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Nepal is one of the post-conflict countries affected by violence from explosive devices. We undertook this study to assess the magnitude of injuries due to intentional explosions in Nepal during 2008-2011 and to describe time trends and epidemiologic patterns for these events.
We analyzed surveillance data on fatal and non-fatal injuries due to intentional explosions in Nepal that occurred between 1 January 2008 and 31 December 2011. The case definition included casualties injured or killed by explosive devices knowingly activated by an individual or a group of individuals with the intent to harm, hurt or terrorize. Data were collected through media-based and active community-based surveillance.
Analysis included 437 casualties injured or killed in 131 intentional explosion incidents. A decrease in the number of incidents and casualties between January 2008 and June 2009 was followed by a pronounced increase between July 2010 and June 2011. Eighty-four (19.2%) casualties were among females and 40 (9.2%) were among children under 18 years of age. Fifty-nine (45.3%) incidents involved one casualty, 47 (35.9%) involved 2 to 4 casualties, and 6 involved more than 10 casualties. The overall case-fatality ratio was 7.8%. The highest numbers of incidents occurred in streets or at crossroads, in victims' homes, and in shops or markets. Incidents on buses and near stadiums claimed the highest numbers of casualties per incident. Socket, sutali, and pressure cooker bombs caused the highest numbers of incidents.
Intentional explosion incidents still pose a threat to the civilian population of Nepal. Most incidents are caused by small homemade explosive devices and occur in public places, and males aged 20 to 39 account for a plurality of casualties. Stakeholders addressing the explosive device problem in Nepal should continue to use surveillance data to plan interventions.
Abstract: Ciudad Juarez is the second largest Mexican border city and one of most violent cities worldwide. Over the past five years, it has suffered from a dramatic wave of homicidal violence related to organized crime. Residents have reacted in different ways to such violence: some have migrated whereas others have decided to stay and organize against it. This is an empirical study of community organization for crime prevention. This study found some of the factors that facilitate and impede community organization against crime. The results constitute a first step in the empirical study of community organization for crime prevention in Mexico.
Abstract: This article reviews the literature on ‘new wars’. It argues that ‘new wars’ should be understood not as an empirical category but rather as a way of elucidating the logic of contemporary war that can offer both a research strategy and a guide to policy. It addresses four components of the debate: whether new wars are ‘new’; whether new wars are war or crime; whether the data supports the claims about new wars; and whether new wars are ‘post-Clausewitzean’. It argues that the obsession with the ‘newness’ of wars misses the point about the logic of new wars; that there is a blurring of war and crime but it is important to address the political elements of new wars; that, although the data should be used with caution, it does seem to offer support for some elements of the new war thesis; and that the argument is indeed post-Clausewitzean because new wars are not ‘contests of wills’ but more similar to a mutual enterprise. It concludes that the debate has greatly enriched the overall argument.
Abstract: On a recent visit to Mogadishu I was again confronted with the tension between local ownership and international self-interest. On the one hand was the Somali President, who wanted to assert his sovereign authority and lead the peace process according to his vision for Somalia. On the other hand, there was a powerful but diverse international community that has the resources necessary to enhance peace, though such resources were accompanied by a set of ideas concerning what the Somali President should be doing. Officially everyone claimed to support the Federal Government of Somalia, but in reality each outside nation and organisation is engaged in Somalia for its own strategic political, security and economic needs and interests.
Following decades of conflict, South Sudan gained independence from Sudan in 2011. Prolonged conflict, which included gender-based violence (GBV), exacerbated gender disparities. This study aimed to assess attitudes towards gender inequitable norms related to GBV and to estimate the frequency of GBV in sampled communities of South Sudan.
Applying a community-based participatory research approach, 680 adult male and female household respondents were interviewed in seven sites within South Sudan in 2009--2011. Sites were selected based on program catchment area for a non-governmental organization and respondents were selected by quota sampling. The verbally-administered survey assessed attitudes using the Gender Equitable Men scale. Results were stratified by gender, age, and education.
