Mobile Phone Use in Disaster, Conflict and Displacement: Difference between revisions

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<div class="editorbox"> '''Original Editor '''- [[User:Robin Tacchetti|Robin Tacchetti]] based on the course by [https://members.physio-pedia.com/course_tutor/sue-piché/ Sue Piché]<br>
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
== Introduction ==
== 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 to disaster situations. Marginalised people encompass women who are more vulnerable to disaster-ridden environments and people with disabilities who are four times more likely to perish in disaster settings. In emergency humanitarian conditions, mobile phones can be used to inform and educate the public about the emergency and to disseminate information.<ref name=":1">Paul JD, Bee E, Budimir M. [https://www.sciencedirect.com/science/article/pii/S2212096321000255 Mobile phone technologies for disaster risk reduction]. Climate Risk Management. 2021 Jan 1;32:100296.</ref>Additionally, communities living in harsh living conditions can use their mobile phone apps or platforms for multiple uses including:  
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.<ref name=":1" /> 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.<ref name=":0" />
 
== Humanitarian Crisis ==
In emergency humanitarian situations, mobile phones can be used to inform and educate the public about the emergency and to disseminate information.<ref name=":1">Paul JD, Bee E, Budimir M. [https://www.sciencedirect.com/science/article/pii/S2212096321000255 Mobile phone technologies for disaster risk reduction]. Climate Risk Management. 2021 Jan 1;32:100296.</ref> Communities living in harsh conditions can use their mobile phone apps or platforms to:  


* access up-to date information  
* access up-to date information  
* stay in touch with eachother
* stay in touch with each other
* report on life-threatening condition that requires emergency help  
* report on life-threatening conditions that require emergency help
* connect with humanitarian facilities<ref name=":0">Akhmatova DM, Akhmatova MS. [https://jhumanitarianaction.springeropen.com/articles/10.1186/s41018-020-00076-2 Promoting digital humanitarian action in protecting human rights: hope or hype]. Journal of International Humanitarian Action. 2020 Dec;5(1):1-7.</ref>  
* connect with humanitarian facilities<ref name=":0">Akhmatova DM, Akhmatova MS. [https://jhumanitarianaction.springeropen.com/articles/10.1186/s41018-020-00076-2 Promoting digital humanitarian action in protecting human rights: hope or hype]. Journal of International Humanitarian Action. 2020 Dec;5(1):1-7.</ref>  


== Refugees ==
. There is emerging evidence that mobile phones became essential tools for accessing information and resources that can help refugees navigate their migration journeys (Dekker, Engbersen, Klaver, & Vonk, 2018) and the complexities of life during resettlement (Alencar, 2017; Kaufmann, 2018). It is estimated for instance that 68% of refugees living in urban centers have access to an internet-enabled phone, with the vast majority prioritizing mobile ownership and connectivity as crucial for their safety<ref name=":3" />
for instance, refugees highlight the importance of mobile applications to check their location and to orient themselves toward their next destinations, whereas in Gillespie et al.'s (2018), the communicative affordances of phones assist refugees in ensuring their safety and survival through the guidance of coastguards during the perilous sea-crossing between Izmir (Turkey) and Greece. In certain moments, however, they need to negotiate online (in)visibility depending on the borders and actors expected to be encountered. This fosters a change in refugees' digital practices and dependence on the subversive affordances of their smartphones in order to avoid being detected, arrested, detained, and deported (Gillespie et al., 2018, p. 7). On this point, there is extensive evidence that the use of GPS applications can be used by state officials, traffickers, and smugglers to track refugees' movements (Latonero & Kift, 2018; Leurs & Smets, 2018; Wall et al., 2017). In a more specific case, Newell, Gomez, and Guajardo (2016) revealed that using mobile phones also poses risks to Mexican refugees at the border, as they are extorted by thieves, human traffickers, and corrupt police forces to disclose information about their list of phone contacts.<ref name=":3" />


Another possibility afforded by smartphones concerns the expansion of migration networks that can facilitate the organization of migration journeys (Dekker et al., 2018; Fiedler, 2019; Zijlstra & Van Liempt, 2017; Schaub, 2012). Refugees draw greatly on social networks to gain knowledge about asylum procedures in Europe, even before leaving their home countries, facilitating decision-making processes regarding host country destinations (Fiedler, 2019; Gillespie et al., 2018). Dekker et al. (2018) and Fiedler (2018) note that social media communication with groups of fellow migrants is a source of information and empowerment for refugees who can rely on the experiences of others who traveled to a certain route and went through registration processes at European borders. Some informants in Gillespie et al.'s (2018) research said they received tips from other fellow refugees in social media groups about the way they should behave and appear when dealing with state actors: “wear hair gel and dress smartly at borders” (p. 7). In the context of trans-Saharan migration journey, Schaub (2012) states that social ties and networks through mobile phones can provide migrants with a scope of services, such as work opportunities, routes, transportation arrangements, and accommodations, as well as insurance mechanisms for those in need of protection and financial assistance (Zijlstra & Van Liempt, 2017).<ref name=":3" />
Mobile phones have become essential tools for displaced persons to "navigate their migration journeys [...] and the complexities of life during resettlement".<ref name=":3">Alencar A. [https://compass.onlinelibrary.wiley.com/doi/full/10.1111/soc4.12802 Mobile communication and refugees: An analytical review of academic literature]. Sociology Compass. 2020 Aug;14(8):e12802.</ref>  


