Pandemics in Crisis-Affected Settings: Ensuring Women & Girls Are Not Forgotten

Written by Alina Potts, MPH, research scientist focused on gender, violence and humanitarian assistance at George Washington University’s Global Women’s Institute.

This post was originally published on Georgetown Institute for Women, Peace and Security

Healthcare workers exercising ‘wartime triage’. Bare store shelves and the shuttering of businesses. Movement restrictions. For those of us living in the United States and other wealthy countries, the COVID-19 pandemic has brought to bear a series of social and economic shocks our governments—and many of us—are struggling to manage. Yet for many of the 71 million people living as refugees, asylum seekers, or ‘internally displaced’ within their own countries, these conditions are not new. The impact of the COVID-19 pandemic in already-fragile settings such as SyriaAfghanistan or South Sudan is potentially devastating. Responding requires informed, as well as inclusive, action.

How can we learn from past infectious disease outbreaks in conflict and disaster-affected settings? And how can we ensure, unlike past outbreaks, women and girls are not lost in the response?

While not rising to the level of a pandemic, cholera outbreaks in Yemen, Syria, and Haiti, along with Ebola in Sierra Leone, Liberia, Guinea, and DR Congo, brought numerous direct and knock-on effects. Health systems already weakened by crisis—or even under deliberate attack—were further strained; increased need for clean water and sanitation outstripped supply in environmentally-precarious areas; loss of livelihoods placed further pressure on weakened markets and food-insecure households; and aid was sometimes re-directed to ‘more urgent’ needs. The scale of the current pandemic has already led to border closures and changed migration policies that have significantly affected resettlement processes as well as safe passage for people seeking asylum or migrating for economic or climate reasons.

Recognizing the possible impact of Covid-19 on the world’s most vulnerable—people forced to flee war or still living in it, who lack access to soap and water, or to a hospital bed should they fall critically ill—the United Nations just launched a $2 billion global humanitarian response plan. “If we leave coronavirus to spread freely in these places, we would be placing millions at high risk, whole regions will be tipped into chaos and the virus will have the opportunity to circle back around the globe,” said Under-Secretary-General for Humanitarian Affairs Mark Lowcock.

While devastating to all, there is a growing recognition of the gendered nature of infectious disease outbreaks in crisis-affected settings. These range from increased risk of domestic violence due to household stressors and quarantine measures, to growing care burdens often falling on women, and risks to female health workers on the front line. Covid-19 will be no different.

The 2013-16 Ebola outbreak made increasingly visible the toll of infectious disease on West African women and girls’ lives. Gender-based violence (GBV), which already disproportionately affects women and girls, was exacerbated by increased household stressors, family separation, quarantine measures and school closures. A qualitative assessment by the UN Development Programme found increases in both intimate partner violence (IPV) and sexual violence against children in Ebola-affected Sierra Leone when comparing 2014 to previous years, with reports mirroring the curve of the outbreak: as the response to Ebola ramped up, the authors note that reported cases dropped, likely due to crowding out of safe places and pathways for accessing GBV services. As Ebola cases started to stabilize in parts of the country, reports in those locations rose once more.  Informal and formal support structures, already strained by conflict or disaster, often face further deterioration in public health emergencies. In Syria and Yemen, the cholera response exacerbated negative ‘coping mechanisms’ such as forced/child marriage, which further links to IPV. The mental health of survivors as well as those who care for them can also impacted.

This type of service-based data speaks to the fundamental need for flexibility and continued funding during public health emergencies, so that vital sexual and reproductive health and rights (SRHR) and GBV services for women and girls can adapt and continue. An IRC assessment showed that in areas of Sierra Leone where funding and flexibility allowed for GBV services to remain open, utilization rates increased by almost 20% at the height of the crisis in comparison to pre-crisis levels. Another study of Sierra Leone from 2014-15 estimates an additional 3,600 deaths occurred due to decreased use of SRH services such as family planning, ante/post-natal care and deliveries in health facilities. It is promising to see this research oft-cited in some of the early and excellent COVID-19 guidance—and it should lead to informed action such as ensuring the Minimum Initial Services Package (MISP), a set of agreed upon, life-saving practices to address SRH needs in emergencies, is prioritized from the outset.  

Sexual exploitation and abuse (SEA) by aid workers remains a concern during public health crises. During the Ebola response, a range of actors took advantage of women and girls—including taxi driversburial teams, and even vaccinators—who chose to exploit existing power differentials that had been further deepened by the outbreak. My own participatory action, feminist research examines the same dynamics in relation to aid distributions, by working with women and girls living as refugees in Uganda and Lebanon to understand how SEA manifests in relation to accessing food, water, shelter, fuel and firewood, and cash assistance. They identify protective strategies for mitigating SEA risk already in use by women and girls, and recommend specific actions aid actors should take.

