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.     

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.     

Operation Child-ID: reunifying children with their legal guardians after Hurricane Katrina

Children constitute a vulnerable population and special considerations are necessary in order to provide proper care for them during disasters. After disasters such as Hurricane Katrina, the rapid identification and protection of separated children and their reunification with legal guardians is necessary in order to minimise secondary injuries (i.e. physical and sexual abuse, neglect and abduction). At Camp Gruber, an Oklahoma shelter for Louisianans displaced by Hurricane Katrina, a survey tool was used to identify children separated from their guardians. Of the 254 children at the camp, 36 (14.2 per cent) were separated from their legal guardians. Answering 'no' to the question of whether the accompanying adult was the guardian of the child prior to Hurricane Katrina was a strong predictor (27.8 per cent versus 3.2 per cent) of being listed as 'missing' by the National Center for Missing and Exploited Children (NCMEC). All the children at Camp Gruber who were listed as 'missing' by the NCMEC were subsequently reunited with their guardians.     

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.     

Shelter recovery in urban Haiti after the earthquake: the dual role of social capital

This paper documents the culture‐specific understanding of social capital among Haitians and examines its benefits and downsides in post‐disaster shelter recovery following the 12 January 2010 earthquake. The case study of shelter recovery processes in three socioeconomically diverse communities (Pétion‐Ville, Delmas and Canapé Vert) in Port‐au‐Prince suggests that social capital plays dual roles in post‐disaster shelter recovery of the displaced population in Haiti. On the one hand, it provides enhanced access to shelter‐related resources for those with connections. On the other hand, it accentuates pre‐existing inequalities or creates new inequalities among displaced Haitians. In some cases, such inequalities lead to tensions between the have and have‐nots and instigate violence among the displaced.     

Concerns and future preparedness plans of a vulnerable population in New Jersey following Hurricane Sandy

Knowing how people prepare for disasters is essential to developing resiliency strategies. This study examined recalled concerns, evacuation experiences, and the future preparedness plans of a vulnerable population in New Jersey, United States, following Hurricane Sandy in 2012. Understanding the responses of minority communities is key to protecting them during forthcoming disasters. Overall, 35 per cent of respondents were not going to prepare for an event. Intended future preparedness actions were unrelated to respondents' ratings of personal impact. More Blacks and Hispanics planned on preparing than Whites (68 versus 55 per cent), and more Hispanics planned on evacuating than did others who were interviewed. A higher percentage of respondents who had trouble getting to health centres were going to prepare than others. Respondents' concerns were connected to safety and survival, protecting family and friends, and having enough food and medicine, whereas future actions included evacuating earlier and buying sufficient supplies to shelter in place.     

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.     

Tsunami mortality and displacement in Aceh province, Indonesia

A survey of 388 Indonesian households displaced by the December 2004 tsunami was conducted in Aceh province in February 2005. Of tsunami-displaced households in Aceh Barat and Nagan Raya districts, 61.8 per cent reported one or more family members as dead or missing due to the tsunami, with an overall mortality rate of 13.9 per cent (95% confidence interval (CI): 12.4-15.4). Risk of death was greatest in the youngest and oldest age groups, and among females. Overall, 36 per cent of tsunami-displaced households indicated an intention to return to their original community within three months, and displaced households residing in host communities were 2.2 (95% CI: 1.2-2.8) times more likely to state an intention to return to their original villages or another community as those residing in camps. The tsunami recovery effort should focus on strategies that facilitate either prompt return or permanent, voluntary relocation for those displaced.     

Special needs hurricane shelters and the ageing population: development of a methodology and a case study application

Recent experience of hurricanes, particularly in the southeast United States, has heightened awareness of the multifaceted nature of and the challenges to effective disaster relief planning. One key element of this planning is providing adequate shelter at secure locations for people who evacuate. Some of these individuals will have ‘special needs’, yet there is little research on the relationship with shelter space. This study designed a geographic information systems‐based network optimisation methodology for the siting of special needs hurricane relief shelters, with a focus on the transportation component. It sought to find new locations for shelters that maximise accessibility by vulnerable populations, given capacity constraints, concentrating on the ageing population. The framework was implemented in a medium‐sized metropolitan statistical area in the state of Florida where data suggest a possible deficit in special needs shelter space. The study analysed options for increasing special needs shelter capacity, while considering potential uncertainties in transportation network availability.     

