Targeting vulnerability after the 2005 earthquake: Pakistan's Livelihood Support Cash Grants programme

The 7.6 magnitude (Richter scale) earthquake that struck northern Pakistan on 8 October 2005 was devastating. This paper gauges success in targeting vulnerable families during the transition from relief to reconstruction through cash assistance provided by the Livelihood Support Cash Grants (LSCG) programme. Families without a male member, with a disabled male member aged between 18 and 60 years or with more than five children, defined as vulnerable, were provided with USD 50 per month for six months via a bank transfer. The LSCG scheme enrolled around 750,000 families and selected 267,402 vulnerable families to whom it disbursed a total of USD 86.95 million. Using a community‐based survey, this paper assesses leakage and under‐coverage (exclusion). Approximately 30 per cent of families received the cash grant. However, only one in two was eligible for the benefit, and one in two deserving families was excluded. This is a matter of grave concern.     

Impact of a commercial destocking relief intervention in Moyale district, southern Ethiopia

A commercial destocking intervention was piloted in southern Ethiopia during the drought of early 2006. The intervention led to the purchase of an estimated 20,000 cattle valued at USD 1.01 million. On average, destocked households received USD 186 from the sale of cattle--approximately 5,405 households were involved. In terms of aid investment, the approximate cost-benefit ratio was 41:1. During the drought, income from destocking accounted for 54.2 per cent of household income (n = 114 households), and was used to buy food, care for livestock, meet various domestic expenses, support relatives, and either pay off debts or augment savings. Seventy-nine per cent of the income derived from destocking was used to buy local goods or services. Expenditure on livestock care amounted to 36.5 per cent of local spending, and included the private transportation of livestock to better grazing areas. The buoyant livestock export trade was considered to be an important driver of commercial destocking, demonstrating a positive link between livestock and meat exports, and pastoral vulnerability during drought.     

The 2006 war and its inter-temporal economic impact on agriculture in Lebanon

The July 2006 war waged by Israel on Lebanon caused an estimated USD 1 billion of direct (financial) damage to infrastructure. However, it generated also significant indirect (economic/inter-temporal) costs. One sector that suffered considerably in this respect was agriculture, the main source of income for 30–40 per cent of Lebanese. This paper's main objective is to develop a methodology to estimate the total—direct and indirect—cost of the war to agricultural crop production, using an area of south Lebanon as a focal point. The indirect loss assessment viewed inter-temporal reductions in crop production values as the opportunity cost of not working fields due to the presence of unexploded ordnance (UXO). Various crops were evaluated for two scenarios (50 and 100 per cent damage due to UXO) over UXO-clearance periods of five and 10 years. The results indicate that any damage estimates that include only direct losses will under-estimate total losses by 80 and 87 per cent for the five- and 10-year periods, respectively.     

Risk of flood-related mortality in Nepal

In July 1993, severe flooding devastated Sarlahi district in Nepal. The next month, a follow-up study of a large population cohort was undertaken. The study is unique in that a prospective research database was used to verify residency prior to the flood and to confirm vital status afterwards. It evaluated 41,501 children aged between two and nine years and adults aged 15-70 in 7,252 households. Flood-related fatality rates were 13.3 per 1,000 for girls and 9.4 per 1,000 for boys, 6.1 per 1,000 for women and 4.1 per 1,000 for men. Flood-related fatality rates for children were six times higher than mortality rates in the same villages a year before the flood (relative risk (RR) = 5.9, 95 per cent confidence interval (CI) 5.0-6.8). Flood-related fatality was associated with low socio-economic status preflood (RR = 6.4, 95 per cent CI 2.7-20.0), and having a house constructed of thatch (RR = 5.1, 95 per cent CI 1.7-24.5).     

