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BackgroundBecause of the high burden of untreated mental illness in humanitarian settings and low- and middle-income countries, scaling-up effective psychological interventions require a cultural adaptation process that is feasible and acceptable. Our adaptation process incorporates changes into both content and implementation strategies, with a focus on local understandings of distress and treatment mechanisms of action.MethodsBuilding upon the ecological validity model, we developed a 10-step process, the mental health Cultural Adaptation and Contextualization for Implementation (mhCACI) procedure, and piloted this approach in Nepal for Group Problem Management Plus (PM+), a task-sharing intervention, proven effective for adults with psychological distress in low-resource settings. Detailed documentation tools were used to ensure rigor and transparency during the adaptation process.FindingsThe mhCACI is a 10-step process: (1) identify mechanisms of action, (2) conduct a literature desk review for the culture and context, (3) conduct a training-of-trainers, (4) translate intervention materials, (5) conduct an expert read-through of the materials, (6) qualitative assessment of intervention population and site, (7) conduct practice rounds, (8) conduct an adaptation workshop with experts and implementers, (9) pilot test the training, supervision, and implementation, and (10) review through process evaluation. For Group PM+, key adaptations were harmonizing the mechanisms of action with cultural models of ‘tension’; modification of recruitment procedures to assure fit; and development of a skills checklist.ConclusionA 10-step mhCACI process could feasibly be implemented in a humanitarian setting to rapidly prepare a psychological intervention for widespread implementation.

\"Ambitious humanitarian military, economic and social interventions, undertaken by Western actors acting in defence of liberal values, have today become indelible features of Africa's engagement with the world. Yet the continent's long, complex historical relationship with Western humanitarian intervention, dating back to the origins of imperial engagement with the continent, is often overlooked in the study of contemporary African security and development issues. This volume responds to a need for greater historical grounding in the study of humanitarian intervention, by bringing together a wide and interdisciplinary range of contributors who explore the history, theory, and practice of humanitarian intervention in Africa. In doing so, it traces continuities in the discourse and practice of the concept as it evolved from the colonial past to the present, and argues that the West's colonial relationship with Africa is crucial for better understanding humanitarian intervention and how the legacies of colonialism continue to impact emerging international policy. \"-- Provided by publisher.

Background It has been widely acknowledged that refugees are at risk of poorer health outcomes, spanning mental health and general well‐being. A common point of access to health care for the migrant population is via the primary health care network in the country of resettlement. This review aims to synthesize the evidence of primary health care interventions to improve the quality of health care provided to refugees and asylum seekers. Methods A systematic review was undertaken, and 55 articles were included in the final review. The Preferred Reporting Items for Systematic Reviews was used to guide the reporting of the review, and articles were managed using a reference‐management software (Covidence). The findings were analysed using a narrative empirical synthesis. A quality assessment was conducted for all the studies included. Results The interventions within the broad primary care setting could be organized into four categories, that is, those that focused on developing the skills of individual refugees/asylum seekers and their families; skills of primary health care workers; system and/or service integration models and structures; and lastly, interventions enhancing communication services. Promoting effective health care delivery for refugees, asylum seekers and their families is a complex challenge faced by primary care professionals, the patients themselves and the communication between them. Conclusion This review highlights the innovative interventions in primary care promoting refugee health. Primary care interventions mostly focused on upskilling doctors, with a paucity of research exploring the involvement of other health care members. Further research can explore the involvement of interprofessional team members in providing effective refugee/migrant health. Patient or Public Contribution Patient and public involvement was explored in terms of interventions designed to improve health care delivery for the humanitarian migrant population, that is, specifically refugees and asylum seekers.

The issue of humanitarian intervention has generated one of the most heated debates in international relations over the past decade, for both theorists and practitioners. At its heart is the alleged tension between the principle of state sovereignty, and the evolving norms related to individual human rights. This edited collection examines the challenges to international society posed by humanitarian intervention in a post-September 11th world. It brings scholars of law, philosophy, and international relations together with those who have actively engaged in cases of intervention, in order to examine the legitimacy and consequences of the use of military force for humanitarian purposes. The book demonstrates why humanitarian intervention continues to be a controversial question not only for the United Nations but also for Western states and humanitarian organisations.

This review links practice, funding, and evidence for interventions for mental health and psychosocial wellbeing in humanitarian settings. We studied practice by reviewing reports of mental health and psychosocial support activities (2007–10); funding by analysis of the financial tracking service and the creditor reporting system (2007–09); and interventions by systematic review and meta-analysis. In 160 reports, the five most commonly reported activities were basic counselling for individuals (39%); facilitation of community support of vulnerable individuals (23%); provision of child-friendly spaces (21%); support of community-initiated social support (21%); and basic counselling for groups and families (20%). Most interventions took place and were funded outside national mental health and protection systems. 32 controlled studies of interventions were identified, 13 of which were randomised controlled trials (RCTs) that met the criteria for meta-analysis. Two studies showed promising effects for strengthening community and family supports. Psychosocial wellbeing was not included as an outcome in the meta-analysis, because its definition varied across studies. In adults with symptoms of post-traumatic stress disorder (PTSD), meta-analysis of seven RCTs showed beneficial effects for several interventions (psychotherapy and psychosocial supports) compared with usual care or waiting list (standardised mean difference [SMD] −0·38, 95% CI −0·55 to −0·20). In children, meta-analysis of four RCTs failed to show an effect for symptoms of PTSD (–0·36, −0·83 to 0·10), but showed a beneficial effect of interventions (group psychotherapy, school-based support, and other psychosocial support) for internalising symptoms (six RCTs; SMD −0·24, −0·40 to −0·09). Overall, research and evidence focuses on interventions that are infrequently implemented, whereas the most commonly used interventions have had little rigorous scrutiny.

