It is difficult to consider, describe or address the ethical issues particular to qualitative research without experience and understanding of the technicalities of qualitative methodologies. The Australian National Statement on the Ethical Conduct of Research Involving Humans charges researchers with a responsibility to demonstrate that they have the appropriate experience, qualifications and competence for their proposed research. Ethical review committees have the responsibility to judge claimed research competence. This article provides practical guidance to researchers and review committees on using formal qualifications and training, explicit claims of competence, and markers of in/competence to assess qualitative research competence.
Graduate students typically first experience research ethics when they submit their masters or doctoral research projects for ethics approval. Research ethics boards in Canada review and grant ethical approval for student research projects and often have to provide additional support to these novice researchers. Previous studies have explored curriculum content, teaching approaches, and the learning environment related to research ethics for graduate students. However, research does not exist that examines students’ actual experience with the research ethics process. Qualitative description was used to explore the research ethics review experience of 11 masters and doctoral students in health discipline programs. Data analysis revealed four themes: curriculum, supervisor support, the ethics application process, and students’ overall experience. The results of this research suggest ideas for enhancing curriculum, deepening students’ relationships with supervisors, and developing the role of research ethics boards to support education for novice researchers. This study contributes to comprehension of the research ethics experience for graduate students and what they value as new researchers.
Most countries, including Botswana, have established Institutional Review Boards (IRBs) to provide oversight of research involving human beings. Although much has been published on the structure and function of IRBs around the world, there is less literature that empirically describes the perspectives of stakeholders in low- and middle-income country (LMIC) settings regarding IRB processes. In this study, we employed primarily quantitative methods to examine the perceptions of researchers at the University of Botswana (UB) about the review of research protocols by local IRBs. Data were collected using a web-based survey (SurveyMonkey1). This was a preliminary effort to document some of the emerging experiences of researchers with ethics review in a context where both research and research oversight are relatively new. Findings from 85 researchers indicate that researchers recognized the need for an IRB to review all human research protocols, expressed the need for research ethics training, experienced high rates of approval at government ministries and UB, and generally believed that ethics review processes can help researchers themselves better understand and appreciate research ethics in general. Though only about one-quarter of respondents reported a more positive view of research ethics after interacting with the UB IRB, 56.5 percent reported no change. In contexts where IRBs have recently been established, it can be particularly important to document the perspectives of researchers in order to align expectations with capabilities, and identify areas where IRBs can improve operations. Future efforts to advance research ethics and ethical review in Botswana should include establishing research ethics training requirements and courses for researchers, increasing investment in IRBs and their training, further developing institutional and national research ethics policies, and formalizing agreements between IRBs and others involved in research oversight in the country to support coordinated review.
Privacy by Design, a globally accepted framework for personal data management and privacy protection, advances the view that privacy cannot be assured solely by compliance with regulatory frameworks but must become an organisation’s default mode of operation. We are proposing a similar template for the research ethics review process. The Research Ethics by Design framework involves research ethics committees engaging researchers during the design phase of the proposal so that ethical considerations may be directly embedded in the science as opposed to being viewed as addendums after the fact. This collaborative research design proposal results in the establishment of a culture of ethical research rather than research with ethical oversight. Both researchers and research ethics committees come to view the review process as one in which individual protection and collective benefit co-exist in a doubly-enabling positive-sum manner.
This article provides an analysis of the issues and ethical challenges faced in a study with LGBTIQ student participants concerning their experiences of violence, harassment and bullying in tertiary settings. The authors detail the ethical challenges behind the development of the project, and around conducting research with a minority and vulnerable population. The article illustrates how the utilization of feminist and queer theory has impacted the process of conducting ethical research, including approaches to recruitment and participant autonomy. The dilemmas of confidentiality within a self-labelled and easily identifiable population are resolved. Further, unexpected challenges and risks to participant safety created through adherence to institutional ethical research frameworks are rectified. Importantly, the authors seek to avoid revictimization of participants and to instead empower students in their responses to violence, harassment and bullying that they may have experienced. The authors point to utilization of theoretical foundations and continual reflexive improvement as elements of best practice for those seeking to research minority populations, and in projects marked by the participation of those deemed vulnerable and high-risk.