Emotional,physical, and social needs among 0–5‐year‐old children displaced by the 2010 Chilean earthquake: associated characteristics and exposures

An 8.8‐magnitude earthquake occurred off the coast of Chile on 27 February 2010, displacing nearly 2,000 children aged less than five years to emergency housing camps. Nine months later, this study assessed the needs of 140 displaced 0–5‐year‐old children in six domains: caregiver stability and protection; health; housing; nutrition; psychosocial situation; and stimulation. Multivariate regression was applied to examine the degree to which emotional, physical, and social needs were associated with baseline characteristics and exposure to the earthquake, to stressful events, and to ongoing risks in the proximal post‐earthquake context. In each domain, 20 per cent or fewer children had unmet needs. Of all children in the sample, 20 per cent had unmet needs in multiple domains. Children's emotional, physical, and social needs were associated with ongoing exposures amenable to intervention, more than with baseline characteristics or epicentre proximity. Relief efforts should address multiple interrelated domains of child well‐being and ongoing risks in post‐disaster settings.     

Earthquake mortality in Pakistan

A strong earthquake, measuring 7.6 on the Richter scale, hit northern Pakistan on 8 October 2005, causing massive destruction, including an official death toll of 73,276. Four cross-sectional surveys were performed in late 2005 to assess mortality before the event, on the day, and subsequently. Two surveys were community-based and two were situated in camps for internally displaced persons. Crude mortality rates were low in the 3.5 months preceding the earthquake (less than 0.1 deaths per 10,000 per day) and slightly higher in the six-to-eight weeks after the earthquake (ranging from 0.10–0.43 per 10,000 per day). On 8 October 2005, approximately two per cent of the population in one community survey died and around five per cent in the other three surveys. Children less than five years and adults more than or equal to 50 years tended to have a higher risk of mortality on the day of the disaster. These results corroborate the high mortality caused by the earthquake.     

Evaluation of Two Kurdish Refugee Camps in Iran, May 1991: The Value of Cluster Sampling in Producing Priorities and Policy

Following the end of the Gulf war in March 1991, Kurdish refugees from Iraq crossed the border into Western Iran. To plan public health interventions and to assist in priority setting for scarce resources, a rapid epidemiological assessment of two camps, Hafez and Kaliche, was conducted in May 1991. A 30 cluster sampling method was used to determine the demographics of the camp population, the morbidity and mortality from certain diseases, and the nutritional status of the children <5 years of age. The estimated population of the camps at the time of the survey was 28,500 and 22,500 for Hafez and Kaliche respectively; children < 5 years of age accounted for approximately 25 per cent of both camp populations. The mortality rate was highest in Hafez and estimated to be 2.5/10,000 per day (95%CI:0.3–5) for adults (> 14 years of age) and 4.9/10,000 per day (95%CI:2.4–7.4) for children. Diarrhoeal and respiratory diseases accounted for major morbidity in both camps with diarrhoea the commonest stated cause of death. Little malnutrition was found but it was greater in Hafez where 6 per cent (19/327) of the children between 1 and 5 years of age had a mid upper arm circumference (MUAC) <12 cm and eleven (5.2 per cent) of the 211 children measured for height and weight were below 80 per cent of the median (95%CI:2.6%;7.8%). The survey identified that morbidity and mortality were less severe than in the Kurdish camps on the Turkish border and provided information for camp authorities to plan appropriate relief interventions.     

Health Effects of the 1991 Bangladesh Cyclone: Report of a UNICEF Evaluation Team

To assess the impact on health of the cyclone and tidal wave that struck the southern coast of Bangladesh on the evening of 29 April 1991, a team of health professionals visited cyclone affected areas from 4–27 June, 1991. Team members met with health workers and officials of the Government of Bangladesh and with staff pom nongovernmental organizations, and conducted field surveys in two severely affected areas.
Mortality among the 135 households surveyed (pre-cyclone population 1,123) was 14 per cent. At highest risk of deaths were children of less than 10 years (26 per cent mortality) and women of more than 40 (31 per cent mortality). Almost all deaths occurred as a result of drowning from the tidal wave that accompanied the cyclone. Although 95 per cent of the population surveyed had received warning of the cyclone four or more hours before it struck, the 300 existing cyclone shelters had capacity for only 450,000 of the 5,000,000 people affected by the cyclone. Deaths following the cyclone were few. Diarrhea caused by Vibrio cholerae and Shigella dysenteria type 1, both of which are endemic in Bangladesh, occurred in the post-cyclone period. Reports by the national Diarrhea Surveillance System of large increases in diarrheal incidence following the cyclone were difficult to assess because of inconsistencies in pre-and post-cyclone reporting methods. No increase in other infectious diseases was identified.
Although water availability had been a major concern following the cyclone, the tubewell system was functioning well in the area that was surveyed. Distribution of relief assistance by the Government of Bangladesh and by non-governmental organizations was good, with 95 per cent of families surveyed receiving food aid within five days of the cyclone.
The major health effect of this cyclone was acute deaths due to drowning. Preventing deaths during future cyclones will require increasing accessible shelter.     

