July 2013 - Volume 11 - Issue 2
REFLECTIONS, COMMENTS, LETTERS
Child friendly spaces: a systematic review of the the current evidence base on outcomes and impact
Child friendly spaces are widely used in emergencies as a mechanism for protecting children from risk, as a means of promoting children's psychosocial wellbeing, and as a foundation for strengthening capacities within communities for child protection. A systematic review of published and ‘grey’ literature identified 10 studies that met specified inclusion criteria. Each study was reviewed with respect to the potential protective, promotive, and mobilising impacts of the intervention. All 10 studies documented reports of positive outcomes of child friendly spaces, particularly with respect to psychosocial wellbeing. However, major weaknesses in design constrain the ability to robustly confirm change over time (only three studies reported pre intervention baselines) or attribute any such change to this intervention (only two studies utilised a comparison with communities without child friendly spaces). Analysis suggests that: greater commitment to documentation and measurement of outcomes and impacts is required; more standardised and rigorous measurement of processes, outputs, outcomes and impacts is necessary; evaluation designs need to more robustly address assessment of outcomes without intervention; there is a need to sustain engagement of children within the context of evaluations; and long term follow-up is critical to establishing evidence driven interventions.
Experiences of forced mothers in northern Uganda: the legacy of war
From 1986–2007, the Lord's Resistance Army inflicted severe suffering on civilians in northern Uganda through indiscriminate killing and child abductions. While both abducted boys and girls were trained to use arms, girls were commonly distributed among commanders as forced ‘wives’. These traumatised girls and young women (both pregnant and ‘forced mothers’) were retained in rehabilitation centres longer than any other ex-combatants. While they may have been accorded special privileges in the centres, after reintegration, their home communities stigmatised and discriminated against both mothers and children. This paper discusses the experiences of forced mothers and their children, while at rehabilitation centres, and through the reintegration process. Additionally, it examines how communities should be stimulated to view forced mothers and their children as survivors of multiple human rights violations.
Common Threads: a recovery programme for survivors of gender based violence
A multi-dimensional, intervention programme for survivors of gender based violence was piloted in Lago Agrio, Ecuador and a nearby Colombian refugee settlement. Local facilitators were trained to implement the programme with small groups of women. The model introduces art therapy techniques, psycho-education, peer support, symptom reduction techniques and psychosocial skill building, within the context of a women's hand sewing collective. Participants design and sew narrative textiles (known as ‘arpilleras’ in parts of Latin America) in order to share their experiences and process memories. This article documents the development of the model, and its implementation in that community.
Psychosocial support for Bhutanese refugees in Nepal
For more than 20 years, thousands of Bhutanese refugees have been living in refugee camps in eastern Nepal, in an uncertain and challenging situation. Now, the possibility of resettlement is bringing even more challenges into their lives. In recognition of this situation, the nongovernmental organisation Transcultural Psychosocial Organisation Nepal provides psychosocial support to this group, in collaboration with United Nations High Commission for Refugees and other humanitarian agencies. This field report provides an overview of the psychosocial issues, interventions and implications, as well as lessons learned. It also includes the case study of a refugee. Direct psychosocial support, psycho-education and capacity development are major elements of the programme provided, not only to refugees, but also to the host community and aid workers as well. Recommendations include: continuing and strengthening services for both refugee and host communities, increasing attention to vulnerable groups (such as the elderly), and enhancing links and cooperation with local and international services and structures.
Evaluating the psychosocial components of a humanitarian project
The author describes the evaluation of the activities of a group of psychosocial workers in Internally Displace Person camps and resettlement areas. These psychosocial activities were offered as an addition to a programme aimed at improving the living conditions of the target group by building shelters and livelihood programmes. The approach of the psychosocial workers was based on intuition and common sense, but not on an explicit view on the objectives of their interventions and the connection between these objectives and the methods they were using. During interviews and a workshop these matters were discussed, and thus an ‘intervention logic’ could be made explicit, including some verifiable indicators for the effect of each of the psychosocial activities and some combinations of activities. It also became clear which possibilities were available to improve the quality of the psychosocial activities, by training the psychosocial workers in regard to skills and insights they, so far, were not using. This report, therefore, shows what kind of psychosocial activities can be effective when integrated in programmes aimed at improving the physical life environment.
'Against all odds': UNHCR's mental health and and psychosocial support programma for Iraqi refugees and internally displaced Syrians
Intensified fighting and insecurity in Damascus has limited the ability of the Iraqi refugees, displaced Syrians, partners and staff to physically access many of the fixed facilities offering mental health and psychosocial services. Those that do, have to travel substantial distances through checkpoints and ‘hot areas’. However, before the conflict in 2011, UNHCR Syria was already in the area, operating a comprehensive mental health and psychosocial support programme for Iraqi refugees, building on the resources and capacities of the refugee population. In 2012, this programme was opened to support Syrians affected by conflict through a mixture of (mobile) individualised case management, family and community level supports provided by outreach volunteers, and targeted assistance to displaced persons living in collective shelters. So, while not making the headlines, the quiet, day-to-day activities of humanitarian workers providing mental health and psychosocial support services to an increasingly distressed population continue, against all odds.
REFLECTIONS, COMMENTS, LETTERS
Psychological support during an Ebola outbreak in the Democratic Republic of the Congo
In this paper, the author reflects on her personal experiences as an expatriate psychologist, in the Democratic Republic of the Congo, during an outbreak of Ebola haemorrhagic fever in 2007. As there is still no cure for this highly contagious, fatal disease, segregation from those infected appears to be the only preventative solution. This has quite different impacts and consequences for local people than for expatriate staff. Yet, in their quest to find meaning and to deal with the horrible events that took place, expatriates, staff and local people all felt powerless.