Journal on Training in Emergencies Quantity 7, #1 (June 2021) – World
By Sweta Shah and Joan Lombardi
Children learn constantly from birth to the age of eight. What happens in these early years, starting with pregnant women’s physical and mental health, affects children’s long-term health, learning, and behavior. As babies and toddlers explore and learn to play peekaboo, they are developing thousands of neural connections each second. While children gradually gain confidence and independence, their emotional connection with their parents remains important throughout life. Parents and primary caregivers are children’s first and most important teachers, their protectors, and their emotional anchors. What a child is exposed to in his or her environment, the love she or he receives from a caring adult, and the opportunities available to him or her are the critical building blocks of life. When these building blocks are strong, children thrive.
When young children experience an emergency due to conflict or a natural disaster, it can change their entire early life experiences and alter their life trajectories. An increasing number of children today are born into crises caused by violent conflicts and environmental changes. There are currently more than 70.8 million forcibly displaced people worldwide: 25.9 million are refugees, 41.3 million are internally displaced, and 3.5 million are asylum seekers (UNHCR 2018). Approximately 35 million of these uprooted individuals are children ages 0-18. In 2018 alone, 29 million babies were born in crisis settings (UNICEF 2019).
For many children, protracted conflicts mean a lifetime of displacement and disruption. Young children may sustain deep emotional scars from witnessing violence, migrating under difficult physical conditions, and living in dangerous and stressful conditions for long periods of time. They also may be separated from their parents or primary caregivers. Moreover, crisis-affected children frequently lack access to adequate health care and early learning opportunities, face food and water shortages, and experience the loss of a parent or other caregiver, physical injuries, and other extreme challenges to survival, which increase their mortality rates.
For many years, attention to the effects such disruptions have on the developing child has been severely limited or nonexistent. However, due to the number and nature of recent crises, international aid agencies and other critical actors have started to broaden their focus to include the plight of very young children. In the past 18 months, the COVID-19 pandemic has created a double tragedy for children and families already displaced or caught in conflict.
Early childhood interventions that support development from conception to age eight can create a buffer against the difficulties young children face in emergencies. These efforts can be enhanced by the people who are most important in a child’s environment—parents and primary caregivers, teachers, health-care workers, and others. Writing from our position as long-time advocates for young children, we know the time is right to highlight the challenges they confront, and to showcase the programs and the researchers currently working to improve their lives.
This issue of the Journal on Education in Emergencies (JEiE) provides a glimpse into some of the work taking place to address the needs of young children and families around the world who were facing emergencies before the outbreak of COVID-19. Early childhood development (ECD) in emergencies is in a relatively nascent stage compared to other aspects of education in emergencies and humanitarian response. Although this area of work is growing, there are few articles and books available on the subject. This special issue of JEiE brings visibility to early childhood development in emergencies and highlights some of the lessons being learned through efforts to address the needs of young children and families living in humanitarian situations. This issue is also a call to action to bring additional attention to this critical age group.
We have framed the articles in this special issue within the Nurturing Care Framework for Early Childhood Development, which was launched in 2018 by WHO, UNICEF, and others (WHO, UNICEF, and World Bank 2018).The authors of these articles explain ECD through various lenses: education, child protection, health and nutrition, mental health and psychosocial support, and responsive caregiving. They underscore the importance of focusing not only on children after birth but also on their mothers during pregnancy and through their children’s early years.
Emergency settings are highly stressful, ever-changing contexts that affect children and their families and place heroic demands on those working to provide the services that meet their critical needs. It is difficult to collect data when families are moving back and forth across borders or within them. Furthermore, few research tools have been adapted to measure the critical aspects of child development that are grounded in cultural realities and local definitions. With most scholarship dominated by the Global North and published in English, those who are well placed to develop these tools—scholars from the Global South who are working and writing in a language other than English—face high barriers to access. Thus, there is a paucity of rigorous research focused on young children at different stages (i.e., acute crisis, postdisaster recovery) of various types of emergencies (i.e., conflict, climate-related natural disasters). This dearth of rigorous research and published work about best practices and lessons learned from programming in humanitarian contexts leaves key pieces missing from the kind of work needed to guide funding, policy, and programming decisions.
This special issue includes two research articles, five field notes, three commentaries, and two book reviews. The collection of articles provides an overall approach to the promotion of ECD that reflects three core principles. First is the importance of taking a “life course” approach, which starts by recognizing the needs of pregnant women and of families with very young children up to the age they enter school. The second is the importance of working across various development domains—physical, cognitive, linguistic, social, and emotional—to address the comprehensive needs of young children and families. And, finally, the third addresses the essential need to provide parents with economic and social support so they can be a solid anchor for their children. All three principles are especially critical in times of crisis. Despite the recognition of these key ingredients, programs that provide ECD in emergencies are only able to focus on a fraction of these needs, and often in a piecemeal way. Nevertheless, the contributors to this special issue provide hope that a pathway toward providing greater support for young children and their families in humanitarian contexts is emerging, and that growing experience and increasing evidence are creating a foundation on which programs that provide ECD in emergencies can build.