Deaths in natural hazards in the solomon islands

Archival and library search techniques have been used to establish extensive databases on deaths and damage resulting from natural hazards in the Solomon Islands. Although the records of fatalities are certainly incomplete, volcanic eruptions, tropical cyclones, landslides, tsunami and earthquakes appear to have been the most important. Only 22 per cent of the recorded deaths have resulted from meteorological hazards but a single event could change this proportion significantly. Five events in the fatality database account for 88 per cent of the recorded deaths. Future death tolls are also likely to be dominated by a small number of events. While the expected number of deaths in a given period is dependent upon the length of record considered, it is clear that a disaster which kills one hundred or more people in the Solomons can be expected more frequently than once in a hundred years.     

The Accuracy of Mortality Reporting in Displaced Persons Camps During the Post-emergency Phase

For humanitarian organisations, accurate data are essential to identify emerging health problems and determine programme needs. We visited 45 post-emergency phase displaced persons camps and collected three months' mortality data which we compared with organisations' routine mortality reports. Organisations reported 612 deaths and we identified 741 deaths, for a mortality-reporting ratio, defined as the number of organisation-reported deaths divided by the number of investigator-identified deaths, of 83 per cent. For the majority of camps which under-reported deaths, mortality reporting ratios were significantly higher for women than men, and for camps with central mortality registers rather than those without. In the few camps which over-reported deaths, these occurred primarily among children younger than five years of age, probably due to the inclusion of abortions and stillbirths. Despite the overall under-reporting of deaths by humanitarian organisations, the existing health information systems appear to estimate mortality rates adequately in these post-emergency camps. However, organisations should improve the precision and completeness with which they report the characteristics of deaths in order to provide valuable data to target their programmes at the most vulnerable people.     

The great Australian drought: 1982-1983*

The development of drought over eastern Australia from April 1982 to February 1983 is described. National wheat production for the 1982-1983 season was 63 per cent of the average for the previous five years, while for New South Wales and Victoria production was 29 and 16 per cent respectively. Production of other grains was similarly reduced. Net value of rural production was reduced from over $4,000 million to $2,300 million nationally, the percentage reduction being much larger in drought-affected States. Methods of assessing drought severity are discussed and it is concluded that the 1982-1983 drought must be regarded as one of the most severe in the last 100 years. Impact of drought is also discussed, including that on wheat production and sheep and cattle populations since 1885. It is suggested that the limits of grain growing areas, and of sheep and cattle populations, beyond which environmental degradation may occur, have been exceeded during that period. The view is expressed that more attention should be given to the development of strategies to ameliorate drought impacts.     

Changes in HIV/AIDS/STI knowledge, attitudes and practices among commercial sex workers and military forces in Port Loko, Sierra Leone

Sierra Leone suffered from 11 years of civil war (1991-2002) resulting in tens of thousands of deaths and mutilations together with massive population displacement. In 2001, ARC International, Sierra Leone conducted a baseline survey of 201 commercial sex workers (CSWs) and 202 military respondents on the knowledge, attitudes and practices surrounding HIV/AIDS and STIs in Port Loko, Sierra Leone. In 2003, a comparable post-intervention survey of 202 CSWs and 205 military respondents was performed. Comparison of baseline and post-intervention results showed that HIV/AIDS knowledge increased among both groups, with those able to name three effective means of avoiding AIDS increasing from 5 per cent to 70 per cent among CSWs, and 11 to 75 per cent among the military. Reported condom use during last sex increased among CSWs from 38 to 68 per cent and among military from 39 to 68 per cent. These results demonstrate that, despite the challenges inherent in a post-conflict country, good-quality AIDS-prevention programmes can be effective.     

