Cash-Based Interventions to Enhance Dignity in Persistent Humanitarian Refugee Crises: A System Dynamics Approach

Cash-based interventions (CBIs) as one form of aid have recently received substantial interest from humanitarian organizations in persistent humanitarian crises. This article proposes a system dynamics (SD) approach to study the CBIs’ impact factors on all aspects of the beneficiaries’ dignity in longstanding refugee crises, such as the case of Syrian refugees in Turkey. Reviewing the humanitarian management literature, we first develop a set of holistic causal loops to better understand the building boxes of refugees’ dignity and their interactions. Then, an SD model is proposed and calibrated by field data from humanitarian organizations. The result of CBI amount sensitivity and payment time periods shows that CBIs are significantly more effective in diminishing child labor rates and to improve in health and accommodation service reception by the refugees in short terms, but to be as much effective in longer terms, humanitarian organizations must be more directly contribute to service capacity-building activities that are strategies by the hosting governments and supported by the international bodies, such as EU and UN. Otherwise, long-term or enhanced CBI supports can only lead to accelerated service capacity saturation and thus put extra pressure on already strained services and cause tensions between hosting and refugee communities.

disrupts the functioning of a community or society and causes human, material, and economic or environmental losses that exceed the ability of a community or society to cope using its own resources" [4]. Since 1990, more than 200 million people have been affected by the direct consequences of natural and man-made disasters, which have become one of the most significant problems of human life [5]- [7]. Currently, among the most man-made disaster-affected regions in the world are the Middle East and North Africa with continuous wars in Iraq, Libya, Syria, and Yemen. This has caused the largest scale of contemporary emigration, including inner displacement of people as well as refugees to other countries. Syria has seen more than 5 million people leave their homeland since the start of the civil war in the country in 2011. Many Syrians sought refuge in neighboring countries, and now over 3.6 million are living in Turkey [8], turning Turkey into the country with the greatest number of refugees in the world [9].
It is essential to help victims immediately after the occurrence of a disaster in various ways [10], [11], such as in-kind assistance or by supporting the affected places to reduce the impacts of disasters and initiating the improvement of operational skills to face the emergency situation better [4], [12]. The main purpose of humanitarian agencies is to save lives, alleviate poverty and vulnerability in the longer term, and preserve human dignity [13]. Over the past century, humanitarian support has been provided by means of in-kind products and services. However, such inkind assistance may not always be the most proper response [14], [15], in particular, when the immediate needs are met and the sudden disaster is stabilized. Developing countries and donors are increasingly interested in moving away from in-kind assistance and replacing it with alternative transfer modalities, such as CBIs. These are considered more cost-effective for all parties and more enabling for the beneficiaries to supply and consume a wider range of foods or goods than what would be otherwise distributed by in-kind programs [13], [16], [17]. The field data show, with an access to CBIs, beneficiaries more frequently buy food and in a greater quantity and variety [18]. Thus, it increases their access to fresh products, improves their dietary diversity, and often saves them money as well.
CBIs are modes of transferring direct financial aid (either through cash or vouchers) to beneficiaries and are known to improve beneficiaries' livelihood and to generate feelings of hope and a sense of security [19]. CBIs can be classified into four categories; unconditional cash transfers, conditional cash This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/ interventions, vouchers (cash or commodity), and microcredits [20]. Most of these means have been implemented by aid organizations for many years. For instance, in the 1990s, UNHCR distributed a considerable amount of cash to over 3.5 million beneficiaries in Central America and Afghanistan, and by 2011, over 35% of humanitarian agencies were using CBIs [15].
CBIs enhance beneficiaries' dignity by giving the freedom of choice, and hence provide them with a higher level of satisfaction and well-being [21]. In fact, one could argue that as CBIs have become a major part of humanitarian aid around the world, the well-being of beneficiaries have improved in both developed and developing countries [13], [17].
