Form 2 Instrument for Household Survey-Control Group

DRAFT

Form Approved

OMB No. 0920-XXXX

Exp. Date __xx/xx/20xx__

Lebanon: Psychological Impact on Communities Affected by Landmines¹

Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA

Centers for Disease Control and Prevention, Atlanta, GA, USA

Instrument for Household Survey – to be filled in by interviewer.

Questionnaire #: Interviewer: _________________

GPS Data: Latitude: _ _ . _ _ _ _ _ Longitude: _ _ _ . _ _ _ _ _

Date of Interview: __/___/____ Day of Interview: 1 2 3 4 5 6 7

Time Started _____: _____ Time Finished _____:_____

Informed Consent

Hello, my name is ___________________________ and I am working with a research center at Harvard University to better understand the effects of cluster munitions and unexploded remnants of war on households and communities. We would very much appreciate your participation in a survey that asks you about your family, your work, and your opinions and perceptions on your living in this community and your plans for the future. We think this information will be helpful in guiding the social and economic development of communities affected by landmines and the effects of de-mining activities in your area. The survey usually takes 45 minutes to complete. Whatever information you provide will be safeguarded to the fullest extent possible and we do not plan to share any information that might identify individual participants. We will not record your name or the names of your family members.

Participation in this survey is voluntary and you can choose not to answer any you do not wish to answer. You can choose to stop participating at any time without obligation. However, we hope that you will participate in this survey since we believe your views are extremely important and will benefit your family, neighborhood, and village/city. The study is funded by the Centers for Disease Control and Prevention in the United States.

At this time, do you want to ask me anything about the survey? Y N

May I begin the interview now? Y N

Signature of interviewee: _______________________Date: _________________

Respondent(s) agree (s) to be interviewed: Y N

Demographics

Governorate _______________ District _______________

Municipality ________________ Village _______________

Household __________________

Group: Cluster Remote ERW

Cluster Munition Density Measure:

1. Head of Household: Male  Female 

   1. If female head of household, what is marital status?

1. Single, not divorced

2. Divorced

3. Widowed

4. Married, husband not living with family

2. Who are the persons who reside permanently in this household?

Person #	Relation to Head A-Household Head B- Spouse C- Son/Daughter D-Parent E-Sibling F- Grandparent G- Grandchild H- Son/Daughter in law I- Other Relative J- Other	Sex 1.M 2. F	Age	Contributes to HH economy 1. Yes 2. No	Occupation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17

If there are more members please write on the back of the page

3. 1. Yes

   2. No

   Did you lose family members during the 2006 war?

   1. If yes, which family member(s)?

relation ___________ age _____ gender ___ cause of death ____________

relation ___________ age _____ gender ___ cause of death ____________

relation ___________ age _____ gender ___ cause of death ____________

4. 1. Yes

   2. No

   Was any family member killed from a cluster bomb?

   1. If yes, which family member(s)?

relation ___________ age _____ gender ___ circumstance ____________

relation ___________ age _____ gender ___ circumstance ____________

relation ___________ age _____ gender ___ circumstance ____________

5. 1. Yes

   2. No

   Was any family member disabled from a cluster bomb since living in this village (after July 2006)?

   1. If yes, which family member(s)?

relation ___________ occupation _________age ___gender ___ circumstance _______

relation ___________ occupation _________age ___gender ___ circumstance _______

relation ___________ occupation _________age ___gender ___ circumstance _______

6. Are any members of your family missing (not known to have been killed and unknown location) since the 2006 war?

1. Yes

2. No

If no, go to #7

1. If yes, please list:

relation ___________ occupation _________age ___gender ___

relation ___________ occupation _________age ___gender ___

relation ___________ occupation _________age ___gender ___

7. Have any household members left the village

   1. 1. Yes

      2. No

      Since the 2006 war (including yourself)?

   2. 1. Yes

      2. No

      Prior to 2006 war (including yourself?)