The 1998 Flood in Bangladesh: Is Different Targeting Needed During Emergencies and Recovery to Tackle Malnutrition?

Bangladesh suffered the century's worst flood during July-October 1998 and appealed for assistance. To provide information for appropriate interventions to tackle nutritional problems, a rapid assessment survey was conducted to look at the nutritional situation, problems encountered by the community, their coping mechanisms and rehabilitation priorities in six rural areas. The survey was repeated after four months to measure the outcome of activities during the flood and the necessity for future assistance. There were 3,048 children measured in both surveys (1,597 and 1,451). The sample of most interest was a sub-group of 180 children present in two previous independent surveys. The analysis found that while moving from the crisis period to post-flood phase there was evidence of a 'crossover phenomenon' in the recovery pattern of nutritional status. Sixty-eight per cent of the children who were malnourished (WHZ < -2SD) during the crisis period (18 per cent) recovered enough to cross the cut-off point and became normal after four months. Another 8 per cent of children (9 per cent of all normal) who were normal during the crisis period, after four months had deteriorated to be malnourished. Thus, despite there being a shift in the overall distribution of nutritional status, there has been another shift that reduced the net effect. Subsequent episodes of diarrhoea, access to food and loan burden had also influenced the recovery pattern of the children's nutritional status as evident from the statistically significant associations. These findings raise questions about targeting acute malnutrition during emergencies, and using the same criteria during both the crisis and rehabilitation phases.     

Analysis of hazardous material releases due to natural hazards in the United States

Natural hazards were the cause of approximately 16,600 hazardous material (hazmat) releases reported to the National Response Center (NRC) between 1990 and 2008-three per cent of all reported hazmat releases. Rain-induced releases were most numerous (26 per cent of the total), followed by those associated with hurricanes (20 per cent), many of which resulted from major episodes in 2005 and 2008. Winds, storms or other weather-related phenomena were responsible for another 25 per cent of hazmat releases. Large releases were most frequently due to major natural disasters. For instance, hurricane-induced releases of petroleum from storage tanks account for a large fraction of the total volume of petroleum released during 'natechs' (understood here as a natural hazard and the hazardous materials release that results). Among the most commonly released chemicals were nitrogen oxides, benzene, and polychlorinated biphenyls. Three deaths, 52 injuries, and the evacuation of at least 5,000 persons were recorded as a consequence of natech events. Overall, results suggest that the number of natechs increased over the study period (1990-2008) with potential for serious human and environmental impacts.     

Profile of Mortality from the 1989 Loma Prieta Earthquake using Coroner and Medical Examiner Reports

Mortality patterns from earthquakes in the United States may differ from those observed in other parts of the world. We reviewed coroner and medical examiner records for all investigated deaths from seven California counties for 15 days following the Loma Prieta earthquake of October 17, 1989 (N = 327). Data on the circumstances surrounding death were used to classify each case as directly earthquakerelated, indirectly earthquake-related, or not earthquake-related. Fifty-seven deaths were judged as directly earthquake-related. Six other deaths were indirectly related. Ten circumstances accounted for all directly earthquake-related deaths, with the collapse of an elevated freeway accounting for 40 of these deaths. Forty-six (80.8 per cent) of the 57 directly earthquake-related deaths occurred in motor vehicles on public roadways. Fifty-three (93.0 per cent) of the directly earthquake-related deaths occurred within seconds or minutes of injury. Future earthquake deaths in the United States may best be prevented by identifying and modifying seismic hazards in earthquake-prone regions, particularly transportation structures.     