Despite the importance of online networks and the wide range of resources they offer to refugees, studies highlight problems regarding the lack of credible information emerging from social media ties, as refugees on the move experience a condition of “information precarity” (Wall et al., 2017). For instance, there have been several accounts of refugees being subject to online fraud like one Syrian informant in Alencar et al.'s (2018, p. 838) study who reported being stolen 3,000 dollars by a fake “Lebanon embassy” contact on Facebook who falsely promised to help him obtain a European visa. Mouaz, an Iraqi informant, said: “I don't trust any news or information people tell me. I trust no-one. Only my Mother” (Gillespie et al., 2018, p. 8). In light of these events, Borkert, Fisher, and Yafi (2018) emphasize the agency of Arab refugees in negotiating the validity of informational sources, as well as in developing digital strategies to protect their identities online and information accessed and shared about intended routes and destinations. Many said they engaged in closed Facebook groups, or used avatars and pseudonyms on Facebook to avoid surveillance from the government of their home country and other hostile groups.<ref name=":3" />
== Displaced Persons ==
For displaced persons fleeing their country, modern communication can provide some level of emotional support.<ref name=":2" /> Having mobile phones also allows displaced persons to avoid carrying maps, cash, documents, torches and dictionaries.<ref name=":6" /> 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.<ref name=":2">Eide E. Mobile flight: [https://journal-njmr.org/articles/10.33134/njmr.250 Refugees and the importance of cell phones]. Nordic Journal of Migration Research. 2020 May 28;10(2).</ref> Specific logistical guidance is often needed regarding borders to cross, distance to cover, food, transportation and accommodation.<ref name=":3" /> In addition to logistics and communication, mobile phone use can help provide refugees with information, surveillance, entertainment and diversions along their journey.<ref name=":4">Alencar A, Kondova K, Ribbens W. [https://journals.sagepub.com/doi/pdf/10.1177/0163443718813486 The smartphone as a lifeline: An exploration of refugees’ use of mobile communication technologies during their flight.] Media, Culture & Society. 2019 Sep;41(6):828-44.</ref> Refugees prioritise mobile ownership and connectivity as crucial for their safety.<ref name=":3" />


Fragile and unpredictable mobile access and connectivity do not prevent refugees from keeping their families and friends updated about their journeys. Maintenance of links to their loved ones is also made possible through the “mobile polymedia affordances” of calling and texting (Gillespie et al., 2016; Kutscher & Kreß, 2018), with many refugees reporting as essential for ''financing their journey'' while providing ''emotional support'' (Alencar et al., 2018). In some cases, however, Syrians preferred to avoid contacting home until they reached their final destination. During the journey, the diversion affordances of the phone helped refugees to relieve boredom and to document memories of their experiences<ref name=":3" />
The video below by Ars Technica demonstrates the importance of mobile phones for refugees:
{{#ev:youtube|SgK-JcaddBM}}


The use of mobile technologies among refugees experiencing resettlement has been associated with social inclusion and opportunities to enhance access to relevant information that can nurture their daily lives.<ref name=":3" />  
== 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.<ref name=":3" />


In the context of refugee health, mobile technologies can be used as an integrative part of face-to-face interventions. Considering the affordability and accessibility of mobile phones, scholars demonstrated that mental health apps and short messaging service (SMS) became complementary methods for monitoring mental health conditions among refugees.<ref name=":3">Alencar A. [https://compass.onlinelibrary.wiley.com/doi/full/10.1111/soc4.12802 Mobile communication and refugees: An analytical review of academic literature]. Sociology Compass. 2020 Aug;14(8):e12802.</ref>
== 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.<ref name=":3" /> 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.<ref name=":5" />


r refugees’ use of technology can be derived from the large body of empirical studies applying the U&G framework to both traditional and digital media content. The most common motivations, on a broad level, are (1) cognitive (or information seeking), (2) entertainment, (3) interpersonal communication (or relationship maintenance, social connection), (4) diversion (escape boredom, pass time) and (5) surveillance (acquire information about events, society and civic engagement) (Rubin, 2009; Ruggiero, 2000). With mobile communication technologies however, such as the smartphone, gratifications become easily accessible anytime and everywhere (Jung, 2014). The smartphone and its app driven mobile operating system in particular enhances daily productivity and facilitates formal and informal socialisation, entertainment (e.g. games), communication (e.g. messengers, social media), localisation (e.g. maps) and information acquisition (e.g. social media and news media applications) (Gerlich<ref name=":4">Alencar A, Kondova K, Ribbens W. [https://journals.sagepub.com/doi/pdf/10.1177/0163443718813486 The smartphone as a lifeline: An exploration of refugees’ use of mobile communication technologies during their flight.] Media, Culture & Society. 2019 Sep;41(6):828-44.</ref>
== 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:


Despite increasing Internet penetration and mobile device proliferation in the lives of displaced people (Gillespie et al., 2016), the use of smartphones by refugees in exile may be constrained by problems related to limited connectivity and the issues of surveillance Alencar et al. 833 and information quality and credibility (Dekker et al., 2018). First, refugees’ connectivity while on the move is subject to fragile and unpredictable access to Internet via Wi-Fi, SIM-cards and battery charging resources. When facing conditions of ‘information precarity’ (Wall et al., 2017), mainly regarding the challenges of access to online information, Gillespie et al. (2018: 5) highlight that refugees also tend to make complementary use of analog sources of information, such as leaflets at refugee camps and hand-drawn maps. Second, the use of smartphones also enables new forms of digital surveillance of (irregular) migration by both state and non-state actors (Dekker et al., 2018: 3). Studies revealed that refugees have developed strategies to reduce this risk and protect their digital identities and access to any information about routes, smugglers, for example, through the use of avatars and pseudonyms (Gillespie et al., 2016), as well as communicating with smugglers and/or other travellers through closed Facebook groups and encrypted platforms such as WhatsApp (Gillespie et al., 2018: 5). On the other contrary, the fact that refugees can access a wide range of sources through their smartphones does not imply that all the information that is available online is trustworthy (Wall et al., 2017; Zijlstra and Van Liempt, 2017). Many report struggling to identify which information can be trusted, who the sources of information are and the reasons behind the sharing of this information (e.g. false promises by smugglers and government deterrence) (Dekker et al., 2018: 3). Finally, in analysing digital practices in contexts of refugee mobility, it is also important to consider the various contingencies that are encountered while fleeing (e.g. distance to cover, borders to cross, transport, accommodation and food insecurity and anxiety), as well as the characteristics of the people on the move (e.g. demographic and gender dimensions), as these factors will shape not only refugees’ personal experiences and needs but also the ‘gratifications’ that their specific use of smartphones can provide. In the following sections of this article, we introduce our methodology and the results of this study, in which we present the main themes (needs) that emerge from the journey experiences of refugees and immediately link them to the gratifications provided by smartphones, as both aspects are scrutinised together    refugees’ use of smartphones was greatly linked to their need to contact family, friends and connect with refugee communities. In contexts of forced displacement, the role of mobile technologies for social bonding and community-building processes requires different forms of interpretation. The practices of maintaining strong ties and forming migration networks will be reflected on the refugees’ ability and motivation to flee as well as on the decisions made regarding the routes and destination countries (Zijlstra and Van Lie<ref name=":4" />
* appropriate behaviour
* style of dress
* rights
* citizenship
* support services
* employment
* community housing
* language learning programmes<ref name=":5">Dasuki S, Effah J. [https://www.tandfonline.com/doi/full/10.1080/02681102.2021.1976714 Mobile phone use for social inclusion: the case of internally displaced people in Nigeria]. Information Technology for Development. 2022 Jul 3;28(3):532-57.</ref><ref name=":3" />


== 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.<ref name=":5" /> Subsequently, providers can monitor a displaced person's health conditions virtually with the use of various apps.<ref name=":3" /><blockquote>" ... 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</blockquote>


An important aspect of migration is border control. “The national borders of rich countries are increasingly becoming militarized” (Eriksen 2007: 95), and the refugees are subject to “a curious mix of humanitarianism and military action emanating from Europe in the Mediterranean” (Eriksen 2016: 76). These developments represent challenges to people in flight, and in the past 10–15 years, they have increasingly used modern electronic devices such as smartphones to meet these challenges.<ref name=":2">Eide E. Mobile flight: [https://journal-njmr.org/articles/10.33134/njmr.250 Refugees and the importance of cell phones]. Nordic Journal of Migration Research. 2020 May 28;10(2).</ref>
== 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.<ref name=":5" />


Modern communication may be of some emotional comfort for people in distress: it is good to ascertain that your folks at home worry less if you keep them informed of your current situation. Moreover, the cell phone represents a logistic device to facilitate a stressful and dangerous journey. Thus, it plays a crucial role in today’s ecology of communication (Altheide 2013); it provides organisation (of travel, togetherness), accessibility of information (when connection and charging devices are available) and contributes to structuring of sorts, of the whole flight<ref name=":2" />.
== Issues ==
Displaced persons may claim mobile phones are a lifeline, but there are inherent risks with their use during the journey to resettlement.<ref name=":6">Mancini T, Sibilla F, Argiropoulos D, Rossi M, Everri M. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886855/ The opportunities and risks of mobile phones for refugees’ experience:] A scoping review. PloS one. 2019 Dec 2;14(12):e0225684.</ref> In exile, displaced persons may face issues of connectivity and surveillance.<ref name=":4" />


