Paul Spiegel
Datos Biográficos
| ID | 133713 |
|---|---|
| NOMBRE | Paul Spiegel |
| NOMBRES | Paul |
| APELLIDO | Spiegel |
| FIRMA | SPIEGEL P |
| AFILIACIONES | Johns Hopkins University |
| ORCID | 0000-0002-6158-6661 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 77 |
| TOTAL DE CITAS | 85 |
| TOTAL COMO AUTOR | 76 |
| TOTAL COMO EDITOR | 1 |
| PRIMER AÑO DE PUBLICACIÓN | 1998 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2026 |
| ÍNDICE H | 5 |
The humanitarian-development nexus and sexual and reproductive health interventions in fragile settings
The concurrent need for both humanitarian and development assistance in fragile settings and protracted emergencies has been termed the humanitarian-development nexus (HDN) or the humanitarian-development-peace nexus (HDpN). We undertook a scoping review on the operationalization of the HDpN for sexual, reproductive, maternal, newborn, child, and adolescent health interventions in fragile settings. We screened 2,570 publications, of which 36 peer…
Increased utilization of health care services for non-communicable diseases during the Covid-19 pandemic among refugees in Jordan
BACKGROUND: Maintaining routine health services during epidemics and humanitarian crises is instrumental to reduce preventable mortality and morbidity. Given the health service disruptions observed during the COVID-19 pandemic worldwide, we aimed to investigate the evolution of health care service utilization for acute and routine chronic care among refugees in Jordan during distinct phases of the COVID-19 pandemic and discuss the interventions t…
From ground realities to policy
INTRODUCTION: Understanding and evaluating health system governance is essential for resilient health systems. This study develops a framework to analyse health system governance in conflict-affected and high-risk areas, including fragmented systems. METHODS: The methodology adopts a qualitative multi-faceted approach, encompassing five methods: consultations with experts, thematic analysis of existing health system governance frameworks, focus g…
Strategies to maintain health service provision during the Covid-19 pandemic in refugee settings in Jordan and Uganda
Health system adaptations were rapidly introduced at the start of the COVID-19 pandemic to protect the public and maintain access to health services. Given the specific vulnerabilities of forced displacement settings, understanding which adaptations were used, how they were implemented, their success, and challenges is important for preparedness and response efforts. In this paper, we characterize adaptations in health service delivery implemente…
“Crises are a perpetual restart”—A comparative analysis of maternal and newborn health political prioritization across four fragile and conflict affected settings
Fragile settings account for the highest burden of maternal and neonatal mortality in the world. Although policies and strategies for intervention exist, there are gaps on political prioritization of maternal and newborn health (MNH) by key actors to maximize resources and impact of programs. This study offers a comparative analysis of MNH political prioritization across four fragile national and sub-national settings, and recommendations for imp…
The Gaza health information system
The doom loop of conflict and unsustainability
Exploring opportunities to strengthen maternal and perinatal death surveillance and response
Our findings uncover a wealth of implementation experience that is essential to inform the development, implementation, and extension of MPDSR systems tailored for optimal functionality in crisis-affected contexts. Structural system inputs must be addressed alongside socio-cultural dynamics that influence reporting and review of maternal and perinatal deaths. The intervention mechanism in crisis contexts must include a component aimed at strength…
The impact of policy and policy communication on Covid-19 vaccination inequalities among Venezuelan refugees and migrants in Colombia
INTRODUCTION: Equitable access to vaccines for migrants and refugees is necessary to ensure their right to health and to achieve public health goals of reducing vaccine-preventable illness. Public health policies require regulatory frameworks and communication to effect uptake of effective vaccines among the target population. In Colombia, the National COVID-19 Vaccination Plan implicitly included Venezuelan refugees and migrants; however, initia…
Covid-19 epidemiology, health services utilisation and health care seeking behaviour during the first year of the Covid-19 pandemic in Mweso health zone, Democratic Republic of Congo
Background: Although the evidence about coronavirus disease 2019 (COVID-19) has increased exponentially since the beginning of the pandemic, less is known about the direct and indirect effects of the pandemic in humanitarian settings. In the Democratic Republic of the Congo (DRC), most studies occurred in Kinshasa and other cities. Limited research was conducted in remote conflict-affected settings. We investigated the COVID-19 epidemiology, heal…
The emergence and regression of political priority for refugee integration into the Jordanian health system
This case study underscores the dynamic nature of policymaking and the challenge of sustaining government commitment to the right to health among refugees. Our analysis has important implications for advocates seeking to advance and maintain momentum for the integration of refugees into national health systems
Health care utilisation in Cox’s Bazar district, Bangladesh, during the first year of the Covid-19 pandemic