Severe drought and the vitamin A status of rural pre-school children in India

A community-based cross-sectional study was carried out in six drought-affected areas of India in 2003 to assess the impact of drought on the vitamin A status of 3,657 rural pre-school children. The prevalence of Bitot's spots was found to be significantly (p < 0.01) higher (1.8 per cent) during drought (odds ratio (OR) = 2.0; 95 per cent confidence interval: 1.6 -2.7). The dietary intake of vitamin A was lower during drought and in 81 per cent of households it was less than 50 per cent of the recommended rate. Severe drought has an adverse impact on the vitamin A status of rural pre-school children, particularly those with illiterate mothers and belonging to an older age group (p < 0.01). Communities need to be sensitised, therefore, to vitamin A deficiency through health and nutrition education, and there needs to be wider coverage of vitamin A supplementation, particularly among children in drought-affected and drought-prone areas.     

Long-Term Effects of Hurricane Andrew: Revisiting Mental Health Indicators

Two population-based surveys of South Dade County, Florida, were conducted after Hurricane Andrew to compare hurricane-related symptoms of mental distress and describe the impact of mental health outreach teams. Households were selected by three-stage cluster sampling and findings from the two surveys, 13 months apart, were compared. Response rates were 75 per cent and 84 per cent. The prevalence of symptoms of mental distress decreased over time. However, in the households contacted by the teams (25 per cent of sample), the prevalence of symptoms (50 per cent) did not differ from households not contacted (43 per cent). Households contacted by teams that reported symptoms were just as likely to have been referred for help by the teams (72 per cent) as those without symptoms (68 per cent). Households reporting symptoms were equally likely to get counselling regardless of whether the teams visited. Mental health teams had no significant impact on mental health symptoms or the use of mental health services. Alternative approaches to mental health outreach teams need to be explored.     

Humanitarian aid and local power structures: lessons from Haiti's ‘shadow disaster’

This paper investigates the confluence of humanitarian aid, centralisation, and politics. The 7.0 magnitude earthquake in Haiti on 12 January 2010 led to more than USD 16 billion in pledges. By contrast, Hurricane Matthew, which made landfall in Haiti on 4 October 2016, stayed in the shadows, attracting about one per cent of the amount. While the earthquake exhibited one face of centralisation, the Category 4 storm laid bare rural vulnerabilities shaped by postcolonial state neglect, and reinforced by the influx of non-governmental organisations in the ‘Republic of Port-au-Prince’. The study draws on data from four case studies in two departments to illuminate the legacies of hyper-centralisation in Haiti. Compounding matters, Matthew struck in the middle of an extended election that the international community attempted to control again. The paper argues that disaster assistance and politics are uncomfortably close, while reflecting on the momentary decentralisation of aid after the hurricane and its effectiveness.     

The bangladesh cyclone of 1991: why so many people died

Living with natural disasters has become a way of life in Bangladesh. On the night of 29 April 1991 a severe cyclonic storm, accompanied by tidal surges up to 30 feet high, battered the coastal areas of Bangladesh for 3–4 hours. Thousands of people were killed and property worth billions of dollars was destroyed. After the cyclone, several studies, using epidemiological and anthropological methods, looked at the impact of the cyclone. It was estimated that over 67,000 people lost their lives. Women, children and the elderly were much more at risk and so were those from the socio-economically disadvantaged section of the population. Cyclone shelters were few in relation to need but proved very helpful in saving lives. At least 20 per cent more deaths would have occurred in the absence of these shelters. The article documents impressive improvements in Bangladesh's-ability to cope and makes recommendations for the future.     

An exploratory study on perceptions of seismic risk and mitigation in two districts of Istanbul

Istanbul is one of the world's cities most vulnerable to seismic events. According to seismologists, the probability of a severe earthquake in the next 30 years is approximately 40 per cent. Following an outline of the seismicity of this vital Turkish city and a summary of current seismic risks and mitigation studies, this paper presents the results of a survey conducted in two districts of Istanbul, Avcilar and Bakirkoy. The survey comprised some 60 questions on the seismic risk perceptions of individuals and requested basic personal data, such as on age, education level, employment type, financial income, and gender. Despite various differences among the survey population, such as academic background and level of financial income, responses were surprisingly similar, especially in terms of having no plan for a safer house. The data may help those planning mitigation programmes and public awareness campaigns on preparedness and particularly mitigation in highly vulnerable regions.