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Institute of Epidemiology and Health Care Blog

Social Capital and Political Dynamics in the Refugee Experience

By Eleanor Mason, on 19 August 2024

This blog for World Humanitarian Day (WHD) by visiting PhD student Samah Halwany from UNIMC-Italia explores the implications of refugees’ precarious status on their dignity, identity and overall well-being. Samah’s thesis investigates the strategies that Syrian refugee women with disabilities utilise to foster their social inclusion in Gaziantep, Türkiye.

The 2024 WHD theme, #ActForHumanity, focuses on addressing the alarming rise in attacks against humanitarian workers and civilians, advocating for the enforcement of International Humanitarian Law to end impunity for these violations .

Refugees often navigate a challenging landscape of displacement and uncertainty, which significantly hampers their efforts to rebuild their lives. In this blog I will explore how the broader socio-political challenges encountered by refugees are often exacerbated by political labelling.

The humanitarian principle is founded on the protection of all individuals. However, individuals in vulnerable situations are often subjected to political categorization, which significantly shapes how their presence in the world is perceived. According to Samuel Dinger (2022), the concept of rights is closely linked to one’s status as a citizen of a sovereign nation. if a country were to lose its sovereignty, individuals may also lose certain rights. This leads to their categorisation based on political status, such as “migrants”, “refugees” “displaced persons” (as used in Lebanon), and those “under permanent protection” (in Türkiye). The semantic distinction is significant and has been the subject of considerable scholarly and political discourse. Notably, state authorities frequently employ the term “migrant”, “displaced”, “permenantly protected” to implicitly challenge the legitimacy of individuals seeking asylum, while non-governmental organisations conversely utilise “refugee” to underscore the veracity of their protection claims (Fassin 2021, p. 63).

The rights of refugees are primarily restricted to the provision of services, which are often short-lived, dependent upon the availability of international aid. The availability and nature of these services can vary significantly based on the location where refugees are placed in relation ot the hosting population (Dinger 2022). Basic services are usually the only rights available in camps, whereas outside the camps, individuals may have access to formal education, livelihood opportunities, and social engagement. However, in both settings, political attitudes often aim to keep individuals in a state of temporary emergency with the goal of returning them to their home countries, whether by choice or by force.

Governments often view refugees as mere numbers to manage, restricting their mobility and quality of life to encourage return and prevent permanent resettlement. They may also resort to using refugees to secure international funding and may threaten repatriation if aid is reduced, while fostering negative sentiments to gain electoral support (the case of Lebanon and Türkiye). In contrast, humanitarian agencies focus on emergency contexts, struggling to overcome barriers to increase their services. This dichotomy frequently reduces refugees to statistics and emergency cases, overshadowing their broader human dignity and rights.

In this context, refugees face daily challenges that undermine their human dignity and the value of their lives. They lose all privileges and social and cultural capitals once labelled politically. Those with economic capital are often more readily accepted and integrated into host communities. For many refugees, especially those living outside controlled zones such as camps, survival depends on building social capital within both the host and their own communities to access economic resources and gain solidarity. Through these interactions, refugees may find jobs and establish NGOs to support their communities. However, host governments generally accept this social capital only if it does not challenge the status quo. In Lebanon, for example, refugee activists who collaborated with Lebanese counterparts to advocate for the rights of refugees and other vulnerable groups began to gain social position. Unfortunately, activists became targets for attacks, facing threats from local authorities and armed individuals, and were subjected to detention. Security forces investigated their mobile contacts, questioned them about their associations with activists, and used various tactics to make them feel unsafe, including surveillance and, in some cases, torture (as recently documented by the Access Centre for Human Rights (ACHR, July 2024). Some activists were even threatened with deportation back to Syria. To escape these dangers, many sought asylums at European embassies, hoping for a better life while leaving their families behind under threat until they could reunite.

Even though refugees often lose the social and economic resources they acquired in their homeland to survive in host countries, they strive to resist the political attitudes that reduce their existence to its most basic form. They work to maintain their dignity and identity despite being perceived as a “burden” or “confined” to camps, as described by Shaabo (2024). This struggle reflects a broader issue of “double absence”, a concept introduced by Algerian sociologist Abdelmalek Sayad as cited in Yafa’ al Hasan (2024). It is the feeling of being “neither here nor there,” meaning they are neither truly present in their country of origin nor fully accepted in the host country. This ongoing struggle underscores the complex challenges refugees face as they seek to assert their identity and rights in a world that often oppresses them.

