The Institute for Global Health and Development
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9
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Item Care as Resistance, Care as Agency, Care as a Burden: A Relational Exploration of the Impact of Giving and Receiving Care on Refugees’ Lives(Oxford University Press, 2025-09-23) Baillot, Helen; Vera Espinoza, Marcia; Yurdakul, G.; Beaman, J.; Mügge, L.; Scuzzarello, S.; Sunanta, S.This chapter discusses the multidimensionality and multidirectionality of care and its impact upon refugees’ pathways toward inclusion. Drawing on qualitative data collected during workshops and interviews with 55 recently recognized refugees in Scotland, the chapter explores how care in multiple forms is experienced, given, and negotiated. The chapter draws from ideas around care that conceptualize it as a means to resist restrictive government policies, as an expression of agency within familial and social contexts, and as a burden that affects people differentially as they seek to rebuild lives in new country contexts. In exploring the multiple dimensions and directions of care and the ways it intersects with gender and immigration status, among other social locations, we highlight conceptual and empirical parallels between care and integration. One, the text suggests, should not be understood without full consideration of the other. The chapter concludes by calling for care to be accorded a greater importance in explorations of refugees’ integration experiences, in ways that fully encompass care’s potentialities and limitations for the people who provide and receive it.Item Rethinking pathways to well-being: the function of faith practice in distress alleviation among displaced Muslim women affected by war(Frontiers Media, 2025-07-21) Rutledge, Kathleen K.Background: For many populations globally, coping approaches employed during times of extreme adversity are rooted in religious convictions. Positive religious coping following potentially traumatic events and in times of crisis is widely evidenced as resilience promoting. Despite international mandates for aid and mental health responses to enable such coping, there is limited guidance for work with distinct faith groups and limited quantitative evidence overall. This mixed methods study examined the role of faith in mental health among displaced Muslim women affected by conflict, highlighting implications for responders. Methods: A total of 160 questionnaires, 50 interviews, and four focus groups were conducted among 160 Sunni Muslim women in an Iraqi internally displaced persons (IDP) camp with subjects who had been affected by the Islamic State of Iraq and Syria (ISIS) conflict. A total of 19 faith leaders, MHPSS providers, and humanitarian workers were interviewed as key informants. Qualitative responses were analyzed using inductive thematic analysis, while statistical tests examined variable correlations between the mean scores of response groups. Results: Religious meanings were attributed to every aspect of daily life, in addition to shaping fundamental understandings of wellbeing, the ultimate goals of life, and the coping strategies employed. Religiosity was high. Prayer, reciting, or reading the Qur’an, and fasting were widely reported as a means of comfort, stress relief, divine protection, and daily provision. The function of faith practices in distress alleviation was mediated by the individual’s beliefs regarding the afterlife and by their perception of God’s “care” for their life and situation. Self-appraised “inadequate” faith practice—seen as incompatible with the fundamental goal of life for many in the study, entering Paradise after death—and feeling that God does not “care”, were variables associated with higher distress and poor mental health. Gender-blind approaches in the camp and exclusion of faith needs from assessments and response actions compounded distress by creating access barriers. Ensuring access to gender- and faith-sensitive coping resources (when requested by the affected individuals) is likely to boost mental health outcomes, particularly when such supports align with recovery and/or strengthening of the individual’s sense of connectedness to a benevolent, responsive God.Item Women informal food traders during COVID-19: A South African case study(Taylor & Francis Group, 2022-07-01) Sinyolo, Sikhulumile; Jacobs, Peter; Nyamwanza, Admire; Maila, MatumeVaried roles of informal food traders, ranging from localised distribution of foods to provision of jobs, became more accentuated in the context of the COVID-19 pandemic in South Africa. While women might be the majority of informal food traders, they are more likely than men to suffer a heavier burden of the adverse outcomes, due to structural, social, institutional and administrative biases. This article draws from a survey of 840 informal food traders in South Africa to investigate the extent to which the impacts of COVID-19, and the government assistance measures, were gendered. Adopting a gendered lens and analysing the data using descriptive statistics, the findings show that the informal food traders experienced significant disruptions, which led to business closures, fewer customers, reduced supplies, and increased operating costs. Further, the study found that the informal enterprises operated by women experienced higher impacts than those owned by men. The analysis also shows that while access to COVID-19-related assistance from either state or non-state actors was generally limited, women had the least access to it. The findings of the study indicate that women experienced the worst economic effects of the pandemic, yet received the least assistance. This highlights the need to improve the gender sensitivity of interventions. The role of informal food traders and women in the country’s agri-food system needs to be acknowledged and harnessed. It is crucial that an updated information management system be established, that is not only inclusive of informal food traders, but that specific focus should be exerted in identifying those enterprises operated by marginalised actors, such as women.Item Factors influencing the retention of secondary midwives at health centres in rural areas in Cambodia: The role of gender—a qualitative study(BMC, 2021-11-19) Abe, Kimiko; Ros, Bandeth; Chea, Kimly; Tung, Rathavy; Fustukian, SuzanneBackground: Retention of skilled midwives is crucial to reducing maternal mortality in rural areas; hence, Cambodia has been trying to retain at least one secondary midwife who can provide basic emergency obstetric care at every health centre even in rural areas. The factors influencing the retention of midwives, but not solely secondary midwives, have been identified; however, the security issues that affected female health workers during the conflict and the post-conflict years and gender issues have been unexplored. This study explores these and other potential factors influencing secondary midwife retention and their significance. Methods: Sequential two-stage qualitative interviews explored influential factors and their significance. The first stage comprised semi-structured interviews with 19 key informants concerned with secondary midwife retention and in-depth interviews with eight women who