Strategies to mitigate SEA risk—such as moving in groups and ensuring adequate female aid staff—become increasingly difficult given COVID-19 distancing practices that impact the ways in which women’s groups and aid programs function. For example, women workers may face pressure to stay home and care for others if their own families are impacted, potentially leaving a staffing gap. The emphasis on handwashing and increased need to gather water, usually a gendered activity, may further put women and children at risk in displacement contexts where accessing hygiene facilities is often accompanied by fear of harassment and assault. Adolescent girlsunaccompanied/separated children, the elderly and those living with disabilities may face increased risks given potential shortages of aid and/or increased difficulties in accessing it due to containment measures. At the same time, existing barriers to seeking help may increase. Support to adapt a minimum standard of services that can continue to be safely offered is crucial. Given recommendations around remote services delivered via mobile phone or messaging apps, women and girls’ access to technology has never been more urgent.

Much of the work to make the gendered impacts of disease outbreaks more visible has been done by women and girls themselves—as members of community groups, local activists, human rights defenders, and feminist researchers applying an intersectional and gendered analysis in documenting the extent of the crises that affect them. Their voices, and participation in decision-making and planning, must be centered both in immediate response—where the ‘localization’ agenda can be harnessed to better support women on the frontlines—as well as within longer-term preparedness efforts. Duty of care for staff, and shared assessments of how remote management strategies may displace risk onto the most vulnerable actors, are important considerations for responding responsibly.

Lasting peace and security in fragile settings is achievable when women and girls are included at the table. This is no less true when layered against a global pandemic that threatens the very connectedness by which their societies and families are held together. Communities who have been living in crisis for some time now have much to teach us about adaptation, resilience, and mobilization—if we know how to ask, and how to listen.

The Program on Forced Migration and Health is launching a bi-monthly blog to profile how our students, faculty and alum are responding to and experiencing the COVID 19 pandemic.  Through your contributions, we hope to caste further light on the impact of the COVID 19 pandemic and response on refugees, displaced populations and migrant communities, both in the US and globally. Contributions may also reflect on the personal impact of the pandemic in terms of working and daily lives. We invite all students, faculty and alum who are interested in contributing to this blog to please contact Rocio Rodriguez Casquete ( and Sabeen Rokerya ( for more information. 

Reprogramming for COVID-19 without retreating on human rights

Written by Joanne Csete, Associate Professor, Population and Family Health, Mailman School of Public Health

We didn’t need the calamity of COVID-19 to remind us that infectious diseases rarely affect all people uniformly across societies.  Almost 40 years of grappling with HIV has been a constant reminder that LGBTQ persons, people who use drugs, people in prison, sex workers, migrants, adolescent girls and others have been disproportionately affected by the disease.  The Stop TB Partnership and its collaborators have also urged national programs to address stigma and other human rights-related barriers to access to TB services, noting that TB programs will not succeed until inequities in exposure and access to care are addressed.

COVID-19 showed its hand quickly in this regard as in the US, for example, African-Americans and Latinx populations have been disproportionately hit, as have others with a lifetime of poor access to health care in the US’ profit-based health system.  In low-income and middle-income countries, we are only beginning to see how inequities will play out as the coronavirus takes hold.

The Global Fund to Fight AIDS, TB and Malaria (for which I have been a paid consultant for six years) has recognized that work on those three diseases in low- and middle-income countries (LMIC) may easily be undermined by the emergency demands of COVID-19.  It has made new funding available for COVID responses and also allowed some degree or reprogramming of existing Global Fund grants.

Through its human rights initiatives, the Global Fund has greatly increased both its own and some LMIC governments’ investment in programs that address inequities in access to health care that are linked to stigma, discrimination, unjustified criminalization, violence and other marginalization.  These are programs such as training health workers on non-stigmatizing care, “know your rights” campaigns with local health committees and communities, legal or paralegal services for people unjustly denied health care, training of police on rights-friendly practices, programs to address gender-based violence and discrimination, advocacy for removal of punitive laws and regulations, and improvement of prison services.

So the challenge in the COVID moment is to respond adequately to COVID but without undermining health services generally and also without going backward on this important support to reducing human rights-related barriers to care for people in LMIC.  I was glad to be asked by the Global Fund to help the human rights unit at the Fund to craft guidance to countries on this point.  The Global Fund’s earlier guidance on preserving human rights-related programs in complex emergencies was a good starting point.

It was our hope that many of the human rights-related programs that have been scaled up with respect to HIV and TB in recent years could be adapted to include the human rights concerns raised by COVID.  Examples of these adaptations include:

  • The many Global Fund-supported pre-service and in-service trainings for health workers on rights-friendly care could be adapted to cover COVID-related stigma and, importantly, capacity-building for health workers to assert their right to safety in the workplace and compensation for occupational exposure.
  • Programs to address gender-based violence, including building the capacity of police and social service providers, could be adapted to include raising awareness about GBV linked to COVID-19 quarantine and “stay at home” orders.
  • The teams of paralegals that have been trained to help people get access to HIV, TB and malaria services could also help those being excluded from COVID services and information.
  • Improvements in HIV, TB and malaria services in prisons, including helping people in prison to know their rights to health services, could be adapted to include working with corrections officials toward COVID-related release of as many persons as possible (with support for released persons to be safe in the community) or toward improved testing, prevention and care for those who remain detained.
  • Efforts to ensure access to culturally and linguistically appropriate and user-friendly information on health rights focused on HIV, TB and malaria for migrants, low-literacy and other marginalized persons could also include information on COVID-19.

The full guidance provided to Global Fund grantee countries on COVID and human rights, with many more examples, is available here.