Cell phones, and particularly the smartphone versions, may be viewed as part of an “interplay among social activities, social change, and social organization and activities” or the “structure, organization, and accessibility of information technology, various forums, media, and channels of information  Cell phones, as a means of communication in situations of flight, have proven to guide refugees’ everyday and non-routine extraordinary activities (e.g. finding the way, escaping danger and securing financial supplies); in short, they prove to be an indispensable travel companion.  f course, most refugees in Europe use their cell phones in different ways for “staying in touch with friends and family, but they are even more essential for refugees en route” (Gillespie et al. 2016: 11). This is a two-way process: those who are in flight are constantly worrying about those who are left behind, especially those who live with war; and those who have not left worry about their relatives’ perilous border crossings.<ref name=":2" />
=== Connectivity ===
Access to the internet via Wi-Fi, SIM-cards and battery charging resources are unpredictable and fragile.<ref name=":4" /> 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.<ref name=":6" /> 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<ref name=":5" />


== 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.<ref name=":6" /> 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.<ref name=":4" /><ref name=":3" />


refugees to stay connected with families back home and establish new connections with locals in their host communities(Wall et al., Citation2017). This helps them overcome the feeling of social isolation and develop a sense of belonging in their host communities (Kaufmann, Citation2018; Wilding, Citation2012). Also, interacting with members of their host communities using mobile phones help refugees overcome language barriers and also learn about host communities’ behaviour and culture, which is useful to their social and economic integration (Bacishoga et al., Citation2016; Mancini et al., Citation2019). Access to the internet using mobile phones have provided refugees with the means to access general information about issues relating to settlement, such as support services, rights, settlement, citizenships, employment, community facilities housing and language learning programmes (AbuJarour & Krasnova, Citation2017; Maitland et al., Citation2015). Refugees use text messages and translation applications to overcome language barriers when accessing services relating to healthcare, housing and employment (Abujarour et al., Citation2021; Danielson, Citation2013). Besides helping refugees access information, Veronis et al. (Citation2018) noted that mobile phones provide a virtual space where refugees develop transcultural connections, that is, negotiating and bridging the cultural gap between refugees and the local culture.<ref name=":5">Dasuki S, Effah J. [https://www.tandfonline.com/doi/full/10.1080/02681102.2021.1976714 Mobile phone use for social inclusion: the case of internally displaced people in Nigeria]. Information Technology for Development. 2022 Jul 3;28(3):532-57.</ref>
== 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.


The role of mobile phones for fostering learning and skills development that allows for a faster integration into their host communities was also considered in the literature. Refugees use e-learning platforms through mobile apps to learn the languages of their host communities during their first phase of resettlement (AbuJarour & Krasnova, Citation2018). Mobile phones used in the education context provide refugees the opportunities to experiment, socialise, learn and grow (Mancini et al., Citation2019). Dahya and Dryden-Peterson’s (Citation2017) study shows that mobile phones enabled access to social networks which allowed refugee women to engage in transnational conversation with other women studying in higher education and this, in turn, contributed to creating a new pathway for refugee education.<ref name=":5" />
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.<ref name=":7">Karen Finnin. What video platforms are suitable for telehealth. Published on 8 April 2020. Available from https://www.karenfinnin.com/what-video-platforms-are-suitable-for-telehealth/ (last accessed 13 November 2023)</ref>


Mobile technologies can have an impact on not only educational but also health inclusion. Refugees connect with online platforms using their mobile phones to access health information and health care from host communities (Pottie et al., Citation2020). Also, refugees relied on social media and text messaging for health care integration, that is, to communicate with health care providers (Danielson, Citation2013). In addition, mobile phones facilitate online self-help and access to online health support groups that provide therapeutic support and collaborative relationships among refugees (Pottie et al., Citation2020; Siapera & Veikou, Citation2013)<ref name=":5" />.
A suitable mobile app must be:  


Politically, mobile phones have provided refugees the possibility to exercise their right to express and engage in political discussions in both their host societies and their home of origin (Leurs, Citation2017). Refugees connect to social network to voice out their opinions, engage in both online and offline activism, influence politics and policy, and advocate for refugees rights (Alhayek, Citation2016; Godin & Doná, Citation2016; Pottie et al., Citation2020). According to Siapera and Veikou (Citation2013), refugee youths use their mobile phones to contribute to discussions on social media aimed to bring about their empowerment and action from short postings, storytelling and movements.<ref name=":5" />
* encrypted
* not interceptable
* not-hackable