Displacements and reconstruction: the case of west beirut - Lebanon

This paper focusses on the housing conditions of the displaced people who were forced to move to West Beirut due to the conflict in Lebanon which started in 1975. With the lack of any emergency housing provision, people have adopted two ways to shelter their families; either by occupying vacant buildings or by squatting on unused land (land squatting).
The study is based on fieldwork undertaken in order to gain a deeper insight into the displaced people's housing conditions. The results of the survey analysis are believed to be common to other displaced people, as has been verified by comparison with the available information in newspaper reports, unpublished documents, and other accounts.
The paper concludes with a reconstruction strategy, composed of two policies. First, a short-term policy which deals with the urgent needs of the people in the place of refuge. Thus mitigation and risk reduction are the aims of this policy. Second, a long-term policy which concentrates on future housing reconstruction; in which economic development, social integration and cultural identity are the basic features.     

Psychological consequences among adults following the 1999 earthquake in Athens, Greece

One year after the 7 September 1999 earthquake in Athens, Greece, we investigated the psychological consequences among 305 individuals (71 per cent female) residing in the settlements of Ano Liosia Municipality. Adaptability was difficult (63 per cent) due to limited space (50 per cent). Insecurity feelings were predictive of difficult adaptability (chi2= 29.8, p<0.0001) and were common (63 per cent) among married subjects, independent of age (chi2= 5.0, odds ratio (OR): 0.49, 95 per cent confidence interval (CI): 0.26-0.90). Eighty per cent expressed stress feelings, mainly nervousness/tension (60 per cent). Adaptability (chi2= 5.3, OR: 0.5, 95 per cent CI: 0.27-0.9), age (chi2= 6.5, OR: 1.03, 95 per cent CI: 1.01-1.06), and female gender (chi2= 4.7, OR: 0.48, 95 per cent CI: 0.25-0.90) were independent predictors of stress feelings. The majority (55 percent) developed sleep disorders, chiefly insomnia (60 percent). Adaptability problems were the only predictor of sleep disorders (chi2= 6.4, OR: 0.5, 95 per cent CI: 0.33-0.87). Psychiatric medication use increased after the earthquake.     

Survivor needs or logistical convenience? Factors shaping decisions to deliver relief to earthquake‐affected communities,Pakistan 2005–06

In Bureaucratizing the Good Samaritan , Waters (2001) argues that bureaucratic rationality distracts humanitarian agencies from the needs of the people they are supposed to assist, in favour of other values that their institutional frameworks dictate. We test his claim by investigating the response to the Pakistan 2005 earthquake. One of us (Dittemore) worked with the United Nations Joint Logistics Centre in the theatre, managing a relief cargo shipment database. The response, known as 'Operation Winter Race', was hampered by extreme logistical challenges, but ultimately succeeded in averting a second disaster resulting from cold and starvation. We use statistical models to probe whether survivor needs significantly guided decisions to deliver relief to affected communities. Needs assessments remained incomplete and incoherent. We measure needs through proxy indicators and integrate them, on a Geographic Information System (GIS) platform, with logistics and relief delivery data. We find that, despite strong logistics effects, needs orientations were significant. However, the strength of decision factors varies between commodity types (food versus clothing and shelter versus reconstruction materials) as well as over the different phases of the response. This study confirms Thomas's observation that logistics databases are rich 'repositories of data that can be analyzed to provide post-event learning' (Thomas, 2003, p. 4). This article is an invitation for others to engage in creative humanitarian data management.     