With its wealth of readily and often publicly available information about Web users’ lives, the Web has created new opportunities for conducting online research. Although digital data are easily accessible, ethical guidelines are inconsistent about how researchers should use them. Some academics claim that traditional ethical principles are sufficient and applicable to online research. However, the Web poses new challenges that compel researchers to reconsider concerns of consent, privacy and anonymity. Based on doctoral research into the investigation of online medicine purchasing, this article presents a case study involving online forums, and reviews the existing ethical guidance surrounding the Web. The suggestion is that new ethical guidelines, particularly in relation to informed consent and participants’ own perceptions of what is public or private, are needed owing to the unique challenges of online research.
The role of ethics committees is to protect and safeguard the rights and welfare of participants, and promote good research by providing ethical guidance to researchers. In order for ethics committees to fulfil their role and obligations, they need to have adequate understanding of the science and scientific methods used in research. Genomics is a novel and rapidly evolving research field, and identifying the ethical issues raised by it is not straightforward. Limited understanding of, and expertise in, reviewing genomic research may lead ethics committees to either hamper novel research, or overlook important ethical problems. Researchers are in the best position to assist ethics committees in their efforts to remain informed about scientific advancements.
Medical research involving human subjects must be evaluated by a research ethics committee (REC) before a study is initiated. However, knowledge of REC decision processes, particularly in relation to evaluating the risk–benefit balance in various study types, appears scant.
The study protocols and records of a Finnish university hospital REC were surveyed for a time span of 5 years. All study procedures in each study plan were examined, and the studies were divided into clinical drug trials, clinical trials with medical devices, studies with other invasive interventions, studies with non-invasive physical procedures, and non-physical procedures only.
In clinical drug trials, the REC posed queries more frequently about the risk–benefit ratio and less frequently about study methods and participant-related issues in comparison with other study types. Relative to other studies, those with non-physical procedures were subject to more frequent queries related to reliability of the study methodology and to data protection and confidentiality. Most of the queries focused on the recruitment process.
The emphasis on risk–benefit evaluation in clinical drug trials may arise from RECs’ concern that clinical drug trials are most often conducted on patients and may involve new chemical entities with limited safety data. The relative scarcity of method queries in relation to clinical drug trials may indicate high scientific quality of industry-sponsored research, whereas the elevated percentage of these queries in investigator-initiated studies with non-physical procedures may suggest a need for better scientific education of independent clinical investigators.
A previous research ethics article by the authors provided evidence to support the claim that the New Zealand Ethics Committee (NZEC) was a powerless ethics committee. Ethics review applicants were not formally obliged to seek ethics review, and any committee recommendations were given on a ‘take it or leave it’ basis. One year later, the capacity of applications has doubled, and NZEC finds its core assumptions challenged as funders and government agencies now compel contracted researchers to make use of this free service. Moreover, NZEC has expanded into research areas inhabited by market researchers, long shy of ethics review. Review requirements and remit expansion challenges some, but not all, aspects of NZEC’s assumption of powerlessness as NZEC remains committed to research ethics, not research governance, and it adheres to the principles of the New Brunswick Declaration to respect applicants the same way it expects applicants to respect participants. This annual survey of applicants makes NZEC accountable to its applicants, providing evidence once more that NZEC’s expeditious and cordial review of applications is considered different from traditional ethics review.
Institutional review boards have a dual goal: first, to protect the rights and welfare of human research subjects, and second, to support and facilitate the conduct of valuable research. In striving to achieve these goals, IRBs must often consider conflicting interests. In the discussion below, we characterize research oversight as having three elements: (i) research regulations, which establish a minimum acceptable standard for research conduct; (ii) ethical principles, which help us identify and define relevant ethical issues; and (iii) virtue ethics, which guides the prioritization of relevant issues. We describe specific ways in which the lessons of virtue ethics suggest revisions to the IRB structure and review process, the education and training of IRB members, and the appropriate limits of regulations in research ethics oversight.
This essay responds to an article, ‘Variation in university research ethics review’, published in this issue. It argues that the authors of that paper do not fully distinguish the usual function of university research ethics committees (RECs) from that of a gatekeeper. The latter term more accurately describes the task they happen to have asked them to fulfil in the course of conducting some empirical research. Whilst they are not alone in making it, the result of this conflation is that the reflections they offer are misguided. In this short comment I briefly discuss the distinction between a REC and a gatekeeper, and indicate how it impacts on the proposals sketched by Vadeboncoeur et al.