If no, go to #8

3. If yes, please list (current at time of departure):

relation ___________ occupation _________age ___gender ___

relation ___________ occupation _________age ___gender ___

relation ___________ occupation _________age ___gender ___

4. If yes, did he/she/they move to:

1. Beirut

2. Other urban area in Lebanon

3. Another village in Lebanon

4. Another country

99. Other

5. 1. Yes

   2. No

   Do former household family members (family members who have left Lebanon) contribute funds in support of the household?

If no, go to #8

1. If yes, how are these funds from former household family members (family members who have left Lebanon) spent?

2. 1. Daily expenses (food, rent)

   2. Special expenses (construction, repair, health care, land, renovations)

   3. Education

   4. Investment, expansion of income

   99. Other

8. Is anyone in the family of marriageable age but unmarried?

1. Yes

2. No

1. If yes, what is the main reason they have not married?

1. Uncertain about the community’s future

2. Have not found potential marriage partners

3. No money

4.

5. Other

Livelihood/Sense of Home, Community

9. 1. Yes

   2. No

   Is this your ancestral village?

If yes, go to #10

1. If no, how far away is your ancestral village?

Kilometers:

2. 1. Yes

   2. No

   Are you planning on staying here?

   1. If yes, why (circle all that apply):

1. Unable to go home: no services or utilities available	2.Unable to go home: land taken and given to someone else	3. Unable to go home: high cluster bomb risk	4. Unable to go home: other non-mine insecurity	5. Employment here
6. Other (non-job) opportunities here	99. Other

2. If no, why not (circle all that apply):

1. Want to eventually go to ancestral home	2. Want to eventually go to Beirut or other urban area in Lebanon	3. Want to eventually go to another country	4. Want to go to place with more opportunity for work	5. Crime is too high
6. Cluster bomb risk is too high	99. Other

Go to #13

10. 1. Yes

    2. No

    Are you living in your ancestral village continuously throughout the year?

If yes, go to #11

1. If no, how much time per year do you spend in this village?

Days

2. Where do you live most of the year (considered home base)?

1. North America	2. Central America	3. South America	4. Europe	5. Middle East – Gulf States
6. Middle East – non-Gulf States	7. Asia

3. 1. Yes

   2. No

   Do you have relatives that live continuously in the village?

11. Are you living on the exact piece of land that belongs to your family/ancestors?

1. Yes

2. No

12. How long has your family lived on this piece of land?

Years Months

1. Yes

2. No

13. Do you personally own any part of this land?

If no, go to #13b

1. If yes, for how long? Years Months

1. How do you know you own this land (circle all that apply)?

1.Have a written deed	2. Written in village registry	3. Have verbal understanding from mukhtar or political party leader	4. Have verbal understanding from family member	99. Other

2. In no, what is your relationship to the land?

1. Tenant

2. Squatter

3. Custodian for other family owner

99. Other

14. Do you farm land/raise food? If no, go to #15

1. Yes

2. No

1. If yes, why do you raise food

   1. Raise food for export? %

   2. Raise food for local market sale? %

   3. Raise food for household consumption? %

   4. Other? %

2. 1. Yes

   2. No

   Do you own the land you farm?

If yes, go to #14c

1. 1. Yes

   2. No

   If no, do you work for a large commercial farm?

1. How large is the piece of land? Hectares:

2. What crops do you grow and how much/season?

___________ Hectares

___________ Hectares

___________ Hectares

5. What is the distance from your house to the land? Meters:

6. 1. Yes

   2. No

   Have you had continuous access to the land since July 2006?

1. If not, why not?

1. Cluster bombs block access	2. Land is far from village	3. Have been away (not related to cluster bombs)	4. Insecurity from tanks, F-16s, soldiers
5. Poor road infrastructure due to war	6. Poor road infrastructure (not due to war)	7. Land is being used by someone else	99.

7. 1. Yes

   2. No

   Was there any time when you planted less or did not plant on the land since July 2006?

