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Mental health and psychosocial support (MHPSS) staff in humanitarian settings have limited access to clinical supervision and are at high risk of experiencing burnout. We previously piloted an online, peer-supervision program for MHPSS professionals working with displaced Rohingya (Bangladesh) and Syrian (Turkey and Northwest Syria) communities. Pilot evaluations demonstrated that online, peer-supervision is feasible, low-cost, and acceptable to MHPSS practitioners in humanitarian settings.
This project will determine the impact of online supervision on i) the wellbeing and burnout levels of local MHPSS practitioners, and ii) practitioner technical skills to improve beneficiary perceived service satisfaction, acceptability, and appropriateness.
MHPSS practitioners in two contexts (Bangladesh and Turkey/Northwest Syria) will participate in 90-minute group-based online supervision, fortnightly for six months. Sessions will be run on zoom and will be co-facilitated by MHPSS practitioners and in-country research assistants. A quasi-experimental multiple-baseline design will enable a quantitative comparison of practitioner and beneficiary outcomes between control periods (12-months) and the intervention. Outcomes to be assessed include the Kessler-6, Harvard Trauma Questionnaire and Copenhagen Burnout Inventory and Client Satisfaction Questionnaire-8.
A total of 80 MHPSS practitioners will complete 24 monthly online assessments from May 2022. Concurrently, 1920 people receiving MHPSS services will be randomly selected for post-session interviews (24 per practitioner).
This study will determine the impact of an online, peer-supervision program for MHPSS practitioners in humanitarian settings. Results from the baseline assessments, pilot evaluation, and theory of change model will be presented.
Chapter 1 immerses the reader into the Za'atari refugee camp. Situated in Jordan just seven and a half miles south of the Syrian border, the camp – a two-square-mile rectangle divided into twelve districts – is nestled in the very heart of the Middle East. Here, in the desert heat, a community was born in the swell of crisis. The reader is immediately introduced to the book's three featured Syrian women entrepreneurs – Yasmina, Asma, and Malak – in their elements. Yasmina, a salon and wedding dress shop owner, is relaxing in the salon with her family as her client celebrates a beautiful wedding a couple of districts away. Asma, a social entrepreneur and teacher, is reading a story to a group of children – including three of her own – in her trailer, which she has converted into a magical hideout for the children. Malak, an artist, is putting the finishing touches on a series of drawings for an event at a youth center that is meant to encourage the girls in Za'atari to push against the harmful practice of child marriage.
Chapter 12 features the three entrepreneurs discussing their hopes for the future. Despite its progress, Za'atari still faces significant challenges in terms of basic resources and opportunities. So each entrepreneur represents a different hope. Yasmina, as the oldest of the group, discusses the ultimate hope within residents: that there will be lasting peace in Syria and they can return home. Asma considers another hope many have: resettlement to new communities. She talks about her potential resettlement to Canada after recently being interviewed at the embassy in Amman, and what it would mean for her children to have more consistent, higher quality education. Malak discusses the hope that, even if she is to remain in Za'atari for long, it will be better resourced so all children will have the opportunity to realize their God-given gifts. Her most recent painting of a woman, covered in vibrant colors and looking upward, represents this hope – as she accepts her life in Za'atari for now and sees her purpose as living out her gifts boldly as a role model for the children around her. In this spirit, the book ends with a poem by Asma about the hopes and dreams of Za'atari.
Chapter 4 provides an overview of today’s global refugee crisis, driven by perspectives of refugees around the world. The Syrian war has displaced a stunning half of Syria’s prewar population, with nearly 80,000 of those Syrians having fled to nearby Za'atari; the UN calls it “the biggest humanitarian and refugee crisis of our time.” But it is only a part of a broader global crisis: today, more people than at any other time in history have been forcibly displaced from their homes. More than twenty-six million refugees, over half of whom are children, have fled their home countries entirely. This chapter provides a brief exploration of the major crises causing displacement, from instability in Central America and Afghanistan, to the Rohingya genocide in Myanmar, to wars in South Sudan and Yemen. And it considers where most refugees end up: in host cities, in refugee camps, and – unfortunately only on rare occurences – resettled permanently in adoptive cities. It discusses how, due to continuing conflicts and tightening restrictions on acceptance of refugees, refugee camps are increasingly becoming like permanent settlements, despite their intended role as temporary safe havens.
Chapter 9 is about the present impact of the three entrepreneurs’ ventures, alongside many others, on the Za'atari community. A far cry from its makeshift origins, Za'atari is now much like a city. The Shams-Élysées, the Saudi Market, and other areas are buzzing as more than 3,000 businesses generate about $13 million in revenue a month and serve community members. These include bird shops, a cinema, sustainable farming solutions, and, of course, the ventures launched by Yasmina, Asma, and Malak. Yasmina is bringing profound joy into the lives of women across Za'atari. She helps brides feel special, valued, and beautiful, sometimes after a long period of feeling forgotten. Asma is uplifting Za'atari's children to reach for their highest aspirations. Much to her delight, her apprentice Nawara creates her own version of the storytelling initiative that is widely attended. In addition to running her studio with Treza, Malak repeatedly uses her art to empower the children around her, especially on the issue of child marriage. She designs twenty powerful drawings that are presented to girls during a workshop, empowering them to push back against such arrangements.