Other studies have shed light on the barriers to the use of mobile phones that limits the social inclusion of refugees into the society. Refugees access to reliable and stable mobile connectivity is usually restricted by limited financial resource, the difficulty of getting a sim-card due to their uncertain legal status and local communication infrastructure in their host communities (Fiedler, Citation2019; Maitland & Xu, Citation2015; Witteborn, Citation2015; Wall et al., Citation2017). Other barriers include language skills, limited digital literacy skills and refugees’ sense of insecurity and fear of being surveilled by the government when using their mobile phones (Mancini et al., Citation2019; Opas & McMurray, Citation2015; Wall et al., Citation2017).<ref name=":5" />
=== 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<ref name=":7" />. 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).<ref>WebPT. The Rehab Therapist’s Guide to Practicing Telehealth.</ref>


==== 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<ref>GDPR.EU. Complete guide to GDPR compliance. Available from [https://gdpr.eu/ https://gdpr.eu/] (last accessed 13 November 2023)</ref>


majority of the studies showed that one of the main needs of the daily life of refugees was the possibility to access information. Indeed, the condition of instability that refugees experience in accessing news and personal information, namely information precarity, may leave them vulnerable to misinformation, stereotyping and rumors that affect their economic and social capita  such as bringing battery chargers and plastic bags to keep the mobile dry. Some migrants highlighted how the mobile allowed them to avoid carrying many objects such as torches, maps, cash money, dictionaries and even documents. An interviewee described the hasty escape preparations as an attempt to digitize and store in the mobile as much as possible of his previous life, in an attempt to preserve it. Many considered their mobile phone as a “travelling light” which was important to escape controls in starting nations. Refugees’ ability to send details of their location to coastguards, friends, or family members while on the move was a matter of necessity and enabled the “distant proximities” t    prospect of losing or damaging their own mobile phone raised a deep existential and physical insecurity in refugees    Having access to electricity to recharge the phone, and access to the Internet, often became a question of life or death in the refugee journey. Most of the respondents reported that they continually “swap, change and share batteries”. Refugees risked being disconnected without battery and remaining without connection even for a short time meant failing to meet or deliver money to a smuggler on time, getting lost, or being separated from companion    veral risks associated with the MPs’ use. As illustrated by Beduschi [10], through the use of GPS applications migrants can be tracked and discovered by border guards, traffickers, smugglers, and common criminals. The study by Gillespie et al. [4] pointed out that using MPs is at once a lifeline and a risk, making specific survival strategies necessary. S<ref name=":6">Mancini T, Sibilla F, Argiropoulos D, Rossi M, Everri M. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886855/ The opportunities and risks of mobile phones for refugees’ experience:] A scoping review. PloS one. 2019 Dec 2;14(12):e0225684.</ref>
==== HIPAA ====


This means that modern devices, such as mobile phones, bring both ''risks'' and ''opportunities'' migrants; therefore, MPs seem both favouring and threatening asylum seekers’ and refugees’ human rights.<ref name=":6" />
* 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<ref>US Department of health and human services. Summary of the HIPAA Security Rule. Available from [https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html] (last accessed 13 November 2023)</ref>


Besides calling and texting, the “polymedia” affordances of devices for online communication, such as mobile phones, offer migrants a sort of “built-in survival kit” [1]. This kit includes several possibilities, among them: to make contacts abroad, to seek help, to find better routes, to stay informed about the situation during the journey and the destination countries, to manage risks and opportunities during the journey and when crossing borders. The kit includes also the possibilities to shed light on covert phenomena and to voice the migrants’ experiences favoring the agency and the sense of personal empowerment. Moreover, mobile phones allow migrants to keep in touch with home and, although to a lesser extent, to get in contact with services and institutions in the new countries, to learn new languages and, more broadly to improve their knowledge and skills in order to integrate in the new context. Therefore, mobile phones seem to guarantee some fundamental human rights: Among them, the literature acknowledged the right of information and expression, the right to cultural identity maintenance, the right to the family life, the right to mental health and the right to work and education. It is important here to stress that the recognition of human rights has not only been confined to asylum seekers or refugees. From the literature reviewed, the usage of MPs in refugees’ experience did not appear as episodic; rather it accompanied migrants throughout the different phases and contexts of migration, thereby creating transcultural communication. Therefore, mobile phones seem to create opportunities to strengthen and develop digital, linguistic, social and educational skills both for migrants and the people left behind in the countries of origin. Moreover, it is arguable that mobile devices promoted social inclusion and the wellbeing of migrants only to the extent that they have allowed the creation or maintenance of a double bond: one with one’s own cultural heritage and one with the new society. This double bond is fostered by mobile technologies’ affordances through the development of a virtual contact zone where refugees nurtured transcultural connections. Therefore, the use of mobile phones in refugees’ experience seem to be a driving force for the increase of the transcultural social capital and the identity capital.<ref name=":6" />
=== Common Publicly used Platforms ===