Moderating effects of empathic concern and personal distress on the emotional reactions of disaster volunteers

This study examines stress and mood outcomes in community volunteers who undertook one week's worth of post‐disaster relief work in L'Aquila, Italy, which had been hit by an earthquake four months earlier. The study team obtained pre‐ and post‐relief work data from 130 volunteers involved in activities such as preparing food for the displaced, cleaning the camps and distributing clean linen. The Perceived Stress Scale, the State‐Trait Anxiety Inventory and the Profile of Mood States were administered at the start and at the end of the aid activities. Psychopathological symptoms and empathy were assessed in the beginning, using the Symptom Checklist 90 Revised and the Interpersonal Reactivity Index, respectively. The results show that, following the assistance work, volunteers displayed decreases in perceived stress, general distress, anxiety and anger, as well as increases in positive emotions. The empathy facets empathic concern and personal distress showed different patterns in modulating the post‐disaster relief work adaptation for some of the mood outcomes.     

Predictors for people's response to a tornado warning: Arkansas, 1 March 1997

On 1 March 1997, powerful tornadoes touched down in Arkansas (USA) on a Saturday afternoon. Twenty-six fatalities and 400 non-fatal injuries were reported. We performed a population-based cross-sectional study to determine factors associated with appropriate responses to tornado warnings. Of 146 survey participants, 140 (96 per cent) knew the difference between 'tornado watch' and 'tornado warning' and were aware of when the warning was announced. Of those 140 participants, 64 (45.7 per cent) responded to the warning by seeking shelter, and 58 (90.6 per cent) of those 64 acted within five minutes of hearing the warning. Four factors were positively associated with those seeking shelter: having graduated from high school (OR = 4.2, 95 per cent CI = 1.1-15.5); having a basement in one's house (OR = 3.8, 95 per cent exact CI = 1.1-17.1); hearing a siren (OR = 4.4, 95 per cent CI = 1.3-18.9); and having prepared a household plan of response when tornadoes occur (OR = 2.6, 95 per cent CI = 1.1-6.3). On the basis of these findings, we recommend: first, that people who live in tornadoprone areas have a personal plan of action to help them respond immediately to warnings; second, public-health education officials in areas with frequent tornadic activity should do more to educate the public about what they can do to protect themselves from a tornado; and third, that emergency-management officials planning protection measures for vulnerable communities should consider that most people have limited time (our study documented five minutes) in which to respond to a tornado warning. Thus, shelters in tornado-prone areas should be quickly accessible by residents.     

Environmental Health and the 1991 Bangladesh Cyclone

A brief post-disaster study was undertaken soon after the cyclone of 1991 in Bangladesh to make a preliminary assessment of existing environmental health conditions. Eighty affected people and 26 relief personnel from the affected areas were interviewed. Faecal coliform counts, salinity conductivity and pH values were determined for 43 water samples from tubewells and ponds. The quality of 32 samples of water purifying tablets was also tested.
Water scarcity was acute, especially water used for washing and personal hygiene. The situation was made worse by the fact that the surface water sources (ponds) which were commonly used for domestic purposes other than drinking were flooded, highly contaminated and regarded as unusable. The user load on existing tubewells doubled, indicating a significantly increased demand for the tubewell water which is commonly used for drinking purposes only. The majority (63 per cent) of the water purifying tablets were found to have lost potency. Sanitation was very poor in households as well as in field clinics and shelters. Most people, including relief personnel, lacked environmental health knowledge. Suggestions regarding immediate preparations for disaster relief include: restoring water systems (tubewells and ponds), training courses for relief personnel, standardizing of water purifying tablets, promoting appropriate water use and its treatment, maintaining sanitation in clinics and shelters and improving the skills and resources of local people to enable them to cope with the situation.     