A human-rights centred approach is essential to address the complex challenges faced by refugees. This requires robust advocacy, rigorous monitoring of human rights violations, and empowering refugee-led initiatives. International collaboration among organizations, governments, and refugees is crucial for developing sustainable solutions, reforming laws to protect and include refugees, and validating their experiences. By prioritizing refugees’ lives and rights, we can advance an “ethics of life” that encompasses not only physical safety but also the “living beings and the lived experiences”-“le vivant et le vécu”(Fassin p 42).

Furthermore, socio-economic integration programs and joint community development initiatives can bridge the gap between refugees and host communities, as well as promote cooperation in economic and community development projects. Cross-cultural exchange programs and heritage sharing can further strengthen this connection, allowing refugees to preserve their culture while adapting to their new environment.

By prioritising these recommendations, we can create a future where refugees are seen not as ‘problems’ needing basic survival support, but as active participants valued for their full humanity.

References :

• Fassin, D. (2018)  La vie. Mode d’emploi critique , Condé-sur-Noireau, Seuil.
• Dinger, S. (2022). Coordinating Care and Coercion: Styles of Sovereignty and the Politics of Humanitarian Aid in Lebanon. Humanity: An International Journal of Human Rights, Humanitarianism, and Development 13(2), 218-239.  https://dx.doi.org/10.1353/hum.2022.0009 .
• Shaabo, R. (2024, March 12). حين تصبح الهوية عبئاً (المثال السوري)) [When Identity Becomes a Burden (The Syrian Example)] Raseef22 . https://raseef22.net/article/1096763 .
• Al Hasan, H. (2024, June 9): من أنت، إلى أين تنتمي؟”… أسئلة الهوية الملحة عند المهاجرين [Who are you, and where do you belong?” … Urgent Identity Questions for Migrants] Raseef22 . https://raseef22.net/article/1097521
• Access Centre for Human Rights-ACHR, Private Letter (July 11,2024): Lebanese Authorities must Immediately Stop Intimidating Human Rights Activist. As a joint statement by Human rights organizations-not published.  Website: https://www.achrights.org/en/

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Efficacy and Safety of Acoramidis in Transthyretin Amyloid Cardiomyopathy - ATTRibute-CM

Contribution to literature:.

Highlighted text has been updated as of January 22, 2024.

The ATTRibute-CM trial showed that acoramidis HCl is superior to placebo for improving both hard CV endpoints as well as quality of life endpoints among patients with ATTR-CM.

Description:

The goal of the trial was to compare the safety and efficacy of acoramidis compared with placebo among patients with transthyretin amyloid cardiomyopathy (ATTR-CM).

Study Design

Eligible patients were randomized in a 2:1 randomized double-blinded fashion to either acoramidis HCl (n = 421) or matching placebo (n = 211). Acoramidis was administered at a dose of 800 mg BID for 30 months .

• Total number of enrollees: 632
• Duration of follow-up: 30 months
• Mean patient age: 77.3 years
• Percentage female: 10%

Inclusion criteria:

• Age 18-90 years
• Met the following two criteria: diagnosed ATTR-CM (wild-type [WT] or variant); New York Heart Association (NYHA) class I-III with ≥1 hospitalization for heart failure (HF); signs and symptoms of volume overload; HF that resulted in diuretic treatment; ATTR-positive biopsy or technetium-99m scintigraphy (99mTc) scan; light chain amyloidosis excluded if diagnosis by 99mTc
• Six-minute walk distance ≥150 m
• N-terminal pro–B-type natriuretic peptide (NT-proBNP) ≥300 pg/mL
• Left ventricular wall thickness ≥12 mm

Exclusion criteria:

• Acute coronary syndrome, stroke, transient ischemic attack, or coronary revascularization within 90 days
• Likely heart transplant within 1 year
• AL amyloidosis
• Transaminitis
• NT-proBNP ≥8500 pg/mL
• Estimated glomerular filtration rate <15

Other salient features/characteristics:

• ATTRwt-CM: 90.4%
• NT-proBNP: 2326 pg/mL
• Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) at baseline: 71
• Concomitant tafamidis use: 18%

Principal Findings:

The primary endpoint, a hierarchical analysis consisting of all-cause mortality, cumulative frequency of cardiovascular (CV)-related hospitalization, change from baseline in NT-proBNP, and change from baseline in 6-minute walk distance, had an overall win ratio favoring acoramidis (win ratio 1.8, 95% confidence interval [CI] 1.4-2.2, p < 0.0001).