The issue starts with two research articles, one that highlights mixed methods research conducted in Nepal after the 2015 earthquake, and one that describes a qualitative study of the impact of wildfires on a community in Canada. In “Effects of Two Early Childhood Interventions on the Developmental Outcomes of Children in Post-Earthquake Nepal,” Jonathan Seiden, Valeria Kunz, Sara Dang, Matrika Sharma, and Sagar Gyawali illustrate the results of two quasiexperimental impact evaluations of a project implemented by Save the Children. Their research looks at the impact of two complementary models: one focused on the parents and caregivers of children from birth to three years old, and another focused on ECD outcomes for children ages three to six in centers established after the earthquake. The impact evaluation shows mixed results for these models. The intervention focused on parents and caregivers did not show any effect, whereas the model focused on ECD centers showed a positive impact. The researchers illustrate these results while also providing a critical examination of the challenges of conducting research in emergencies and possible reasons for the varied results.
In the second research article, “Early Childhood Development in the Aftermath of the 2016 Wildfires in Alberta, Canada,” authors Julie L. Drolet, Caroline McDonald-Harker, Nasreen Lalani, Sarah McGreer, Matthew R. G. Brown, and Peter H. Silverstone describe their use of qualitative methods to examine the experiences of children and families after the 2016 wildfires in Alberta, Canada. Their research illustrates the effects climate-related disasters, such as wildfires, have on children. They focus in particular on the psychosocial difficulties, but also on how parents are affected when infrastructure and services are not in place to support families. The authors illuminate how critically important it is for policymakers to prepare infrastructure and key services to provide for young children before, during, and after an emergency.
The research articles are followed by five important field notes that provide a context for the work taking place around the world to respond to the needs of young children and families experiencing emergencies. These field notes, which are authored by practitioners and practitioner-researchers, showcase emerging innovations and link practice with research. The conditions, responses, and approaches to service delivery vary, but a focus on mitigating stress and supporting parents’ and caregivers’ relationships with their children underscores most efforts. While four of the field notes address refugee families who have been displaced from their countries due to war and conflict, one addresses the stress of family violence—an everyday crisis many children face. The geographies included provide a glimpse of the hotspots around the world that are home to an increasing number of children born and raised in such settings.
The first field note makes a case for adapting a strong evidence-based home visiting model to the conflict-affected settings of Jordan, Lebanon, and Syria. In “Home Visiting in the Middle East: Reflections on the Implementation of Reach Up and Learn,” Katelin Swing Wilton, Aimée Vachon, Katie Maeve Murphy, Ayat Al Aqra, Abdullah Ensour, Iman Ibrahim, Anas Tahhan, Kayla Hoyer, and Christine Powell describe the implementation of this model in all three countries and share their observations and reflections from the first two years of the multiyear project. The authors provide background by describing the original Jamaican Home Visiting Program on which the Middle East program is based, as well as the important process of piloting and adaptation. They discuss the success of the implementation, the challenges faced, and the emerging results that demonstrate the importance of documenting these authentic experiences.
Moving to a different context in “Building Resilience and Mitigating the Impact of Toxic Stress in Young Children: A Model for Transforming Parenting and Male Caregiving in El Salvador,” Fabiola Lara describes her concrete experiences with another type of emergency: family violence. Unfortunately, many very young children around the world are living in countries with high levels of domestic violence, as well as community conflict. In her field note, Lara describes a model for addressing violence prevention and response that draws from a range of approaches used in education, child protection, and health and nutrition. This integrated approach is critically important to the promotion of ECD.
The next three field notes all describe work with the Rohingya refugee population. They again demonstrate the importance of working on multiple levels to address the needs of families, particularly to provide emotional support. In “Implementing a Humanitarian Needs Assessment Framework for Early Childhood Development: Informing Intervention Design for Displaced Rohingya Communities in Bangladesh,” Kim Foulds, Naureen Khan, Sneha Subramanian, and Ashraful Haque present a framework for conducting a needs assessment in humanitarian settings that reflects the value of understanding and incorporating community perspectives. The authors describe their rigorous, systematic approach to carrying out a needs assessment and in so doing set a higher bar for collecting the kind of reliable and nuanced data that are critical to designing contextually relevant research. Their experiences operationalizing this approach reinforce the essential step of assessing needs across sectors.
Further insights into direct service delivery are provided in the final two field notes. In “BRAC Humanitarian Play Lab Model: Promoting Healing, Learning, and Development for Displaced Rohingya Children,” Erum Mariam, Jahanara Ahmad, and Sarwat Sarah Sarwar discuss the power of play and psychosocial supports in promoting child development in a humanitarian setting. The Play Lab model they describe uses a community participatory approach that strongly emphasizes the importance of employing indigenous practices to foster healing and create a sense of belonging. The description of key features of the model provides a clear understanding of the important ingredients of effective programming.
