International Non-Governmental Organisations and Peacebuilding - Perspectives from Peace Studies and Conflict Resolution

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Case Study: Oxfam in Sri Lanka

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Bradford Non-Lethal Weapons Research Project (BNLWRP). Research Report 1.

yesThe NLW database illustrates the extensive and eclectic literature regarding NLWs which covers the last few decades. It currently contains over 250 entries. It is important to have access not only to the more recent material, but also to earlier sources since many of the general debates and controversies have already been rehearsed, and lessons learnt from them are still relevant today. Yet, it is also vital to follow new developments of NLWs closely because rapidly changing technology is producing weapons whose implications for integration into military and civil police forces have yet to be clearly defined and understood. Of particular interest are not only NLW applications for war fighting, but opportunities for deployment in peace enforcement and peace keeping missions. These technologies span many bases including: psycho-chemicals; unmanned weapons platforms and delivery systems; biogenetics; acoustic and microwave weapons; biological and chemical weapons; laser systems; kinetic energy ballistics; dual purpose (lethal/non-lethal) weapons; and, sprays and foams which inhibit movement. The database will keep up to date on these developments and future reports will highlight new issues and debates surrounding them. With these rapid technological advances come a series of associated dangers and concerns including: the ethics of use; implications for weapons control and disarmament treaties; military doctrine; public accountability and guidelines; dangers of misuse and proliferation; and, research and development strategies. Using the database, and drawing from military and non-military sources, this report will select the main current issues and debates within the non-lethal community. Bearing in mind that many operations undertaken by military forces are now more akin to policing actions (such as peace support operations) there are lessons to be learnt by military units from civil police experience. There still remains a tension between perceived benign and malign intent both in NLW operational use and non-lethal research and development

Bradford Non-Lethal Weapons Research Project (BNLWRP). Research Report 2

yesDrawing from the Non-Lethal Weapons Database this report summarises and reviews: non-lethal technology research and development issues, themes and trends developments in non-lethal military organisation and co-ordination capacity recent developments in selected non-lethal technologies commercial opportunities and applications of non-lethal technology ethical and social implications of non-lethal technolgy non-lethal human bioeffect researc

Bradford Non-Lethal Weapons Research Project (BNLWRP). Research Report No. 7.

yesThe length of this Bradford Non-Lethal Weapons Research Project Report No.7 again reflects the interest related to non-lethal weapons from academics, research institutes, policy makers, the police and the military. A number of reports, particularly concerning the Taser electro-shock weapon, have been published from these sectors since our last BNLWRP Report No.6 in October 2004. Some, such as the Amnesty International (U.S. and Canada) have again raised, and stressed, the concerns about the safety of the weapon and the number of deaths associated with its use. Others, such as the Joint Non-Lethal Weapons Human Effects Center of Excellence (HECOE), Human Effectiveness and Risk Characterization of the Electromuscular Incapacitation Device ¿ A Limited Analysis of the TASER. (March 2005) concluded that the Taser was relatively safe, but that further research was needed into potential bio-effects, and for continual development into a safer weapon. Reaction to these reports was mixed. Some US legislators called for limitations on the use of Tasers, more accountability, and the detailed recording of incidents in which they were used.1 Others called for a ban on their use until more testing was carried out regarding their potentially harmful effects. A number of US police forces stopped the use of Taser, slowed down the deployment and ordering of the weapons, reviewed their rules of engagement and reporting, and revisited their operational guidelines. The International Association of Chiefs of Police (IACP) published the Electro- Muscular Disruption Technology (EMDT). A Nine-Step Strategy For Effective Deployment. (April 2005) as a response to these growing concerns. Certain elements of the media, especially The Arizona Republic2 and others, took a hostile view of what they considered the scandal of the number of deaths and associated serious injuries caused by the Taser. Taser International challenged allegations that their weapon was directly responsible for these deaths and quoted reports, such as the Madison Police Department report (February 2005), the study by McDaniel, W & Stratbucker, R & Nerheim, M & Brewer, J. Cardiac Safety of Neuromuscular Incapacitating Defensive Devices (January 2005), and the U.K. DOMILL Statement (March 2005) to support their view. The controversy continues. Other than Tasers, there are still few reports of the newer non-lethal technologies actually being deployed in operations. The exception to this is the Long Range Acoustic Device (LRAD), which is now in widespread use in Iraq. Little additional information has appeared regarding the `active denial¿ weapon we have described in previous reports

Bradford Non-Lethal Weapons Research Project (BNLWRP). Research Report No. 4.

