Current Research and Projects
The Program on Forced Migration and Health faculty lead and collaborate on research that influences policy and practice in complex emergencies, post-emergency recovery and development contexts. We work hand in hand with governments, international agencies and community-based organizations. As part of our commitment to building the next generation of leaders in the field, we regularly engage students in our research through mentorship in field engagements and research assistantships and through the application of applied case studies based on our research as part of our curriculum program.
Devloping a Screening and Referral System for Mental Health Problems Among Internally Displaced Persons in Ethiopia
Ethiopia
Program Faculty: Claire Greene
Columbia Faculty: Tsion Firew, Milton Wainberg
Students: Christina Kay (MPH 2020), Alexander Hammerslough, Eri Tayama
Funded by the Columbia University Council for the Advancement of Research in Global Mental Health, this project aims to identify existing resources and capacity to address mental health problems among internally displaced persons (IDPs) in Ethiopia. In partnership with the Ethiopian Public Health Institute and the Ministry of Health, we will use this information to develop recommendations for strategies to link IDPs with mental health and psychosocial problems to existing services and supports in Ethiopia.
Health and Repatriation: Rebuilding the Health Care System in Post-Conflict Syria
Turkey and Jordan
Program Faculty and Staff: Monette Zard, Goleen Samari, Fouad M. Fouad (AUB), and Ling San Lau
Students: Nour Audi (DrPH), Sabeen Rokerya (MPH 2021), Jennifer Ostrowski (MPH, MIA 2022), Cecile van Maanen (MPH 2024)
Much of the basic infrastructure of Syria has been targeted and decimated during the Syrian conflict. The systematic military targeting of healthcare services during the Syrian conflict is one of the unique characteristics of this conflict – over half of all health facilities have been partially or completely destroyed and at least 15,000 of Syria’s 30,000 physicians have left the country. Assuming that the challenges to peaceful governance and justice can be overcome, decision-making around repatriation will likely then hinge on whether and how returnees will be able to access basic services, in particular, education, livelihoods, and of course, health. In collaboration with the American University of Beirut, the Columbia Global Centers and supported by the Columbia University President’s Global Innovation Fund, this project will utilize a mixed-methods approach to systematically investigate access to health care as a factor in individual refugee decision-making within the repatriation process. It will also explore how this information is (or is not) being integrated into planning for post-conflict reconstruction of the health care sector, building on lessons learned from past reconstruction and repatriation efforts, and exploring the various ethical, accountability and logistical challenges that should be anticipated and addressed prior to large-scale investments in the rebuilding process.
Evaluating the Implementation and Effectiveness of an Integrated Intervention to Reduce Psychological Distress Among Forced Migrants in Ecuador and Panama
Ecuador and Panama
Program Faculty: Claire Greene
Columbia Faculty: Milton Wainberg
This research, funded by USAID, aims to integrate Psychological First Aid (PFA) into violence prevention and protection services provided by HIAS in Ecuador and Panama to forced migrants primarily from Colombia, the Northern Triangle (El Salvador, Guatemala, and Honduras), and Venezuela. In partnership with HIAS, the study implementing partner, we will adapt and test this integrated psychosocial and protection intervention strategy in four sites in Ecuador and Panama that vary in urbanicity, population, migration context, and other factors. We will evaluate the reach, effectiveness, adoption, implementation, and maintenance of this intervention and explore contextual factors that impact these effectiveness and implementation outcomes.
Overcoming challenges to accessing good quality post-abortion care in humanitarian crises
Afghanistan and South Sudan
Program Faculty: Sara Casey
Students: Devin Nagle (MPH 2020), Monica Giuffrida (MPH 2019), Meghana Kulkarni (MPH 2019)
The purpose of this research, supported by Research for Health in Humanitarian Crises (R2HC), is to understand the factors that influence access to and use of post-abortion care (PAC) services in humanitarian crisis settings. The Reproductive Health Access, Information and Services in Emergencies (RAISE) Initiative at Columbia University partnered with the International Medical Corps (IMC) to conduct a mixed-methods study in IMC-supported health facilities in Paktika Province, Afghanistan and in internally displaced persons camps in Juba and refugee camps in Maban, South Sudan. The methods include a review of PAC register data, facility assessments, focus group discussions with community members, in-depth interviews with PAC clients and key informant interviews with community leaders. Findings from this research are being used to strengthen PAC services in the research sites and contribute to the limited evidence base on abortion-related topics in humanitarian settings.