More generally, a key lesson from HIV underscores the crucial importance of meaningful participation of people affected by any disease in program and policy decisions related to the disease.  In infectious disease emergencies, there is a natural tendency toward top-down, non-participatory management.  As has been shown over and over again, the voices of people and communities affected by the illness are indispensable to finding effective responses that preserve dignity and justice to the greatest degree possible.  This is as true for coronavirus as for any health problem.

The Program on Forced Migration and Health is launching a bi-monthly blog to profile how our students, faculty and alum are responding to and experiencing the COVID 19 pandemic.  Through your contributions, we hope to caste further light on the impact of the COVID 19 pandemic and response on refugees, displaced populations and migrant communities, both in the US and globally. Contributions may also reflect on the personal impact of the pandemic in terms of working and daily lives. We invite all students, faculty and alum who are interested in contributing to this blog to please contact Rocio Rodriguez Casquete ( and Sabeen Rokerya ( for more information. 

First-Year Spotlight: Tiffany Firebaugh

We sat down with first-year PHHA student Tiffany Firebaugh to learn more about what led her to PFMH and her vision for her future in public health!

Previous Education: BA in International Affairs from Columbia University

Previous Work Experience: Tiffany has accumulated a wide range of work experience, primarily in non-profit fundraising with Riverside Church, a historic church in Morningside Heights. She also spent some time working with UNICEF and the Center for Migration Studies. Additionally, Tiffany currently takes comedy classes at Upright Citizens Brigade Theatre.

Experience with humanitarian assistance: Tiffany’s first exposure to public health was an Intro to Global Health course she took during undergrad. Soon after her class, she volunteered with Global Brigades, building latrines and assisting with water and sanitation education in Honduras. Since then, she has also worked as a volunteer tutor at the IRC.


After taking an Intro to Global Public Health course, Tiffany was drawn to public health due to its holistic focus and emphasis on creative solutions to complex, wide-ranging problems. Tiffany’s two key passions are pursuing the idea of “wholeness” in health and well-being and combatting what she feels is the greatest challenge of the next 100 years: climate change. PFMH immediately stood out to Tiffany as one of the few programs looking at forced migration in a health context and one that would provide critically relevant skills as we see an increase in climate-related disasters and crises.

What’s next?

Tiffany hopes to apply knowledge around program planning, WASH, nutrition, and emergency response from PHHA to address the health of populations forced to migrate due to climate change. She hopes to incorporate her love of comedy into her public health work as an advocacy tool to deconstruct the issue of climate change and help build linkages between critical issues for the public!


Terry Saw – Getting to know UNICEF

Last Friday, Career Services organized a UNICEF site visit for interested Mailman students and of course, several PFMH students attended it. While I’m no longer a current student, I had always been intrigue with the idea of working for one of the UN agencies, particularly since I’ve had an interesting brush with UNHCR while I was working in refugee resettlement in Malaysia prior to coming to Mailman.

The event started out as all events should, with an introduction of the work that UNICEF does through a visually appealing video.

The visually appealing video – UNICEF: for every child

We were then welcomed formally by Eva Mennel, Director of Human Resources, followed by a series of talks by different UNICEF employees from different units or departments. Shanelle Hall, Deputy Executive Director of UNICEF told us about their strategic plan, and Willibald Zeck gave us insight on what goes on in the world of the Maternal, Newborn and Adolescent Health. programme. Mark Waltham, the Senior Adviser for Education then gave an impassioned speech about the need for education in humanitarian and developing contexts (which we learned about in PFMH), and Geoff Wiffin, the Senior Advisor for Emergency Programme wrapped up the series of ‘Insight Talks’ with a story of how being in the right place at the right time provided him with the opportunity to work in emergency settings (which, as we all know, is exactly how you get involved in emergency work)!

The PFMH Team

After a brief coffee break, we were treated to a buffet of different strategies and tips on how to get a job with UNICEF. Finally, the reason almost 300 of us were gathered there on that cloudy day!

Jill Osborn, the Human Resources Manager (New Talent Unit), told us about the four ways to get into UNICEF. Check out each individual link to learn more!

He doesn’t seemed too convinced…

Additionally, she also mentioned that consultancies are some of the best ways to get into the UN, as they sometimes look for fresh graduates with little to no experience. After doing a few consultancies, and proving to them that you are good, you may be offered a full-time position.

Next up was Nina Segal, Human Resources Manager (Leadership Executive Support Unit) who mirrored Ms. Osborn’s thoughts and added that internships were also a good way to get into the door. She also said that 70% of UNICEF vacancies published on their website were filled by internal candidates, and 30% were from external ones. This was really helpful as it set expectations for those of us applying to UNICEF.

Another helpful ‘tip’ was that UN agencies, unlike most other NGOs and organizations, prefer CV’s/resume’s at least 2 pages and longer. So if you’re a fresh graduate with not much work experience, it’s time to rack up those internships/consultancies over the summer/winter breaks to fill out that resume! The same apparently goes to cover letters. For more tips on how to write for UN applications, check out this website!

She also mentioned that applications are usually run through a system which strictly screens CV/resume’s for minimum qualifications. So if they mentioned in the job description “5 years of related experience” and you only have 4 years and 11 months, then your application most likely won’t be entertained.