Of 680 respondents, 352 were female, 326 were male, and 2 did not provide gender data. Among respondents, 82% of females and 81% of males agreed that 'a woman should tolerate violence in order to keep her family together'. The majority, 68% of females and 63% of males, also agreed that 'there are times when a woman deserves to be beaten.' Women (47%) were more likely than men (37%) to agree that 'it is okay for a man to hit his wife if she won't have sex with him' (p=0.005). Agreement with gender inequitable norms decreased with education. Across sites, 69% of respondents knew at least one woman who was beaten by her husband in the past month and 42% of respondents knew at least one man who forced his wife or partner to have sex.
The study reveals an acceptance of violence against women among sampled communities in South Sudan. Both women and men agreed with gender inequitable norms, further supporting that GBV programming should address the attitudes of both women and men. The results support promotion of education as a strategy for addressing gender inequality and GBV. The findings reveal a high frequency of GBV across all assessment sites; however, population-based studies are needed to determine the prevalence of GBV in South Sudan. South Sudan, the world's newest nation, has the unique opportunity to implement policies that promote gender equality and the protection of women.
Abstract: This article is a rejoinder to Roger Mac Ginty's polemic (Against Stabilization) arguing that, whilst the author is correct in identifying the inconsistencies in the concept and practice of stabilization, it is a viable concept. This article draws on field research from Afghanistan and Nepal to demonstrate that within stabilization's philosophical pedigree and practical application are components that can articulate a form of sub-national international intervention that can address political threats. Further this form of intervention is morally defensible and can promote control rather than constrict it. Stabilization is a new term that has been applied to many old practices, but it has been inconsistently used suggesting that it is both a practice for national level interventions and those directed at a sub-national level. This has been unhelpful as it confuses stabilization activity with other forms of intervention. The article explores the threats that stabilization can address, the stability that is being sought after and the manner in which interventions can be approached in order to address the threats. It suggests there is a space in which stabilization can operate, pragmatically engaging in the complexities of political conflict in states under extreme tension.
Abstract: This practice note1 describes and critiques the initial years of the International Criminal Court’s (ICC) involvement in Uganda from the perspective of local civil society actors. It argues that the substance and process of the ICC’s intervention fell chronically short of generating justice for those who had lived with the conflict for over two decades, and therefore created a disconnect between the priorities of those on the ground, and the priorities of the Court and its international minders. In order to unravel some of the dynamics that underpinned this disconnect, the paper asserts that the pivotal relationship between citizen and state provides a lens through which to assess any approach to generating justice in Uganda. It concludes that those promoting international justice need to be more cognisant of the fact that international justice mechanisms are obsolete unless they can move from theory to practice and make a genuine difference in people’s lives. In this regard, a better understanding and awareness of the political and social context in which they are operating, as well as greater self-critique and honesty, is critical.
Abstract: This commentary examines how Mali entered its current crisis, tracing the fall of the
regime of President Amadou Toumani Touré and the rise of armed Islamist groups in
northern Mali, as well as the events that led to an armed intervention by France. The
piece then discusses some of the conceptual frameworks that could impede effective
policy formation in post-conflict Mali. The piece argues that Somalia does not offer a
compelling model for Mali. The commentary closes by recommending that the Malian
government and its partners should prioritize addressing humanitarian and security
concerns in northern Mali over staging elections.
Concepts of 'what constitutes mental illness', the presumed aetiology and preferred treatment options, vary considerably from one cultural context to another. Knowledge and understanding of these local conceptualisations is essential to inform public mental health programming and policy.
Participants from four locations in Burundi, South Sudan and the Democratic Republic of the Congo, were invited to describe 'problems they knew of that related to thinking, feeling and behaviour?' Data were collected over 31 focus groups discussions (251 participants) and key informant interviews with traditional healers and health workers.
While remarkable similarities occurred across all settings, there were also striking differences. In all areas, participants were able to describe localized syndromes characterized by severe behavioural and cognitive disturbances with considerable resemblance to psychotic disorders. Additionally, respondents throughout all settings described local syndromes that included sadness and social withdrawal as core features. These syndromes had some similarities with nonpsychotic mental disorders, such as major depression or anxiety disorders, but also differed significantly. Aetiological concepts varied a great deal within each setting, and attributed causes varied from supernatural to psychosocial and natural. Local syndromes resembling psychotic disorders were seen as an abnormality in need of treatment, although people did not really know where to go. Local syndromes resembling nonpsychotic mental disorders were not regarded as a 'medical' disorder, and were therefore also not seen as a condition for which help should be sought within the biomedical health-care system. Rather, such conditions were expected to improve through social and emotional support from relatives, traditional healers and community members.