The narratives of CBIs have recently been reviewed [15], and "dignity" has been named as the most significant impact of CBIs in long-term and persistent refugee crises [12]. Dignity can be described as the ability to identify and satisfy one's needs in a prioritized way [22]. The essential and critical building factors of dignity can be described as access to health, social security, and safety, access to education, and access to basic needs (food and accommodation) and enhanced spending choices to exercise "coping strategies," such as selling assets, taking on debts, taking degrading jobs, and child labor [23]- [27]. In this article, we categorize these elements into three pillars of dignity, namely overall health and social security, education, and improved coping strategy. Because CBIs are increasingly becoming a common mode of aid transfer for humanitarian organizations, there is a need to better understand CBI effects on the key components of refugees' dignity and humanitarian operations [20], [28]- [30], and the impact mechanism of CBIs on the building elements of dignity [31]. Such an analysis is particularly needed at the initiation phase of CBI programs [32]. Hence, this article aims to address this need, first by understanding dignity and its building elements, by investigating the interaction dynamics between these building elements, by assessing the impact of CBIs in changing such interactions, and finally by offering a system dynamics (SD) simulation model verified with a series field data, as a future guideline for CBI schemes. This is the first time such a model has been developed for a better understanding of CBI impact on refugees' overall dignity.
We have explored both academic and organizational reports to address and classify impact factors in humanitarian crises. We also contribute to the literature by forming a holistic causal relation between the factors identified, which forms a basis for an SD model. To the best of our knowledge, our article is the first research project that uses a quantitative SD model verified and validated with real data for different factors related to the refugee crisis. Our validated model is then used to forecast the future situation and depict the trend of stock values, which might be the KPIs in a bigger picture for policy makers in humanitarian organizations.
The rest of this article is organized as follows. Section II presents findings on the aforementioned factors within the existing body of the literature. Section III will analyze the subfactors by causal loop models to see the relations and interactions between them. The impacts of CBIs will also be displayed by SD in Section IV. A numerical study to verify and validate our proposed SD model is also presented. Finally, Section V concludes this article .

II. SD IN HUMANITARIAN AID
SD is a simulation methodology, initially developed by J. W. Forrester in 1958 at the Massachusetts Institute of Technology, Revetria et al. [33] featured the multiloop characteristics of the feedback systems in human life. An SD model can be demonstrated graphically by utilizing a mix of simulation modeling to improve comprehension [34]- [36]. SD tools are required to build macromodels and are specified by differential equations [37]. Such simulation models can be used as powerful decision support systems, due to their high ability to generate detailed components and their complex relations to assess the various alternatives [38].
The application of SD has recently been reviewed in crisis management and humanitarian aid [12]. In two separate studies Cassettari et al. [39] and Cooke [40] presented an SD model to study an emergency impact on hospital operations and management. The methodology represented an opportunity to model different phenomena in humanitarian aid to support managers in designing more effective policy interventions in the long run. In another study, human behavior during a flood crisis was modeled by SD to evaluate the effectiveness of various flood emergency management systems [41]. Lately, several efforts have been proposed to analyze the use of systems dynamics in humanitarian emergencies [42], [43]. The proposed methods represent an opportunity to model different phenomena in humanitarian aid to support managers to design more effective policy interventions in the long run.
In a more recent study in the domain of humanitarian supply chain management, an SD model was used to model distribution of critical supplies during relief procedures in case of a hurricane event to understand relief supply required in accommodation and points of distribution [44]. A similar study [45] suggested an SD model for the transfer of food items during a disaster and developed a decision framework on how to allocate budgets in emergencies. Although SD models in humanitarian aid have been increasingly exploited in recent studies, none of the existing studies has managed to implement a holistic set of parameters to gauge and model beneficiaries' dignity and well-being in a persistent and long-term refugee crisis, as directly targeted by this article.