Conducting large multi-site research within universities highlights inconsistencies between universities in approaches, requirements and responses of research ethics committees. Within the context of a social science research study, we attempted to obtain ethical approval from 101 universities across England to recruit students for a short online survey. We received varied responses from research ethics committees of different universities with the steps to obtaining ethics approval ranging from those that only required proof of approval from our home institution, to universities that facilitated fast-track applications to those that required a full ethics review. Some universities also completely refused. After contacting all 101 universities in England, 60 universities gave clearance to our study. In this article, we present the different approaches universities adopted in response to our application to sample from students in their institution. We consider a number of conceptual and ethical issues pertinent to considering ethics approval for researchers from other universities in England and critically discuss three possible models of ethics governance that would cover all universities in England.
Improving the informed consent process is a common theme in literature regarding biomedical human subjects research. Standards for appropriate language and required information have undergone scrutiny and evolved over time. One response to the call for improvement is the provision and use of informed consent templates (ICTs) to ensure that documents have a standardized format and quality of content. Little is known, however, about the prevalence of such ICTs or their effectiveness. This article discusses the rationale for creating and using templates, describes the prevalence of and commonalities between templates, and identifies the need for an evaluation of their effectiveness in terms of their ethical and practical implications. The websites of 144 Association of American Medical Colleges (AAMC)-accredited institutions in the United States, 21 institutes in the National Institutes of Health (NIH), and the World Health Organization (WHO) were searched for the presence of ICTs. A total of 105 (72.9%) medical schools, 3 (14.2%) NIH institutes, and the WHO had at least one ICT publicly available on their websites. The templates varied in format, length, style, language, and sections included. The prevalence of ICTs, variability in their content, and lack of published research regarding their effectiveness suggest that ICTs are available, but more research into their effectiveness and standardization of their development are needed.
Research ethics guidelines grew out of several infamous episodes where research subjects were exploited. There is significant international synchronization of guidelines. However, indigenous groups in New Zealand, Canada and Australia have criticized these guidelines as being inadequate for research involving indigenous people and have developed guidelines from their own cultural perspectives. Whilst traditional research ethics guidelines place a lot of emphasis on informed consent, these indigenous guidelines put much greater emphasis on interdependence and trust. This article argues that traditional guidelines are premised on relationships of equal power, and that often the researcher has more power that is not fully equalized by providing information. Where there is a relationship of unequal power, then focusing on interdependence and trust is more likely to achieve ethical safety. We illustrate this thesis by describing the detail of a research project looking at the use of interpreters, where we video-recorded live consultations and then interviewed the patient, interpreter and doctor. We conclude by suggesting that mainstream research ethics guidelines should pay more attention to the development of a trustworthy relationship between subject and researcher, and that, following the lead from clinical medicine, we should develop a culturally competent ethical framework for research on human subjects.
In 2011, the Secretariat on Responsible Conduct of Research launched a set of educational opportunities to facilitate and enhance the dissemination of TCPS 2, the 2nd edition of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (2010), which guides Canadian research ethics. Three educational modalities were implemented to aid participants in developing or refining their ethical understanding and practice: (i) Regional Workshops, which brought together diverse disciplinary perspectives; (ii) the CORE tutorial, which enabled individuals to discover the various aspects and applications of the Policy; and (iii) Webinars, which provided participants with the opportunity to explore deeper dimensions of research ethics. This article reports on the findings of a national program evaluation team which measured the effectiveness of the educational program and provided recommendations for future opportunities.
In conceptualizing vulnerability, it is common for researchers to assume that some participants are more vulnerable on the basis of their membership of a particular group or because they exhibit particular characteristics. Older people are often viewed as inherently more vulnerable by ethics committees and the ethical guidelines committees construct. Because age alone does not confer or cause vulnerability, risk of harm to older research participants is not purely associated with their intrinsic connection to a vulnerable group, and classifying older research participants as vulnerable may not necessarily protect them from harm. Drawing on the preliminary findings of a qualitative study of older people who had survived a suicide attempt, we reflect on how the specific context of our study had the potential of framing older people as vulnerable, and describe ways in which these were managed and resolved. Specifically, we discuss potential for harm through the ethical principles of coercion and distress.