After her talk, the participants were free to visit individual booths where they could ask more questions about their areas of interests, and the event ended after that.

Maybe… someday…

Overall, it was an interesting experience. Personally, the highlight was that, when every session ended, each speaker was asked to tell the audience why they think UNICEF is a great place to work for. All of them mentioned the mission of the organization, and none mentioned the salary, or the benefits, or the prestige of working in a UN agency. It was as if their answers were scripted. Or maybe, the mission was the main draw which drew all these professionals from many different backgrounds to work and stay in the organization for many years. Perhaps, beneath all those glamorous associations that we associate with UN agencies, there really is something worth working for.

Finding Connections


It happens so subtly here in Jordan. I enter a taxi, offer some basic greetings, and fumble through my Arabic to give my driver my address. Halfway through the drive, we realize that we are both of Lebanese descent; in fact, our families are from the same street in Beirut. My driver warmly tells me where I can get affordable and delicious Lebanese food, gives tips on fair taxi prices, and insists I call him if I ever need anything.

Enjoying the sunset in Wadi Rum, a valley cut into sandstone and granite in southern Jordan.

During my time here, these small connections have helped my colleagues and me adjust to life abroad. From getting help bargaining the best taxi deal, to sharing countless cups of shia ou nana (tea with mint), I have developed a sense of companionship with those I have met over the past two months. It’s no surprise that we find such importance in building this network and so much meaning in our daily interactions within our temporary home because that is what human beings do—we seek out friendships and connections and turn to those connections for support and assistance. But what happens when the feeling of connection, which is so embedded in the culture and processes of the Middle East, is disrupted by forced migration?

For my summer practicum, I am working with Mailman’s Program on Forced Migration’s Syrian Refugee Initiative to understand the impact of family separation on refugee families in Amman, Jordan. As part of our work here, my colleagues and I have been conducting in-depth interviews with Syrian refugee families to understand their experiences in both urban and refugee camp settings.

Amman, Jordan, Middle East, Syrian Refugee Initiative

Wall art in Jabal Al’Weibdeh area of Amman.

Our first day in Za’atari refugee camp, I saw how families attempted to rebuild this feeling of connectedness to person and place following their forced migration out of war-torn Syria. Caravans in the camp were moved, reorganized, and attached to one another to create a network of shared living spaces as a way to keep loved ones together. During interviews with  Syrian families, young nieces and nephews that had moved nearby ran in and out of the open living room, playing. It is easy to forget you are in a metal box as families welcome you with a warm smile into a space that they have made as comfortable as possible, with traditional Syrian décor and even outdoor gardens. The attempt to maintain some semblance to life in Syria is clear.

Before leaving the camp, we had to stop at United Nations High Commissioner for Refugees’ (UNHCR) base camp to process our departure. As we approached, all I could see were dozens of people  huddled against the barbed-wire fence surrounding the camp in the sweltering Jordanian sun. It became clear that this was a group of young men pressed against a fence to push their bodies as close to the barricade as possible, some even reaching their arms through the holes.  All of this was an effort to get their phones as close to the “good wifi” as possible so families could keep in contact with loved ones or simply feel connected to life outside of the camp. Although I was shocked by this image, I was not surprised by the necessity that these men felt to stay connected.

I came to Amman to understand Syrian refugees’ experiences with family separation, and this research allowed me to explore the deep desire for familiarity through all kinds of relationships.

Amman, Jordan, Middle East, Syrian Refugee Initiative

View from the top of the Monastery in Petra. Jordan.

In the interviews we have been conducting, we often hear about the importance of staying in touch online with family members and neighbors despite being on different continents. In fact, the desire to be connected is so strong that many families put themselves in harm’s way in order to fulfill this exigency. Many families leave behind services and support in the camps and head to urban settings, where access to resources are either limited or non-existent, just so they can be with family members that are unregistered refugees. Others have said that despite security risks, they are considering returning to Syria to say goodbye to elderly parents before they pass away or to see the graves of loved ones they have lost. Despite trying to make a familiar house, many refugees are patiently waiting for Syria to become safe in order to return to their homes.

Amman, Jordan, Middle East, Syrian Refugee Initiative, Mailman School of Public Health

In Jordan’s Desert Highway.

Although I am just beginning my career in humanitarian aid work, I can see that we are clearly missing something in our current refugee crisis models. From what I have observed in my short time in Jordan, people will seek out familiarity and family unity by any means necessary, including reunifying in unsafe ways or standing in the heat of the day for a decent wifi connection. It is up to us as humanitarians to address these realities and find creative solutions in order to better protect the human rights of refugees. With limited resources and a system that was not designed for protracted emergencies, we must find new ways to assist safe means of reunification and promote a sense of dignity and belonging for these families.


Laura Zebib is a second-year MPH student in the Department of Epidemiology and part of the Program on Forced Migration and Health. She graduated from the University of Miami in 2015 before pursuing a graduate certificate in geospatial technology. Prior to joining Mailman, she utilized her GIS background to investigate refugee spatial access to healthcare in Europe and the geo-demographic indicators of gun violence in Miami, FL. 

If you would like to be considered for Mailman’s Student Voices, please send a five-sentence article pitch describing your piece to Suzanne Shrekgast at


Reflections From Jordan: A Call for Reform


The longer I’m here, the less I know.