Local conceptualizations have significant implications for the planning of mental-health interventions in resource-poor settings recovering from conflict. Treatment options for people suffering from severe mental disorders should be made available to people, preferably within general health care facilities. For people suffering from local syndromes characterized by loss or sadness, the primary aim for public mental health interventions would be to empower existing social support systems already in place at local levels, and to strengthen social cohesion and self-help within communities.
Recent initiatives by international health and humanitarian aid organizations have focused increased attention on making HIV testing services more widely available to vulnerable populations. To realize potential health benefits from new services, they must be utilized. This research addresses the question of how utilization of testing services might be encouraged and increased for refugees displaced by conflict, to make better use of existing resources.
Open-ended interviews were conducted with HIV-infected refugees (N=73) who had tested for HIV and with HIV clinic staff (N=4) in Nakivale Refugee Settlement in southwest Uganda. Interviews focused on accessibility of HIV/AIDS-related testing and care and perspectives on how to improve utilization of testing services. Data collection took place at the Nakivale HIV/AIDS Clinic from March to July of 2011. Observations of clinical activities were also carried out. An inductive approach to data analysis was used to identify factors related to utilization.
In general, interviewees report focusing daily effort on tasks aimed at meeting survival needs. HIV testing is not prioritized over these responsibilities. Under some circumstances, however, HIV testing occurs. This happens when: (a) circumstances realign to trigger a temporary shift in priorities away from daily survival-related tasks; (b) survival needs are temporarily met; and/or (c) conditions shift to alleviate barriers to HIV testing.
HIV testing services provided for refugees must be not just available, but also utilized. Understanding what makes HIV testing possible for refugees who have tested can inform interventions to increase testing in this population. Intervening by encouraging priority shifts toward HIV testing, by helping ensure survival needs are met, and by eliminating barriers to testing, may result in refugees making better use of existing testing services.
Abstract: Adolescent girls are an overlooked group within conflict-affected populations and their
sexual health needs are often neglected. Girls are disproportionately at risk of HIV and other
STIs in times of conflict, however the lack of recognition of their unique sexual health needs
has resulted in a dearth of distinctive HIV protection and prevention responses. Departing
from the recognition of a paucity of literature on the distinct vulnerabilities of girls in time of
conflict, this study sought to deepen the knowledge base on this issue by qualitatively
exploring the sexual vulnerabilities of adolescent girls surviving abduction and displacement
in Northern Uganda.
Over a ten-month period between 2004–2005, at the height of the Lord’s Resistance Army
insurgency in Northern Uganda, 116 in-depth interviews and 16 focus group discussions were
held with adolescent girls and adult women living in three displacement camps in Gulu
district, Northern Uganda. The data was transcribed and key themes and common issues were
identified. Once all data was coded the ethnographic software programme ATLAS was used
to compare and contrast themes and categories generated in the in-depth interviews and focus
Our results demonstrated the erosion of traditional Acholi mentoring and belief systems that
had previously served to protect adolescent girls’ sexuality. This disintegration combined
with: the collapse of livelihoods; being left in camps unsupervised and idle during the day;
commuting within camp perimeters at night away from the family hut to sleep in more central
locations due to privacy and insecurity issues, and; inadequate access to appropriate sexual
health information and services, all contribute to adolescent girls’ heightened sexual
vulnerability and subsequent enhanced risk for HIV/AIDS in times of conflict.
Conflict prevention planners, resettlement programme developers, and policy-makers need to
recognize adolescent girls affected by armed conflict as having distinctive needs, which
require distinctive responses. More adaptive and sustainable gender-sensitive reproductive
health strategies and HIV prevention initiatives for displaced adolescent girls in conflict
settings must be developed.