If no, go to #14h

1. If yes, how many hectares of each crop did you plant?

___________ Hectares

___________ Hectares

___________ Hectares

2. Why were you not able to plant as much as previous years (check the one main reason)?

1. Cluster bombs block access	2. Land is far from village	3. Have been away (not related to cluster bombs)	4. No capital (seeds, equipment)
5. Less market demand (not related to cluster bombs)	6. Workload demand	7. Weather conditions	99. Other

8. 1. Yes

   2. No

   Are you planning on planting next season?

If no, go to #14i

1. If yes, what would you like to plant?

1.

2.

3.

4.

2. If yes, how many more hectares of each crop do you intend to plant?

___________ Hectares

___________ Hectares

___________ Hectares

Go to #14j

9. If no, what is stopping you from planting what you want to plant (check one main reason)?

1. Cluster bombs block access / fear of cluster bombs	2. Land is far from village	3. Intend on leaving the area (not related to cluster bombs)	4. No capital (seeds, equipment)
5. Less market demand (not related to cluster bombs)	6. Workload demand	7. Weather conditions	99. Other

10. 1. Yes

    2. No

    Do you raise food for market?

If no, go to #15

1. If yes, what is the average distance to the markets?

km

2. To what extent has this distance changed due to the presence of cluster munitions (since July 2006) if at all?

1. Increased (doubled)	2. Slightly increased (less than doubled)	3. Unchanged	4. Slightly decreased
5. Cut in half

1. Yes

2. No

15. Are you saving to buy more land?

If yes, go to #16

1. If not, why not (circle all that apply)?

1. No need to buy additional land	2.Fear of cluster bombs still in area	3. Have no money to save	4. No additional land available
5. Other

16. 1. Yes

    2. No

    Do you gain income by a non-farming activity?

If no, go to # 18

If yes, what activities (circle all that apply)?

1. Raise animals

2. Business outside of home (non-tourism)

3. Business inside home (non-tourism)

4. Tourism

5. Other

If other: ­­­­­­­­­­­­­­­­­­­­­­­­______________

If raise animals only, go to #17

1. What is the distance from your house to workplace? km m (if work at home, put 0)

2. Has this distance increased due to presence of cluster bombs?

1. Yes

2. No

3. Have you had continuous physical access to your workplace since July 2006?

1. Yes

2. No

If yes, go to #17

1. If not, why not?

1. Cluster bombs block access (physical presence of bombs remain)

2. Road and infrastructure damage from war

3. transportation not always available

4. Workplace moved

99. Other

4. Do you plan on expanding your business?

1. Yes

2. No

5. What are the major obstacles to expanding your business?

1. No capital funds	2. No new markets	3. Distance	4. No skilled labor available	5. Lack of infrastructure unrelated to war
6. Danger or access difficulty from cluster bombs	7. General insecurity of the area	8. Not enough time	9. Other personal concerns have priority (family, health, etc)	99. Other

17. If you raise animals, what is the distance from your house to the grazing fields?

If no animals, go to #18

Meters:

1. List type and number of each type of animal:

_______________

_______________

_______________

2. Have you had continuous access to the grazing land since July 2006?

1. Yes

2. No

If yes, go to #17c

1. If not, why not?

1. Cluster bombs block access	2. Land is far from village	3. Have been away (not related to cluster bombs)	4. Insecurity from tanks, F-16s, soldiers
5. Poor road infrastructure due to war	6. Poor road infrastructure (not due to war)	7. Land is being used by someone else	99. Other

3. Was there any time when you did not graze animals on the land since July 2006?

1. Yes

2. No

If no, go to #17d

If yes, why?

1. Cluster bombs block access	2. Land is far from village	3. Have been away (not related to cluster bombs)	4. Insecurity from tanks, F-16s, soldiers
5. Poor road infrastructure due to war	6. Poor road infrastructure (not due to war)	7. Land is being used by someone else	99. Other

4. Are you planning on raising more animals in the near future?

   1. 1. Yes

      2. No

      If yes, how many more of each type:

_______________

_______________

_______________

2. If no, what is stopping you from raising more animals?

1. Fear of cluster bombs in area	2. Not enough money (capital)	3. No market demand	4. Insecurity from tanks, F-16s, soldiers
5. Political pressure	6. No interest in additional work	7.	99. Other

5. What is the distance to the nearest market/road for selling animals?

Meters:

6. 1. Yes

   2. No

   Is this distance increased due to presence of cluster bombs?