Reproductive health in Afghanistan: results of a knowledge, attitudes and practices survey among Afghan women in Kabul

A reproductive-health knowledge, attitudes and practices (KAP) survey was carried out among 468 Afghan women of reproductive age. A convenience sample of women was selected from attendees in the outpatient departments of four health facilities in Kabul. Seventy-nine per cent of respondents had attended at least one antenatal consultation during their last pregnancy. Two-thirds (67 per cent) delivered their first child between 13 and 19 years. The Caesarean-section rate was low (1.6 per cent). Two-thirds (67 per cent) of deliveries occurred in the home. The contraceptive prevalence rate was 23 per cent (16 per cent modern and 7 per cent natural methods). Twenty-four per cent had knowledge of any STIs, although most of these women did not know correctly how to prevent them. Most of the women (93 per cent) needed authorization from their husband or a male relative before seeking professional health-care. In multivariate analysis, women's schooling was significantly associated with antenatal-care attendance (AOR 4.78), institutional delivery (AOR 2.29), skilled attendance at birth (AOR 2.07) and use of family planning (AOR 4.59). Reproductive-health indicators were noted to be poor even among these women living in Kabul, a group often considered to be the most privileged. To meet the reproductive-health needs of Afghan women, the socio-cultural aspects of their situation--especially their decision-making abilities -- will need to be addressed. A long-standing commitment from agencies and donors is required, in which the education of women should be placed as a cornerstone of the reconstruction process of Afghanistan.     

Comparing reactions to two severe tornadoes in one Oklahoma community

The authors compared the effect of the 3 May 1999 F5 and 8 May 2003 F3 tornadoes on the community of Moore, Oklahoma, by canvassing damaged areas after both tornadoes and surveying residents. Significantly more 1999 than 2003 residents reported property damage and injuries. Television and tornado sirens were the most common warnings each year, however, more 1999 residents received and responded to television warnings. Importantly, storm shelters were used more frequently in 2003. Fifty-one per cent of residents who experienced both tornadoes took the same amount of protective action in 2003 as they had in 1999; 22% took less; and 27% took more. Residents who took less action said that the reason for doing so was inadequate warning and shelter. First-hand experience of tornadoes prompts people to heed warnings when adequate notification is received and to take effective protective action when adequate shelter is available.     

Natural disasters and older US adults with disabilities: implications for evacuation

We analysed 2003 and 2004 Behavioral Risk Factor Surveillance System (BRFSS) data from New Orleans-Metairie-Kenner, LA to produce estimates of the number of community dwelling people aged 65 years or older with a disability and requiring special equipment.(4) Approximately, 47,840 (31.6 per cent) older adults with a disability and 24,938 (16.6 per cent) older adults requiring the use of special equipment were community dwelling and might require assistance to evacuate or a shelter that could accommodate special equipment. Older adults who need special equipment were likely to be female, unmarried and white, and to rate their health as fair or poor. Personnel who plan and prepare for evacuations and temporary shelter during disasters need baseline information on the number of older adults with a disability or who require special equipment. A surveillance system, such as the BRFSS, gathers information that planners can use to prepare for and to deliver services.     

Nutritional response to the 1998 Bangladesh flood disaster: Sphere minimum standards in disaster response

In this study we use a cross-sectional survey to evaluate the nutritional response to the 1998 Bangladesh Flood Disaster by 15 relief agencies using standards developed by the Sphere Project. The Sphere Project is a recent attempt by agencies around the world to establish universal minimum standards for the purpose of ensuring quality and accountability in disaster response. The main outcomes measured were resources allocated to disaster relief types of relief activities and percentage of agencies meeting selected Sphere food aid and nutrition indicators. Although the process of nutritional response was measured, specific nutritional and health outcomes were not assessed. This review found that self-reported disaster and nutritional resources varied widely between implementing agencies, ranging from US $58,947 to $15,908,712. The percentage of resources these agencies allocated to food aid and nutritional response also varied, ranging from approximately 6 to 99 per cent of total resources. Agencies met between 8 and 83 per cent of the specific Sphere indicators which were assessed Areas in which performance was poor included preliminary nutritional analysis; beneficiary participation and feedback; disaster preparedness during non-emergency times; monitoring of local markets and impact assessment. Agencies were generally successful in areas of core humanitarian response, such as targeting the vulnerable (83 per cent) and monitoring and evaluating the process of disaster response (75 per cent). The results here identify both strengths and gaps in the quality of humanitarian response in developing nations such as Bangladesh. However, they also raise the question of implementing a rights-based approach to disaster response in nations without a commitment to meeting positive human rights in non-disaster times.     

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.