Mobile Phone Use in Disaster, Conflict and Displacement

Original Editor - Robin Tacchetti based on the course by Sue Piché
Top Contributors - Robin Tacchetti, Jess Bell, Stacy Schiurring, Kim Jackson and Vidya Acharya

Introduction

Mobile device usage has steadily increased with around 95% of the global population having mobile coverage. For marginalised individuals, mobile technologies help ensure more equitable resilience in disaster situations. Marginalised groups include people with disabilities, who are four times more likely to perish in disaster settings, and women, who have been identified as more vulnerable in disaster settings. In low-income countries, women are 10% less likely to own a mobile phone. This exclusion from the digital world negatively impacts a woman's opportunity to be rescued in dangerous situations.

Humanitarian Crisis

In emergency humanitarian situations, mobile phones can be used to inform and educate the public about the emergency and to disseminate information. Communities living in harsh conditions can use their mobile phone apps or platforms to:

• access up-to date information
• stay in touch with each other
• report on life-threatening conditions that require emergency help
• connect with humanitarian facilities

Mobile phones have become essential tools for displaced persons to "navigate their migration journeys [...] and the complexities of life during resettlement".

Displaced Persons

For displaced persons fleeing their country, modern communication can provide some level of emotional support. Having mobile phones also allows displaced persons to avoid carrying maps, cash, documents, torches and dictionaries. Mobile phones not only enable displaced persons to keep in touch with their family at home, they also provide logistical information during dangerous and stressful journeys. Specific logistical guidance is often needed regarding borders to cross, distance to cover, food, transportation and accommodation. In addition to logistics and communication, mobile phone use can help provide refugees with information, surveillance, entertainment and diversions along their journey. Refugees prioritise mobile ownership and connectivity as crucial for their safety.

The video below by Ars Technica demonstrates the importance of mobile phones for refugees:

Communication

Mobile access allows refugees to keep their friends and families updated about their journey. Texting or calling their loved ones provides emotional support through their journey. Some refugees postpone communication until they reach their final destination. In this case, mobile phones might be used to document memories of their experiences to share at a later date.

Social Inclusion

For displaced persons experiencing resettlement, the use of mobile technologies has been associated with social inclusion and opportunities to gain access to information that supports daily life. Being able to connect with loved ones at home while establishing new relationships in host communities helps create a sense of belonging. A mobile phone acts as a virtual space to develop transcultural connections, bridging the cultural gap between the local culture and the displaced person.

Social Network

Social media communication can connect migrants to fellow refugees in host countries, providing them with logistical information about routes, transportation arrangements and accommodation. In addition, these networks provide general information to help displaced persons navigate the following settlement issues:

• appropriate behaviour
• style of dress
• rights
• citizenship
• support services
• employment
• community housing
• language learning programmes

Health

Mobile technologies can be used in a variety of ways to facilitate health inclusion. Displaced persons use online platforms to access health information, health support groups and to communicate with health care providers. Subsequently, providers can monitor a displaced person's health conditions virtually with the use of various apps.

" ... in healthcare, communication failures can directly or indirectly cause preventable harm. High-risk moments in communication may be during transitions of care, for instance, between care areas when patients are going from one area to another or shift changes; or relaying of orders, such as medication or treatments. Risks include any interaction which provides critical information about conditions and/or plan of care and they can be miscommunicated. That can lead to any delays in treatment or inappropriate therapies." - Sue Piché, registered nurse

Politics

Mobile phone use can enable refugees to exercise their right to engage in political discussion. Social media allows them to voice their opinion, advocate for refugee rights, influence policy and politics and engage in both offline and online activism.

Issues

Displaced persons may claim mobile phones are a lifeline, but there are inherent risks with their use during the journey to resettlement. In exile, displaced persons may face issues of connectivity and surveillance.