Chapter 8 describes the extraordinary obstacles facing refugee entrepreneurs and explains why – despite these challenges – refugees excel as entrepreneurs. Refugees face the steepest of uphill climbs, dealing with everything from trauma to a lack of access to credit to discrimination to limited networks. Still, they are much more likely to be entrepreneurs than native-born citizens. Refugees’ sparks are not accidental; they have unique qualities based on their experiences that make them more likely to come up with, and successfully see through, startup ideas. First, many refugees innovate because it is their only way to survive, and are thus immensely committed. For Yasmina, innovating was a requirement to feed her children. Second, refugees benefit from exposure to other cultures' ideas and markets. One appeal of Malak's work is her ability to infuse Syrian flair. Third, refugees, far from home, are often intensely motivated to meet the needs of their new neighbors and find innovations to do just that – as Asma did for Za'atari. Fourth, they are often pushed to entrepreneurship by employment discrimination. Fifth, they have an unmatched level of resilience.
Chapter 2 goes back in time to the three entrepreneurs’ lives in a peaceful prewar Syria, and their flights to safety in Za'atari. All three lead comfortable lives before the sudden, life-altering events of the Arab Spring: protests in Dara'a, the Syrian government’s violent response, and families fleeing homes amid subsequent fighting. Yasmina is living out her childhood passion, running a salon and wedding shop in Dara'a. Her family flees when she is seven months pregnant; on the way to Za'atari, they shelter in others' homes and abandoned schoolhouses, and her son is born premature. Asma grew up adoring school, but her lack of confidence and the busyness of raising a family kept her from her dream of teaching. Still, living in a large house with an olive tree in Dara'a, Asma enjoys her days reading to her children, Tamara, Ashraf, and newborn Maya. Just twenty days after Maya’s birth, Asma's family flees. Only a teenager and the youngest of thirteen siblings, Malak leads a joyful life filled with art, family, and friends in Damascus. She cries with her sisters just before leaving, unwilling to accept that the next morning she would wake up in a tent within a refugee camp.
Chapter 11 discusses the economic, social, spiritual, and personal impact of refugee entrepreneurship around the world. Za'atari is but one example: camps across the globe – from Kutupalong in Bangladesh, to Skaramagas in Greece, to Dadaab in Kenya – have emerged as hubs of entrepreneurship, to the surprise of those who imagine refugees in camps as passively reliant on aid. And refugees have ignited significant positive change in refugee-welcoming cities around the world as well – from Bosnian, Burmese, and Somali refugees revitalizing the once-declining Rust Belt city of Utica, New York, to long-persecuted Hazara refugees creating new ventures to revive the community of Port Adelaide, Australia. While there is an up-front economic cost to welcoming refugees into cities from camps like Za'atari, that investment is clearly a positive one thanks to refugees' contributions in the form of business growth, social innovation, and cultural enrichment. This is not to mention the quiet moments of love, comfort, and togetherness created by refugees’ very presence as neighbors, colleagues, and friends in communities around the world.
Chapter 5 describes the moments that the three Za'atari entrepreneurs push beyond their darkness to find their ideas – each tapping into their childhood passions through different catalyzing events. Yasmina helps prepare her cousin for her wedding in Za'atari, receives rave reviews, and sees her passion rekindled. Determining that she needed to help support her children, she makes the monumental decision to sell her rings, necklace, and bracelet for startup capital. She plans for the launch of a salon and wedding dress store from her home trailer. After her son’s death, Asma resolves to treat the children in Za'atari as if they are her own. Much to her joy, she attends a teacher training program sponsored by an NGO and comes home with educational books that she can use in preparing her storytelling initiative. Art continues to be Malak’s light during her transition to Za'atari, especially as she begins to share her art outside of her trailer. With the encouragement of a Za'atari art teacher, her sister Hoda, her father, and her best friend Treza, she decides to launch an art studio from her home trailer. Treza would manage it, and they would seek to share Malak's art widely.