Secondary outcomes for acoramidis vs. placebo:

• All-cause mortality: 19.3% vs. 25.7% ; hazard ratio (HR) 0.77, 95% CI 0.54-1.10 (p = 0.15)
• Adjusted mean factor change in NT-proBNP from baseline: 0.529 (95% CI 0.46-0.60, p < 0.05)
• Improvement from baseline in 6-minute walk distance: 39.6 m (95% CI 21.1-58.2, p < 0.001)
• CV-related hospitalization: 26.7% vs. 42.6% (p < 0.0001)
• Least means square change in KCCQ-OS: 9.94 points (95% CI 5.97-13.91, p < 0.001)

Composite of all-cause mortality and CV-related hospitalization: HR 0.65, 95% CI 0.50-0.83 (p = 0.0008; number needed to treat = 7)

Interpretation:

The results of this trial indicate that acoramidis 800 mg BID is superior to placebo for improving both CV endpoints (primarily CV-related hospitalization) as well as surrogate (NT-proBNP) and quality of life endpoints among patients with ATTR-CM. Both tafamidis and acoramidis are stabilizers of transthyretin. Acoramidis has the potential to be an effective and safe alternative to tafamidis for the treatment of ATTR-CM. A head-to-head comparison and cost considerations are important next steps.

References:

Gillmore JD, Judge DP, Cappelli F, et al., on behalf of the ATTRibute-CM Investigators. Efficacy and Safety of Acoramidis in Transthyretin Amyloid Cardiomyopathy. N Engl J Med 2024;390:132-42 .

Presented by Dr. Daniel Judge at the American Heart Association Scientific Sessions, Philadelphia, PA, November 12, 2023.

Presented by Dr. Julian Gillmore at the European Society of Cardiology Congress, Amsterdam, Netherlands, August 27, 2023.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: AHA23, Amyloid, Cardiomyopathies, Heart Failure

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Money A+E Volunteers

Applications for this opportunity are now closed.

22 September 2023

About the Organisation

Money A+E are a non-profit social enterprise that provide money advice and education projects / services to people from disadvantaged communities. Volunteers play an invaluable part in helping them achieve this aim.

About the Role

Money A+E are looking for volunteers in their Project Support Department:

Project Support Volunteers – (x3) volunteers to provide administrative support to project workers including:

• Conducting initial triage assessments of clients (via telephone)
• Assisting clients with form filling and completing a basic financial statement
• Booking in clients for appointments with Money Coaches
• Inputting information into their Case Management System, monitoring spreadhseets and email database
• Communicating with clients via phone or email to share updates on their case and/or gather information
• Assisting Money Coaches with client appointments
• To provide assistance to the Workshop Trainers at workshops
• General administrative tasks (photocopying, scanning, creating client files and filing)
• To signpost and refer attendees to internal/external services

You will be volunteering for a community focused organisation. You will make a significant difference in the lives of 100's of individuals and families impacted by austerity, low paid income and more.

Venue for Volunteer Work

Money A+E is based in Mansfield House, London, E13 8HT but work will primarily take place remotely or at outreach locations, where Money A+E go to deliver services . 

Required Skills and Characteristics 

• Ability to work as part of a team
• Good administration skills
• Excellent communications skills with the ability to clearly articulate verbally and in written form
• Good people skills
• You must be self-motivated and have good time management
• Good I.T. skills (Microsoft office, outlook, using the internet).
• We are looking for someone who has a desire to help people deal with the challenges of financial exclusion, debt and financial confidence.
• We are looking for someone who is able to work as part of a team, nonjudgmental in thinking and able to communicate and engage with diverse groups within the local communities.
• Open to a flexible working approach.

Desirable Qualities 

• To have an interest in social / financial inclusion challenges in the local community.
• Have the ability to be creative and innovative within the scope of the role.
• Have a passion to bring positive change to the local community.
• Able to self-motivate and work well as part of team.
• Ability to be creative and innovative within role.
• Passion to change the local community.

Training and Supervision Provided: 

Money A+E will provide you with: 

• an induction
• E-Learning opportunities
• Provide in-house CMS training
• Information on their Policies and Procedures
• Students undertaking the Money Mentoring role will be provided with a mandatory 8 week training course (one half day a week). 

Students will also be asked to watch a series of skills based short training videos provided by the Centre for Access to Justice prior to beginning their placement. 

Time and Student Commitment: 

Students are expected to commit at least one half day a week from the period of November until end of March. 

Eligibility

This opportunity is open to all LLB and LLM students.

How to Apply

Key information and deadline.

Deadline for applications : CLOSED.

Who can apply : All LLB and LLM Students. 

Time Commitment : At least one half day per week from November to end of March.

Can be done remotely:  Yes with potential to visit outreach locations.