quality of life; existential, psychological and social suffering; humiliation; injuries to dignity; multiple losses; and led to life being experienced as ‘on hold’. Local expressions and idioms to express distress were identified. The findings contributed to unique insights regarding how continual, systemic, and structural oppression can be potentially more psychologically detrimental than specific incidents of conflict and violence. The implications and the relevance of the findings to mental health and disaster relief are considered. Interventions providing human security and economic security should be prioritised

Psychosocial Capacity Building in Response to Cascading Disasters: A Culturally Informed Approach

The dominant paradigm guiding mental health professionals responding to major disasters is the field of \u27disaster mental health\u27, which historically focused more on psychological factors than social factors, privileging individual over collective interventions. However, resilience to complex events is a result of multiple drivers, such as social networks and local culture, that must be considered together in the assessment and planning process. This paper adopts a multi-disciplinary perspective for disaster response, applying a social-ecological approach to disaster risk reduction which has been developed through practice and a review of the literature. In particular, we investigated how psychosocial healing, collective efficacy and social justice as intertwined aspects of the recovery process may inhibit the escalation of cascading disasters. The article argues that psychosocial capacity building can be used in disaster preparation as well as to respond to cascading events, as the escalation of secondary emergencies caused by the loss of vital services can heavily influence collective behaviors, and hinder the response capacity of emergency services. Our research suggests that adopting a multi-systemic approach, drawing on local cultural practices, can deepen the capacity of local people to take control over their own process of healing and psychosocial restoration, enhancing a sustainable recovery process. The conclusions suggest some possible applications for responders, utilizing groups and activities, and raise questions for researchers in the field

Resilience of refugees displaced in the developing world: a qualitative analysis of strengths and struggles of urban refugees in Nepal

BACKGROUND: Mental health and psychosocial wellbeing are key concerns in displaced populations. Despite urban refugees constituting more than half of the world's refugees, minimal attention has been paid to their psychosocial wellbeing. The purpose of this study was to assess coping behaviour and aspects of resilience amongst refugees in Kathmandu, Nepal. METHODS: This study examined the experiences of 16 Pakistani and 8 Somali urban refugees in Kathmandu, Nepal through in-depth individual interviews, focus groups, and Photovoice methodology. Such qualitative approaches enabled us to broadly discuss themes such as personal experiences of being a refugee in Kathmandu, perceived causes of psychosocial distress, and strategies and resources for coping. Thematic network analysis was used in this study to systematically interpret and code the data. RESULTS: Our findings highlight that urban refugees' active coping efforts, notwithstanding significant adversity and resulting distress, are most frequently through primary relationships. Informed by Axel Honneth's theory on the struggle for recognition, findings suggest that coping is a function beyond the individual and involves the ability to negotiate recognition. This negotiation involves not only primary relationships, but also the legal order and other social networks such as family and friends. Honneth's work was used because of its emphasis on the importance of legal recognition and larger structural factors in facilitating daily coping. CONCLUSIONS: Understanding how urban refugees cope by negotiating access to various forms of recognition in the absence of legal-recognition will enable organisations working with them to leverage such strengths and develop relevant programmes. In particular, building on these existing resources will lead to culturally compelling and sustainable care for these populations

Regulating disasters? The role of international law in disaster prevention and management

Purpose – This article explores the role of international law in disaster prevention and management, with a particular focus on the emerging field of international disaster law, and its relationship with international human rights law. It further introduces the four articles of the special column of this journal issue, dedicated to disasters and international law. Design/methodology/approach – The analysis is based upon primary sources of legislation and policy, as well as academic literature on disasters and international law. Findings – Although the field of international disaster law is at its infancy, we argue that this emergent area does have the potential to gain widespread recognition as a distinct field of law, and that this could be of benefit for the wider disaster management community. Originality/value – The article introduces key legal features and themes relating to international law and disasters, highlighting their relevance for disaster management. The added value is to widen the discussion on aspects of disasters regulated by international law, thus facilitating the future exchange with other academic subjects and operational fields. Keywords – disasters; international law; disaster management; treaties; human rights; international disaster law; international human rights law. Paper type – Research pape