Effectiveness of an evidence-based stepped care system for alcohol and other drug use problems among Congolese refugees in Zambia
Zambia
Program Faculty: Claire Greene
Columbia Faculty: Jeremy Kane
Students: Lina Demis (MPH 2021)
Funded by Research for Health in Humanitarian Crises (R2HC), this study aims to develop and evaluate a stepped care system to address alcohol and other drug use problems among refugees and the host community in Mantapala, an integrated refugee settlement in Zambia. In this project we are developing a stepped care service delivery model comprised of a validated approach to screening, brief intervention for hazardous alcohol and other drug use problems, and delivery of an evidence-based substance use and mental health treatment program delivered by non-specialist providers through task-sharing for individuals with hazardous and harmful substance use. Using a hybrid randomized effectiveness-implementation trial design, we will evaluate the acceptability, relevance, reach, feasibility, and cost-effectiveness of this stepped care system as well as its effectiveness for reducing unhealthy substance use and co-occurring mental health problems in a low-resource refugee setting. This study is being conducted in partnership with the Ministry of Health in Zambia, UNHCR, UNODC, Women in Law and Development in Africa (WiLDAF), CARE, and Johns Hopkins University.
Community-Based Birth and Death Surveillance in Ouham-Pende Prefecture in the Central African Republic
Central African Republic
Program Faculty: Les Roberts
Students: Alyssa Green (MPH 2019), Christina Kay (MPH 2020)
A PFMH research team, led by Professor Les Roberts, has partnered with the IRC to establish a new way to monitor births and deaths in unstable populations. This CDC funded project to develop innovative monitoring techniques has since 2018 been monitoring a population of 93,000 people that were provided medical services by IRC in rural North-Western CAR. This is the third location where this technique has been deployed as part of this CDC funding stream.
The setting is complicated, with a very high mortality rate, low access to advanced medical services, and three rebel groups controlling different parts of the area. 435 randomly picked households have been visited on a monthly basis by a local monitor trained by the team. The monitor records births, deaths, migration in and out of the household, and any illnesses among family members that were serious enough to prevent them from working or going to school. This last element has proven profoundly useful as COVID-19 and swept through the region. There is no evidence that COVID 19 has caused an increase in death in the monitored populations Because the surveillance had been operating for 18 months before the arrival of COVID to the region, the data create a rather compelling case that this population has yet to experience significant adverse effects from the virus. The table below is from the monthly update provided to IRC and local partners.
Ouhem-Pende IRC service area random sample surveillance of potential indicators of COVID-19
|
Mar-2020 |
Apr |
May |
June |
July |
Aug. |
Sept |
Oct. |
Nov. |
Dec. |
|
|
Births |
5 |
4 |
6 |
3 |
6 |
0 |
9 |
10 |
4 |
3 |
|
Deaths |
2 |
2 |
2 |
4 |
4 |
2 |
3 |
2 |
5 |
0 |
* Over the 18 months before COVID, there was an average of 3.1 deaths per month in this cohort.
** While the numbers reporting change a little each month, please assume an average monitored population of 2120 people over this period.
Among the 26 deaths recorded during COVID, 3 (1 June, 1 July, 1 Nov.) were respiratory in nature, all three being elderly individuals. No deaths were recorded in December but the team suspects adult deaths, especially violence-related, may be associated with families moving across the border so we are concerned about potential under-reporting in this violent period with high mobility.
Because of the value of this system for monitoring the effects of COVID-19, CDC has extended this 5-year grant to allow another year of surveillance to take place.
A past example of this approach undertaken by the team in DRC can be found at https://onlinelibrary.wiley.com/doi/full/10.1111/disa.12370?af=R
Evaluating the feasibility of an integrated mental health and intimate partner violence prevention intervention for refugees
Tanzania
Program Faculty: Claire Greene
This project, funded by National Institute of Mental Health (NIMH), aims to explore the feasibility of a multi-sectoral, integrated psychosocial intervention developed and tested in Nyarugusu Refugee Camp, Tanzania. This project builds on an intervention development and randomized feasibility trial funded by Research for Health in Humanitarian Crises (R2HC) and led by Dr. Wietse Tol (University of Copenhagen), which was completed in 2018. In the original study we developed an integrated intervention that combined elements of Cognitive Processing Therapy and Advocacy Counseling for Congolese refugee survivors of intimate partner violence experiencing elevated levels of psychological distress in Nyarugusu Refugee Camp. We enrolled 311 women meeting these criteria into a randomized feasibility trial and, using a mixed-methods design, evaluated the relevance, acceptability, and feasibility of this integrated intervention approach. The current project extends these findings to further explore feasibility, mental health and violence outcomes, potential intervention moderators, and opportunities and challenges for implementation of multi-sectoral psychosocial interventions in refugee camp settings.
Publications:
https://pubmed.ncbi.nlm.nih.gov/28521751/