Chapter 10 demonstrates how the three featured entrepreneurs’ ventures represent dignity for them, for the people they influence, and for the Za'atari community. Coming full circle, Yasmina prepares her apprentice Mona for her own wedding in what is a special, motherly moment. She speaks on the value of being able to train and encourage Mona over the years – of gaining an adoptive daughter through a mutual entrepreneurial passion. Asma is invited to speak at an International Women’s Day event in Za'atari. She is slated to speak last, after three celebrities and global human rights leaders. The doubts of her youth creep in slightly, but a now-confident Asma presents beautifully – to thunderous applause and a standing ovation. Conquering her own fears of publicity, Malak does an interview on a Jordanian radio show where she speaks boldly for herself and her community, helping dispel attitudes that Za'atari is a place where everyone should be pitied. For someone who once dreaded going to Za'atari more than anything she could have ever imagined, this moment of standing up as an advocate and leader within Za'atari means the world to her.
Chapter 6, "Khatwa, Khatwa" – Arabic for "Step by Step" – shares the three entrepreneurs’ stories of beginning to transform their ideas into reality and pushing through early obstacles. Yasmina hires a young and dynamic assistant, Mona, who becomes like a daughter to her. Together, the duo builds an initial client base and a collection of hilarious stories at the newly founded "Salon of Lights." Asma, with her educational books in tow, launches a community library and chases kids around her neighborhood, begging them to come listen to a story. After nervously practicing her storytelling techniques with Tamara and Maya, she officially launches the initiative – "Stories of the Sun" – from her newly decorated home trailer. After her first activity with the children, she learns just how much the experience of war has impacted their thoughts. Malak and her best friend Treza win their dream scholarship to study medical analysis at a university in Amman. Despite the importance of art in her life, Malak resolves to focus on her professional studies and to put art on the backburner. Still, she brings her art supplies with her in case she might have a bit of time to continue her first passion.
Chapter 3 narrates the three entrepreneurs’ early challenges adjusting to Za'atari. The camp is barren and devoid of activity in its first months of existence. White tents house residents, early mornings see long lines for meager bread rations, and residents protest about the severe shortage of resources. All three entrepreneurs struggle mightily. Yasmina is thankful that her newborn son Ashraf is healthy despite his premature birth, but she worries the environment surrounding him will stifle his growth. So she continues to hold out on working, praying she will return home to a peaceful Syria any day now. Falling into depression due to the lack of activity and resources, Asma runs away with her family to try to settle in nearby towns. A dearth of opportunity forces her to return to Za'atari, where she faces the tragic death of her son Ashraf. She fears the worst for Tamara and Maya, believing all hope for their education has died. Without any schooling options and separated from her friends, Malak sits alone in a small corner within her family’s tent and paints, releasing her emotions through her art from morning until night.
Chapter 7 describes the continued development of the three entrepreneurs' ventures and the impact they make on the Za'atari community. Za'atari increasingly shows signs of life: shops pop up along the main road nicknamed the “Shams-Élysées," color and art can be seen on trailers and the camp's walls, social events become more common, and social initiatives occupy children’s time. Yasmina moves her business from her home to the bustling Saudi Market, beautifully decorates her new trailer, and expands her client base as her and Mona's reputation grows. Asma’s storytelling initiative, with the support of her apprentice Nawara, increases in popularity and regularly fills her trailer with children. She begins to see the fruits of her work, as the activities she does with the children reveal more aspirational thinking. Though she had planned to ignore art during school to focus on studies, Malak again turns to art as an outlet during the intensity of university. After winning prizes in competitions and with Treza’s inspiration, Malak finally launches her studio: "Malak Art." Malak and Treza create Instagram and Facebook pages to share Malak's work and accept orders, which come in regularly.
25 Million Sparks takes readers inside the Za'atari refugee camp to follow the stories of three courageous Syrian women entrepreneurs: Yasmina, a wedding shop and salon owner creating moments of celebration; Malak, a young artist infusing color and beauty throughout the camp; and Asma, a social entrepreneur leading a storytelling initiative to enrich children's lives. Anchored by these three inspiring stories, as well as accompanying artwork and poetry by Malak and Asma, the narrative expands beyond Za'atari to explore the broader refugee entrepreneurship phenomenon in more than twenty camps and cities across the globe. What emerges is a tale of power, determination, and dignity – of igniting the brightest sparks of joy, even when the rest of the world sees only the darkness. A significant portion of the proceeds from this book are being contributed to support refugee entrepreneurs and general refugee causes in Za'atari and around the world.
This chapter highlights three areas where local communities across the Asia-Pacific region – supported by National Red Cross and Red Crescent Societies (National Societies) – are already active in addressing climate- and disaster-related displacements. These areas include community engagement in developing legal and policy frameworks; community-led vulnerability, risk, and capacity assessments; and community participation in innovative anticipatory humanitarian approaches to addressing displacement. This chapter highlights both best practices associated with these examples and some of the challenges that these examples face in successful implementation. It proposes that these examples warrant further attention, support, and engagement, both as stand-alone practices and as part of a broader commitment and support for community participation and leadership in addressing climate- and disaster-related displacement.
The objective of this study is to evaluate the status of the Syrian refugees (SR) in Turkey in terms of using the National Health System (NHS) between 2011 and 2017.