In this article, we use SD approach to simulate CBI impact on refugees' dignity and its building elements. CBIs for refugees are by nature systemic and complex, influencing many interconnected subsystems (e.g., level of refugee health), which can be demonstrated by causal loop diagrams (CLDs) to systemically demonstrate and interpret the dynamic complexity. CLDs are essential tools and visual qualitative models for interpreting the feedback structure of systems by employing feedback loops to show links between the variables that define a system [46]. They have long been employed in academic studies and frequently applied in organizations to quickly capture assumptions about the causes of dynamics [34]. The consequences of relations between the variables can be further simulated via the model to evaluate and enhance the perception of this complex system.

III. CBIS IMPACT ON DIGNITY
Reviewing crisis management and humanitarian aid literature, this section studies the building boxes of dignity, as categorized in Section I, in three main groups of coping strategy, health and social security, and education. The interaction between factors is extensively reviewed and the impact of CBIs on such interactions is discussed. A CLD will be developed as a result of this section, as the discussion progresses. We first discuss the elements of dignity in the following order: first the impact on coping strategies, then the impact on health and social security, and last the impact on education.

A. Impact on Coping Strategies
Regrettably, the longer the civil war lasts in Syria, the more refugees exhaust their saving resources and assets, leading to more debts and poverty [9]. One study shows that 80% of Syrian refugees in Turkey are living under the poverty line while housing expenses are constantly rising [47]. Food and rent account for 75% of the average household expenditure, leaving refugees with no choice but to exercise a wide range of coping strategies [48]. Coping strategies are the decisions made by beneficiaries to overcome the existing and mainly financial problems in emergency situations or at refugee camps. Such decisions may involve using emergency savings, selling assets, incurring debts, exploitative or degrading employment, and child labor [49]. CBIs enhance dignity by enabling beneficiaries to fulfill their own high-priority needs with less reliance on exercising their coping strategies [15]. The main elements of the coping strategies are discussed below and summarized in Table I. Reportedly, the total debt of CBI recipients is lower than for those who receive no cash interventions [29], [50]. Moreover, studies show that one-third of cash recipients often pay off some of their debts to avoid accumulating and increasing debt [27].
Recent field research [21] has shown that CBIs have provided a majority of beneficiaries with an option of living outside refugee camps in the city areas with relatively high living costs, thus providing them with an opportunity to better blend with the hosting culture, find jobs, and thus better contribute to their own and the hosting community. CBIs play a critical role in affording accommodation in urban areas for the beneficiaries and, therefore, have indirect positive effects on the mental wellbeing of many recipients. With regard to the Syrian refugees in Turkey, data show over 90% of beneficiaries reported that CBIs enabled them to pay rent in urban areas, and 40% reported CBIs supported them in moving to better accommodation [47].
Another study [11] shows that 47% of households that receive CBIs are even able to save part of the cash transfer, which increases their resilience and reduces their reliance on coping strategies. Field research in [51] and [52] find evidence that CBI receivers are more likely to generate more income and hence have a higher total income as well. As a result of the increased total income, beneficiaries are more likely to afford dietary diversity, which improves their physical and mental well-being [21], [48], [50].
Poverty is the main cause for increasing the amount of child labor in refugee households, which is a significant measure in persistent refugee crisis [53]. Reports [54] show the effectiveness of CBIs in enabling refugees to better utilize their cash resources that often reduces child-labor rates and instead increases child school attendance. Moreover, CBI narratives work permits by the hosting governments enable adult refugees to legally work that not only contributes to the local economy, but also prevents them from exercising their coping strategies and engaging in black market or antisocial activities [15], [29], [55].
