As the use of child soldiers continues to proliferate throughout the world, effective psychosocial interventions must be developed and evaluated. Our research shows that former child soldiers who are provided rehabilitative services and accepted back into their families and communities are able to become productive, responsible and caring adults. In 1988, 39 captured or escaped child soldiers were brought by the Mozambican government to the Lhanguene Rehabilitation Center in Maputo, Mozambique's capital city. Interventions that focused on rehabilitating the children both psychologically and physically were initiated during their 6-month stay at the Lhanguene centre, and reintegration assistance was provided for 2 years thereafter to support their return to families and communities. Our research continued to follow these former child soldiers for 16 years, and focused on their psychological, social and economic functioning. The study included qualitative and quantitative data collection methods to obtain adult well-being outcomes and was also designed to identify interventions that enabled these child soldiers to re-enter civilian life and lead relatively productive lives. Efficacious rehabilitation activities included those that strengthened individuals' coping skills for anticipated trauma and grief, instilled a sense of social responsibility and promoted self-regulation and security (versus survival) seeking behaviour. Activities that supported long term reintegration and self-sufficiency included community acceptance and forgiveness, traditional cleansing and healing rituals, livelihoods and apprenticeships.

Background Humanitarian actors and host-countries in the Middle East and North Africa region are challenged with meeting the health needs of Syrian refugees and adjusting the response to contemporary humanitarian conditions – urban-based refugees, stressed host-country health systems and high NCD prevalence. Although several studies have explored NCD prevalence, utilization of services and barriers to access, these analyses took place prior to dramatic shifts in Jordanian health policy and did not account for nuances in health seeking and utilization behaviors or operational barriers. Accordingly, we aimed to understand the depth and nuances of Syrian refugees’ experiences accessing NCD services in urban and semi-urban settings in Jordan. Methods A qualitative study was conducted to explore the healthcare experiences of Syrian refugees in Jordan. The study team conducted 68 in-depth interviews with Syrian refugees in urban and semi-urban locations in central and northern Jordan. Results The findings indicated four themes key to understanding the healthcare experience: (1) emotional distress is a central concern and is frequently highlighted as the trigger for a non-communicable disease or its exacerbation; (2) service provision across all sectors – government, NGO, private – is complex, inadequate, expensive and fragmented, making engagement with the health sector physically and financially burdensome; (3) given financial constraints, participants make harmful decisions that further damage their health in order to reduce financial burdens, and (4) host-community members actively exhibit solidarity with their refugee neighbors and specifically do so during emergency health episodes. The findings from this study can be used to inform program design for forcibly displaced persons with NCDs and identify points of entry for effective interventions. Conclusions Opportunities exist for humanitarian and host-country actors to provide more comprehensive NCD services and to improve the relevance and the quality of care provided to Syrian refugees in Jordan. Global and national funding will need to align with front-line realities and foster better coordination of services between host-country health systems, private actors and non-governmental organizations.

Gender-based violence-particularly intimate partner violence-is commonplace in postconflict Uganda. The neighbourhood method provides a promising approach to estimating human right violations in humanitarian settings.

Thirty specialists in humanitarian work supporting the care and protection of children in crisis settings completed a 3-phase Delphi consultation. Proposals of best practice were elicited, reviewed, and rated by participants. A high level of consensus support was reached for 55 statements. These statements emphasized utilization of existing resources, participation, and inclusivity. The influences of resilience theory, social ecology, and cultural sensitivity were clearly evident. The utilization of developmental theory could be strengthened in relation to more differentiated understanding of the operation of protective influences and conceptualization of such influences in terms of "adaptive systems." Wider research engagement by development scientists in diverse cultural settings and clear formulation of findings for practitioners and policy makers would further support evidence-based humanitarian practice.

No abstract

BackgroundThis paper reports on the use of a “neighborhood method” to measure the nature and incidence of violence against women and girls in post-conflict Liberia.MethodsThe study population comprised females in Montserrado and Nimba counties. Study participants were randomly selected for interviews using multi-stage cluster sampling. 30 clusters of households were sampled in each county. Information on incidents of domestic violence and rape within the preceding 18 months was collected with regard to females of all ages in the respondent’s household, and those of her four closest neighbors to make up the full sample.FindingsHouseholds in the sample contained 7015 females (1687 girls, 4586 women, 742 age missing) in Montserrado and 6632 (2070 girls, 4167 women, 95 age missing) in Nimba. In the previous 18 months 54.1% (CI 53.1-55.1) and 55.8% (CI 54.8-56.8) of females in Montserrado and Nimba respectively were indicated to have experienced non-sexual domestic abuse; 19.4% (CI 18.6-20.2) and 26.0% (CI 25.1-26.9) of females in Montserrado and Nimba respectively to have been raped outside of marriage; and 72.3% (CI 70.7-73.9) and 73.8% (CI 72.0-75.7) of married or separated women in Montserrado and Nimba respectively to have experienced marital rape. Husbands and boyfriends were reported as the perpetrators of the vast majority of reported violence. Strangers were reported to account for less than 2% of the perpetrators of rape in either county. Incidents were most commonly disclosed to other family members or to friends and neighbors, and less often to formal authorities such as the police, court or community leaders. Incidents were approaching fifty times more likely to be reported to police if perpetrated by strangers rather than intimate partners.ConclusionsViolence against women and girls is widespread in the areas studied. Programming needs to address the fact that this violence is primarily occurring in the household, where most incidents go unreported outside the immediate family or social circle. Police and hospital reports severely under-represent these known perpetrators. Inter-interviewer variance and differences in reports for self and neighbors for some outcomes caution the precision and validity of some estimates. However, the potential utility of the neighborhood method for estimating prevalence rates with an accuracy suitable for programmatic purposes in conflict-affected and post-conflict settings is noted.

Aims and methodTo share evaluation findings of a new decentralised mental healthcare system addressing Axis I disorders, developed in four subdistricts of Aceh Besar in Indonesia following the 2004 Asian tsunami. Two complementary methodologies were employed: an adequacy survey that assessed whether agreed programme implementation tasks were completed, and an outcome study that utilised patient, caregiver and staff assessment of the programme to determine what changes, if any, resulted from participation in the programme.ResultsThe system is functional in 3 of 4 subdistricts, and 47 of 53 subdistrict clinics (puskesmas) have trained mental healthcare nurses. Both patients and caregivers reported statistically significant differences when ranking patient wellbeing and were able to qualitatively describe specific changes in patient symptomatology and social functioning.Clinical implicationsResults indicate that (a) the creation of a decentralised system with outreach at multiple levels, (b) emphasis on staff capacity building within a wider household-to-hospital continuum of care, and (c) incorporation of community volunteers working with trained medical personnel led to effective treatment options for people with Axis I disorders in a resource-poor setting.

No abstract