Despite the fact that the Colombian armed conflict has continued for almost five decades there is still very little information on how it affects the mental health of civilians. Although it is well established in post-conflict populations that experience of organised violence has a negative impact on mental health, little research has been done on those living in active conflict zones. Medecins Sans Frontieres provides mental health services in areas of active conflict in Colombia and using data from these services we aimed to establish which characteristics of the conflict are most associated with specific symptoms of mental ill health.
An analysis of clinical data from patients (N = 6,353), 16 years and over, from 2010--2011, who consulted in the Colombian departments (equivalent to states) of Narino, Cauca, Putumayo and Caqueta. Risk factors were grouped using a hierarchical cluster analysis and the clusters were included with demographic information as predictors in logistic regressions to discern which risk factor clusters best predicted specific symptoms.
Three clear risk factor clusters emerged which were interpreted as 'direct conflict related violence', 'personal violence not directly conflict-related' and 'general hardship'. The regression analyses indicated that conflict related violence was more highly related to anxiety-related psychopathology than other risk factor groupings while non-conflict violence was more related to aggression and substance abuse, which was more common in males. Depression and suicide risk were represented equally across risk factor clusters.
As the largest study of its kind in Colombia it demonstrates a clear impact of the conflict on mental health. Among those who consulted with mental health professionals, specific conflict characteristics could predict symptom profiles. However, some of the highest risk outcomes, like depression, suicide risk and aggression, were more related to factors indirectly related to the conflict. This suggests a need to focus on the systemic affects of armed conflict and not solely on direct exposure to fighting.
Abstract: The process of globalisation has brought the world innumerable improvements and opportunities. Economically, for example, it has vastly increased global trade and foreign direct investment, opened up markets for exports and often optimised allocation of capital. Politically, it has stimulated waves of regional integration and democratisation. In identity terms, it has connected cultures and worldviews as never before.
Abstract: Operation Charge of the Knights in the Spring of 2008, which cleared extremist militias out of Basra, created a strategic opportunity for building stability in that troubled Province. Security had improved but the situation was still fragile: attacks on Coalition forces were common, essential services were poor, the City needed cleaning up and revitalising, and the people had to believe that the future was going to be a better place than the present. I was about to assume command of Coalition Forces in South East Iraq in the Summer of 2008 and my team and I were working out how to seize this “Kyros” moment.
Abstract: Preventive diplomacy, conflict prevention and other forms of preventive action intended to stop armed conflicts before they escalate to widespread violence are the subject of intense debate. And despite their elevation to a norm in the United Nations, where they have been debated in the General Assembly and addressed in prominent reports from the Secretary-General, preventive diplomacy and conflict prevention continue to face daunting obstacles. Drawing from recent high-level consultations on the topic, this piece considers some recurrent obstacles and emerging opportunities in relation to preventive action (Muggah 2012).
Abstract: The settling of the 32-year Aceh conflict not only transformed former members
of the Free Aceh Movement (GAM) into administrators, constructing a new circle
of elites, but also created opportunities and new spaces for economic and sociopolitical
competition and contestation. Hence, this transformation sowed the seeds
of an emerging conflict in Aceh. This study investigates the emerging conflict patterns
along with their causes and the actors involved. Three patterns of conflict
have emerged during the post-Helsinki Peace Agreement period: (i) a conflict among
the former GAM elites, (ii) a conflict between the former GAM elites and the former
GAM rank-and-file combatants, and (iii) a conflict between the ethnic Acehnese
majority and the diverse ethnic minority groups. While the first and second conflicts
are primarily induced by individual self-interest, the third is specifically triggered by
social and political discrimination as well as by under-development.