had deliveries at rural health centres. Based on these interview results, in-depth interviews with six secondary midwives who were deployed to a rural health centre were conducted in the second stage. These midwives ranked the factors using a participatory rural appraisal tool. These interviews were coded with the framework approach. Results: Living with one’s parents or husband, accommodation and security issues were identified as more significant influential factors for secondary midwife retention than current salary and the physical condition of the health centre. Gender norms were entrenched in these highly influential factors. The deployed secondary midwives who were living apart from one’s parents or spouse requested transfer (end of retention) to health centres closer to home, as other midwives had done. They feared gender-based violence, although violence against them and the women around them was not reported. The health workers surrounding the midwives endorsed the gender norms and the midwives’ responses. The ranking of factors showed similarities to the interview results. Conclusions: This study suggests that gender norms increased the significance of issues with deployments to rural areas and security issues as negative factors on female health workforce retention in rural areas in Cambodia. This finding implies that further incorporating gendered perspectives into research and developing and implementing gender-responsive policies are necessary to retain the female health workforce, thereby achieving SDGs 3 and 5.Item Living with transience in high-risk humanitarian spaces: Gendered experiences of international staff and policy implications for building resilience(Wiley, 2020-08-10) Strohmeier, Hannah; Panter-Brick, CatherineBeing deployed in crisis zones is perilous business. To-date, little is known regarding how humanitarian workers relate social and professional goals to lived experiences of high-risk environments. In South Sudan, ranked as the most dangerous country for aid workers globally, we interviewed international humanitarian staff (n=20) to examine, using thematic and interpretative phenomenological analysis, their sense of place, wellbeing, and vocation. Subjectivities of humanitarian spaces hinged upon negotiating physical hardships and social relationships: Juba was described both as a "prison" and "party hot spot." For expatriate staff, making sense of spatial, social, and professional transience was sharply gendered and rooted in subjectivities of risk-taking, crisis-managing, and career-building. We highlight two policy measures to address the implications of transience for human wellbeing and organizational effectiveness. Efforts to support teams and structure work environments, altering the humanitarian and vocational bubble, will help build resilience at the heart of humanitarian systems.Item The gendered health workforce: Mixed methods analysis from four fragile and post-conflict contexts(Oxford Academic, 2017-12-09) Witter, Sophie; Namakula, Justine; Wurie, Haja; Chirwa, Yotamu; So, Sovanarith; Vong, Sreytouch; Ros, Bandeth; Buzuzi, Stephen; Theobald, SallyIt is well known that the health workforce composition is influenced by gender relations. However, little research has been done which examines the experiences of health workers through a gender lens, especially in fragile and post-conflict states. In these contexts, there may not only be opportunities to (re)shape occupational norms and responsibilities in the light of challenges in the health workforce, but also threats that put pressure on resources and undermine gender balance, diversity and gender responsive human resources for health (HRH). We present mixed method research on HRH in four fragile and post-conflict contexts (Sierra Leone, Zimbabwe, northern Uganda and Cambodia) with different histories to understand how gender influences the health workforce. We apply a gender analysis framework to explore access to resources, occupations, values, decision-making and power. We draw largely on life histories with male and female health workers to explore their lived experiences, but complement the analysis with evidence from surveys, document reviews, key informant interviews, human resource data and stakeholder mapping. Our findings shed light on patterns of employment: in all contexts women predominate in nursing and midwifery cadres, are under-represented in management positions and are clustered in lower paying positions. Gendered power relations shaped by caring responsibilities at the household level, affect attitudes to rural deployment and women in all contexts face challenges in accessing both pre- and in-service training. Coping strategies within conflict emerged as a key theme, with experiences here shaped by gender, poverty and household structure. Most HRH regulatory frameworks did not sufficiently address gender concerns. Unless these are proactively addressed post-crisis, health workforces will remain too few, poorly distributed and unable to meet the health needs of vulnerable populations. Practical steps need to be taken to identify gender barriers proactively and engage staff and communities on best approaches for change.Item Minding the gaps: health financing, universal health coverage and gender(Oxford University Press, 2017-07-25) Witter, Sophie; Govender, Veloshnee; Ravindran, T. K. Sundari; Yates, RobertIn a webinar in 2015 on health financing and gender, the question was raised why we need to focus on gender, given that a well-functioning system moving towards Universal Health Coverage (UHC) will automatically be equitable and gender balanced. This article provides a reflection on this question from a panel of health financing and gender experts. We trace the evidence of how health-financing reforms have impacted gender and health access through a general literature review and a more detailed case-study of India. We find that unless explicit attention is paid to gender and its intersectionality with other social stratifications, through explicit protection and careful linking of benefits to needs of target populations (e.g. poor women, unemployed men, femaleheaded households), movement towards UHC can fail to achieve gender balance or improve equity, and may even exacerbate gender inequity. Political trade-offs are made on the road to UHC and the needs of less powerful groups, which can include women and children, are not necessarily given priority. We identify the need for closer collaboration between health economists and gender experts, and highlight a number of research gaps in this field which should be addressed. While some aspects of cost sharing and some analysis of expenditure on maternal and child health have been analysed from a gender perspective, there is a much richer set of research questions to be explored to guide policy making. Given the political nature of UHC decisions, political economy as well as technical research should be prioritized. We conclude that countries should adopt an equitable approach towards achieving UHC and, therefore, prioritize high-need groups and those requiring additional financial protection, in particular women and children. This constitutes the 'progressive universalism' advocated for by the 2013 Lancet Commission on Investing in Health.