The impact on researchers of working with sensitive data is often not considered by ethics committees when approving research proposals. We conducted interviews with eight research assistants processing clinical notes on emergency department presentations for deliberate self-harm and suicide attempts during a suicide prevention trial. Common experiences of working with the data included feeling unprepared for the level of detail in the records, being drawn deeply into individual stories, emotional exhaustion from the cumulative exposure to the data over long periods of time while working alone, and experiencing a heightened awareness of the fragility of life and the need for safety. The research assistants also reported on some of the strategies they had developed to cope with the sensitive nature of the data and the demands of the work. The ethical implications for suicide research reliant on non-clinically trained researchers exploring sensitive data are considered. These include the need for research leaders and ethics committees to be aware of the potential adverse mental health impacts for these researchers examining sensitive data and to make appropriate arrangements to minimize the mental health impacts of such work.
Institutional Review Boards (IRBs) and their federal overseers protect human subjects, but this vital work is often dysfunctional despite their conscientious efforts. A cardinal, but unrecognized, explanation is that IRBs are performing a specific function – the management of risk – using a flawed theoretical and practical approach. At the time of the IRB system’s creation, risk management theory emphasized the suppression of risk. Since then, scholars of governance, studying the experience of business and government, have learned that we must distinguish pure from opportunity risks. Pure risks should be suppressed. Some opportunity risks, in contrast, must be accepted if the institution is to meet its goals. Contemporary theory shows how institutions may make these decisions wisely. It also shows how a sound organizational understanding of risk, a proper locus of responsibility, and appropriate institutional oversight all contribute to effective risk management. We can apply this general theory, developed in other contexts, to the problems of the IRB system. Doing so provides a unifying explanation for IRBs’ disparate dysfunctions by spotlighting five related deficiencies in IRB theory and structure. These deficiencies are (i) inability to focus on greater risks, (ii) loss of balanced theory, (iii) inaccessibility to guidance from senior leadership, (iv) unbalanced federal oversight, and (v) inflexibility. These flaws are deeply rooted in the system, and superficial reform cannot resolve them. Congress should overhaul the system to meet contemporary standards of risk management; this would benefit subjects, scientists, and the public that needs the fruits of research.
Background: For many years, studies have shown that the results of clinical trials are often published or reported selectively with a statistically significant bias in favour of positive trial results. Trial registration as a precondition for publication had only limited effects on current practice. Results of trials which were approved by research ethics committees (RECs) are often published only partially, with a substantial time lag or not at all. This study examined existing procedures of RECs in the European Union to monitor and prevent incomplete registration of trials and selective reporting of trial results. It further investigated opinions of REC members about the need to update current legislation on this matter. Methods: Web-based survey on members of RECs in 22 European countries. Results: Over 90 percent of respondents agreed that the incomplete publication of trial results had a strong or somewhat negative impact on public health and on healthcare professionals’ trust in the validity of clinical research, yet only 30 percent reported that their REC had some (often unsystematic) mechanism in place to check that findings of approved studies are published in some form. Less than 10 percent stated that their REC has further specific procedures in place to prevent or minimize selective reporting of study results. Respondents stated variously that their REC did not have the resources to follow up on this matter. Conclusions: The existing legislation to regulate trial registration and encourage complete publication of trial results leaves room for improvement. REC members welcome guidelines to adequately address both problems. The new Regulation EU No. 536/2014 as well as the FDA Amendment Act from 2007 require the reporting of summary results within 1 year after study end. As recent reviews demonstrated, without any systematic approach to monitor the adherence to these regulations, publication rates remain rather low.
Controversy over providing financial incentives to research participants has a long history and remains an issue of contention in both current discussions about research ethics and for institutional review bodies/human research ethics committees which are charged with the responsibility of deciding whether such incentives fall within ethical guidelines. The arguments both for and against financial incentives have been well aired in the literature. A point of agreement for many is that inducement in the form of financial incentive is permissible when the risk of harm to the individual is negligible in terms of degree and probability of occurrence. In the absence of harm to the individual, encouraging more people to participate in research would appear to be a good thing in so far as it will lead to statistically more robust research outcomes, which can then be translated into better healthcare and other practice. Whilst, on the face of it, this position seems highly defensible, I will explore the possibility that it is counterproductive – that is, providing individuals with financial incentives to become research participants may have the unintended outcome of reducing participation rates in some areas of research. In exploring this idea I will draw on empirical findings from the literature on crowding-out – the hypothesis that providing monetary incentives to people can backfire by overall reducing intrinsic motivation, in this instance intrinsic motivation to behave altruistically or undertake civic duties.