Abstract: The ongoing transition process in Afghanistan will deliver three shocks in the coming
few years: foreign forces will complete the handover of security responsibility
to their Afghan counterparts, aid volumes and international spending in the country
will decrease and, lastly, the political dispensation will be upended by presidential
elections in which President Hamid Karzai is not supposed to run again. These challenges
are mounting at a time when, due to inconsistent international approaches
and a lack of appreciation for the Afghan context, Afghanistan is dealing with rising
insecurity, dysfunctional governance, rampant corruption, and ethnic factionalization
within the society and the domestic security forces. Based upon a review of the
security sector, governance, social and economic conditions, regional relations and
negotiation efforts with the insurgents, this article finds that fundamental questions
about the efficacy of stabilization efforts in Afghanistan continue to lack clear
answers. Regardless, significant room for improvement – both in policy and execution
– appears to exist. It remains to be seen whether, as many Afghans fear, a civil
war will engulf Afghanistan once again in the post-transition period or whether the
international community will take those steps – re-energizing governance reform efforts,
maintaining financial support and continuing to strengthen the Afghan army
and police – which could help to bolster stability.
Abstract: This is a polemic against the concept and practice of stabilization as practiced by
leading states from the global north in peace support interventions. It is not an argument
against stability. Instead, it depicts stabilization as an essentially conservative
doctrine that runs counter to its stated aims of enhancing local participation
and legitimacy. It is an agenda of control that privileges notions of assimilation with
international (western) standards and mainstreams the military into peace-support
operations. As a result, the value of peace is undercut.
Abstract: Using data on Israeli closure in the Palestinian West Bank, we provide new evidence on the labour market effects of conflict-induced restrictions to mobility. We exploit the fact that the placement of physical barriers by Israel was exogenous to local labour market conditions and find a causal negative effect of these barriers on employment, wages and days worked per month. On the other hand the barriers had a positive impact on the number of hours per working day. These effects are driven mainly by checkpoints and only a tiny portion of the effects is due to direct restrictions on workers’ mobility. Despite being an under-estimation of the actual effects, the overall costs of the barriers on the West Bank labour market are far from being negligible: in 2007 for example these costs amounted to 6% of GDP.
Abstract: The main aim of this report is to analyse how changes in the roles and activities of women during episodes of violent conflict may shape their contribution to post-conflict economic recovery and sustainable peace. The report poses two important questions for which limited evidence is to date available in the academic literature on violent conflict or in policy programming in post-conflict contexts:
1. How does violent conflict change the roles that women take on within their households and communities?
2. How do changes in female roles during conflict affect women‘s own status after the conflict, and the capacity of households and communities to recover from the conflict?
In order to address these questions, the report reviews existing knowledge and provides new empirical evidence on the nature and extent of changes in women‘s roles and activities as a result of their exposure to violent conflict and the impact of these changes on post-conflict economic recovery at the household and community levels. The purpose of this empirical analysis is to provide a better understanding of (i) how changes in women‘s roles and activities may contribute towards processes of economic recovery; (ii) whether existing interventions are able to support these new roles (if positive) or to help women overcome negative outcomes; and (iii) what interventions the international community and local governments need to encourage in order to support the role of women in economic recovery and peacebuilding processes.
Abstract: The main aim of this paper is to analyse these mechanisms based on available empirical evidence, and discuss how this evidence can be best incorporated into international and national interventions aimed at securing the access to food and livelihoods by individuals, households and communities affected by violence and conflict.3 The paper is organised as follows. Section 2 discusses the main channels whereby violent conflict may impact on welfare outcomes of individuals and households exposed to violence, including food security. Section 3 analyses available empirical evidence on how individuals and households cope with and adapt to living under violence, insecurity and conflict. Section 4 discusses the effectiveness of such strategies in the short- and long-term in protecting the lives and livelihoods of conflict-affected people, and proposes a framework to explain household resilience in maintaining food and welfare security in contexts of violent conflict. This framework is based on two key pillars: (i) individual and household factors that affect levels of vulnerability to poverty and to violence; and (ii) institutional factors that shape people‘s access to food markets and livelihood opportunities. Section 5 concludes the paper by discussing how these two pillars may offer important entry points for policy interventions in conflict-affected contexts.
Optimal adherence to highly active antiretroviral therapy (HAART) is required to promote viral suppression and to prevent disease progression and mortality. Forcibly displaced and conflict-affected populations may face challenges succeeding on HAART. We performed a systematic review of the literature on adherence to HAART and treatment outcomes in these groups, including refugees and internally-displaced persons (IDPs), assessed the quality of the evidence and suggest a future research program.