The critical need to focus on emotional supports that is evident throughout this special issue is underscored by Samier Mansur in “Accessible Strategies to Support Children’s Mental Health and Wellbeing in Emergencies: Experience from the Rohingya Refugee Camp.” In this field note, Mansur documents the pilot study No Limit Generation, which was conducted to develop a video training platform for frontline aid workers, parents, and guardians. Mansur emphasizes the importance of innovation, including the use of new technologies, to reach caregivers and support their ability to ensure the wellbeing of vulnerable children, in particular those experiencing the detrimental effects of prolonged stress.
The field notes are followed by three critically important commentaries, a new feature of JEiE. These concise articles provide critical insights into a specific issue, question, policy matter, or research topic of current relevance to education in emergencies. These three commentaries highlight burgeoning areas that are critical aspects of ECD in emergencies. The section starts with “Newborns in Fragile and Humanitarian Settings: A Multi-Agency Partnership Roadmap” by Saverio Bellizzi, Lori McDougall, Sheila Manji, and Ornella Lincetto. As the authors point out, an estimated one-third of the annual neonatal deaths worldwide occur in humanitarian and fragile settings. They call for a coordinated response to support newborns and the relationship between newborn and maternal health, and for collective action across stakeholders to address these pressing issues.
“Supporting Maternal Mental Health and Nurturing Care in Humanitarian Settings,” by Bernadette Daelmans, Mahalakshmi Nair, Fahmy Hanna, Ornella Lincetto, Tarun Dua, and Xanthe Hunt, reinforces the critical need to focus on the mental health of mothers. This is an increasingly recognized theme in ECD in general but particularly during high-stress and protracted emergencies.
In the third commentary, “Children with Developmental Disorders in Humanitarian Settings: A Call for Evidence and Action,” Xanthe Hunt, Theresa Betancourt, Laura Pacione, Mayada Elsabbagh, and Chiara Servili point out that the impact of emergencies is magnified for children with disabilities. Services for these children are often extremely limited, if they exist at all; the damage this lack of services causes is particularly harmful when compounded by other vulnerabilities. Good practices, increased investment, and additional research are urgently needed to meet the needs of children with special needs and to provide critical supports for their families.
As the field of ECD in emergencies continues to grow, there are ever more books on the subject. This issue offers two book reviews, one that highlights how to conduct research in the early years and in humanitarian contexts, and one that offers insights into programmatic approaches to support young children in emergencies. Amy Jo Dowd reviews Collaborative Cross-Cultural Research Methodologies in Early Care and Education Contexts, edited by Samara Madrid Akpovo, Mary Jane Moran, and Robyn Brookshire. She explains that the book illustrates ways to conduct collaborative cross-cultural research for young children while delving deeper into the myriad nuances and dilemmas of doing research for and with young children. Dowd comments that, even as a seasoned researcher, this book gave her ways to improve her own research practice.
Reviewer Kate Schwartz explains that Early Childhood Development in Humanitarian Crises: South Sudanese Refugees in Uganda by Sweta Shah aims to reach a broad audience that includes researchers, practitioners, and policymakers. Schwartz describes how the book illustrates the challenges of conducting research in refugee contexts, including a mixed methods investigation of an ECD model used with South Sudanese refugee children living in Ugandan refugee settlements. She notes that the book provides a primer and a comprehensive picture of ECD in humanitarian settings: what it is or is not, what it could be, why we need it, and why it is not already more widespread. Both books provide useful insights for new and seasoned researchers, practitioners, and policymakers.
It is our fervent hope that the articles in this JEiE special issue provide evidence that we can, and should, support young children and their families in emergencies, starting when their mothers become pregnant and through their primary schooling and beyond. We also know that we have much more to learn to ensure the effectiveness of early childhood development in emergency interventions. We therefore call upon researchers to adopt new methods that will help them gain a better understanding of the impact of new and innovative interventions, particularly implementation research. Much can be learned from nongovernmental practitioners and frontline workers engaged in ECD in humanitarian contexts. For documentation of those experiences to be useful, it must clearly articulate goals, provide details of both the conditions and the implementation, and offer reflections on what was learned along the way. We believe it is both timely and essential that researchers and frontline workers are given many more opportunities to come together to share and learn from their respective experiences.
If we have learned anything from the decades of research done on the developing child, it is that we must invest early, and that investing in families and communities is critical to successful child development, especially in humanitarian contexts. We call on those who have resources available to invest in programming and research that enables the field of ECD in emergencies to continue to expand. We hope that our readers will be inspired by the efforts already taking place around the globe to nurture and protect a generation of children so that they may thrive wherever they live, and that these efforts will help to create a world in which conflict will give way to a peaceful and a more sustainable world.