This paper's main contribution is to the agency of the South in support of the transformation of MHIs in the early 1990s. This is in contradiction to current literature on how the norm emerged after the Cold War. The study shows that strategic narratives used in hundreds of deliberations in the UNSC were used by the South as part of a social interaction that encouraged the transformation of humanitarian norms. This approach reveals that the South was able to support the interventions while overcoming contestation over practices and identities. Therefore, the South created a narrative of a preferred web of practices that was generally aligned with the transformation of MHIs.

Introduction The ongoing crisis in Syria has divided the country, leading to significant deterioration of the healthcare infrastructure and leaving millions of people struggling with poor socioeconomic conditions. Consequently, the affordability of healthcare services for the population has been compromised. Cancer patients in Northwest Syria have faced difficulties in accessing healthcare services, which increased their financial distress despite the existence of humanitarian health and aid programs. This study aimed to provide insights into how humanitarian assistance can alleviate the financial burdens associated with cancer treatment in conflict-affected regions. Materials and methods This research employed a quantitative, quasi-experimental design with a pre-test-post-test approach, focusing on evaluating the financial toxicity among cancer patients in Northwest Syria before and after receiving humanitarian aid. The study used purposeful sampling to select participants and included comprehensive demographic data collection. The primary tool for measuring financial toxicity was the Comprehensive Score for Financial Toxicity (FACIT-COST) tool, administered in Arabic. Data analysis was conducted using SPSS v25, employing various statistical tests to explore relationships and impacts. Results A total of 99 cancer patients were recruited in the first round of data collection, out of whom 28 patients affirmed consistent receipt of humanitarian aid throughout the follow-up period. The results of the study revealed that humanitarian aid has no significant relationship with reducing the financial toxicity experienced by cancer patients in Northwest Syria. Despite the aid efforts, many patients continued to face significant financial distress. Conclusion The research findings indicate that current humanitarian assistance models might not sufficiently address the complex financial challenges faced by cancer patients in conflict zones. The research emphasizes the need for a more comprehensive and integrated approach in humanitarian aid programs. The study highlights the importance of addressing the economic burdens associated with cancer care in conflict settings and calls for a re-evaluation of aid delivery models to better serve the needs of chronic disease patients. The findings suggest a need for multi-sectoral collaboration and a systemic approach to improve the overall effectiveness of humanitarian assistance in such contexts.

In this provocative and timely book, David Kennedy explores what can go awry when we put our humanitarian yearnings into action on a global scale--and what we can do in response. Rooted in Kennedy's own experience in numerous humanitarian efforts, the book examines campaigns for human rights, refugee protection, economic development, and for humanitarian limits to the conduct of war. It takes us from the jails of Uruguay to the corridors of the United Nations, from the founding of a non-governmental organization dedicated to the liberation of East Timor to work aboard an aircraft carrier in the Persian Gulf. Kennedy shares the satisfactions of international humanitarian engagement--but also the disappointments of a faith betrayed. With humanitarianism's new power comes knowledge that even the most well-intentioned projects can create as many problems as they solve. Kennedy develops a checklist of the unforeseen consequences, blind spots, and biases of humanitarian work--from focusing too much on rules and too little on results to the ambiguities of waging war in the name of human rights. He explores the mix of altruism, self-doubt, self-congratulation, and simple disorientation that accompany efforts to bring humanitarian commitments to foreign settings. Writing for all those who wish that \"globalization\" could be more humane, Kennedy urges us to think and work more pragmatically. A work of unusual verve, honesty, and insight, this insider's account urges us to embrace the freedom and the responsibility that come with a deeper awareness of the dark sides of humanitarian governance.

In low- and middle-income countries (LMICs), children and families face a multitude of risk factors for mental health and well-being. These risks are even further exacerbated in humanitarian emergencies. However, access to effective mental health services in such settings is severely limited, leading to a large mental health treatment gap. Middle childhood (5–12 years) is a crucial period for human development during which symptoms of emotional distress often emerge, with one in three mental disorders developing prior to age 14. However, there is little evidence of effective psychological interventions for children in this developmental stage, and suitable for implementation within LMICs and humanitarian emergencies. We conducted this evidence review to inform the development of a new intervention package based on existing best practice for this age group, drawing insights from both global and LMIC resources. Our review synthesizes the findings of 52 intervention studies from LMICs and humanitarian settings; 53 existing systematic reviews and meta-analyses covering both LMICs and high-income countries, and 15 technical guidelines. Overall, there is limited high-quality evidence from which to draw recommendations for this age group; however, some promising intervention approaches were identified for children experiencing externalizing and internalizing symptoms, traumatic stress and a combination of difficulties. Several effective interventions utilize cognitive-behavioral techniques for children, in either group or individual format, and incorporate caregiver skills training into treatment, although the findings are mixed. Most evaluated interventions use specialists as delivery agents and are lengthy, which poses challenges for scale-up in settings where financial and human resources are scarce. These findings will inform the development of new psychological interventions for children in this age group with emotional and behavioral difficulties.