Alastair Ager

Alastair Ager
QMU, Edinburgh and Columbia University, New York

BA, MSc, PhD

About

195
Publications
71,275
Reads
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5,681
Citations
Introduction
Alastair is active in five major areas of research: the evaluation of humanitarian programming (particularly with regard to protection and psychosocial support of refugee children); health systems resilience in contexts of crisis (especially through work in northern Nigeria and the Middle East); and the engagement of local faith communities in humanitarian response. His work is currently funded by NIHR, the Wellcome Trust, the US National Institutes of Health, the ESRC and the AHRC.
Additional affiliations
July 2015 - present
Queen Margaret University
Position
  • Managing Director
January 2006 - January 2012
Columbia University
Position
  • Professor
Description
  • Population and Family Health, 2012; Globalization & Global Health, MPH Core Module, 2012; Fundamentals of Global Health, 2010; Investigative Methods in Humanitarian Emergencies, 2006; Refugee Issues Seminar, 2006-2008
January 2000 - January 2017
Queen Margaret University
Position
  • Professor
Description
  • Psychosocial Intervention with Refugees, Displaced Persons and War-affected Populations, 2000-2004 / 2015-present; Project Design & Management, 1998-2004

Publications

Publications (195)
Article
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Objectives Assess and describe the health service use and delivery patterns for non-communicable disease (NCD) services in two contrasting fragility contexts and by other principal equity-related characteristics including gender, nationality and health coverage. Setting Primary healthcare centres located in the urbanised area of Greater Beirut and...
Article
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Purpose Growing evidence demonstrates that daily stressors such as family violence, unemployment, and living conditions play an important part in causing psychological distress. This paper investigates the impact of distressing events and day-to-day living conditions on psychological distress in the fragile context of Sierra Leone. Methods A cross...
Article
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Evidence for a single underlying factor structure of posttraumatic stress disorder (PTSD) in children remains elusive. We assessed the underlying factor structure of the Child PTSD Symptom Scale through exploratory (EFA) and confirmatory factor analyses (CFA) in 570 survivors of the 2015 Gorkha earthquake in Nepal. The EFA suggests that the three-f...
Article
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We seek to strengthen understanding of the health needs of internally displaced persons (IDPs) in contexts of conflict or violence. Based upon a scoping review, our paper identified limited evidence on IDPs health, but nevertheless indicates that IDPs tend to experience worse health outcomes than other conflict-affected populations across a range o...
Article
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Background Social mobilisation is potentially a key tool in the prevention of non-communicable diseases (NCDs) in fragile settings. This formative study addressed existing and potential social mobilisation mechanisms seeking behaviour to tackle NCDs in El Salvador, with an emphasis on the implications in the context of the current COVID-19 pandemic...
Article
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Non-communicable diseases (NCDs) disproportionately affect people living in fragile contexts marked by poor governance and health systems struggling to deliver quality services for the benefit of all. This combination can lead to the erosion of trust in the health system, affecting health-seeking behaviours and the ability of individuals to sustain...
Article
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Localisation is a key element of the humanitarian reform agenda. However, there are continuing debates regarding its form and emphasis, linked to understandings of the local, the role of the state and the implications for interpretation of humanitarian principles of “de-internationalised” humanitarian response. This paper considers UK engagement wi...
Article
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Background Studies of psychological distress in Sierra Leone have typically used measures which were developed for use in other contexts, and which often have not been adapted or validated for use in Sierra Leone. This has resulted in a lack of reliable information about the patterns of psychological distress within the population, which is a barri...
Article
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Qualitative comparative analysis (QCA) is a relatively new method that examines causal complexity. Its use in mental health research is nascent. In low-income and fragile settings, with weak mental health service provision, identifying pathways of recovery from psychological distress can inform the appropriate deployment of scarce community and pub...
Article
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Background Noncommunicable diseases (NCDs), including mental health, have become a major concern in low- and middle-income countries. Despite increased attention to them over the past decade, progress toward addressing NCDs has been slow. A lack of bold policy commitments has been suggested as one of the contributors to limited progress in NCD prev...
Article
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Background There is increasing global evidence that mental health is strongly determined by social, economic and environmental factors, and that strategic action in these areas has considerable potential for improving mental health and preventing and alleviating mental disorders. Prevention and promotion activities in mental health must address the...
Article
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Background: The experiences of protracted conflict and displacement are clear threats to children's developmental progress. Understanding the factors that shape the trajectories of children's well-being and adjustment in such contexts is important for informing interventions. Methods: We collected data at three time points from a sample of Syria...
Article
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Faith leaders are well-positioned to address violence against children, but the extent to which they do so is unclear. This mixed-method study examined faith leaders’ child protection practices, attitudes towards child rights, and views around physical punishment in Senegal, Uganda, and Guatemala. Child protection practices—specifically listening t...
Article