Nevertheless, mobile communication could also be a ubiquitous digital threat; through the same tools, refugees could become victims of human traffickers, tracked and controlled by the regimes from which they flee, intercepted or even rejected by the digital control systems of the countries to which they are directed and exploited and manipulated by mainstream media. Therefore, in the absence of clear ethical regulations, the traces left behind by mobile devices could threat migrants’ right to life and security and, consequently, the right to asylum, to citizenship and to wellbeing.<ref name=":6" />
==== Zoom ====


== IDP ==
* less streamlined interface
ccording to the Internal Displacement Monitoring Centre (IDMC), there are an estimated 41 million Internally Displaced People (IDP) globally that have been forcibly displaced from their homes due to conflicts or natural disasters (IDMC, Citation2019). Unlike refugees, IDP remains within national borders under their state’s sovereignt    IDP are subject to various forms of social exclusion, such as limited participation in social, economic, cultural and political activities. Recently, the increasing use of mobile phones by displaced people to enhance their social inclusion has attracted research interest in the Information and Communication Technology for Development (ICT4<ref name=":5" />
* 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.


== Hurdles ==
==== Facetime ====
Usage of messaging apps, social networks, media platforms, and mobile money by people that are affected by humanitarian crises, critical situations, disasters, and accidents is being actively introduced (Lunt 2017; Kaspersen and Lindsey-Curtet 2016; Bouffet 2017). However, while the digital technologies provide new opportunities for communication in complex situations, the humanitarian and volunteer organizations do not have appropriate standards or internationally agreed and approved ethical norms for their deployment that in combination with people’s living conditions, specific culture of developing countries, social and material inequalities, and women’s rights problems can cause serious obstacles in facilitating humanitarian support.<ref name=":0" />


== Different Apps ==
* available anytime
s the digital state-of-the-art solutions, the mentioned platforms together with messaging apps contribute to response coordination and communication between affected communities, volunteers, and aid workers to provide the integrated digital environment for transparent and timely humanitarian assistance.  For instance, 4W (Who, What, Where, and When) maps were developed to provide information for the planning of humanitarian assistance, covering the critical questions, such as who is doing what, where, and when. Tracking of humanitarian responders, automated updating of their location and responsibilities were piloted for Nepal, Vanuatu, and the Philippines (Comes and de Walle 2016). Further, KoBoToolbox, developed by the Harvard Humanitarian Initiative, is a free suite of tools for humanitarian data collection to be used in challenging environments (KoBoToolbox 2009). TraceRx platform is positioned as a well-known humanitarian supply chain solution. In large-scale emergencies, such as the earthquake in Nepal in April 2015 and the hurricane in Haiti in October 2016, Humanitarian ID was used to perform the humanitarian contact lists management (United Nations Office for the Coordination of Humanitarian Affairs 2015; Stewart 2015).<ref name=":0" />
* 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<ref name=":7" />
* have had security flaws in the past


messaging apps actualize problems related to data protection, privacy, and security since the information environment is often contested, and misinformation, propaganda, and rumors travel swiftly (Roby 2017), particularly, in the case of armed conflicts and disasters. For humanitarians, the risks of mobile app usage are associated with submitting or providing the permission to access the personal information, such as name, location, contacts, email address, and photos. The negative side is that this allows the provider of messaging app to collect a significant information on the user, including his daily routine, personal preferences, and list of trustees.<ref name=":0" />
==== Skype ====


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


==== Whatsapp ====


spectrum of different technologies that could usefully be exploited for DRR (Fig. 1). In areas of poor Internet provision and/or depressed smartphone ownership, voice calls and SMS messaging are used to target broad swathes of the population; for instance, Monsoon flood alerts for certain rivers in Nepal and India, sent by each respective country’s governmental water bureaucracy (Pandeya et al., 2020). For Internet-connected smartphones, social media platforms such as Twitter and Facebook, as well as messaging services like WhatsApp, while commonly associated with emergency response, also offer an important channel for official hazard warning communications, and may also augment social capital (Kaigo, 2012, Agahari et al., 2018). Similarly, Geographic Information System (GIS)-based technologies represent another (spatial) means of risk communication. Google Maps, for instance, has been used to develop a user-led disaster management system in Bangladesh (Sonwane, 2014). OpenStreetMap (OSM), an open-source and collaborative GIS platform, has also been used to develop similar systems (Rahman et al., 2012), or to allow affected communities to generate local landslide hazard, risk, and vulnerability maps dynamically (Parajuli et al., 2020). However, the most commonly utilised mobile technology in DRR are apps: they provide a user-friendly means of feeding raw data into hazard early-warning systems (EWS), the output from which can then be disseminated in visually appealing form back to users (Paul et al., 2018). They are generally highly context (i.e. country, natural hazard)-specific: two examples are MAppERS (Mobile Applications for Emergency Response and Support), which aims to reduce flood risk in Denmark by allowing users to share geospatial data such as geotagged images of flood extent with basin authorities (Frigerio et al., 2018); and MyShake, a global seismic platform that exploits users’ smartphones to detect earthquakes and record the magnitude of ground<ref name=":1" />
* application is connected to individual mobile phone numbers
* issues for data security and compliance
* reports of security issues and hacking<ref name=":7" />


