The protection and security of vulnerable populations in complex emergencies using the Dadaab refugee camps in the north eastern province of Kenya as a case study

The past two decades has seen a dramatic upheaval in the international world order: the end of the Cold War, the 9/11 attacks and the subsequent 'War on Terror', increased Jihadist activities, the accelerated pace of globalization, climate change and the 2008 global financial crisis have contributed to fear, uncertainty, poverty, conflict, massive displacements of populations of asylum seekers and refugees globally and a proliferation of Protracted Refugee Situations (PRS), defined as situations in which refugees have been in exile 'for 5 years or more after their initial displacement, without immediate prospects for implementation of durable solutions. In the past two decades there has been a huge proliferation of these with more than 7.2 million refugees now trapped in these PRS, with a further 16 million internally displaced persons (IDPs) trapped in camps within their own countries. The Dadaab refugee complex in Kenya, which of as March 2012, holds over 463,000 refugees, is the most significant and extreme example in recent times of a PRS. It was established in 1991 following the collapse of the Somali Government of Dictator Siad Barre, and the disintegration of Somalia into the chaos that still exists today. PRS such as Dadaab raise particular issues about humanitarianism in terms of aid, protection, security, human rights and the actions (or inaction) of the various stakeholders on an international, national and local level. This thesis investigates these issues by the use of a case study methodology on Dadaab as a PRS, framed in the context of humanitarianism and in particular the issues that arise in terms of how the international community, the UN system and individual states provide assistance and protection to vulnerable populations. Although the refugee camps have been in existence (as of 2012) for over 20 years, there has never been such a detailed study of Dadaab (or any other PRS) undertaken to date and would be of interest to academics in the areas of international relations, refugee/migration studies and global Governance as well as practitioners in both humanitarian response and development

The quality of diabetes care in the community: practice, policy and culture

Aim: Diabetes is an important barometer of health system performance. This chronic condition is a source of significant morbidity, premature mortality and a major contributor to health care costs. There is an increasing focus internationally, and more recently nationally, on system, practice and professional-level initiatives to promote the quality of care. The aim of this thesis was to investigate the ‘quality chasm’ around the organisation and delivery of diabetes care in general practice, to explore GPs’ attitudes to engaging in quality improvement activities and to examine efforts to improve the quality of diabetes care in Ireland from practice to policy. Methods: Quantitative and qualitative methods were used. As part of a mixed methods sequential design, a postal survey of 600 GPs was conducted to assess the organization of care. This was followed by an in-depth qualitative study using semi-structured interviews with a purposive sample of 31 GPs from urban and rural areas. The qualitative methodology was also used to examine GPs’ attitudes to engaging in quality improvement. Data were analysed using a Framework approach. A 2nd observation study was used to assess the quality of care in 63 practices with a special interest in diabetes. Data on 3010 adults with Type 2 diabetes from 3 primary care initiatives were analysed and the results were benchmarked against national guidelines and standards of care in the UK. The final study was an instrumental case study of policy formulation. Semi-structured interviews were conducted with 15 members of the Expert Advisory Group (EAG) for Diabetes. Thematic analysis was applied to the data using 3 theories of the policy process as analytical tools. Results: The survey response rate was 44% (n=262). Results suggested care delivery was largely unstructured; 45% of GPs had a diabetes register (n=157), 53% reported using guidelines (n=140), 30% had formal call recall system (n=78) and 24% had none of these organizational features (n=62). Only 10% of GPs had a formal shared protocol with the local hospital specialist diabetes team (n=26). The lack of coordination between settings was identified as a major barrier to providing optimal care leading to waiting times, overburdened hospitals and avoidable duplication. The lack of remuneration for chronic disease management had a ripple effect also creating costs for patients and apathy among GPs. There was also a sense of inertia around quality improvement activities particularly at a national level. This attitude was strongly influenced by previous experiences of change in the health system. In contrast GP’s spoke positively about change at a local level which was facilitated by a practice ethos, leadership and special interest in diabetes. The 2nd quantitative study found that practices with a special interest in diabetes achieved a standard of care comparable to the UK in terms of the recording of clinical processes of care and the achievement of clinical targets; 35% of patients reached the HbA1c target of <6.5% compared to 26% in England and Wales. With regard to diabetes policy formulation, the evolving process of action and inaction was best described by the Multiple Streams Theory. Within the EAG, the formulation of recommendations was facilitated by overarching agreement on the “obvious” priorities while the details of proposals were influenced by personal preferences and local capacity. In contrast the national decision-making process was protracted and ambiguous. The lack of impetus from senior management coupled with the lack of power conferred on the EAG impeded progress. Conclusions: The findings highlight the inconsistency of diabetes care in Ireland. The main barriers to optimal diabetes management center on the organization and coordination of care at the systems level with consequences for practice, providers and patients. Quality improvement initiatives need to stimulate a sense of ownership and interest among frontline service providers to address the local sense of inertia to national change. To date quality improvement in diabetes care has been largely dependent the “special interest” of professionals. The challenge for the Irish health system is to embed this activity as part of routine practice, professional responsibility and the underlying health care culture.

A social history of sport in Cork, Tipperary and Waterford, c. 1880-1930

This thesis seeks to explore the development of sport in Munster in the late nineteenth and early twentieth centuries by comparing developments in three counties: Cork, Tipperary and Waterford. In particular this thesis considers the development of rugby and soccer in comparative perspective across these three counties, asking what local factors impacted on their uneven development in the region and considering the extent to which the traditional model of diffusion applies to the reception of these sports in the three counties. By giving consideration to these two particular non-indigenous sports, the thesis will, through answering that question, explore ideas of cultural reception, national identity and class as expressed at local level. These themes will be explored by placing the comparative analysis of these two sports into a wider context of sporting development regionally and nationally in the period, in particular the emerging commercialisation of sport, and also the diverse sporting culture of which these two sports were a part. Utilising a wide range of archival sources from local, national and sporting newspapers, to club records, official publications and ephemera this thesis builds a picture of sport in Munster that is deeply rooted in the community, and that forms an important facet of the social world of Cork, Tipperary and Waterford from 1880-1930.

An archaeology of female monasticism in medieval Ireland

This thesis considers the archaeological evidence for female monasticism in medieval Ireland, with a particular emphasis on the later medieval period. Female monasticism has been considered from an archaeological perspective in several countries, most notably Britain, but has yet to be considered in any detail in Ireland. The study aims to bring together all the currently available evidence on female monasticism and consider it through an engendered archaeological approach. The data gathering for this research has been deliberately wide, and where gaps have been identified in the Irish evidence, comparative material from elsewhere has been considered. Nunneries should not be expected to conform to what has become the male monastic template of a claustrally-planned monastery. The research conducted shows a distinct and varied archaeology and architecture for medieval nunneries in Ireland which suggests that a claustral plan was not considered an essential part of a nunnery scheme. Nunneries provided an enclosed environment where women, for a variety of motives could become brides of Christ. Through the performance and celebration of the daily Divine Office, the Mass and seasonal liturgy, spaces used by the nunnery community were negotiated and transformed into a sacred Paradise on earth. However, rather than being isolated in the landscape nunneries in later medieval Ireland were located either within or close to walled towns, larger unenclosed settlements and settlement clusters and would have been well known throughout their hinterlands. This research concludes that nunneries were an intrinsic part of the medieval monastic landscape in Ireland and an essential component of patrons’ portfolios of patronage, at a particularly local level, and where they interacted closely with their local community.