This is the most honest realization that I can share with you because when you come to a refugee camp equipped with a partial master’s degree and the best of intentions—you really do feel like you can change the world.

But then you sit down and hear people’s stories—stories of incredible hardship and need, stories of long journeys, lost homes, and possible indefinite family separation. These are the same people that you have been reading about for months and years, and you realize that you don’t have an answer for them. You realize how truly complex a complex emergency is and how small you are in the scheme of it all.

Amman, Jordan, Middle East, Syrian Refugee Initiative, Mailman School of Public Health

As a second year MPH student at the Mailman School of Public Health, I spent the summer studying of family separation in Jordan.

This summer, I have been working in Amman, Jordan, with the Mailman School’s Program on Forced Migration and Health to learn about the impact of family separation on Syrian Refugees. Together, my colleagues and I conducted over 80 qualitative interviews with refugees across the country to learn about their experiences.

Syrian refugees here have access to certain rights, but only if they are registered with United Nations High Commissioner for Refugees (UNHCR). Out of 1.4 million, only 657,000 Jordanian refugees are registered and even then resources are limited and there is still a great deal of unmet need. Many refugees have been displaced for years and they lack access to basics like food, money for rent, and healthcare. I am increasingly aware of the many hoops that refugees have to step through to get what they need to survive—and live with dignity.

Even something seemingly as simple as getting registered, and applying for services like food stamps and resettlement can be complicated and perplexing. Many refugees are confused as to why they may not be eligible for certain services, or how to even apply. Humanitarian agencies are overwhelmed and can be unresponsive. Part of me understands and respects that the existing process is in place for a reason, but the another part keeps thinking that we must do better.

Amman, Jordan, Middle East, Syrian Refugee Initiative, Mailman School of Public Health

Taking a break from conducting interviews with my fellow Mailman teammates.

My teammates and I, who live and work together, often come home and debrief about what we’ve been seeing and experiencing. For hours we go around talking about our participants’ experiences and try to come up with solutions. Is it more money? Better policies? Better organization? More decentralization? A complete re-structuring? Who should take on a bigger role?

Historically, the humanitarian system has been set up for short-term emergencies where basic human needs are met. Increasingly, crises are protracted and we have to adjust to meet longer-term needs. A clear example of this, which my team and I have observed while conducting interviews, is that many refugees lack access to secondary and tertiary healthcare. This includes medications for chronic disease like diabetes and hypertension, important surgeries such as those for tonsillitis and kidney stones, and even treatment for illnesses like cancer. Without an end to the Syrian crisis in sight, and other crises emerging, we have to find a way to better meet these refugees’ long-term needs. But how? Here’s where the more personal questions come in:

What can I do?

How can I be useful?

Where do I place myself to create the most positive change?

The answer isn’t simple, but humanitarians like Dr. Paul Spiegel, director of the Johns Hopkins Center for Refugee Disaster Response, and Dr. Francesco Checci, an epidemiologist at the London School of Hygiene and Tropical Medicine, have been advocating for an overhaul to the existing system. Changing that system involves a shift from short-term techniques to long-term approaches with revised leadership and a focus on efficient, effective, and sustainable interventions.

As part of the future generation of humanitarian responders—still a little green and wide-eyed—I don’t see any option but to overhaul how we’re approaching things now. I am looking forward to working with my peers at Mailman this fall and learning from the experiences of Syrian refugees to find durable response solutions for those in the future.

Hannah Chandler is a second-year MPH student in the Heilbrunn Department of Population and Family Health and part of the Program on Forced Migration and Health. She graduated from Azusa Pacific University in 2015 before joining the Johns Hopkins Center for Health Security as a Research Assistant.

If you would like to be considered for Mailman’s Student Voices, please send a five-sentence article pitch describing your piece to Suzanne Shrekgast at

Refugee Lessons

This blog post originally appeared on the Mailman School of Public Health’s Student Voices blog.

I’m nearing the end of my time in Amman, Jordan, on my summer practicum, meaning I only have a few weeks left to experience as much as I can: deserts, mountains, seas, cities, delicious food, and wonderful, welcoming people. I’ve been keeping my family updated on sights and experiences through instant messaging apps like Whatsapp. “This is Petra! It’s beautiful!” I’ll send them with a picture, next to which little blue checkmarks indicate they received it instantly. Isn’t technology amazing?

What’s great about using these technologies in Jordan is that it makes the distance between family shrink. But I wonder if it would feel the same if I didn’t know when I would see my family next?

Petra, Amman, Jordan, Syrian refugee
Two of my Syrian Refugee Initiative team members and I climbed over 850 steps to reach the Monastery, the largest monument of Petra.

Before arriving in Jordan, I studied the basics of the spoken Levantine Arabic dialect (Marhabaa! Ismi Lainey!) in Beirut for one month. There I met a young lady, Ayah, who is soft-spoken, yet strong-willed, and incredibly kind-hearted. She told me she wants to be a veterinarian and spent her free time at a local pet-shop. Over the next few weeks, Ayah and I met in cafes and studied together: myself, Arabic, and her, German.

