Study Region

Part one of the study took place in Iran's capital, Tehran. Many of the disaster management protocols in Iran are coordinated from Tehran. Part two of the study was conducted in the earthquake affected region of Bam; a suitable research site as many NGOs are still active there following the disaster in 2003.

Study Design

Research was conducted within a six week period. A combination of 25 informal meetings and semi-structured interviews, that were in-depth when appropriate, were carried out. Interviews involved a mixture of open and closed questions, and were designed to last between 30 and 40 minutes. The interview was structured according to recommendations on qualitative research [12–14]. The content of each question was developed from the guidelines [1, 2, 4–7, 15, 16] examined as part of the literature review conducted prior to field work. Interviews took place in the organisation's headquarters, or in mutually convenient locations.

The following people were present at each interview:

1. Interviewer (Principal Investigator (FB): International Health BSc Student)

2. Interviewee (Subject from relevant organisation)

3. Male translator and chaperone

The translator served a dual role as a chaperone because the Principal Investigator (FB) is female and was unfamiliar with the country. The translator/chaperone was briefed prior to conducting research.

Additional literature was collected from organisational headquarters, or from recommended sources, throughout the study since literature relating to Iran is limited in the UK.

Recruitment Strategy

Research began with a meeting with a Health Systems Specialist at the World Health Organisation (WHO) office in Tehran. Here the spreadsheet of contacts was reviewed, and advice obtained on the best manner in which to approach people. Further contacts were given, and most importantly the Principal Investigator was introduced to the Managing Director of Health Improvement at the Ministry of Health and Social Welfare, in Tehran. A meeting with the Managing Director of Health Improvement, involving an explanation of this study and presentation of the British ethical approval it received, was conducted. Following the meeting a letter acknowledging this study, that also had the dual role of introducing the Principal Investigator to other agencies, was prepared. A copy of this letter was also faxed to the Ministry of Health and Social Welfare in Bam, ahead of our arrival. This official letter was the most useful resource for this study in Iran, as all interviewees were comforted by the fact that this project had been approved by the Ministry of Health and Social Welfare, meaning that everyone approached was willing to be interviewed.

Initial discussions with academics in Iran revealed that the majority of work in the country is done through personal contacts. Therefore, meetings to build relationships and seek guidance became necessary. Through such meetings introductions were made to other subjects; these were vital in order for subjects to agree to being interviewed.

Prior to arrival in Iran, the interview questions were emailed to a WHO field worker on request. This subject took it upon themselves to interview three relevant NGOs in Bam and return the data to the Principal Investigator via email. In order to validate these results, a meeting with the WHO field worker was conducted where the results were discussed and clarified so they could be included in the study.

Study Sample

Due to time constraints and the depth of the interviews and meetings being conducted, the sample size could not consist of more than 25 subjects. All subjects are, or have been, involved in the management of separated and/or unaccompanied children, following a disaster(s) in Iran. The sample size was sufficient to answer the research question and includes an adequate variety of opinions at the required depth. Limiting the sample size also ensured accurate translating and transcribing in the given time.

Meetings and interviews were not only with NGOs, as originally planned, because during initial meetings in Iran it became evident that it was necessary to also interview relevant personnel from other agencies, for the findings to be complete and accurate.

Ethical Considerations

The information sheet relating to this study was translated into Persian (Farsi), and offered to subjects to allow them to give informed consent when opting to participate in this study. Confidentiality and anonymity were always respected, with only the name of each organisation and the interviewee's job title according to their own description being included. References to the subject's personal details from which they could be identified were also omitted. The fact that there would be no negative repercussions from participating in the study was stressed. The verbal consent was obtained as, considering the circumstances, this was deemed the most appropriate and ethical method.

The study design was ethically approved by the ethics board at the Nuffield Centre for International Health and Development, Leeds. Ethical Approval was not required by any ethics committees in Iran.

Data Collection

Interviews and meetings were conducted in Persian (Farsi) language by the Principal Investigator, with the translator only assisting in maintaining interviews when necessary. Three interviews that were conducted in English, as the subjects were equally as confident in English as they were in Persian (Farsi). With informed consent from subjects, interviews were recorded to allow accurate transcription and the opportunity to refer to the exact content of the interview at a later date.