1. Yes

2. No

7. Have any animals been killed or injured from cluster bombs since July 2006?

If none, go to #18

1. If yes, how many? Type _________________

18. What best describes the water supply for the household?

1. In-house, municipal	2. In-house, well	3. Outside house, well	4. Outside house, spring
5. Other surface	6.	7.	99. Other

19. What is the distance to the house water supply? Meters:

(If in-house, write “0”)

20. 1. Yes

    2. No

    Have you had continuous access to water since July 2006?

If yes, go to #21

1. If not, why not?

1. Cluster bombs block access	2. Water source is far from house	3. Have been away (no need to access)	4. Insecurity from tanks, F-16s, soldiers
5. Water shortages from disruption of infrastructure due to war	6. Water shortages from disruption of infrastructure unrelated to war	7. Water shortages from other causes	99. Other

21. 1. Yes

    2. No

    Do your children attend school?

If no, go to #22

1. If yes, which children?

age _____ gender ________

age _____ gender ________

age _____ gender ________

2. 1. Yes

   2. No

   Have your children continuously attended school since the end of the war?

If yes, go to #23

1. If not, why not?

2. 1. Cluster bombs block access	2. School is far from village	3. Need to work occasionally	4. Fear of tanks, F16s, other war machinery
   5. School not always in session due to cluster bombs	6. School not always in session due to ongoing fighting from war	7. School not always in session due to non-war causes	8. Other insecurity (not war related)
   	99. Other

G

o

Go to #23

22. Why do your children not attend school?

1. Cluster bombs block access	2.School is far from village	3. Need to work	4. Fear of tanks, F16s, other war machinery	5. Too young
6. No school available in village	7. School damaged from war	8. School damaged not due to war	9. Other insecurity (not war related)	99. Other

23. Have you saved or do you plan to save for your children’s education?

1. Yes

2. No

If yes, go to #24

If not, why not?

1. No money to save	2. No plans for future education (not due to lack of opportunity)	3. No opportunities for future education	4. Presence of cluster bombs make it too dangerous to continue to go to school	5. Too young to start saving
6. Level of insecurity from war make it too dangerous to continue school	7..	99. Other

24. 1. Yes

    2. No

    Do you and your family have access to health care facilities?

If no, go to #24b

1. 1. Yes

   2. No

   If yes, do you have continuous access to health care facilities?

If yes, go to #25

1. If not, why not?

1. Cluster bombs block access	2. Health facility is far from village	3. Health facility is not always open (non-war related)	4. Fear of tanks, F16s, other war machinery
5. Health facility not always open due to cluster bombs	6. Health facility not always open due to ongoing fighting from war	7. Other insecurity (not war related)	8. Money not always available to cover costs
9.	99. Other

GGo to #25

2. If not, why not?

1. Cluster bombs block access	2. Health facility is too far from village	3. No health facility or health provider	4. Ongoing fighting/war prevents me from going
5. Too costly	6. Other insecurity (not war related	7.	99. Other

25. 1. Yes

    2. No

    Is your extended family in the same village?

26. 1. Yes

    2. No

    Did you have to flee during the war?

If no, go to #27

1. If yes, how many times?

2. Length of longest time away? Months Days

3. How far was that? Kilometers:

27. 1. Yes

    2. No

    Are there current (ongoing) cluster bomb removal activities in or near your village?

1. Yes

2. No

If no, go to #27b

1. If yes, these are (circle all that apply):

1. Active clearing by NGOs

2.Active clearing by Lebanese army

3. Active clearing by villagers/local population

4.