Ayah is from Syria, and her parents were resettled in Germany. When she applied for reunification to be with them, her request was denied. She had just turned 18, and Germany considered her a self-sufficient adult.

Germany’s policies for family reunification — and most European countries’—prioritize children, but only those under the age of 18. After 18, separated young adults must prove dependency (emotional, physical, or financial) in order to be considered for reunification. So, Ayah learns German while waiting on updates. Like me, she is currently communicating with her family via Whatsapp, but unlike me, she has been away from her family for over three years.

Even if Ayah was 18, does it make sense to keep a family separated? Would it be better for all of her family to be together? It seems counterproductive to the purpose of asylum if her parents are provided protection, but worry about their daughter alone in Lebanon, a small country that faces a myriad of challenges related to hosting more than 1 million Syrian refugees. (These challenges include social tension, discrimination, insufficient financial support, and the government’s decision to suspend registration of refugees in May 2015.)


In July 2017, I camped in Wadi Rum, a protected desert valley in southern Jordan known for its incredible night sky.

As it happened, my friendship with Ayah personalized an issue I have been working on here in Jordan with the Syrian Refugee Initiative. I’m here with seven Mailman classmates and Jordanian colleagues to understand and document refugee experiences like Ayah’s in a country that faces similar challenges to Lebanon. We’ve been conducting in-depth interviews with Syrians separated from family members, looking at the barriers to reunification — including countries’ logistical, procedural, and legal requirements — and the impact that separation has on families.

Germany’s age requirement is far from the only hurdle. For example, family sponsors who apply for reunification three months after their status determination must prove sufficient living space, health insurance, and financial subsistence for themselves and their family members. Spouses may be asked to prove they are able to communicate in German on a basic level before entering the country. Germany also suspended family reunification for two years for those issued residency permits under “subsidiary protection” status after March 2016.

Amman, Jordan, Middle East, Syrian Refugee Initiative

The hills of Amman, Jordan taken from the Amman Citadel downtown.

With support from the Columbia Global Center in Amman, the Syrian Refugee Initiative was commissioned by UNHCR to assess the impact of separation on families’ livelihoods and their overall wellbeing. In Ayah’s case, safety is a major concern. She told me she does not feel safe in Lebanon without her parents, mainly due to discrimination. It has also been next to impossible for her to find a job since work permits are limited to just a few sectors such as construction and agriculture.

I believe our research is important not only in elevating the voices of separated refugee families, but also in supporting the global community in crafting policy responses. This research will allow us to engage in evidence-based advocacy in an effort to improve current family reunification programs. We aim to disseminate findings to policymakers, academic journals, humanitarian actors, and other communities of practice.

While technologies like WhatsApp have been so important in keeping families in communication, I am hopeful that in the future, policies will make it unnecessary by allowing Ayah and others to reunite with their loved ones.

Lainey Freels is a second-year MPH student in the Heilbrunn Department of Population and Family Health and part of the Program on Forced Migration and HealthShe graduated cum laude from UCLA in 2012 before joining the University’s International Education Office as an International Programs Advisor. From 2014 – 2015, she was a Princeton University Fellow with the Asia Injury Prevention Foundation in Vietnam. 

Yana Mayevskaya – Adolescent Empowerment in Zambia

Over the summer I traveled to Lusaka, Zambia to participate in the evaluation of an adolescent girl empowerment program for an International NGO.  It was an experience that both reinforced my commitment and passion to global public health and at the same time raised challenges for me that I think many of us face when we work outside of our own countries.

The ever-present white Land Cruisers became home for me in Lusaka, Zambia during my practicum. Every day a team of 35 incredible local staff and I would hop into those vehicles, blast the top Zed hits, and head to the compounds in the nearby communities. The group of local female enumerators would spend hours locating and interviewing adolescent girls, asking them seemingly endless questions, ranging from who lives in their household to the last time they had sex. It seems like we wanted to know just about everything we possibly could about these 5,000 girls we would spend time with over the next few months as we evaluated the program.


I was given the option of staying in the office while I did ‘QC’ (quality checks) or going into the field with the enumerators. I ALWAYS chose the field. I love to be in the mix of things—learning, laughing, and (most importantly) interacting with the project’s intended beneficiaries. However, in the third week of fieldwork, I had two drastically dissimilar experiences that made me question the effect my obviously foreign presence had on this research project.


In the field, one of my roles was to observe Early Childhood Development (ECD) assessments and to provide feedback for the enumerators. However, in many of the households, the children were terrified of me, and I would have to step outside in order for the enumerators to complete their interviews. During these times, often lasting for a couple of hours, I would hang out with the child’s family members and their neighbors—can someone say a dream come true?? On one such occasion, there were a few teenagers cooking greens and doing laundry with their caretaker right outside the house. I awkwardly stood next to them and put on my big, cheesy smile. I wanted to hang out too! That awkward moment soon passed and moments later we were huddled in a circle attempting to chat about school in broken English and Nyanja, singing songs, and learning to cook greens Zambia-style. About an hour into the hangout session, one of the young boys ran into the house and brought out a photo of himself with a Muzungu (white person), holding it very tightly to his chest with evident pride. The  caretaker followed him out, carrying a bag of peanuts as a gift for me.  She told me:

The kids and I get very excited when we see Muzungus. All of these kids are orphans, and the photo that the boy is holding is his sponsor. All of these kids get sponsored to go to school. They got excited when they saw you because they know that people like you help them a lot.