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Background: Internationally deployed humanitarian aid (HA) workers are routinely confronted with potentially traumatic stressors. However, it remains unknown whether HA deployment and related traumatic stress are associated with long-term changes in hypothalamic-pituitary-adrenal (HPA) axis function. Therefore, we investigated whether cortisol awak...
Article
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Abstract Background: This paper revisits the themes of an influential 1993 review regarding the factors shaping the mental health and psychosocial well‐being of refugees to take stock of developments in the evidence base and conceptualisation of issues for refugee children over the last 25 years. Methods: The study deployed a systematic search stra...
Article
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Major knowledge gaps remain concerning the most effective ways to address mental health and psychosocial needs of populations affected by humanitarian crises. The Research for Health in Humanitarian Crisis (R2HC) program aims to strengthen humanitarian health practice and policy through research. As a significant portion of R2HC’s research has focu...
Article
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Background: Accurately identifying the magnitude of gender-based violence (GBV) in humanitarian settings is hindered by logistical and methodological complexities. The 'Neighborhood Method', an adapted household survey that uses primary and secondary reporting to assess the prevalence of GBV in humanitarian settings, reduces the length of time and...
Article
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Background Over recent decades there has been considerable mental health research in Sierra Leone but little on local conceptualisations of mental health conditions. Understanding these is crucial both for identifying the experienced needs of the population and utilising relevant community-based resources to address them. This study took a grounded...
Article
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Background: Evidence of 'what works' in humanitarian programming is important for addressing the disruptive consequences of conflict and forced displacement. However, collecting robust scientific evidence, and ensuring contextual relevance, is challenging. We measured the biological, psychosocial, and cognitive impacts of a structured psychosocial...
Article
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Psychological first aid (PFA) is a world-wide implemented approach to helping people affected by an emergency, disaster, or other adverse event. Controlled evaluations of PFA’s training effects are lacking. We evaluated the effectiveness of a one-day PFA training on the acquisition and retention of knowledge of appropriate responses and skills in t...
Article
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Advances in population health outcomes risk being slowed-and potentially reversed-by a range of threats increasingly presented as 'fragility'. Widely used and critiqued within the development arena, the concept is increasingly used in the field of global health, where its relationship to population health, health service delivery, access and utiliz...
Article
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Health system resilience reflects the ability to continue service delivery in the face of extraordinary shocks. We examined the case of the United Nations Relief and Works Agency (UNRWA) and its delivery of services to Palestine refugees in Syria during the ongoing crisis to identify factors enabling system resilience. The study is a retrospective...
Article
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Health system resilience reflects the ability to continue service delivery in the face of extraordinary shocks. We examined the case of the United Nations Relief and Works Agency (UNRWA) and its delivery of services to Palestine refugees in Syria during the ongoing crisis to identify factors enabling system resilience. The study is a retrospective...
Article
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Provision of child‐ and youth‐friendly spaces has become a common feature of emergency humanitarian response. The evidence‐base regarding such provision is, however, severely limited. This study reports outcomes of Child and Youth Learning Centres (CYLCs) established in Buramino refugee camp for those fleeing conflict in Somalia. Eighty‐five youths...
Article
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The myth of the 1-day training: the effectiveness of psychosocial support capacity-building during the Ebola outbreak in West Africa – ADDENDUM - Volume 6 - Rebecca Horn, Fiona O'May, Rebecca Esliker, Wilfred Gwaikolo, Lise Woensdregt, Leontien Ruttenberg, Alastair Ager
Article
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Background The establishment of Child Friendly Spaces (CFSs) has become a widespread intervention targeting protection and support for displaced children in humanitarian contexts. There is a lack of evidence of impact of these interventions with respect to both short‐term outcomes and longer‐term developmental trajectories. Methods We collected da...
Article
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Background: Humanitarian crises present major threats to the wellbeing of children. These threats include risks of violence, abduction and abuse, emotional distress and the disruption of development. Humanitarian response efforts frequently address these threats through psychosocial programming. Systematic reviews have demonstrated the weak eviden...
Article
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Background In emergencies and resource-poor settings, non-specialists are increasingly being trained to provide psychosocial support to people in distress, with Psychological First Aid (PFA) one of the most widely-used approaches. This paper considers the effectiveness of short training programmes to equip volunteers to provide psychosocial support...
Article
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Humanitarian workers experience high symptom burdens of common mental health problems. This requires action from the organisations they are employed with. However, many studies have documented continuing weaknesses in organisational staff support, as well as disparities in access to the services for national and international staff. Systematic data...
Article
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Background The Eastern Cape Province reports among the poorest health service indicators in South Africa with some of its districts standing out as worst performing as regards maternal health indicators. To understand key drivers and outcomes of this underperformance and to explore whether a participatory analysis could deepen action-oriented under...