Connectivity

Access to the internet via Wi-Fi, SIM-cards and battery charging resources are unpredictable and fragile. The ability to recharge a phone during the migration journey becomes a question of life or death. Many refugees report that they continually share, change and swap batteries with each other so as to not be disconnected. Once in a resettlement community, displaced persons may experience difficulty using their mobile phones due to:

• limited financial resources, which impacts access to a reliable / stable mobile network
• the difficulty of getting a sim-card due to uncertain legal / immigration status
• local communication infrastructure in host country / community

Surveillance

Digital surveillance of displaced persons can be accomplished through smartphone use. Displaced persons can be tracked by the countries they have left or the countries they are going to and/or by human traffickers. To counteract this surveillance, refugees report using pseudonyms and avatars to try and protect their identities and intended routes and destinations from the government of their home country or other groups.

Clinical Considerations When Selecting a Suitable Mobile App

Security and privacy of client data and records are paramount in healthcare. This does not change when consulting via telehealth or when using a mobile app. Safety and security with video platforms is therefore extremely important and a necessity.

Countries and states have their own legislation, regulations and privacy acts related to health services. These can regulate how a client's personal information is handled and kept secure. The rehabilitation professional may be held liable if sensitive information is not well-protected as the result of using a less secure or poor quality platform.

A suitable mobile app must be:

• encrypted
• not interceptable
• not-hackable

Platform Security

The practitioner has to demonstrate that the selected platform is secure and private and if that changes in the future, a different platform needs to be considered. End to end encryption is necessary for video calls. A comprehensive risk assessment should be done on the platform. Follow your country or state guidelines regarding General Data Protection Regulation (GDPR) and Health Insurance Portability and Accountability Act (HIPAA).

GDPR

• implemented by the European Union (EU)
• highest levels of data security standards in the world
• although not healthcare specific - it incorporates the storage and transmission of patient health data
• Under GDPR:
  • healthcare provider known as the "data controller"
• data controllers have specific legal obligations such as "the right to be forgotten" - this allows the data controller to delete patient info upon request

HIPAA

• US law
• purpose of the act - ensure that the healthcare providers keep protected health information safe
• Under the act:
  • health care providers are "HIPAA covered entity"
  • providers of assistance and support to health care providers are "business associates"
• Requires health care providers (covered entity) that stores and conveys confidential health data through technology platforms, to sign a business agreement with the technology platform (business associate)
• HIPAA compliant platforms ensure that security requirements fall within HIPAA guidelines

Common Publicly used Platforms

Zoom

• less streamlined interface
• download required for first-time use
• designed for meetings and webinars
• media-reports of security breaches of the platform - not ideal for health services where secure and private health information is conveyed
• calls may not be encrypted by default - the "Require Encryption for 3rd party Endpoints" setting needs to be switched on
• [https:/zoom.us/healthcare Zoom for Healthcare] - higher subscription fee. Integrates with some physiotherapy software and gives higher-level security with HIPAA compliance.

Facetime

• available anytime
• data from chat and video call on Facetime can be stored in your personal iCloud - this may lead to non-compliant and legislative issues on the storage of private and confidential health records
• have had security flaws in the past

Skype

• reports of poor quality of calls
• privacy and security issues and vulnerabilities

Whatsapp

• application is connected to individual mobile phone numbers
• issues for data security and compliance
• reports of security issues and hacking

Microsoft Teams

• more secure than Skype
• set-up can be tricky
• user-friendliness can be an issue

Summary

Mobile phone use provides opportunities for displaced persons to develop educational, social, linguistic, digital skills. Most importantly, smartphones promote social inclusion via a virtual double bond with an individual's own culture and their new society. When providing care for displaced person, there are many available mobile phone apps to help facilitate communication and continuity of care. It remains the responsibility of the healthcare provider to ensure the privacy and security of sensitive health information for clients.

This video by BBC Media Action summarises the benefits and risks of cell phone use during a displaced person's migration:

Resources

• Global Challenges Relating to the Refugee Experience
• Cultural Competence and Access to Healthcare for Displaced Persons
• Health Concerns for Displaced Persons
• Serval Project
• Trilogy Emergency Response Application (TERA)