yesNon-lethal weapons (NLWs) are explicitly designed and primarily employed to incapacitate personnel or material whilst minimising collateral damage to property and the environment. Existing NLWs include rubber and plastic bullets, entangling nets, chemical sprays such as OC and CS gas, and electrical stunning devices such as the `Taser¿ gun. New NLWs are on the way, which will include acoustic and microwave weapons, non-lethal landmines, malodorants, and sophisticated weapons developed through rapid advances in neuroscience and the genomics revolution. Most analysts would agree that there is a `legitimate¿ role for non-lethal weapons, both for civil and military applications. However there is considerable disagreement as to the operational effectiveness of NLWs, and the threat such weapons pose to arms conventions and international law. As usual, a balance has to be achieved where the benign advantages of developing and deploying non-lethal weapons are not outweighed by their more malign effects. In particular, emerging non-lethal technologies offer an increasing opportunity for the suppression of civil dissent and control of populations ¿ these are sometimes referred to as the `technologies of political control¿. There is a continuing need for sustained and informed commentary to such developments which highlights the impact and threats that these technologies pose to civil liberties and human rights. Because the last BNLWP Report was produced in August 2001, this edition is somewhat longer than usual so that key developments since then can be highlighted and summarised. Future BNLWRP reports will be published three times a year, and we welcome material to be considered for inclusion

Risk of discharge against medical advice among hospital inpatients with a history of opioid agonist therapy in New South Wales, Australia: a cohort study and nested crossover-cohort analysis

Background: People who use illicit opioids have high rates of hospital admission. We aimed to measure the risk of discharge against medical advice among inpatients with a history of opioid agonist therapy (OAT), and test whether OAT is associated with lower risk of discharge against medical advice. Methods: We conducted a cohort study of patients admitted to hospital in an emergency between 1 August 2001 and 30 April 2018 in New South Wales, Australia. All patients had a previous episode of OAT in the community. The main outcome was discharge against medical advice, and the main exposure was whether patients had an active OAT permit at the time of admission. Results: 14,035/116,957 admissions (12 %) ended in discharge against medical advice. Admissions during periods of OAT had 0.79 (0.76−0.83; p < 0.001) times the risk of discharge against medical advice, corresponding to an absolute risk reduction of 3.0 percentage points. Risk of discharge against medical advice was higher among patients who were younger, male, identified as Aboriginal and/or Torres Strait Islander, and those admitted for accidents, drug-related reasons, or injecting-related injuries (such as cutaneous abscesses). In a subsample of 7793 patients included in a crossover-cohort analysis, OAT was associated with 0.84 (95 % CI 0.76−0.93; p < 0.001) times the risk of discharge against medical advice. Conclusions: Among patients with a history of OAT, one in eight emergency hospital admissions ends in discharge against medical advice. OAT enrolment at the time of admission is associated with a reduction of this risk

Causes of death among people who used illicit opioids in England, 2001–18: a matched cohort study

Background: In many countries, the average age of people who use illicit opioids, such as heroin, is increasing. This has been suggested to be a reason for increasing numbers of opioid-related deaths seen in surveillance data. We aimed to describe causes of death among people who use illicit opioids in England, how causes of death have changed over time, and how they change with age. Methods: In this matched cohort study, we studied patients in the Clinical Practice Research Datalink with recorded illicit opioid use (defined as aged 18–64 years, with prescriptions or clinical observations that indicate use of illicit opioids) in England between Jan 1, 2001, and Oct 30, 2018. We also included a comparison group, matched (1:3) for age, sex, and general practice with no records of illicit opioid use before cohort entry. Dates and causes of death were obtained from the UK Office for National Statistics. The cohort exit date was the earliest of date of death or Oct 30, 2018. We described rates of death and calculated cause-specific standardised mortality ratios. We used Poisson regression to estimate associations between age, calendar year, and cause-specific death. Findings: We collected data for 106 789 participants with a history of illicit opioid use, with a median follow-up of 8·7 years (IQR 4·3–13·5), and 320 367 matched controls with a median follow-up of 9·5 years (5·0–14·4). 13 209 (12·4%) of 106 789 participants in the exposed cohort had died, with a standardised mortality ratio of 7·72 (95% CI 7·47–7·97). The most common causes of death were drug poisoning (4375 [33·1%] of 13 209), liver disease (1272 [9·6%]), chronic obstructive pulmonary disease (COPD; 681 [5·2%]), and suicide (645 [4·9%]). Participants with a history of illicit opioid use had higher mortality rates than the comparison group for all causes of death analysed, with highest standardised mortality ratios being seen for viral hepatitis (103·5 [95% CI 61·7–242·6]), HIV (16·7 [9·5–34·9]), and COPD (14·8 [12·6–17·6]). In the exposed cohort, at age 20 years, the rate of fatal drug poisonings was 271 (95% CI 230–313) per 100 000 person-years, accounting for 59·9% of deaths at this age, whereas the mortality rate due to non-communicable diseases was 31 (16–45) per 100 000 person-years, accounting for 6·8% of deaths at this age. Deaths due to non-communicable diseases increased more rapidly with age (1155 [95% CI 880–1431] deaths per 100 000 person-years at age 50 years; accounting for 52·0% of deaths at this age) than did deaths due to drug poisoning (507 (95% CI 452–562) per 100 000 person-years at age 50 years; accounting for 22·8% of deaths at this age). Mirroring national surveillance data, the rate of fatal drug poisonings in the exposed cohort increased from 345 (95% CI 299–391) deaths per 100 000 person-years in 2010–12 to 534 (468–600) per 100 000 person-years in 2016–18; an increase of 55%, a trend that was not explained by ageing of participants. Interpretation: People who use illicit opioids have excess risk of death across all major causes of death we analysed. Our findings suggest that population ageing is unlikely to explain the increasing number of fatal drug poisonings seen in surveillance data, but is associated with many more deaths due to non-communicable diseases