To respond to the COVID-19 pandemic, countries introduced public health and social measures that had indirect societal, economic consequences. Concerns during epidemics include continuity of routine health services. We investigate how healthcare utilisation and healthcare seeking behaviour changed during the first year of the COVID-19 pandemic among host communities in Cox's Bazar, Bangladesh. This mixed-methods study combines quantitative analys…
The “New-Old” Dimensions of Caring in Humanitarian Response
How can palliative care framings advance humanitarian discourse? The imperative for palliative care in humanitarian settings is increasingly urgent. Recent efforts by health and humanitarian organizations demonstrate increasing attention to the issue. Yet palliative care is still not adequately formally considered or enacted by humanitarian agencies in rhetoric, policy, research, or practice. Even where it is considered in humanitarian action, pa…
Factors associated with attendance to and completion of prenatal care visits in Colombia among urban-residing Venezuelan refugee and migrant women
Between 2015 and 2023, 7.3 million Venezuelans have been displaced globally. We aimed to assess uptake of and factors associated with prenatal care among Venezuelan refugees and migrants in Colombia. We analyzed data from a cross-sectional survey of 6,221 urban-residing adult Venezuelans who were displaced to Colombia between 2015 and 2022. Analyses were restricted to 917 women aged 18-49 years who reported at least one pregnancy and delivered in…
The crisis of maternal and child health in Afghanistan
The combination of economic collapse, lack of sustained donor support for health care and Taliban interference with human rights has severely compromised access and quality of maternal and child health care. Strong and concerted international pressure on the Taliban to respect women and children rights to essential health service is critical for the future of the Afghan population
The first year of the Covid-19 pandemic in humanitarian settings
Background Despite increasing evidence on COVID-19, few studies have been conducted in humanitarian settings and none have investigated the direct and indirect effects of the pandemic in the Central African Republic. We studied the COVID-19 epidemiology, health service utilization, and health care seeking behavior in the first year of the pandemic in Bangui and surrounding areas. Methods This mixed-methods study encompasses four components: descr…
Qualitative assessment of the impacts of the Covid-19 pandemic on migration, access to healthcare, and social wellbeing among Venezuelan migrants and refugees in Colombia
This study demonstrates the unique impacts of the COVID-19 pandemic among Venezuelans residing in Colombia by both compounding extant vulnerabilities and introducing new challenges, such as high rates of eviction. Colombia has enacted increasingly inclusive migration policies for Venezuelan refugees and migrants within the country; findings from this study underscore the necessity for such policies both in and outside of the Colombian context
Multi-purpose cash transfers and health among vulnerable Syrian refugees in Jordan
Cash assistance has rapidly expanded in the Syrian refugee response in Jordan and global humanitarian programming, yet little is known about the effect of multipurpose cash transfers (MPC) on health in humanitarian contexts. A prospective cohort study was conducted from May 2018 through July 2019 to evaluate the effectiveness of MPC in improving access to healthcare and health expenditures by Syrian refugees in Jordan. Households receiving MPCs (…
How Should Relief Organizations Fund Care of Patient-Asylees Who Have Cancer
Several clinical and ethical dilemmas arise when caring for refugees with complex, costly, and chronic conditions in low- and middle-income countries where they often first seek asylum. This commentary responds to a case involving a patient asylee with a malignant brain tumor and considers these questions: (1) Should refugee care costs be allocated as a specific amount per refugee or designated to fund only specific interventions? (2) Should inte…
Measuring results of humanitarian action
Humanitarian crises represent a significant public health risk factor for affected populations exacerbating mortality, morbidity, disabilities, and reducing access to and quality of health care. Reliable and timely information on the health status of and services provided to crisis-affected populations is crucial to establish public health priorities, mobilize funds, and monitor the performance of humanitarian action. Numerous efforts have contri…
Covid-19 epidemiology and changes in health service utilization in Uganda’s refugee settlements during the first year of the pandemic
COVID-19 transmission seemed lower in settlement regions than the national average, but so was testing capacity. Disruptions to health services were limited, and mainly affected consultations for acute conditions. This study, focusing on the first year of the pandemic, warrants follow-up research to investigate how susceptibility evolved over time, and how and whether health services could be maintained
The United States detention system for migrants
The United States of America (US) detains more migrants than any other nation. Customs and Border Patrol (CBP) and Immigration and Customs Enforcement (ICE) detain adults and families under the Department of Homeland Security, while unaccompanied minors are housed under the Office of Refugee Resettlement (ORR) within the Department of Health and Human Services. Migrants are subject to the standards and oversight of each individual agency and faci…
The effects of armed conflict on the health of women and children