Community-based participatory research (CBPR) is growing in popularity as a research strategy to engage communities affected by health issues. Although much has been written about the benefits of using CBPR with diverse groups, this research has usually taken place in community-based organizations which offer social services and programs. The purpose of this article is to explore the opportunities and challenges encountered during a CBPR project conducted in a small hospital serving people living with HIV and addictions issues. The structure of hospital-based care delivery required the team to account for participants’ health-related limitations, including adopting recruitment strategies built on clinical care, and modifying the original research design to better protect participant confidentiality in a small space. Although CBPR offers an important strategy for researching with members of hospitalized communities, it requires research teams to develop context-relevant approaches to ethically engaging community members that recognize the ways clinical space mediates the research process.
Although most researchers are familiar with the application of the Common Rule in research, fewer are aware of specific requirements and restrictions for conducting human subjects research when employees of the US Department of Defense (DoD) will be participants. Because of the additional regulations concerning DoD employees as participants, federal regulations and research policies require researchers to submit their human subjects research proposals through a DoD review process to ensure compliance with DoD research policies, regardless of a non-DoD IRB’s approval. These research policies recognize the vulnerability of military subjects within a hierarchical organization to potential coercion and abuse during research studies. This article describes some of the unique requirements to conduct human subjects research within the DoD (in which the participants are military or civilian). The article concludes with steps researchers can follow to facilitate the DoD review process for research, and timely research within the DoD.
We systematically reviewed contemporary literature to create an evidence-informed framework for research studies involving children and adolescents who can assent to participate. We searched seven citation indices to locate peer-reviewed research published in English language journals between 2000 and 2012. After screening 1,231 titles and abstracts for relevance, we assessed levels of evidence, extracted information, and analysed content from 87 articles. Most articles narrowly focused on paediatric assent barriers and facilitators for decision-making about research participation. No articles provided a single, comprehensive ethical framework to guide the development and review of research assent protocols. We developed a 6-step framework that provides guidance to: prepare the child for the assent process; assess the child’s readiness to engage in decision making; discuss the elements of informed consent to the greatest extent possible; seek an initial assent decision; monitor and affirm assent; and respect the child’s role as a research participant. The PAeDS-MoRe framework also supports the creation of process models that address the unique, developmental needs of paediatric sub-groups, and guides the operationalization of jurisdictional requirements for ethical research involving children who are unable to provide free, informed and ongoing consent.
The first objective of this article is to demonstrate that ethics committee members can learn a great deal from a forensic analysis of two classic psychology studies: Zimbardo’s Stanford Prison Study and Milgram’s Obedience Study. Rather than using hindsight to retrospectively eradicate the harm in these studies, the article uses a prospective minimization of harm technique. Milgram attempted to be ethical by trying to protect his subjects through debriefing and a follow-up survey. He could have done more, however, by carrying out what ethics committees routinely insist on today for those researching sensitive topics. The establishment of counselling supports to identify harm to participants would have minimized additional harm. Were these in place, or in Zimbardo’s case had the Stanford Ethics Committee properly identified Zimbardo’s conflict of interest – he was both a principal investigator and the prison warden – how much harm could have been minimized? The second aim is to examine how some qualitative authors routinely demonize these classic studies. It might appear that there are too few cases of unethical qualitative research to justify such an examination; however, this article identifies a number of recent examples of ethically dubious qualitative research. This would suggest that qualitative research should examine its own ethics before poaching from psychology.
Research confidentiality in Britain is under attack. Indeed, in some quarters the ‘Law of the Land’ doctrine that absolutely subjugates research ethics to law is already a fait accompli. To illustrate the academic freedom issues at stake, the article discusses: (i) the Cambridge Psychology Research Ethics Committee’s ban of interview questions about a research participant’s involvement in criminal acts; (ii) the awarding of damages against Exeter University when it reneged on its agreement to uphold a doctoral student’s guarantee of ‘absolute confidentiality’ in his research on assisted suicide; and (iii) the controversy around the UK government’s attempt to obtain confidential records from the Belfast Project – an oral history of paramilitaries involved in the Troubles in Northern Ireland. The article urges British researchers to practice – or, at least, defend the academic freedom of their colleagues to practice – the ‘ethics-first’ doctrine of strict confidentiality that several North American disciplinary associations encourage.