Ideally results would have been transcribed in Persian (Farsi) first and then translated into English. However, time constraints prevented this from being possible. Translation of interviews was done in Iran as translators were available to assist when required. Furthermore, translation and transcription in Iran provided the opportunity for any gaps in the research to be identified, and these could then be researched before leaving the country. Transcription was done word for word wherever possible; however the nature of language prevented literal translation in some instances. Copies of transcriptions can be obtained from the author on request. Following transcription all recordings were erased to ensure confidentiality and anonymity.

Data Analysis

Use of the Grounded Theory Approach was suitable in this study [12–14] as was thematic analysis [12, 13], in order to identify recurrent or common themes in the participant's responses. Following the principles of thematic analysis subheadings were created and the content of each transcript was analysed, and then put under the relevant subheading. Furthermore, the additional literature acquired in Iran was analysed along with the hand written notes made following each interview and throughout the research. Any relevant information from these sources was then also included under the appropriate subheadings.

Behzisti (Government Welfare Organisation of Iran)

Behzisti is responsible for separated and unaccompanied children in Iran. However, these children are not necessarily separated or unaccompanied as a result of a disaster:

"Children come into the care of Behzisti because they have gotten lost, they have been abandoned in places like mosques, they have been found by the police ... legally all children in these circumstances should be brought to Behzisti" (Interview 14)

As a number of children are inevitably separated or unaccompanied following a disaster, Behzisti is active immediately after a disaster occurs and continues it's work into the long term phases of the management process:

"Immediately after a disaster we [Behzisti] setup camps with psychiatrists, psychologists and social relief workers ..." (Interview 13)

When a child has become separated from their family, for whatever reason, the main aim is to search for the child's family and reunite them, where possible and suitable:

"...after investigating the circumstances to see why the child was left...our main aim is to return these children to their families." (Interview 14)

When reunification is not an option children are placed in residential care either in the private (NGOs) or public sector:

"60% of the services for guardian-less children are provided in co-operation with the private sector, and 40% are carried out by the public sector." (Interview 15)

According to Behzisti, NGOs who are given children to care for have to uphold certain standards set by Behzisti. They also provide financial assistance and regular supervision:

" ..we do give these [guardian-less] children to NGOs, these foundations work under our supervision receiving financial and consultative assistance... an NGO who gets a child from us, if they don't maintain our standards, we take the child back from them..." (Interview 13)

"Standards relating to the building [where children are housed] also need to be upheld.. for every 8 children there should be at least one carer, and each centre should have at least three instructors, working on a shift bases so they change every 8 to 12 hours...each child should also have a private room, and there should be social spaces and spaces to study." (Interview 15)

Committee Emdad Imam Khomeini

Committee Emdad Imam Khomeini, a national organisation unique to Iran, was established officially following the Islamic revolution. The organisation aims to:

"... bridge the gap between those who are wealthy and those who are not....we are protected by the government and we are supported by public contributions." (Interview 3)

One of Committee Emdad Imam Khomeini's specific duties is the "support of needy people and families against the problems coming from accidents and natural and non-natural disasters" [17].

Committee Emdad Imam Khomeini assesses each individual crisis situation and then provides what is needed to the best of their ability. Specifically for orphans, Committee Emdad Imam Khomeini has an 'OrphansRespect Plan':

"...orphans are protected by someone who is wealthy...the wealthy person pays a monthly amount into the orphans account...this financial assistance is conveyed to the orphans or their families through Committee Emdad..." (Interview 3)

"People who use this service are under the care of Committee Emdad. People who don't use this service are under the care of Behzisti of the whole country." (Interview 6)

Non-Governmental Organisations (NGOs)

The support and/or care provided by NGOs takes several forms, but it is often not exclusive to separated and unaccompanied children. Where this is the case, children are not necessarily in their circumstance as a result of a disaster:

Residential care in the form of small group homes

"...everything is like a home here, just like at home children go out to school...go out to the doctors...we don't even have a sign up outside our organisation as homes don't have signs up outside so we don't have one either ..." (Interview 9)

Financial assistance and provision of furniture

"...all our children have mothers...we give the families a set amount every month...we check how they use it...we assess what equipment they need and try to provide it...and check that it is still there on a regular basis..." (Interview 20)

"...if a child was cared for by their aunt, in case this aunt didn't have home appliances, we gave them an oven, a fridge...to prevent them from having problems with caring for the child..." (Interview 11)

"...following the Bam earthquake, we support 40 children financially...giving them a monthly allowance..." (Interview 10)