1) CLD of CBIs Impact on Coping Strategies: The CLD illustrated in Fig. 1 shows feedback loops focusing on relationships amongst the major elements of the coping strategies. The figure shows seven basic structure loops; positive causal links (in blue) and negative causal links (in red) create different positive (reinforcing-"R") and negative (balancing-"B") feedback loops. The balancing loop B1 indicates that with more income, refugees stop sending their children to work, thus reducing the amount of child labor [21]. Moreover, the exogenous number of issued work permit factor, shown within the reinforcing loop R1, demonstrates the impact of a work permit along with the CBIs program on the legal employment of beneficiaries [15]. This in turn generates more income and lessens the chance of taking a degrading job in a black market [27], [60]. In addition, as shown in loop B2, an increase in the total income can lead to an increase of the total assets [52]. An increase in the total income as a part of total assets also leads to a reduction in debt, whereas borrowing money provides extra assets [48], as shown in loop B3. Moreover, the more beneficiaries are enabled to pay their debt, the less poverty they may face and, thus, less child labor may occur [50]. Beneficiaries with higher assets are more likely to save more and similarly more saving by increased purchasing power is correlated to the total asset growth of recipients [26], which is reflected in loop R2. Furthermore, Bailey et al. [29] and Creti [66] declared that the more income beneficiaries receive, the more they can spend because of enhanced purchasing power, which results in the improvement of saving and assets, leading to overcoming poverty and the less amount of child labor, which is shown in loop B4.
As shown in loop R3, lower debts preserve the total assets that beneficiaries possess, and protects beneficiaries against the risk of remaining in poverty longer, which in turn results in a reduced need to exercise different coping strategies, such as cashing available assets or withdrawing children from school.

B. Impact on Health and Social Security
Access to healthcare services is a basic human right that humanitarian organizations aim to provide [26], [70]. Field research on the Syrian refugee crisis in Turkey [52] reports that approximately 60% of all financial support by humanitarian agencies aims at ensuring primary assistance to refugees, which in particular means supporting them in their food and healthcare requirements.  I  OVERVIEW OF THE IMPACT FACTORS FOR COPING STRATEGIES  TABLE I  CONTINUED. Healthcare and social security needs are categorized in eight measures of access to healthcare service: access to water and sanitation facilities, availability of health services, dietary diversity, health expenditure, general or physical health, mental health, and violence [26]. These are defined and described in Table II. CBIs have been reportedly described as one of the most effective means of enhancing refugees' access to healthcare services they need most [20]. The high costs of healthcare is one of the most commonly reported hindering factors for refugees not to seek healthcare services [70]. Furthermore, CBIs are reported to positively impact food security, nutrition status, and access to clean water and hygiene facilities, which all enhance the general health of refugees [29]. Reviving CBIs often plays a significant role in affording daily meals [20] and dietary diversity [29]. As discussed before, CBIs reduce violence in refugee communities and hence improve the mental health of the community in general, and in particular, for the women who experienced different kinds of abuse due to the absence of cash resources and increased poverty in their community [30].
1) CLD of CBIs Impact on Health and Social Security: Fig. 2 demonstrates the effects of CBIs on health and social security and behavior, and their interactions with the elements of coping strategies. The causal interconnections corresponding to these two subsystems are specified with green and blue colors, respectively. CBIs empower beneficiaries to be more employed and earn more income, thus improve the chance of dietary diversity and overall health [50], [71] (loop R4). Enhanced overall health state of refugees positively affects their well-being and reduces stress levels to refine mental health level [47] (loop R6). This can reduce the level of violence and antisocial activities [79] (loop R7), which in turn saves refugees money, IEEE TRANSACTIONS ON ENGINEERING MANAGEMENT  increases the level of saving, and reinforces the health loop (loop R5). Moreover, recipients of CBIs show an increase in their total expenditure, and particularly in their health expenditure [50]. In addition, increased health expenditure is associated with improvement of access to health services and, thus, enhanced overall health of the beneficiaries [61]. The interconnections between level of general health, number of employed refugees, total income, and purchasing power are shown in loop R8, which emphasizes the positive effect of CBIs on the health status of refugees.
Refugees with access to improved self-accommodation have better access to adequate water and sanitation facilities and are healthier [73]. Hence, in the positive loop R9, the relations of health, employment, income, and self-accommodation declare an important outcome of CBIs on the accommodation for refugees.