I did nothing to help these teens. I was welcomed and cared for by this family because of someone else’s kind deed only because I had the same skin color as them. It did, on some level, warm my heart to know that something as simple as a school sponsorship significantly helped this family, even if I had nothing to do with it and even if it wasn’t enough.

A few days later, once again, another child was uncomfortable in my presence. The living room was very small, so I sat in the doorway to observe because I knew that the child needed a bit more space from me. A few minutes later, the adolescent girl’s brother-in-law walks by, stops in front of me and gets noticeably upset:

Why is SHE in my brother’s house?! She is drawing attention to my household! The neighbors will have questions. Did you even talk to my brother? Is she here because we are orphans?    

He was raising his voice and, soon enough, neighbors’ faces began peeking out from their homes. I told him that I could leave, but he just kept repeating that I was attracting attention to his house. My heart dropped. I was sad and uncomfortable. Would the girl’s husband come home and be upset with her? Would his brother-in-law cause a scene after we left? Did my presence negatively impact this research? Later, I was told that it is not unusual for enumerators to be chased out by some families. Still, I couldn’t help but think that my presence made this situation a whole lot worse. Both of these families lived in the same area and included orphans, but they had vastly different (if equally acceptable) responses to my presence in their homes.



I had an incredible couple of months in Zambia and wished I didn’t have to leave. After I graduate, I would love to live and work internationally, but I know that these feelings will continue to well up and cause me to question the value of my presence in these settings. I love to be in the middle of all the action, but perhaps there are moments when it is better that I step back—and that is absolutely okay!


Anaise Williams- Aid and “Othering” in Ethiopia

I got there, and I saw this woman standing completely naked washing her dress in the river. I was appalled. But then a few days later, I realized it was because she only has one dress, so she didn’t have anything to wear while washing it. – American woman wearing a red polo featuring a “Teen Mission International” logo with a gold cross

Other middle-aged white woman: Incredible

First woman: It just made me realize, we Westerners are so unsatisfied. We have more than anyone in the world yet we can’t find satisfaction. This mission was life-changing, it made me realize the best way to serve the Lord. All we need to do is give them supplies – you know the women, they’re really good at sewing.

Second woman: I know, they’re so talented, really talented. If only they were educated. In Malawi we were focusing on education and we provided Bible sessions for two weeks in three villages.

First woman (nodding enthusiastically): You know if they have tin for their huts, and if they have food, they’re happy.


I overheard this conversation on the plane ride back from my practicum in Ethiopia, where I was working on a program evaluation in Sudanese refugee camps. I realized that, apart from not wearing a red polo, I blended right in with the crowd of missionaries. I had a sudden urge to punch open the window and jump off the plane. What was it about this conversation and their “missions” that made me so angry?

The refugee camps were better looking than I had expected. Mud huts are set up in perfect dynamic blocks, surrounded by neat straw fences with a few holes here and there for small children to stick there heads through to yell and wave at the white land cruisers trundling past. Women walk by carrying packages labeled “World Food Program” on their heads while babies wearing Pepsi shirts with no bottoms cling to their legs and backs. Men sit in circles in the “culture center” talking all morning, and often end up lying down, a bottle of homemade liquor in hand, later in the afternoon. The fact that few people have livelihoods makes the atmosphere dramatically stagnant. Though people are active, it feels like a place to pass time.

It’s strange to be in a community almost completely functioning on handouts. It was even more unsettling to be associated with that aid. USAID, UKAID, UNHCR, UNFPA and WFP signs litter the camp. Do they see me and think I’m the face behind the signs? Is that why they so warmly greeted me? One day we were walking to the camp coffee stall when a woman I had never seen before suddenly appeared and started crying with a smile, hugging me while saying thank you, thank you in Arabic. It was awkward and I felt guilty for receiving her greeting.

During our training for data collectors, we talked about reflexivity for our project to interview Sudanese refugees about gender-based violence.


We conceptualized the fact that what the interviewer looks like and represents influences the data and interaction. The IRC had selected translators who are Muslim and from the bordering communities, and one was a refugee herself. The researchers were Ethiopian but none were Muslim and all were highly educated in Addis Ababa. We therefore had three levels of “foreignness” in the room: translators who were not refugees, educated Ethiopian women, and an American. I was not interviewing for this project, with good reason. One researcher pointed out that if I were to interview, the girls might alter their answers to make them seem more needy, with the idea being that if I heard their need they might get further assistance.

In one of my courses at Mailman, a professor described this phenomenon as “the aid game.” Local people, especially those in emergency settings living on aid, know the game and they play it well. They know agencies and what their interests are, and they sometimes put on an act for agency representatives in a way that might continue or increase assistance. While the people are indeed in need and their actions justified, this fosters a relationship that is artificial and lacks transparency. When the khaki-vested white person shows up in the white land cruiser, the people show both their gratitude and their continuing problems. It’s the humanitarian song and dance.