Article
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Background The latest data on major attacks against civilian aid operations have identified South Sudan as the most dangerous country for aid workers globally. Exposure to other traumatic events and chronic stress is also common in this population. No research exists on the mental health of humanitarian workers in South Sudan. Objectives This stud...
Article
Resilience is increasingly recognised as a key process mitigating the impact of shocks and stressors on functioning. The literature on individual and community resilience is being extended to address characteristics of resilient service delivery systems in contexts of adversity. The validity and utility of a capacity-oriented resilience framework (...
Data
Table S1. Correlations and internal consistency for baseline study variables and 7‐day test–retest reliability with a separate sample. Table S2. Baseline (T1) characteristics of youth lost versus retained to study.
Data
Figure S1. Symptom scores at three time‐points for cycle‐specific and pooled‐cycle data for Advancing Adolescents. Significance levels are for differences across time, within treatment and within control groups.
Article
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Background: Cholera is a highly infectious diarrheal disease spread via fecal contamination of water and food sources; it is endemic in parts of Africa and Asia and recent outbreaks have been reported in Haiti, the Zambia and Democratic Republic of the Congo. If left untreated, the disease can be fatal in less than 24 h and result in case fatality...
Article
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Background Gender-based violence (GBV) is a significant problem in conflict-affected settings. Understanding local constructions of such violence is crucial to developing preventive and responsive interventions to address this issue. Methods This study reports on a secondary analysis of archived data collected as part of formative qualitative work...
Article
Drawing upon evidence compiled in a recent literature review, we identify five arguments for seeking faith-sensitivity in psychosocial programming: it is indicated by the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support (MHPSS); it is implied by humanitarian law and principles; religion is an active and ef...
Data
Table S1. Child and Youth Resilience Measure (CYRM‐12)
Data
Table S2. Child and Youth Resilience Measure (CYRM‐28)
Article
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Background: Strengthening the evidence base for humanitarian interventions that provide psychosocial support to war-affected youth is a key priority. We tested the impacts of an 8-week programme of structured activities informed by a profound stress attunement (PSA) framework (Advancing Adolescents), delivered in group-format to 12-18 year-olds in...
Article
Frequently, community based strategies include engagement with local faith leaders. However, there have been few systematic attempts to document how faith leaders themselves define their roles in these initiatives. This study examined local faith leaders and their spouses, in flood affected areas of Malawi, who had been oriented to child protection...
Article
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Validated measures are needed for assessing resilience in conflict settings. An Arabic version of the Child and Youth Resilience Measure (CYRM) was developed and tested in Jordan. Following qualitative work, surveys were implemented with male/female, refugee/nonrefugee samples (N = 603, 11–18 years). Confirmatory fac- tor analyses tested three-fact...
Article
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The availability of simple, specific, and inexpensive on-site detection methods is of key importance for deployment of pathogen surveillance networks. We developed a nontechnical and highly specific colorimetric assay for detection of pathogen-derived peptides based on Saccharomyces cerevisiae—a genetically tractable model organism and household pr...
Article
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The last decade has been marked by increasing attention to rigor in the evaluation of interventions that seek to promote the mental health and psychosocial well-being of children in crisis contexts. One of the key markers of such rigor has been the increased adoption of strong quasi-experimental designs, where children receiving an intervention are...
Technical Report
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Evidence Brief created for the World Humanitarian Summit on the religious engagement in humanitarian action in relation to the fourth core responsibility of the UNSG's report "One Humanity, Shared Responsibility."
Technical Report
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Evidence Brief created for the World Humanitarian Summit on religious engagement in humanitarian action in relation to the fifth core responsibility of the UNSG's report "One Humanity, Shared Responsibility."
Research
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Briefing paper for meeting on lessons for DFID's health response in Syria, 25 February 2016. The brief highlights - on the basis of a series of case studies and ongoing work - three observations: (1) participatory Group Model Building (GMB) provides a promising mechanism for local consideration of systems resilience; (2) adversity prompts diverse,...
Chapter
More than one in every hundred of the world?s population has experienced being forcibly displaced. Religion constitutes a key dimension of the experience of the vast majority of forced migrants, but humanitarian response?on the basis of its concern for neutrality and impartiality?has an uneasy relation with it. The secular framing of humanitarianis...
Research
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In response to the commitment to strengthen the evidence base for humanitarian practice and the prioritisation of CFS as a key area for research, World Vision and Columbia University, working with Save the Children, UNICEF and others, engaged in a three-year collaborative project to document the outcomes and impacts of CFS and develop capacity for...
Article
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Background: Yobe State has faced severe disruption of its health service as a result of the Boko Haram insurgency. A systems dynamics analysis was conducted to identify key pathways of threat to provision and emerging pathways of response and adaptation. Methods: Structured interviews were conducted with 39 stakeholders from three local governme...