C. Impact on Education
General studies of low-income communities highlight that households have on average 2-3 children of school age (5-17 years old), although more than half of these children often do not attend school [50]. More than half of all Syrian refugees are under the age of 18, with over 75% not enrolled in any school in Turkey [9]. CBIs help to reduce the number of children missing school by covering a large proportion of their education costs [47] and their transportation costs [61]. Moreover, covering the cost of attending schools, CBIs are reported to enhance the children's education level by up to 40% [74]. In addition, UNHCR in Turkey initiated a CBI program to incentivize primary and secondary school enrollment and retention [9], [48]. Outcomes of CBI evaluations to this end have been widely positive, showing considerable improvements in school enrollment rates as well as a decreased rate of child labor [62]. In other research, the World Food Program reported 38% of cash recipients spent cash on education costs for their children [20]. All the impact factors regarding the education are summarized in Table III. 1) CLD of CBIs Impact on Education: Fig. 3 illustrates the final CLD of this article, which combines the interactions of the coping strategies, health and social security, with those of refugees' education, which all together covers refugees' dignity, as discussed earlier.
In this final CLD, a total of 16 interconnected key feedback loops are suggested, of which 14 are those from previous sections (coping strategies and health and social security). The education elements have been highlighted in red. Two positive and negative feedback loops labeled as R10 and B6 represent the effects of school attendance on employment and of access to education services on total income, respectively.
Loop R10 illustrates the positive impact of education on the employ ability of refugees, learning skill, and hosting country's language [48]. In a crises situation and with no CBI support, households often send their children to work to support the family by earning some extra income, which can be reversed by increased total household income, pushing more children to schools [20], [49], [63]. Lower child labor rate often means more school attendance and thus improved education level, and consequently more employment rates in the legal market over a longer time [53] (see R10 loop). Loop B6 demonstrates the impact of total household income on education expenditure and consequently on children's school attendance. Some field research shows 38% of refugees who received CBIs spend more money on the education costs for their kids [47], [61].
In the following section, a stock and flow simulation model is provided, and numerical verification and validation are presented.

IV. QUANTITATIVE ANALYSIS: STOCK AND FLOW SIMULATION MODEL
In this section, a simulation structure of the CLDs described in the previous section is presented. The quantified stock and flow diagrams of the above discussed CBI CLDs are created using Vensim software [80]. As the quantified SD modeling requires specification of the major flows and stocks in the system, the major factors in the causal model were used in the simulation development.
The impact of CBIs on different factors of dignity is simulated, whereas seven main stock variables related to Syrian refugees are considered: Net incomes for the refugees population (in US dollars); total antisocial expenditures by the refugees population (in US dollars); number of employed refugees; amount of child labor; number of refugees receiving health services; number of refugees receiving educational services; and number of self-accommodated refugees.
The quantitative model is designed around the concept of "Net Income" of Syrian refugees as a direct factor influencing refugees dignity in their hosting country, Turkey. "Net income" is modeled as a stock whose value increases based on the inflow of money (money making rate) and decreases based on the outflow of money (money spending rate). Income sources of Syrian refugees comprise the following.