The Humanitarian Lives Saved Tool
A shared understanding of key priorities and the path forward is critical to improving reproductive, maternal, newborn, and child health (RMNCH) in humanitarian emergencies. Stakeholders, including local governments, multilateral, United Nations (UN) agencies, and non-governmental organization (NGO) partners, must plan and implement coherent programs to reduce disease burden while working with available financial resources. However, tools to supp…
Care-Seeking and Health Service Utilization for Hypertension and Type 2 Diabetes Among Syrian Refugee and Host Community Care-Seekers in Lebanon
HIV/Aids among Conflict-affected and Displaced Populations
Conflict, displacement, food insecurity and poverty make affected populations more vulnerable to HIV transmission. However, the common assumption that this vulnerability necessarily translates into more HIV infections and consequently fuels the HIV/AIDS epidemic is not supported by data. Whether or not conflict and displacement affect HIV transmission depends upon numerous competing and interacting factors. This paper explores and explains the ep…
Venezuelan Migration and the Border Health Crisis in Colombia and Brazil
Executive Summary Venezuela’s economic crisis has triggered mass migration; more than 3.4 million Venezuelans have fled to other countries in the region and beyond. An assessment mission to Cúcuta, in the Colombian border state of North Santander, was undertaken from July 26 to August 1, 2018, and to Bôa Vista and Pacaraima, in the state of Roraima, Brazil, between August 24 and 28, 2018. Interviews were conducted with key informants, including h…
The Application of Geographic Information Systems and Global Positioning Systems in Humanitarian Emergencies
Geographic information systems (GIS), global positioning systems and remote sensing have been increasingly used in public health settings since the 1990s, but application of these methods in humanitarian emergencies has been less documented. Recent areas of application of GIS methods in humanitarian emergencies include hazard, vulnerability, and risk assessments; rapid assessment and survey methods; disease distribution and outbreak investigation…
The food security and nutrition crisis in Venezuela
The Accuracy of Mortality Reporting in Displaced Persons Camps During the Post-emergency Phase
For humanitarian organisations, accurate data are essential to identify emerging health problems and determine programme needs. We visited 45 post-emergency phase displaced persons camps and collected three months' mortality data which we compared with organisations' routine mortality reports. Organisations reported 612 deaths and we identified 741 deaths, for a mortality-reporting ratio, defined as the number of organisation-reported deaths divi…
Using Design Effects From Previous Cluster Surveys to Guide Sample Size Calculation in Emergency Settings
A good estimate of the design effect is critical for calculating the most efficient sample size for cluster surveys. We reviewed the design effects for seven nutrition and health outcomes from nine population-based cluster surveys conducted in emergency settings. Most of the design effects for outcomes in children, and one-half of the design effects for crude mortality, were below two. A reassessment of mortality data from Kosovo and Badghis, Afg…
Qualitative assessment of the impacts of the Covid-19 pandemic on migration, access to healthcare, and social wellbeing among Venezuelan migrants and refugees in Colombia
This study demonstrates the unique impacts of the COVID-19 pandemic among Venezuelans residing in Colombia by both compounding extant vulnerabilities and introducing new challenges, such as high rates of eviction. Colombia has enacted increasingly inclusive migration policies for Venezuelan refugees and migrants within the country; findings from this study underscore the necessity for such policies both in and outside of the Colombian context
The United States detention system for migrants
The United States of America (US) detains more migrants than any other nation. Customs and Border Patrol (CBP) and Immigration and Customs Enforcement (ICE) detain adults and families under the Department of Homeland Security, while unaccompanied minors are housed under the Office of Refugee Resettlement (ORR) within the Department of Health and Human Services. Migrants are subject to the standards and oversight of each individual agency and faci…
Bounded agency in humanitarian settings
The Health Sector Gap in the Southern Africa Crisis in 2002/2003
The southern Africa crisis represents the first widespread emergency in a region with a mature HIV/AIDS epidemic. It provides a steep learning curve for the international humanitarian system in understanding and responding to the complex interactions between the epidemic and the causes and the effects of this crisis. It also provoked much debate about the severity and causes of this emergency, and the appropriateness of the response by the humani…
Determining the Number of Refugees to Be Resettled in the United States
Through engagement with key informants and review of ethical theories applicable to refugee policy, this paper examines the ethical and policy considerations that policy-level stakeholders believe should factor into setting the refugee resettlement ceiling. We find that the ceiling traditionally has been influenced by policy goals, underlying values, and practical considerations. These factors map onto several ethical approaches to resettlement. …
Health Issues Affecting Displaced Populations
The field of humanitarian response has made tremendous strides over the past decade. In the Cambodian refugee camps in the 1980s, the establishment of
