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. 

The PFMH Action Hub on COVID-19 and Displacement

Global

Responding to the need for credible public health information to guide the humanitarian response during the COVID-19 pandemic, PFMH has received support from Open Society Foundations and Unbound Philanthropy to develop a knowledge and action hub that equips policy-makers, advocates, humanitarian actors and affected communities with the public health information, evidence and resources they need to effectively respond to COVID-19 and protect vulnerable populations. The PFMH Action Hub on COVID-19 and Displacement involves the mobilization of public health professionals to provide targeted advice and direct stakeholders to relevant information sources, the publication of high-impact knowledge briefs to apply past lessons to the current pandemic, technical assistance and support for local researchers, and the collation of clear and concise information about the pandemic and its impact on displaced populations. As part of this effort, PFMH has produced a digest of relevant news media since March 2020, providing nearly 600 subscribers, including donors, NGOs, governments, and UN agencies, with timely information on COVID-19 and its impact on displaced populations. The Action Hub is now LIVE! 

Protecting Asylum during the COVID-19 Pandemic: A Public Health Primer on the July 9 Trump Administration Proposed Rule on Asylum

Uncertainty and health among forced migrants

Jordan, Colombia, and the United States

Program Faculty: Goleen Samari, Claire Greene, Fouad M. Fouad (AUB), and Monette Zard

Students: Sabeen Rokerya (MPH 2021)

The purpose of this research is to conceptualize and measure chronic uncertainty as a determinant of health among forcibly displaced populations in Jordan, Colombia, and the United States. Forced migrants are a marginalized group at a structural disadvantage because of complex and rapidly changing transnational and national migration policy environments that lead to uncertainty regarding safety, protection, and refugee or asylee status. These conditions of uncertainty have been further brought to light with the ongoing Covid-19 pandemic. Immigrants, asylum-seekers, and refugees often face chronic uncertainty in destination countries, as they undergo lengthy status determination procedures to find out whether they can stay or what sort of legal status they will be granted, if any. The impact of uncertainty as part of individual adaptation and reproductive health has yet to be researched and understood. This study uses three immigration contexts: Syrians in Jordan, Venezuelans in Colombia, and Central and Mexican Americans in the United States to understand and measure uncertainty as it pertains to health over the life course. We hypothesize that uncertainty is a unique mechanism contributing to reproductive choices and outcomes among displaced populations. Findings will include a robust measure of uncertainty for population health research and contribute to the limited evidence base on chronic uncertainty and health among forced migrants.

“Big Questions in Forced Displacement and Health”: Building the Evidence on Health System Strengthening in Protracted Displacement

Bangladesh, Colombia, Democratic Republic of Congo, Jordan

Program Faculty and Staff: Monette Zard, Patrick Kachur, Sara Casey, Claire Greene, Rachel Moresky, Les Roberts, Goleen Samari, Ling San Lau

Students: Nour Audi (DrPH), Sarah Guyer (MPH 2020), Christina Kay (MPH 2020), Rocio Rodriguez-Casquete (MPH 2020), Sabeen Rokerya (MPH 2021), Katherine McCann (MPH 2021)

PFMH is leading a consortium with American University of Beirut, Brandeis University, Georgetown University, and Universidad de los Andes to conduct a two-year project supported by the World Bank that aims to provide evidence and guidance to strengthen health systems to address the needs of displaced and host populations in contexts of protracted displacement. The project seeks to understand how health systems and health system financing can better respond to the needs of displaced and host communities, supported by research on economic, demographic and epidemiological trends. The mixed methods research project is based in four country sites - Bangladesh, Colombia, Democratic Republic of Congo, and Jordan – and will involve key informant interviews, focus group discussions, health facility assessments, a macro-costing assessment, and mini National Health Account surveys. In response to the COVID-19 pandemic, the project will produce six Knowledge Briefs examining the implications of various aspects of the pandemic for displaced and host communities. The Knowledge Briefs will be published here as they are released.

DEVELOPING 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)

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. 

Migration policy environments, structural stigma, and birth outcomes

United States

Program Faculty: Goleen Samari

Adverse birth outcomes, such as preterm birth, low birth weight, and small for gestational age, have serious health consequences not just during infancy but across the life course. Recent studies show that in a rapidly changing policy environment that marginalizes migrants, immigrant women have worse birth outcomes than non-Hispanic white women. There is growing evidence that structural factors such as migration policies are associated with health disparities yet there is limited understanding of the process by which social and policy environments and structural stigma impact individual-level maternal–fetal medicine outcomes. This study focuses on multilevel effects of social and policy environments and structural stigma on foreign and US-born women’s pregnancy and birth outcomes. Expected outcomes are rigorous knowledge of the impact of structural contexts on pregnancy and birth outcomes as well as health system precursors of birth outcomes for immigrants in the US. Findings from this research can both identify immigrant responses to social and policy environments and suggest educational and behavioral interventions that could improve immigrant responses to structural environment stressors, access to prenatal care, and birth outcomes. This work is supported by the CUIMC Grants Program for Junior Faculty who contribute to the diversity goals of the university.

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/

https://pubmed.ncbi.nlm.nih.gov/31428190/

https://odihpn.org/magazine/improving-humanitarian-assistance-across-sectors-through-mental-health-and-psychosocial-support/

"In My Own Hands: A Medium-Term Approach towards Self-Reliance and Resilience of Syrian Refugees and Host Communities in Jordan” 

Jordan

Program Faculty and Staff: Monette Zard, Goleen Samari, Ling San Lau

Students: Sarah Guyer (MPH 2020), Trena Mukherjee

A PFMH research team, led by Professor Monette Zard, Director of PFMH, partnered with the Durable Solutions Platform to conduct research exploring the needs and priorities of Syrian refugees and host populations in Jordan. The research aimed to inform policy recommendations to support the resilience and self-reliance of Syrians and Jordanians and to promote social cohesion, focusing on three critical areas of education, livelihoods and social protection. The team conducted nine focus groups around Jordan with Syrian refugees (based in camps and non-camp rural and urban settings) and vulnerable Jordanians, as well as key informant interviews with Jordanian civil society leaders, local NGOs, international NGOs, UN agencies, donors and government officials. The research was developed through extensive consultations with key stakeholders working with refugee and host populations in Jordan.  The team traveled to Amman in February 2020 to launch a report based on the research findings, entitled "In My Own Hands: A Medium-Term Approach towards Self-Reliance and Resilience of Syrian Refugees and Host Communities in Jordan.” The report launch at Columbia Global Centers in Amman featured an expert panel discussion, including Omar Rifai, Senior Adviser to HRH Prince Hassan and Director General of the WANA Institute, Ayat Nashwan, from Yarmouk University, Souzan Mohareb from Arab Renaissance for Democracy and Development (ARDD) and Bryn Boyce from the International Rescue Committee (IRC) Jordan.

The report is available at: https://data2.unhcr.org/en/documents/details/73879

The Executive Summary is available at: https://reliefweb.int/report/jordan/my-own-hands-medium-term-approach-towards-self-reliance-and-resilience-syrian-refugees

The Jordan Times also covered the launch:  http://www.jordantimes.com/news/local/panel-discussion-explores-modes-enhancing-self-reliance-refugees-host-communities