The study is a descriptive and cross-sectional epidemiological research ORACLE SQL Developer program was used for data analysis, and frequency analyzes regarding the person, place, and time characteristics of the health services that SR received between 2011 and 2017 were presented.
The SRs benefited from NHS hospital services approximately 35 million times (34,973,029). Approximately 40% of the SRs that benefited from the NHS are under the age of 18. The proportion of those under 5 y old is 15.8%; 55.8% of the SRs that benefited from the NHS are women. The utilization status of the SRs from the NHS by region is as follows: 33.4% Mediterranean Region, 29.2% Southeastern Anatolia Region, and 19.0% Marmara Region. The types of health institutions that the SRs used are as follows: 44.0% state hospitals, 15.0% family medicine centers, and 13.3% training and research hospitals. A total of 16,009,524 cases were intervened as part of EMS.
Syrian refugees in Turkey comprehensively benefited from primary, secondary, and tertiary health services free of charge between 2011 and 2017 in Turkey. It is seen that they have access to private and high-cost health services, such as air ambulance, cancer treatment, and dental treatment.
This chapter explores the evolution of the governance of so-called “fragile states” as a case of change in the architecture of global governance. Reduced funding from states and broader ideational trends about managerialism and effectiveness have rendered international organizations (IOs) less important in defining policy responses and assigning roles to other actors. This change in the governance architecture has engendered more networked and market-based forms of governance, with different stripes of professional networks becoming more important. The chapter argues that this transformation helps explain substantive changes in how fragile states are governed: in the 1990s and into the early 2000s, the treatment of fragile states was dominated by a “peacebuilding” approach focused on building institutions to support the rule of law and democracy, and with IOs such as the UN and the World Bank in authoritative roles. Gradually, over the course of the 2000s and 2010s, this approach became bifurcated, which reflects the prominence of professional networks and the reduced authority of IOs to define an overarching framework: military professionals in states advanced “stabilization” and counterterrorism – focused on fighting insurgents and conducting anti-terrorism operations – while networks consisting of humanitarian and human rights professionals advanced a focus on protection of civilians.
In DRC, the North Kivu province has been plagued by recurring humanitarian crises for nearly two decades, with multiple displacements of populations triggered low intensity armed inter-communal conflicts spread throughout nearly all territories. 818,605 people (displaced, returnees and indigenous) affected by these movements are in alarming psychosocial vulnerability.
In 2019, the NGO Action contre la Faim started a psychological intervention with the objective to contribute to reducing the vulnerability of conflict-affected populations.
Participants have been identified through psychoeducation sessions in the community in which people recognizing corresponding symptoms in themselves were evaluated through a short one-on-one interview. Persons identified as particularly in distress, including those who have experienced gender-based violence, have been involved in a short group therapeutic intervention. Two different options have been proposed in order to evaluate the most effective for the specific context: six sessions with a weekly or bi-weekly frequency.
767 people participated in the psychosocial intervention, 457 with weekly frequency and 310 bi-weekly. The measures of post traumatic symptoms (PCL-5), anxiety and depression (HAD) and resilience (CD-RISC) show that the two approaches have the same positive effects. This is very important in volatile contexts with difficulties of access to the population due to security problems.
The fact that even a short intervention focused on a bi-weekly frequency, can reduce the distress and increase the psychological resilience of populations living in contexts of conflict, gives us the possibility of intervening in areas with limited access, while guaranteeing therapeutic efficacy.
In the aftermath of the devastating 2015 earthquakes in Nepal, three non-governmental organizations collaborated to develop a program responding to the immediate mental health and psychosocial support (MHPSS) needs in three severely affected districts: Dhading, Gorkha, and Sindhuli. The program was implemented between April 2015 and February 2017 and aimed to (i) strengthen health worker capacity to provide integrated MHPSS services; and (ii) increase access to mental health services. This paper describes the program's implementation and the results of a pragmatic evaluation of the program's overall reach, effectiveness, and lessons learned.
The mixed-methods evaluation used routine program data, quantitative data from pre- and post-tests conducted with trainees and service users, and qualitative data from stakeholder interviews and focus group discussions.
A total of 1041 health workers received MHPSS training and supervision. Participants demonstrated significant improvements in skills, knowledge, and self-rated perceived competency. Trainees went on to provide MHPSS services to 3422 people. The most commonly identified presenting problems were epilepsy (29%) and depression (26%). A total of 67% of service users reported being ‘completely satisfied’ with the services received and 83% of those experiencing severe functional impairments on enrollment demonstrated improvement after receiving services.
Despite operational challenges, the program successfully engaged both laypeople and health workers to provide MHPSS in the aftermath of the crisis. Lessons learned can inform the planning and implementation of future training and integration programs to provide large-scale MHPSS efforts in humanitarian settings.