Engineering a Holistic Response to the Global Crisis of Forced Displacement

The global coronavirus pandemic has demonstrated the necessity of engineering approaches, from research and development to rapid prototyping and production, in saving lives all across the world [1]. From personal protective equipment design to vaccine production and distribution, engineering has been the bedrock of an effective global response. However, despite major gains made in the last several decades, there are still millions all across the world, including the vulnerable displaced, who rarely benefit from new developments at the interface of engineering, biology, and health. 

Conservative estimates suggest that at the end of 2022, over a hundred million people were displaced due to conflict, climate change, and persecution [2]. Research and development in engineering has provided little relief to these communities that are in need of shelter, medicines, diagnostics, clean water, and so much more [3]. Those who are forced to flee their homes are often likely to be at a higher risk of infections and malnourishment, and also facing tremendous short- and long-term mental health challenges. Pregnant women, elderly, children, and those with physical or cognitive special needs are particularly vulnerable. If they were already under treatment for a condition, they will have fewer resources to continue the course of their treatment as they flee [4]. 

Too often, what is provided to the forcibly displaced are not what they need, but what is available. For example, in case of an infection, there are rarely any tests available in a camp or a settlement to determine whether the pathogen is resistant to antibiotics. They are given not the antibiotic they need, but what is available on site [5]. This practice is likely to make their condition worse and inevitably puts others at risk. The solutions to take care of refugees, stateless communities, and internally displaced persons must include fit for purpose technologies, such as appropriate prosthetics, standalone diagnostics that are able to work in local conditions, and technologies that do not disregard the basic rights and privacy of the displaced and vulnerable. 

Engineering approaches rooted in ethics and inclusion and cognizant of culture, history, law, and local realities can make a significant contribution in saving lives and improving the health outcomes of forcibly displaced persons. This idea of interdisciplinary scholarship that combines science, technology, engineering, and mathematics (STEM) disciplines with arts, humanities, social sciences, law, and ethics is at the core of the new research Center on Forced Displacement (CFD) at Boston University [6]. The mission of the CFD is to “develop and support ideas, technologies, scholarship, awareness, and solution identification that will improve the human condition of vulnerable persons who are forced to leave their homes. The center supports research and engagement with forced displacement and humanitarian emergencies that is truly interdisciplinary and of the highest scholarly and ethical standards.” 

The structure of the center is open, inclusive, and multidisciplinary. The research scholars and affiliates, who come from diverse disciplines, work in a collaborative environment and engage deeply with local scholars and practitioners with expertise and experience in studying, analyzing, and addressing challenges faced by the forcibly displaced communities in camps, informal settlements, and urban environments. Current research questions relevant to engineering, such as a better understanding of microbiome of migrants, or development of better tests to quantify antimicrobial resistance, are pursued in close partnership with local communities, scholars at universities in the region, Non-governmental organizations (NGOs), and local public health authorities. Engineering approaches are being used not just to create new technologies, but also to do systems-level quantitative analysis of the supply chain for life-saving medicines. Multiscale modeling efforts are analyzing how the presence of pollutants in the wastewater, combined with local living environments, could lead to an outbreak of a particular infection. In partnership with policy makers and legal and policy scholars, our work also aims to generate awareness about better strategies and aims to identify concrete, actionable, and sustainable policies that focus on human dignity and healthier lives of the forcibly displaced. 

We are cognizant of many other efforts in engineering departments and nonprofit institutions (such as engineers without borders) that have made significant contributions in low- and middle-income countries. Our center provides a complimentary model to these efforts in several important ways. First is the interdisciplinary nature of our approach, where engineering methods benefit and are constantly informed by history, culture, and local practices and policies. This approach forms the core of all our efforts. Second, while most efforts in engineering departments or nonprofits often focus on low-tech solutions, we want to challenge that approach by also focusing on original discovery and development of novel solutions (as opposed to a low-tech version of existing solutions in high-income settings). Similarly, we utilize systems modeling and complexity theory to go beyond technology development and address system-wide bottlenecks in issues such as disease dynamics, access to care, improved diagnostics, or enhanced performance of existing facilities. Third, we want to challenge a north-to-south model where a technology developed by scholars in the global north would simply be installed in a low income setting. Instead, we are focused on codeveloping solutions and in this regard, we partner and engage with local universities, research centers, and academic institutions. Finally, we work closely with local policy makers and policy experts to better understand the legal, structural, and social framework in an effort to scale the solutions that make a positive impact and ensure their sustainability. 

The CFD at Boston University was launched in late summer of 2022. We recognize that we have a long way to go and we hope that it becomes a hub of creation and practice of knowledge, reflection, engagement, and impact on one of the most important moral imperatives of our time. More importantly, we hope that our center is part of new developments in scholarship, teaching, and research that combines the disciplinary strengths with a passion for truly interdisciplinary efforts to improve the lives of forcibly displaced communities all across the world.

References

1. G. A. Barabino, “Engineering solutions to COVID-19 and racial and ethnic health disparities,” J. Racial Ethnic Health Disparities, vol. 8, no. 2, pp. 277–279, 2021.
2. UN High Commission for Refugees Report. Accessed: Feb. 21, 2023. [Online]. Available: https://www.unhcr.org/refugee-statistics/ insights/explainers/100-million-forcibly-displaced.html
3. I. Sutradhar and M. H. Zaman, “One health approaches to improve refugee health,” Lancet Global Health, vol. 9, no. 12, pp. e1646–e1647, 2021.
4. Common Health Needs of Refugees and Migrants: Literature Review, World Health Org., Geneva, Switzerland, 2021.
5. E. S. F. Orubu et al., “Assessing antimicrobial resistance, utilization, and stewardship in Yemen: An exploratory mixed-methods study,” Amer. J. Tropical Med. Hygiene, vol. 105, no. 5, pp. 1404–1412, Aug. 2021, doi: 10.4269/ajtmh.21-0101.
6. Boston University Center on Forced Displacement. Accessed: Feb. 21, 2023. [Online]. Available: https://www.bu.edu/cfd