1) The total CBIs paid by the government and the organizations, which is modeled as a constant and total "CBI" and currently sums up to US$320 per year per eligible family member [81]. 2) Salaries in case of formal or informal employments in Turkey. 3) Other sources of income, including cashing the savings and assets, debts, and bank loans. Since there is no reliable source of data for the other sources of income, they are all aggregated as a constant "Other sources" into the variable "Money making rate." If the net income of Syrian refugees is less than the poverty line in Turkey, they will exercise their coping strategies. Due to data scarcity, amount of child labor is the only coping strategy that is quantitatively modeled in this article. As long as the net income of beneficiaries is below the poverty line, the number of child labor increases based on a first-degree stock and flow model, and the child labor income contributes to the beneficiaries' net income. The way refugees tend to spend money is modeled as follows (the Money Spending Rate). In general, beneficiaries will first spend money to cover their essential needs. If their net income is above the poverty line, then the surplus of money will be spent on their secondary needs, including accommodation, education, and health service, which are all modeled as first-order stocks and flows. In addition, part of the money will also cover beneficiaries' antisocial expenditure (mainly buying tobacco [82]). The amount of money spent on these different needs are determined by indices in the model, whose numerical values will be defined during the calibration of the model and through finding the best fit between the model outcomes and the available time-series data, similar to other studies [83].   Although an increase in beneficiaries' total net income provides them with an access to health, education, and accommodation, constant increase in this figure does not result in unlimited increase in such services and, thus, in the total beneficiaries' dignity, due to the limited capacity of these services in the hosting country. The available capacity and total investment in the service infrastructures will not be able to cover a sharp rise in the demand for education, accommodation and health services in Turkey arising from the population increase of Syrian refugees, along with national rising requirements.
These limits are modeled using "availability" constants in the model whose approximate values are extracted from available data. Exceeding the limits might lead money toward antisocial expenditure and is an issue that needs to be addressed in CBI plans. The equations to calculate the number of beneficiaries whom receive educational services are as follows. The model overview is illustrated in Fig. 4, and its variables and full equations are provided in Table VIII of Appendix A.

A. Model Verification and Related Data
The model is validated using different structural and behavioral validity tests [84]. Comparing the quantitative model with the causal loop model, which is developed based on the extensive literature review, shows that important concepts and structures are endogenous to the model, and the structure is consistent with the relevant descriptive knowledge of the model. The model also passes the dimensional consistency and extreme condition analysis tests. The model calibration estimates the values of different indices to best fit the real time-series data related to Syrian refugees in Turkey in a time horizon of six years (2012-2018), which are presented in Tables IV and V.   TABLE IV  INPUT  The data used are continuous, and the six-year period is selected based on availability of the real data.
According to Oliva [95], the model calibration is based on the numerical optimization, which minimizes the difference between model output and real data using the best estimation of the model parameters. For this purpose, similar to Parvan et al. [83], a payoff function as a linear combination of differences between data and model for the number of children doing child labor (CL), number of refugees employed (EM), number of self-accommodated refugees (SA), number of refugees received health services (HS), and number of refugees received educational services (ES) is defined and minimized. Fig. 5 illustrates a component of the payoff function, whereas (1) represents the  payoff function for the model that includes the sum of squared percentage error for the aforementioned parameters. Once the errors of different parameters are normalized into percentages, they could be added together using their corresponding weights, which is symbolized by (W ). The values of weights, as listed in Table VI, are set so that all parameters are scaled to be of the same order of magnitude The optimization is conducted using Vensim's built-in Powell conjugate search algorithm (see [96]) using different combinations of weight values and start points in the parameter space. Through this iterative process, Vensim repeatedly runs the model using a set of parameter values sent by its optimizer, and after each run, the payoff value is sent back to the optimizer, where it is compared with the previous runs. The stopping criterion is 1000 iterations, among which the best fit between the model outcomes  Fig. 6 illustrates the best fit for selected variables in the calibrated model.