Arrangement of educational and extra-curricular activities

"Most of our work is teaching children activities of daily living. Also we do some exciting games and we teach painting." (Interview 25)

"...part of our target group also is separated and unaccompanied children...we have some workshops like music classes, computers..." (Interview 28)

Psychosocial support

"...PTSD [Post Traumatic Stress Disorder] techniques were within the framework of play...games included playing the life train...within this we familiarised children with death, at some stations people got off the train, representing death, at other stops people got on, representing birth..." (Interview 24)

"...all our children have social problems at first, all our carers are trained to deal with these problems and make sure the children are happy..." (Interview 9)

Provision of emergency relief supplies

"...we usually participate in natural disasters by providing aid and equipment such as blankets, food..." (Interview 10)

Family Reunification Project

The overwhelming nature of the Bam earthquake lead UNICEF and Behzisti in Kerman to form a joint partnership called the Family Reunification Project, between December 29th 2003 and December 26th 2005, to help reunify families who had become separated as a result of the disaster.

"...the main objective of this agreement being to organise and follow up issues related to children under 18 years of age who have lost their families and parents...." (Interview 23)

Due to the success of the project, it is now continuing with the support of Behzisti:

"...we learned a lot from our experience with UNICEF during this time...and now having seen our results, Behzisti is supporting our project..." (Interview 23)

Management of Separated and Unaccompanied Children

Durable Arrangements

Non-Governmental Organisations in Bam

In general the role of local, national and some international NGOs in Bam was, and still is, to support unaccompanied children. In contrast to the findings in Part one, relating to Iran in general, it was not deemed suitable following the earthquake to delegate the responsibility of permanently caring for unaccompanied children to NGOs. However, the rest of their roles were similar to the roles of NGOs described in part one of this study:

"...we seek support from other NGOs... we allow them to work with us. Behzisti does not give children to NGOs, for example there is a NGO run play school for children, but these children only visit this NGO centre during the day, they do not stay the night as they go back to their families in the evening." (Interview 17)

The Role of NGOs in the Management of Separated and Unaccompanied Children, following Disasters in Iran

Research has shown that NGOs in Iran have a restricted role in the management of separated and unaccompanied children. Firstly, it should be noted that NGOs are viewed with some scepticism in Iran. Even though the number of NGOs has been increasing since1990, Iran is still unfamiliar with their work.

Literature obtained at the Educational Research Centre of Behzisti in Tehran, acknowledged that the general consensus in Iran is that NGOs should be "managed under the supervision of, and their programs should be coordinated by, governmental organisations", however cooperation between agencies was stressed [18]. This questions whether NGOs actually exist in Iran, as they largely do not conform to the standard definition.

As a consequence of the way in which NGOs are viewed in Iran, combined with the fact that separated and unaccompanied children are extremely vulnerable, it is not surprising that few NGOs in Iran are delegated the responsibility of caring for unaccompanied children. Yet the fact that in general NGOs play at least a supporting role in the care of separated and unaccompanied children, shows that progress is being made.

In addition, the majority of NGOs interviewed as part of this research have multiple roles, one of which involves separated and unaccompanied children. Few institutes cater exclusively for unaccompanied children, and no organisations were found to deal solely with children separated or unaccompanied as a result of disasters. This may be due to the fact that NGOs are limited in the care they can provide, as the majority of the responsibility for separated and unaccompanied children lies with Behzisti (the government welfare organisation of Iran). Alternatively organisations may have chosen not to segregate unaccompanied children to avoid children being stigmatisatised. Research has also shown that community involvement in NGO lead projects is high, and as a result many projects are proving successful.

Furthermore, as the work of NGOs in Iran is still relatively new, especially in rural areas, their work is yet to take an established form. There is also little cooperation between NGOs, especially between local and international organisations. In spite of this, coordination between government and international agencies seems to be improving, especially after the success of recent collaborations such as the Family Reunification Project.

The Role of other agencies in the Management of Separated and Unaccompanied Children, following Disasters in Iran

Research has shown that the work of a number of other agencies, actively involved in the management of separated and unaccompanied children in Iran, is related to the work of NGOs.

Iranian Red Crescent

The Iranian Red Crescent organisation, a member the world's largest humanitarian network [19], was found to be central in providing basic relief supplies [4, 20, 21] to all victims of disasters, immediately after the event.