Medline, Embase, and Global Health databases for 1995--2011 were searched using the Ovid platform. A backward citation review of subsequent work that had cited the Ovid results was performed using the Web of Science database. ReliefWeb and Medecins Sans Frontieres (MSF) websites were searched for additional grey literature.
Results and conclusion
We screened 297 records and identified 17 reports covering 15 quantitative and two qualitative studies from 13 countries. Three-quarters (11/15) of the quantitative studies were retrospective studies based on chart review; five studies included <100 clients. Adherence or treatment outcomes were reported in resettled refugees, conflict-affected persons, internally-displaced persons (IDPs), and combinations of refugees, IDPs and other foreign-born persons. The reviewed reports showed promise for conflict-affected and forcibly-displaced populations; the range of optimal adherence prevalence reported was 87--99.5%. Treatment outcomes, measured using virological, immunological and mortality estimates, were good in relation to non-affected groups. Given the diversity of settings where forcibly-displaced and conflict-affected persons access ART, further studies on adherence and treatment outcomes are needed to support scale-up and provide evidence-based justifications for inclusion of these vulnerable groups in national treatment plans. Future studies and program evaluations should focus on systematic monitoring of adherence and treatment interruptions by using facility-based pharmacy records, understanding threats to optimal adherence and timely linkage to care throughout the displacement cycle, and testing interventions designed to support adherence and treatment outcomes in these settings.
Abstract: As a graduate student, two months shy of defending
my dissertation proposal, I yanked a first, respectable
rough draft off my advisers’ desks and replaced
it with something completely new: a pitch to head to
Uganda and start a study of child soldiering. My advisers
were unimpressed. “This sounds more like a policy report
than a dissertation,” said one, “I’m not sure you should
go.” No one disagreed the issue was important. But is
tackling a humanitarian issue the sensible start for a budding
social scientist? It’s a question young earnest scholars
ask themselves every year: Can I get my Ph.D. and still
save the world?
As it happened, there was more to my pitch. Buried
inside the proposal, hidden to me at the time, was the
germ of actual social science, something more than a policy
report. Ultimately, the study would change the way I
think about fundamental questions in international relations
and comparative politics: the organization of rebellion,
the diffusion of international norms, and the legacy
of political violence on economic and political development.
Big questions, I discovered, get answered in unusual
Abstract: This paper explores the causes of displacement during civil wars. Recent scholarship
has shown that conventional civil wars – those in which forces are relatively balanced – and
irregular civil wars – those in which one side is substantially stronger than the other – exhibit
different patterns of violence. We hypothesize that, while the mode of violence differs, the form of
displacement should be consistent across the wars: displacement is a tactic of war that armed
groups use to conquer new territories. By expelling civilians associated with rivals, armed groups
improve their odds of gaining control of contested territory. This implies that members of a group
are targeted for displacement because of their identity and presumed loyalties. We test the theory
using two fine-grained datasets on individuals displaced during a conventional civil war, in Spain
(1936-1939), and an irregular civil war, in Colombia (1964-). In both cases, the war cleavage was
reflected in national elections: thus, where political parties received support indicated which
populations were sympathetic to rivals. In both civil wars, we observe higher levels of displacement
in locations where more sympathizers of rival armed groups reside. The paper makes three
contributions. First, it shows that the microfoundations of displacement are similar in two types of
civil wars. Second, it is the first comparison to our knowledge of the sub-national dynamics of
displacement within two different civil wars. Third, it explains macro-level differences with a
coherent micro-level framework.
Abstract: This chapter examines how the relationship between economic exclusion, inequality, conflict and violence shape the goal of establishing shared societies. The chapter discusses how this impact is largely determined by the emergence and organisation of social and political institutions in areas of violent conflict. Two areas of institutional change are central to understanding the relationship between armed conflict and shared societies. The first is the change caused by armed conflict on social interactions and norms of trust and cooperation. The second is the influence exercised by informal mediators, informal service providers and informal systems of governance – often controlled by non-state armed actors – that emerge from processes of violence and are prevalent in areas of armed conflict. These forms of institutional transformation are central to understanding how societies may be able to restrict the use of violence as a strategic way of resolving social conflicts and how to transition from violence-ridden to shared societies.