The reason the women on the plane made me angry is that I felt like they were objectifying Africans. They were shaping the people into vehicles for serving the Lord, and they were taking on the authority to label the people’s needs. I don’t doubt that humanitarian aid workers do this too; I’m sure I’m guilty, or will be guilty, of it as well. Not only is this objectifying, but it is also othering. Their dialogue creates an “us” and a “them.” The more I work abroad the more I see it, and it prevents true relationships from being formed. It reproduces the idea that we live in two separate worlds separated by a precarious bridge.

The “two separate worlds” situation is created by two sides: the people playing “the game” and the people labeling the people playing the game with their definition of vulnerability. I’m not blaming local people for playing the game; they’re being strategic. And I’m not blaming missionaries—we’re all susceptible to this type of satisfaction. What I struggled with during my practicum is that sometimes the dialogue (between local people and foreigners, and between foreigners) makes interactions feel fake, like some sort of rehearsed play. It hampers collaboration. It highlights our differences, and it separates us.

And ultimately, I’m not sure what anyone could do about it. One thing that made me feel better while working on this project was that the work was set up collaboratively, and I was able to make real, lasting friendships with the Ethiopians I worked with. And the project was strong in that, to the extent possible, it employed the people closest to the problem.


Another answer is to live in a place for a very long time and work on relationship building. But home is home, and skin, clothes, language and assets have political and historical meanings. So unfortunately, this is an ongoing struggle that I, as I begin on this career path, am grappling with.

Anaise Williams- Creating Relationships in the Field: Experiences from Dhaka

dhakaOn the first day of lecture in my introductory global health course, the professor asked if Americans working in low-income settings abroad causes more harm than good. I know this is a basic question that we have all heard, but for me it caused a flashback.

It is three days until my flight out of Bangladesh, after a year of ethnographic research on postpartum depression in Dhaka, and I’m standing ankle deep in water in a four feet wide slum road. Trash and a dead rat float near by. Drenched in sweat, all I can think about is a shower and how I shouldn’t have come today. I didn’t have to give gifts to all my informants; I had come the week before but a few women had not been home. I look up and see three shredded pieces of tin that make the walls of some of the shacks appear as prison bars. Through them, the face of one of my informants, a seventeen-year-old named Teeptee, peered through, her baby slumped over her shoulder.

There are of course many different ways that “westerners” work in global health, and therefore many different ways to cause harm and good. For me, I was doing an exploratory, anthropological study on stigma towards mental health and the experience of post-birth stress. I was not providing services, but rather getting to know thirty-six women living in a slum on a very personal basis to understand their life struggles, with the goal being to generate knowledge of a generally neglected population. I did not have any connections with people who would make a program or intervention out of my findings. Is this harmful?

Teeptee and I shared our lives with each other over the course of months. I showed her
pictures of my family, my university, my parents’ house in Maine on the lake. She shared her story of marrying her drug-addicted husband without her parents’ consent, leaving her, a teenage mother, in a situation where her family refuses to help her because it was a love marriage rather than an arranged one. She told me about her husband’s abuse and the time he tried to kill her. My interpreter, an incredible Bangladeshi woman, and I knew that Teeptee enjoyed our company and consistently invited us to return. I consciously made my questions extremely open ended and vague so that she drove the dialog. We had a connection, and it was a safe space for her to open up about her life.


But was it harmful that I gave her a glimpse of my world? She saw my IPhone, and asked to see pictures of my life. She saw my wallet and the way I regularly bought scores of children treats. She saw the way I walked wherever I wanted, whenever I wanted, unaccompanied by a man.

And before we both realized it, it was time for me to go home. We had been in her space together and I had momentarily felt the harsh reality of her life sentence: and now I could leave. Leave to go back to a bedroom two times the size of her slum home that I share with no one, back to my restaurants, my libraries and theories and lecturers who claim ownership and scholarship of places they have never lived long-term – something I find myself doing all the time about Bangladesh. Is this harmful? There is an argument saying no: her story might not be heard if I don’t share it, her health problems not evaluated, her needs not assessed.dhaka2

The true privilege that characterizes the global power dynamic is that I can have both my world and hers, but she can only have hers. I can go to her home and learn about the tragedies of humanity, but I can step out of it as soon as I want. I can cry with her; I can help her buy baby formula and medicine. She spoke with me, maybe because she wanted to, but it is naive to ignore the possibility that she only talked to me because she wanted economic assistance. I figured this was good for both of us- I get access to a secret world and people in her situation could benefit from research that will hopefully contribute to our general knowledge of how to make the world a better place for women.

But sometimes, when I think about it late at night, I feel like I was buying her world. I was taking it for my Fulbright stamp of approval, I was sharing it at conferences and in classrooms, I was using it to grow and feel passionate and successful and purposeful.

dhaka4I feared my friend had become dependent on me, after months of sharing her struggle and me listening intently. Then I left, and I know from her words and her situation in a Dhaka slum, that there is no one else she can regularly share her emotional stress with. I know it was good for her to be heard- she told me she wanted her name and story in a book. But when I chose to leave, had the choice to leave, how did that make her feel? My presence undoubtedly gave her hope and demonstrated how there are people who care about her wellbeing. It gave her a glimpse of how things could get better, how there is a world out there that is better. What happened to that hope when I made my last slum visit, gave my last smile and parcel of fruit?

If I knew, I could more readily approach the question of if this kind of global health work causes more harm than good.