Assessments without borders during complex humanitarian emergencies: Lessons learned from initiatives for displaced war-affected children in Northern Uganda

How do we conduct rapid yet robust public health assessments during complex humanitarian emergencies to inform policymakers and adjust programming? What are the borders that limit needs assessments and program evaluations and how do we go beyond these borders in ethical, participatory, and time-sensitive ways? Drawing from two summers of field research in war-affected Northern Uganda, this session will explore the challenges of conducting assessments without borders and will call for minimum standards in humanitarian assessments. This study will show how the issues of shelter and insecurity in the minds of civilians were ignored by the government leaving the itinerant population of displaced children known as the “night commuters” at greater risk for child protection concerns and negative health outcomes.

Methods included a retrospective cohort design with a prospective cohort evaluation conducted in 2006 and 2007 with assistance from UNICEF, Caritas, and War Child Holland. The team gathered qualitative data (key informant interviews n=35, focus groups n=30, direct observation) from 13 shelters and 15 villages and IDP (internally displaced persons) camps. This revealed major gaps in understanding while helping inform the quantitative instruments (a stratified randomized survey of night commuting children n=715 with a neighborhood cluster control of non-night commuting children=410). A one year follow-up used convenience sampling with a prospective cohort (n=120) to conduct semi-structured interviews.

Results challenged the government's view that children were secondarily displaced and chose to “night commute” because of insecurity (42%, p <.05). Physical congestion and lack of land and shelter was a greater reason (45%, p <.05) for secondary displacement. Furthermore, insecurity was found to come not just from rebels, but also from thugs and government sponsored local defense units. Overall, dozens of push and pull factors for displacement were elucidated revealing the necessity for a population based study.

To reliably conduct assessments beyond borders, minimum standards should be drafted in an international collaborative process to improve the quality and utility of rapid assessments during complex humanitarian emergencies (analogous to the Sphere Project's Minimum Standards in Disaster Response). NGOs, academics, and government agencies should create assessment standards that promote efficiency, evidence-based decision-making and programming that includes the perspectives of the populations served.