== Drones ==
==== Microsoft Teams ====
The advanced unmanned aerial vehicle (UAV), also known as a drone, is an item whose flight is controlled either autonomously by artificial intelligence, computers, or a pilot on the ground. The promising directions of drone application in humanitarian crises are the following: mapping, delivering essential items to hard-to-access locations, monitoring environmental changes, supporting damage assessments, etc. (Fondation Suisse de Déminage 2016). Humanitarian organizations have started to use UAVs, including in Haiti and the Philippines to provide real-time information and situation monitoring, public information, search and rescue, etc. (United Nations Office for the Coordination of Humanitarian Affairs 2014). In this way, different types of drones ensure accurate and up-to-date data on demand, helping representatives of humanitarian missions to make more informed decisions. However, some issues, such as data protection, should be addressed during application of drones.<ref name=":0" />


== Gender Gap ==
* more secure than Skype
1.7 billion women now own a mobile phone in low- and middle-income countries (LMICs), and over a billion use the mobile internet. However, a significant gender gap in mobile phone ownership and usage exposes women to the risk of being left behind in an increasingly digitized world. In this context, females in LMICs are 10% less likely to own a mobile phone than a man. The variations within specific regions and countries are significant (Downer 2019). Furthermore, women in South Asia are 26% less likely to own a mobile than men and 70% less likely to use mobile internet (Rowntree 2018). In India, 67% of men own personal mobile phones, but only 33% percent of women do (Vota 2019). The reasons for this situation are as old as time and associated with such obvious barriers such as the availability of new technologies, cultural, religious and social background, and attitude to women’s rights.<ref name=":0" />
* set-up can be tricky
* user-friendliness can be an issue


The exclusion of women refugees and internally displaced women from the digital world and societies would negatively affect the possibilities to be rescued from dangerous situations and to express the rights to life, liberty, and security of a person, as it is stated in the Universal Declaration of Human Rights (1948).<ref name=":0" />
== 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.<ref name=":6" /> 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.


The existence of such trends requires the immediate identification of cause-and-effect relationships and concerted action to remove obstacles to women’s equal access to mobile services in the context of countries, where the gender gap is greatest. Mobile operators, software developers, humanitarian facilities, and non-governmental organizations (NGOs) can work together to promote policies and initiatives aimed to reduce the cost of phones or enhance work on mitigation of the impact of cultural traditions and social norms on their use, such as awareness sessions, informative talks, and seminars.<ref name=":0" />
This video by BBC Media Action summarises the benefits and risks of cell phone use during a displaced person's migration:
 
{{#ev:youtube|m1BLsySgsHM}}
The role of women humanitarians should be emphasized as they are also vulnerable to the dangers and perform the precious work in the conditions of armed conflicts, nature disasters, hunger, and humanitarian catastrophe, risking their health and lives. Subject of women humanitarians’ vulnerability has been brought to light in discussions of #AidToo movement, inspired by #MeToo and opposed to the sexual harassment, exploitation, and abuse. Widespread reports of sexual misconduct in humanitarian contexts threaten women humanitarians’ own safety and security (O’Donnell 2019) and confirm the violations of inviolable human rights.<ref name=":0" />
 
In the current context, there is a need to actively address the issues of gender equality in humanitarian action and protection of women from sexual harassment and abuse in order to ensure respect for women rights and dignity, since, according to Article 2 of Universal Declaration of Human Rights (1948), “everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, color, sex, language, religion, political or other opinion, national or social origin, property, birth or other status”. Furthermore, the specific limitations should not affect the access of women humanitarians to the digital solutions developed to enhance the effectiveness of their work under the changing environment.<ref name=":0" />
 
One of the most important links that connects those who need humanitarian assistance with those who are interested in responding is digital media and communications, integrating mobile mass communication with the Internet. According to Lobb and Mock (2007), during humanitarian response efforts, the mass media serves as the primary informational intermediary, informing donors, and policy-makers as well as the non-affected public.<ref name=":0" />


== Resources ==
== Resources ==
https://www.youtube.com/watch?v=SgK-JcaddBM
https://www.youtube.com/watch?v=gc_5ksnkGA0


https://www.youtube.com/watch?v=RYTo9ItL0zk
* [[Global Challenges Relating to the Refugee Experience]]
* [[Cultural Competence and Access to Healthcare for Displaced Persons]]
* [[Health Concerns for Displaced Persons]]
* [https://www.servalproject.org Serval Project]
* [https://acalltoendpoverty.weebly.com/tera.html Trilogy Emergency Response Application (TERA)]