Opioid agonist treatment and risk of death or rehospitalization following injection drug use–associated bacterial and fungal infections: A cohort study in New South Wales, Australia

Background AU Injecting-related: Pleaseconfirmthatallheadinglevelsarerepresentedcorrectly bacterial and fungal infections are associated : with significant morbidity and mortality among people who inject drugs (PWID), and they are increasing in incidence. Following hospitalization with an injecting-related infection, use of opioid agonist treatment (OAT; methadone or buprenorphine) may be associated with reduced risk of death or rehospitalization with an injecting-related infection. Methods and findings Data came from the Opioid Agonist Treatment Safety (OATS) study, an administrative linkage cohort including all people in New South Wales, Australia, who accessed OAT between July 1, 2001 and June 28, 2018. Included participants survived a hospitalization with injecting-related infections (i.e., skin and soft-tissue infection, sepsis/bacteremia, endocarditis, osteomyelitis, septic arthritis, or epidural/brain abscess). Outcomes were all-cause death and rehospitalization for injecting-related infections. OAT exposure was classified as time varying by days on or off treatment, following hospital discharge. We used separate Cox proportional hazards models to assess associations between each outcome and OAT exposure. The study included 8,943 participants (mean age 39 years, standard deviation [SD] 11 years; 34% women). The most common infections during participants’ index hospitalizations were skin and soft tissue (7,021; 79%), sepsis/bacteremia (1,207; 14%), and endocarditis (431; 5%). During median 6.56 years follow-up, 1,481 (17%) participants died; use of OAT was associated with lower hazard of death (adjusted hazard ratio [aHR] 0.63, 95% confidence interval [CI] 0.57 to 0.70). During median 3.41 years follow-up, 3,653 (41%) were rehospitalized for injecting-related infections; use of OAT was associated with lower hazard of these rehospitalizations (aHR 0.89, 95% CI 0.84 to 0.96). Study limitations include the use of routinely collected administrative data, which lacks information on other risk factors for injecting-related infections including injecting practices, injection stimulant use, housing status, and access to harm reduction services (e.g., needle exchange and supervised injecting sites); we also lacked information on OAT medication dosages. Conclusions Following hospitalizations with injection drug use–associated bacterial and fungal infections, use of OAT is associated with lower risks of death and recurrent injecting-related infections among people with opioid use disorder

Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data [version 2; peer review: 2 approved, 1 approved with reservations]

Background: International and UK data suggest that Black, Asian and Minority Ethnic (BAME) groups are at increased risk of infection and death from COVID-19. We aimed to explore the risk of death in minority ethnic groups in England using data reported by NHS England. / Methods: We used NHS data on patients with a positive COVID-19 test who died in hospitals in England published on 28th April, with deaths by ethnicity available from 1st March 2020 up to 5pm on 21 April 2020. We undertook indirect standardisation of these data (using the whole population of England as the reference) to produce ethnic specific standardised mortality ratios (SMRs) adjusted for age and geographical region. / Results: The largest total number of deaths in minority ethnic groups were Indian (492 deaths) and Black Caribbean (460 deaths) groups. Adjusting for region we found a lower risk of death for White Irish (SMR 0.52; 95%CIs 0.45-0.60) and White British ethnic groups (0.88; 95%CIs 0.86-0.0.89), but increased risk of death for Black African (3.24; 95%CIs 2.90-3.62), Black Caribbean (2.21; 95%CIs 2.02-2.41), Pakistani (3.29; 95%CIs 2.96-3.64), Bangladeshi (2.41; 95%CIs 1.98-2.91) and Indian (1.70; 95%CIs 1.56-1.85) minority ethnic groups. / Conclusion: Our analysis adds to the evidence that BAME people are at increased risk of death from COVID-19 even after adjusting for geographical region. We believe there is an urgent need to take action to reduce the risk of death for BAME groups and better understand why some ethnic groups experience greater risk. Actions that are likely to reduce these inequities include ensuring adequate income protection (so that low paid and zero-hours contract workers can afford to follow social distancing recommendations), reducing occupational risks (such as ensuring adequate personal protective equipment), reducing barriers in accessing healthcare and providing culturally and linguistically appropriate public health communications