The Relief-Reconstruction-Development Dynamic
After a critical analysis of the relief-development continuum, a new conceptual model is proposed for areas with chronic instability in complex humanitarian emergencies - the Relief-Reconstruction- Development Dynamic (R2D2). This model incorporates the dynamic interactions of the relief, reconstruction and development phases over time and geography. Using the chronic instability of Liberia between 1990 and 1997 as an example, the author applies …
Notes from the Field in Kigoma, Tanzania
In these short notes the authors provide some insight to their visit to displaced persons camps in Kigoma, Tanzania. This trip marks the fourth set of camps examined in the Post Emergency Phase Indicators Project, a joint collaboration between the Johns Hopkins Center for Refugee and Disaster Studies, and the International Emergency and Refugee Health Branch at the Centers for Disease Control
Health Issues Affecting Displaced Populations
The field of humanitarian response has made tremendous strides over the past decade. In the Cambodian refugee camps in the 1980s, the establishment of
Continuous Quality Improvement Applied to Outpatient Health Care Delivery in Displaced Persons Camps
Continuous Quality Improvement (CQI) has been shown to be a highly effective approach for the evaluation and management of hospitals in developed countries, but it has barely begun to be utilised in less developed countries. This article defines the principles and the main tools of CQI and then applies them to the postemergency phase of a displaed persons camp situation, specifically towards improving the utilisation and the quality of care in an…
The Accuracy of Mortality Reporting in Displaced Persons Camps During the Post-emergency Phase
For humanitarian organisations, accurate data are essential to identify emerging health problems and determine programme needs. We visited 45 post-emergency phase displaced persons camps and collected three months' mortality data which we compared with organisations' routine mortality reports. Organisations reported 612 deaths and we identified 741 deaths, for a mortality-reporting ratio, defined as the number of organisation-reported deaths divi…
The Application of Geographic Information Systems and Global Positioning Systems in Humanitarian Emergencies
Geographic information systems (GIS), global positioning systems and remote sensing have been increasingly used in public health settings since the 1990s, but application of these methods in humanitarian emergencies has been less documented. Recent areas of application of GIS methods in humanitarian emergencies include hazard, vulnerability, and risk assessments; rapid assessment and survey methods; disease distribution and outbreak investigation…
Communicable diseases in complex emergencies
Lessons learned from complex emergencies over past decade
HIV/Aids among Conflict-affected and Displaced Populations
Conflict, displacement, food insecurity and poverty make affected populations more vulnerable to HIV transmission. However, the common assumption that this vulnerability necessarily translates into more HIV infections and consequently fuels the HIV/AIDS epidemic is not supported by data. Whether or not conflict and displacement affect HIV transmission depends upon numerous competing and interacting factors. This paper explores and explains the ep…
The Health Sector Gap in the Southern Africa Crisis in 2002/2003
The southern Africa crisis represents the first widespread emergency in a region with a mature HIV/AIDS epidemic. It provides a steep learning curve for the international humanitarian system in understanding and responding to the complex interactions between the epidemic and the causes and the effects of this crisis. It also provoked much debate about the severity and causes of this emergency, and the appropriateness of the response by the humani…
HIV behavioural surveillance surveys in conflict and post-conflict situations
Behavioural surveillance surveys (BSSs), an evolution from the knowledge-attitudes-practice surveys (KAPs), are a tool to track trends in HIV/AIDS knowledge, attitudes and risk behaviour among populations. The data collected support organizations in targeting specific HIV/AIDS prevention and care activities, monitoring their effectiveness and coverage, and allocating scarce resources. The objectives are to evaluate the quality and standardization…
Using Design Effects From Previous Cluster Surveys to Guide Sample Size Calculation in Emergency Settings
A good estimate of the design effect is critical for calculating the most efficient sample size for cluster surveys. We reviewed the design effects for seven nutrition and health outcomes from nine population-based cluster surveys conducted in emergency settings. Most of the design effects for outcomes in children, and one-half of the design effects for crude mortality, were below two. A reassessment of mortality data from Kosovo and Badghis, Afg…
Occurrence and overlap of natural disasters, complex emergencies and epidemics during the past decade (1995–2004)
Epidemics commonly occur during CEs. The data presented in this article do not support the often-repeated assertion that epidemics, especially large-scale epidemics, commonly occur following large-scale natural disasters. This observation has important policy and programmatic implications when preparing and responding to epidemics. There is an important and previously unrecognized overlap between natural disasters and CEs. Training and tools are …
Differences in HIV-related behaviors at Lugufu refugee camp and surrounding host villages, Tanzania