== References ==
== References ==
<references />
[[Category:Rehabilitation]]
[[Category:Rehabilitation in Disaster and Conflict Situations Content Development Project]]
[[Category:ReLAB-HS Course Page]]
[[Category:Course Pages]]
[[Category:Global Health]]

Latest revision as of 12:24, 22 November 2023

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[edit | edit source]

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.[1] 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.[2]

Humanitarian Crisis[edit | edit source]

In emergency humanitarian situations, mobile phones can be used to inform and educate the public about the emergency and to disseminate information.[1] 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[2]


Mobile phones have become essential tools for displaced persons to "navigate their migration journeys [...] and the complexities of life during resettlement".[3]

Displaced Persons[edit | edit source]

For displaced persons fleeing their country, modern communication can provide some level of emotional support.[4] Having mobile phones also allows displaced persons to avoid carrying maps, cash, documents, torches and dictionaries.[5] 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.[4] Specific logistical guidance is often needed regarding borders to cross, distance to cover, food, transportation and accommodation.[3] In addition to logistics and communication, mobile phone use can help provide refugees with information, surveillance, entertainment and diversions along their journey.[6] Refugees prioritise mobile ownership and connectivity as crucial for their safety.[3]

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

Communication[edit | edit source]

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.[3]

Social Inclusion[edit | edit source]

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.[3] 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.[7]

Social Network[edit | edit source]

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[7][3]

Health[edit | edit source]

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.[7] Subsequently, providers can monitor a displaced person's health conditions virtually with the use of various apps.[3]

" ... 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[edit | edit source]

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.[7]

Issues[edit | edit source]

Displaced persons may claim mobile phones are a lifeline, but there are inherent risks with their use during the journey to resettlement.[5] In exile, displaced persons may face issues of connectivity and surveillance.[6]

Connectivity[edit | edit source]

Access to the internet via Wi-Fi, SIM-cards and battery charging resources are unpredictable and fragile.[6] 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.[5] 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[7]

Surveillance[edit | edit source]

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.[5] 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.[6][3]

Clinical Considerations When Selecting a Suitable Mobile App[edit | edit source]

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.[8]

A suitable mobile app must be:

  • encrypted
  • not interceptable
  • not-hackable

Platform Security[edit | edit source]

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[8]. 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).[9]

GDPR[edit | edit source]

  • 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[10]

HIPAA[edit | edit source]

  • 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[11]

Common Publicly used Platforms[edit | edit source]

Zoom[edit | edit source]

  • 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[edit | edit source]

  • 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[8]
  • have had security flaws in the past

Skype[edit | edit source]

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

Whatsapp[edit | edit source]

  • application is connected to individual mobile phone numbers
  • issues for data security and compliance
  • reports of security issues and hacking[8]

Microsoft Teams[edit | edit source]

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

Summary[edit | edit source]

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.[5] 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[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 Paul JD, Bee E, Budimir M. Mobile phone technologies for disaster risk reduction. Climate Risk Management. 2021 Jan 1;32:100296.
  2. ↑ 2.0 2.1 Akhmatova DM, Akhmatova MS. Promoting digital humanitarian action in protecting human rights: hope or hype. Journal of International Humanitarian Action. 2020 Dec;5(1):1-7.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Alencar A. Mobile communication and refugees: An analytical review of academic literature. Sociology Compass. 2020 Aug;14(8):e12802.
  4. ↑ 4.0 4.1 Eide E. Mobile flight: Refugees and the importance of cell phones. Nordic Journal of Migration Research. 2020 May 28;10(2).
  5. ↑ 5.0 5.1 5.2 5.3 5.4 Mancini T, Sibilla F, Argiropoulos D, Rossi M, Everri M. The opportunities and risks of mobile phones for refugees’ experience: A scoping review. PloS one. 2019 Dec 2;14(12):e0225684.
  6. ↑ 6.0 6.1 6.2 6.3 Alencar A, Kondova K, Ribbens W. The smartphone as a lifeline: An exploration of refugees’ use of mobile communication technologies during their flight. Media, Culture & Society. 2019 Sep;41(6):828-44.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 Dasuki S, Effah J. Mobile phone use for social inclusion: the case of internally displaced people in Nigeria. Information Technology for Development. 2022 Jul 3;28(3):532-57.
  8. ↑ 8.0 8.1 8.2 8.3 Karen Finnin. What video platforms are suitable for telehealth. Published on 8 April 2020. Available from https://www.karenfinnin.com/what-video-platforms-are-suitable-for-telehealth/ (last accessed 13 November 2023)
  9. ↑ WebPT. The Rehab Therapist’s Guide to Practicing Telehealth.
  10. ↑ GDPR.EU. Complete guide to GDPR compliance. Available from https://gdpr.eu/ (last accessed 13 November 2023)
  11. ↑ US Department of health and human services. Summary of the HIPAA Security Rule. Available from https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html (last accessed 13 November 2023)
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