Behzisti

Management of separated and unaccompanied children following disasters is only a small part of Behzisti's work, as it has a range of duties to uphold in Iran. Behzisti outlined a substantial number of conditions NGOs must follow in order to be allocated the duty of caring for unaccompanied children. The organisation conveyed a firm control over NGO activities.

Committee Emdad Imam

Committee Emdad Imam Khomeini has a significant place within Iranian society. In contrast, some independent NGOs are yet to gain the credibility and recognition they deserve. Committee Emdad Imam Khomeini has various roles, but these are not distinct, and in spite of its good work many of its activities seem to overlap with the work of other agencies. Schemes similar to the Orphans Respect Plan are common in Iran and not just for orphans but also for families who struggle financially. A great deal of financial assistance is given in Iran and other forms of support, including psychosocial, are on the increase.

United Nations

United Nations agencies, such as WHO and UNICEF, are continuing to develop their relationship with Iran. For example, following the Bam earthquake time was needed to gain permission for projects, but once consent was given cooperation was commendable. As trust is developed, progress should occur at a more rapid pace.

International Guidelines on the Management of Separated and Unaccompanied Children

Only UNICEF referred to the guidelines for the management of Separated and Unaccompanied children developed by the inter-agency working group [22]. This was unexpected as the literature review indicated these universal guidelines were widely used. Other organisations made vague references to other documents, however there was no evidence suggesting a definite set of guidelines were in active use throughout Iran. Even though documentation was only rarely referred to, many of the principles contained within the international guidelines on the management of separated and unaccompanied children were put into practice in Bam. This was especially true once UNICEF's assistance began in accordance with international guidelines. These state that when an event overwhelms the national government, the victims of the disaster are the responsibility of the United Nations [4], after which other humanitarian organisations should assist where appropriate.

Reasons for Separation

As stated in the literature on this topic, children were separated from their families as a result of the way in which organisations initially worked [7, 5, 23] following the disaster in Bam. However, neither the scale of the disaster nor the necessity of UNICEF's input could have been predicted. Furthermore, the choice of residential care options was not limited to begin with as recommended [23, 24], leading to a number of separations occurring immediately after the earthquake.

Limiting Separation

No evidence of implementing recommendations to limit family separations [8, 22, 23, 25] following the Bam earthquake was found. Although after the subsequent earthquake in Zarand (a city in the same province), the Family Reunification Team that worked in Bam assisted Behzisti in Zarand. Even so, a preparedness plan is yet to be developed and implemented.

Location of Separations

As no specific locations of significant numbers of separations were identified, suggestions relating to methods of reducing separations 5 were not followed.

Identification, Registration and Documentation

Guidelines [5, 7, 23, 26, 27] did not describe the process via which children could be identified, and at operational levels there was no clear system. Where possible, children were sensitively interviewed and registered systematically in accordance with international guidelines [5, 23, 26]. Documentation was kept confidential, and steps were being taken to make information storage standardised through the use of a database.

Tracing

Tracing family members or primary legal or customary care-givers was done by actively searching as suggested in the guidelines [5]. However, computerised cross-matching was not used.

Reunification

Formal reunification procedures followed the guidelines [23]; the validity of the relationship between those being reunited was demonstrated by the Child Welfare Committee and in some cases ongoing support was also provided following reunification [1].

Interim Care

After the initial chaos following the Bam earthquake, guidelines [5, 7] were followed in that unaccompanied children were cared for by relatives and only placed in residential care when this was not possible.

Durable Arrangements

In accordance with international guidelines [5, 23] durable arrangements that would hinder eventual family reunification were not made until tracing efforts had been exhausted.

Extended Family

In line with the guidelines [5, 7, 28] kinship care was always the preferred option for the people of Bam, as well as those coordinating reunification efforts.

Community Care

Again guidelines [23] were adhered to when community and foster care were not arranged, in line with the Islamic Shaaria law in Iran.

Institutional Care

As suggested [7, 23] institutional care was only used as a last resort, and such care has been improving in Iran recently with the formation of small group homes.

Adoption

Following international guidelines, unaccompanied children were not adopted until their status had been clarified [27–29]. The country's rules were considered, along with the circumstances of the situation, from which inter-country adoption was deemed inappropriate.

Overall systems for managing separated and unaccompanied children following disasters in Iran, involving NGOs are emerging. However, most are yet to be formalised.

Recommendations for Future Management

Limitations