Scientific integrity cannot be adequately ensured by appeals to the ethical principles of individual researchers. Research fraud has become a public scandal, exacerbated by our inability accurately to judge its extent. Current reliance on peer review of articles ready for publication as the sole means to control the quality and integrity of the majority of research has been shown to be inadequate, partly because faults in the research process may be concealed and partly because anonymous peer review is itself imperfect. Consequently, the scientific literature is mixed, with the reader unable always to distinguish the good articles from the bad. Scientific research is subject to market forces that will always provide a motivation for a range of misdemeanours. This has led to a ‘market for lemons’. Regulations, and sanctions against miscreants, need to be modelled on those historically found necessary to limit financial fraud. Practical and effective systems of process control and audit have already been devised to ensure the integrity of clinical and pre-clinical research. These should be adapted for use in a much wider range of research activities.
Conducting or overseeing research in correctional settings requires knowledge of specific federal rules and regulations designed to protect the rights of individuals in incarceration. To investigate the extent to which relevant groups possess this knowledge, using a 10-item questionnaire, we surveyed 885 IRB prisoner representatives, IRB members and chairs with and without experience reviewing HIV/AIDS correctional protocols, and researchers with and without correctional HIV/AIDS research experience. Across all groups, respondents answered 4.5 of the items correctly. Individuals who have overseen or conducted correctional research had the highest scores; however, even these groups responded correctly only to slightly more than half of the items. These findings emphasize the need for ongoing training in federal guidelines governing correctional research, particularly for those individuals who are embarking on this type of research.
The ramifications of including genetic components in the clinical studies conducted in non-academic settings create unique ethical challenges. We used a qualitative research design consisting of semi-structured interviews that took place between October 2010 and September 2012. The sample consisted of 80 participants – 38 physicians and 42 coordinators – who worked across a number of different settings, including clinics, private practices, small hospitals, free standing research centers, and blended hospital-institutes in both rural and urban communities in 13 states across the United States. The respondents primarily conducted industry sponsored trials and recruited their own patients as research participants. A majority of the respondents (65%) reported that most of the studies they conducted included an additional genetics component, and so participants were asked to donate specimens for genomics or biobanking. While genomics association studies were perceived as being of benefit, awareness of ethical implications associated with such studies was limited. The rapid advances in genetic technologies make it hard for clinicians and coordinators to help patients make informed decisions about participating in clinical research, and underscore the need to ensure that the regulations governing research on human subjects keep pace with the social and technological changes. It seems essential to discern legitimate ethical concerns and find ways to convey what is going on, what is possible and what might not be possible in terms of protecting privacy, anonymity, and confidentiality.
Some anomalies in the legislation governing National Research Ethics Service Research Ethics Committee (REC) member categories are discussed. It is suggested that not only may some members be in the wrong category, but that the legislation identifies individuals who are simply ineligible for any form of REC membership.
Literature on the ethics of researching refugees, both as participants and partners, presents strong arguments for why anonymity is the safer option in the event of questionable consent. However, blanket anonymity, without asking refugee interviewees if they wish to be anonymous, may cause more harm than good in certain contexts. One such context which this article will explore is the context of Israel, where a working Refugee Status Determination (RSD) system has yet to be established. This case study highlights that, even in extreme circumstances where identity exposure can create risks, there may be a case for allowing identity exposure and perhaps an obligation on the part of the researcher to publish a name if this is the strong wish of the interviewee. This article builds on literature addressing confidentiality of identities (Duvell et al., 2010; Giordano et al., 2007; Kelly, 2009; Lahman et al., 2011; Lee, 1993; Mackenzie et al., 2007; Pittaway et al., 2010) and literature addressing informed consent (Hugman et al., 2011; Mackenzie et al., 2007; Pittaway et al., 2010; Zion et al., 2010). Primary sources demonstrating the use of waiving anonymity were collected between 2007 and 2012. Data were collected from refugee and activist civil society publications, television and newspaper media reports, participatory observation in the Israeli Knesset, and in-depth interviews with refugees and asylum seekers from South Sudan, Sudan, DR Congo, Liberia and Eritrea living in Tel Aviv, Jerusalem and Eilat.