Provision of antiretroviral treatment in conflict settings: the experience of Médecins Sans Frontières

ABSTRACT: INTRODUCTION: Many countries ravaged by conflict have substantial morbidity and mortality attributed to HIV/AIDS yet HIV treatment is uncommonly available. Universal access to HIV care cannot be achieved unless the needs of populations in conflict-affected areas are addressed. METHODS: From 2003 Médecins Sans Frontières introduced HIV care, including antiretroviral therapy, into 24 programmes in conflict or post-conflict settings, mainly in sub-Saharan Africa. HIV care and treatment activities were usually integrated within other medical activities. Project data collected in the Fuchia software system were analysed and outcomes compared with ART-LINC data. Programme reports and other relevant documents and interviews with local and headquarters staff were used to develop lessons learned. RESULTS: In the 22 programmes where ART was initiated, more than 10,500 people were diagnosed with HIV and received medical care, and 4555 commenced antiretroviral therapy, including 348 children. Complete data were available for adults in 20 programmes (n = 4145). At analysis, 2645 (64%) remained on ART, 422 (10%) had died, 466 (11%) lost to follow-up, 417 (10%) transferred to another programme, and 195 (5%) had an unclear outcome. Median 12-month mortality and loss to follow-up were 9% and 11% respectively, and median 6-month CD4 gain was 129 cells/mm 3.Patient outcomes on treatment were comparable to those in stable resource-limited settings, and individuals and communities obtained significant benefits from access to HIV treatment. Programme disruption through instability was uncommon with only one program experiencing interruption to services, and programs were adapted to allow for disruption and population movements. Integration of HIV activities strengthened other health activities contributing to health benefits for all victims of conflict and increasing the potential sustainability for implemented activities. CONCLUSIONS: With commitment, simplified treatment and monitoring, and adaptations for potential instability, HIV treatment can be feasibly and effectively provided in conflict or post-conflict settings

Post-conflict mental health needs: a cross-sectional survey of trauma, depression and associated factors in Juba, Southern Sudan

BACKGROUND: The signing of the Comprehensive Peace Agreement in January 2005 marked the end of the civil conflict in Sudan lasting over 20 years. The conflict was characterised by widespread violence and large-scale forced migration. Mental health is recognised as a key public health issue for conflict-affected populations. Studies revealed high levels of post-traumatic stress disorder (PTSD) amongst populations from Southern Sudan during the conflict. However, no studies have been conducted on mental health in post-war Southern Sudan. The objective of this study was to measure PTSD and depression in the population in the town of Juba in Southern Sudan; and to investigate the association ofdemographic, displacement, and past and recent trauma exposure variables, on the outcomes of PTSD and depression. METHODS: A cross-sectional, random cluster survey with a sample of 1242 adults (aged over 18 years) was conducted in November 2007 in the town of Juba, the capital of Southern Sudan. Levels of exposure to traumatic events and PTSD were measured using the Harvard Trauma Questionnaire (original version), and levels of depression measured using the Hopkins Symptom Checklist-25. Multivariate logistic regression was used to analyse the association ofdemographic, displacement and trauma exposure variables on the outcomes of PTSD and depression. Multivariate logistic regression was also conducted to investigate which demographic and displacement variables were associated with exposure to traumatic events. RESULTS: Over one third (36%) of respondents met symptom criteria for PTSD and half (50%) of respondents met symptom criteria for depression. The multivariate logistic regression analysis showed strong associations of gender, marital status, forced displacement, and trauma exposure with outcomes of PTSD and depression. Men, IDPs, and refugees and persons displaced more than once were all significantly more likely to have experienced eight or more traumatic events. CONCLUSION: This study provides evidence of high levels of mental distress in the population of Juba Town, and associated risk-factors. Comprehensive social and psychological assistance is urgently required in Juba