V. CONCLUSION
To study the impact of different levels of CBI paid to beneficiaries on the impact factors, we have examined a ±100% CBI variation and the results are illustrated in Fig. 8 of Appendix B in which different colors corresponding to each confidence level. According to these graphs, all stocks except the number of employed refugees are sensitive to the changes in the CBI level where the trends of the variables change with almost a linear multiplier offset for each factor. As shown in Fig. 8(a), CBIs only contribute up to 20% of beneficiaries' total income, and thus they often seek and secure formal or informal jobs and sources of income to support themselves and their family, regardless the CBIs they receive. Hence, the employment factor has been formulated independent of CBI level, as shown in Fig. 8(c). In addition, some differences in the magnitude of sensitivity between different variables are observed. For instance, the confidence intervals are narrower initially for net income [see Fig. 8 are more sensitive to CBI changes in the short term, whereas become less sensitive in the longer term, which might be due to the infrastructure and resource capacity consideration of the hosting society. Based on the historical data, the model includes a linear growth of investment in infrastructure, proportional to the population of inflow refugees, and therefore, the number of refugees who receive health service or are self-accommodated are still restricted by the capacity for these services over time. As a result, these stock variables are saturated in the long term and behave less sensitive to the CBI level. In addition, the S-shaped trend of these variables is due to the dominance of the balancing loop corresponding to the capacity limits over the reinforcing loops over time. Fig. 7 shows the current amount of CBI ($320/Person/Year) with two other extreme scenarios of no CBI and 100% increase in CBI to study the impact of different amounts of CBIs on the building boxes of the beneficiaries' dignity. According to Fig. 7(b), doubling the amount of CBI increases antisocial expenditure by above 15% and paying no CBI decreases it roughly 20%. Although it shows the negative impact of CBIs, it indicates a diminishing growth rate of antisocial expenditures by increase of CBI support. Fig. 7(d) also shows a diminishing growth rate of child labor by increasing CBI amount. The absolute growth, however, is done to the constant intake of refugees to the country, as shown in Fig. 6(f).
The results of CBI change on service reception by refugees [see Fig. 7(c)-(e)] show that an increase in CBI programs in short and medium terms have significant impacts on such services and especially on accommodation and health services, and thus can empower them to avoid exercising their negative coping strategies, such as debt, selling valuable assets, and child labor. However, such impacts are less significant in long term if the service infrastructures are not well developed and in a balance with the increasing demand from the inflow of refugees. In such situations, an increase in CBI programs and a loner-term schemes can only lead to a quicker saturation of service capacities, which in turn may cause competition over resources, such as accommodations, and thus lead to enhanced local inflation. Moreover, the result of Fig. 7 shows that the amount of CBI currently paid to the refugees ($320/Person/Year) is well balanced with the increasing demand of growing refugee population on the limited and slow-growing service capacity in the country. As shown in Fig. 7(c) and (e), 100% increase in CBI can lead to an early capacity saturation and extra pressure on already stretched service infrastructures.
This article showed that CBI, in moderate amounts, can be well effective in short and midterms after refugees are settled in a host country, but in for longer term, CBI can only be as effective when well-balanced capacity-building programs are in place and constant investments are made in the service infrastructures. This is in line with what Turkish government as the hosting authority has raised and sought in the last few years and after the mass Syrian refuge situation [97], [98]. These strategic and enabling investments are often overlooked by humanitarian organizations, due their different priorities and missions. Such investments are mostly considered at national government planning as well as UN and EU support schemes, such as the recent 500 million donation by the European Union to Turkey for the educational infrastructure and school capacitybuilding in 2016 [98]. Besides the direct impact of high strains on service capacities on refugees, according to International Crisis Group, intercommunal violence between host communities and Syrian refugees increased threefold in the second half of 2017 compared to the same period in 2016, due to socioeconomic inequality driven by high unemployment and limited service capacities caused by constant and significant inflow of refugees to the country [99]. Although several NGOs are working out ways to ease such tensions [100], their focus is yet on providing supports to beneficiaries, rather than aiming for the root cause. Capacity-building investments in persistent refugee crisis although often required more resources and planning can improve and sustain refugees dignity in all aspects, and ease tensions and facilitate better integration with the hosting community. Thus, a more active and direct capacity-building roles by the humanitarian organizations can enhance the effectiveness and sustainability of their CBI programs in longer terms. As discussed in [101] and [102], humanitarian aid may have significant economic impacts. Potential negative impacts, such as local inflation are due to local competition over resources, such as accommodation. However, this article is highly limited to the availability of the real data for the validation, and as such, the impact of CBIs on local and national inflation have been over viewed. Further studies can address this impact and complete the model. Another direction of research is to encompass the investigation of the effect of mixed CBI and in-kind strategies.