This research has important programmatic implications. Regardless of differences between camp and village populations, study results point to the need for targeted activities within each population. Services should include youth education and life skills programs emphasizing the benefits of delayed sexual initiation and the risks involved in transactional sex, especially in the camp where greater proportions of youth are affected by these issues …
HIV behavioural surveillance among refugees and surrounding host communities in Uganda, 2006
We used a standardised behavioural surveillance survey (BSS), modified to be directly relevant to populations in conflict and post-conflict settings as well as to their surrounding host populations, to survey the populations of a refugee settlement in south-western Uganda and its surrounding area. Two-stage probability sampling was used to conduct 800 interviews in each population. The BSS questionnaire adapted for displaced populations was admin…
Health-care needs of people affected by conflict
Conflict-affected displaced persons need to benefit more from HIV and malaria national strategic plans and Global Fund grants
Countries that have signed the 1951 refugee convention have an obligation to care for refugees and this includes provision of health care. IDPs are citizens of their own country but like refugees may also not be a priority for Governments' NSPs and funding proposals. Besides legal obligations, Governments have a public health imperative to include these groups in NSPs and funding proposals. Governments may wish to add a component for refugees tha…
Performance of UNHCR nutrition programs in post-emergency refugee camps
Inclusion of children identified as moderately and severely wasted in the HIS would allow UNHCR to better track and respond to changes in nutrition status. Improved growth monitoring coverage or active malnutrition surveillance would increase UNHCR's ability to identify and treat cases of acute malnutrition. Expansion of nutrition reporting to address the transition to community-based therapeutic care is essential for adequate performance monitor…
Incidence and risk factors for malaria, pneumonia and diarrhea in children under 5 in UNHCR refugee camps
As in stable settings, pneumonia and diarrhea are important causes of mortality among refugee children. Malaria remains a significant cause of child mortality in refugee camps in Africa and will need to be addressed as part of regional malaria control and elimination efforts. Little is known of neonatal morbidity and mortality in refugee settings, and neonatal deaths are likely to be under-reported. Global measles control efforts have reduced the…
Public health equity in refugee situations
Addressing increasing concerns about public health equity in the context of violent conflict and the consequent forced displacement of populations is complex. Important operational questions now faced by humanitarian agencies can to some extent be clarified by reference to relevant ethical theory. Priorities of service delivery, the allocation choices, and the processes by which they are arrived at are now coming under renewed scrutiny in the lig…
The burden of malaria in post-emergency refugee sites
These findings represent one of the most extensive reports on malaria among refugees in post-emergency sites. Despite declines in malaria incidence among refugees in several countries, malaria remains a significant cause of mortality among children younger than five years of age. Further progress in malaria control, both within and outside of post-emergency sites, is necessary to further reduce malaria incidence and mortality among refugees and a…
Utilization of outpatient services in refugee settlement health facilities
The availability of a centralized database of health information across UNHCR-supported refugee settlements is a rich resource. The SPHERE standard for emergencies of 1-4 visits per person per year appears to be relevant for Asia in the post-emergency phase, but not for Africa. In Africa, a post-emergency standard of 1-2 visits per person per year should be considered. Although it is often assumed that the size of the female population in refugee…
A Study of Refugee Maternal Mortality in 10 Countries, 2008–2010
CONTEXT: Little is known about the prevalence of maternal mortality in refugee camps for populations displaced by conflict, or about the factors contributing to such deaths. METHODS: Maternal Death Review Reports were used to analyze maternal deaths that occurred in 2008-2010 in 25 refugee camps in 10 countries. Assessed outcomes included causes of death; delays in women seeking, reaching or receiving care; and additional aspects of case manageme…
Child Acute Malnutrition and Mortality in Populations Affected by Displacement in the Horn of Africa, 1997–2009
Drought and conflict in the Horn of Africa are causing population displacement, increasing risks of child mortality and malnutrition. Humanitarian agencies are trying to mitigate the impact, with limited resources. Data from previous years may help guide decisions. Trends in different populations affected by displacement (1997-2009) were analyzed to investigate: (1) how elevated malnutrition and mortality were among displaced compared to host pop…
Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring
OBJECTIVE: Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statist…
Medicine (63 obras) · Environmental health (46 obras) · Political science (41 obras) · Migration, Health and Trauma (38 obras) · Refugee (36 obras) · Public health (34 obras) · Nursing (32 obras) · Global Maternal and Child Health (26 obras) · Population (25 obras) · Geography (23 obras)