99. Other

2. If no, why not?

1. No cluster/bombs mine concerns in the area	2. Area has been certified as clear	3. Cluster bombs in area but clearance activity hasn’t started yet	4. Cluster bombs in area but not surveyed yet	5.
99. Other

28. 1. Yes

    2. No

    3. Don’t know

    Have you and/or your family had cluster bomb/mine risk education?

29. If you were here alone, would someone in this village help you?

1. Yes

2. No

3. Don’t know

30. 1. Yes

    2. No

    3. Don’t know

    If you needed financial help, would any non-family people in the village loan you money?

31. If you needed urgent medical care, would any non-family people in the village take you to hospital/medical provider/health facility?

1. Yes

2. No

3. Don’t know

32. Do you intend to stay here in this village/neighborhood over the next few years or are you thinking of going elsewhere?

1. Yes

2. No

3. Don’t know

If no, go to #32b

1. If yes, why do you intend to stay (circle all that apply)?

1. This is my family home	2. I feel safe here	3. My business/livelihood is here	4. I want to defend my village	5.
6.	99. Other

Go to #33

2. If no, why do you intend to leave (circle all that apply)?

1. This is not my ancestral family home	2. Too dangerous due to cluster bombs	3. Too dangerous due to war with Israel (tanks, F16s)	4. Too dangerous due to causes other than war or cluster bombs	5. My immediate family is elsewhere
6. Better opportunities elsewhere	99. Other

1. Where will you go?

1. Beirut

2. Other urban area in Lebanon

3. Other village in Lebanon

4. Another country

5.

33. Perceptions of home: Circle one answer for each.

1. “I feel attached to this community”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

2. “I feel safe here”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

3. “The members of my community form strong relationships and rely on our neighbors for support”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

4. “After the end of active fighting it was important for me to return home to my community quickly”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

If quickly,

1. The main reason for returning quickly was:

1. To secure my land	2. Need to work and support my family	3. I have nowhere else to live	4. To help others in my community	5.
6.	99. Other

5. “I want to grow old and die in this place”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

6. “I believe my child will line in this community in ten years”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

7. “I believe my children will work in this community in ten years”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

8. “My family has had undergone hardship in the past 5 years”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

1. If any hardship, the major reason is:

1. Lack of financial resources	2. Health problems	3. Armed fighting in my community	4. Inability to use my land	5. Cluster bombs or landmines near my home or land
6. I am unlucky or it is my fate	99. Other

2. The second biggest reason for my family’s hardship is:

1. Lack of financial resources	2. Health problems	3. Armed fighting in my community	4. Inability to use my land	5. Cluster bombs or landmines near my home or land
6. I am unlucky or it is my fate	99. Other

9. “My family and I are at risk of injury or death from a cluster bomb”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

10. “Others in my community are at risk of injury or death from cluster bombs”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

11. “I plan to put money away for my children’s education”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

12. “I do not think about cluster bombs when my children go out to play”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

13. “I do not think about cluster bombs when my children leave for school”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

14. “I plan to expand my business in the next 2 years” (e.g. plant more land, hire more workers, expand my shop, etc)

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

15. “I have no difficulty in getting to work”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

16. “I have received information on how to avoid injury/death from cluster bombs”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

17. “My children have received enough information on cluster bombs to avoid injury/death”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

18. “I feel my community has received enough education about the risks of cluster bombs to adequately protect itself”

Strongly Disagree Neither Agree or Agree Strongly

Disagree Disagree Agree

END OF INTERVIEW: Thank you very much for answering these questions and for spending this time with us. We have learned a lot from talking with you and your views are very important in helping us understand the situation in your village/area. We will prepare a report about the situation that is based on what we have learned from you and the other men and women in [your country] whom we have talked with. We will submit this report to the international humanitarian community. If you are interested in hearing about what our report says, please be in touch with [provide name of local coordinator for the study]. Good-bye and we wish you the best of luck for the future. Thank you very much again.

1 Public reporting burden of this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).