Mental and social health in disasters: the Sphere standards and post‐tsunami psychosocial interventions in Asia

The primary objective of this paper is to examine and inform the mental health and psychosocial support standards of the 2011 edition of the Sphere Project's Humanitarian Charter and Minimum Standards in Humanitarian Response. This is done through a qualitative analysis of internal evaluation documents, reflecting four long‐term humanitarian psychosocial programmes in different countries in post‐tsunami Asia. The analysis yielded three overall conclusions. First, the Sphere standards on mental health and psychosocial support generally are highly relevant to long‐term psychosocial interventions after disasters such as the Indian Ocean tsunami of 26 December 2004, and their application in such settings may improve the quality of the response. Second, some of the standards in the current Sphere handbook may lack sufficient guidance to ensure the quality of humanitarian response required. Third, the long‐term intervention approach poses specific challenges to programming, a problem that could be addressed by including additional guidance in the publication.     

Workplace response of companies exposed to the 9/11 World Trade Center attack: a focus‐group study

The terrorist attacks of 11 September 2001 (9/11) left workplaces in pressing need of a mental health response capability. Unaddressed emotional sequelae may be devastating to the productivity and economic stability of a company's workforce. In the second year after the attacks, 85 employees of five highly affected agencies participated in 12 focus groups to discuss workplace mental health issues. Managers felt ill prepared to manage the magnitude and the intensity of employees' emotional responses. Rapid return to work, provision of workplace mental health services, and peer support were viewed as contributory to emotional recovery. Formal mental health services provided were perceived as insufficient. Drawing on their post‐9/11 workplace experience, members of these groups identified practical measures that they found helpful in promoting healing outside of professional mental health services. These measures, consistent with many principles of psychological first aid, may be applied by workplace leaders who are not mental health professionals.     

Children and the Sphere standard on mental and social aspects of health

Most of the world's children live in resource-poor countries where people are at a relatively high risk of exposure to catastrophic situations arising from conflict and natural disasters.(6) Given the potential social, psychological and psychiatric consequences of exposure to disaster, mental health and psychosocial support programmes are increasingly part of humanitarian aid. A minimum standard on mental and social aspects of health is included in the recently revised Humanitarian Charter and Minimum Standards in Disaster Response (Sphere Handbook) (Sphere Project, 2004). Most recommendations for mental health and psychosocial interventions in guidance documents are based on expert opinion rather than research. Consequently, interventions are being implemented without full understanding of their potential benefit or harm. This paper offers a child-focused review of the evidence for each of the interventions described as indicators for the Sphere standard on mental and social aspects of health. It suggests some, but limited, support for each of them. However, the evidence base needs substantial strengthening.     

Privatisation and outsourcing in wartime: the humanitarian challenges

The tendency today to privatise many activities hitherto considered the exclusive preserve of the state has given rise to sharp debate. The specific nature of humanitarian emergencies elucidates in particularly stark contrast some of the main challenges connected to the privatisation and outsourcing of essential public services, such as the provision of drinking water and health care. Privatising the realms of defence and security, which are at the very core of state prerogative, raises several legal and humanitarian concerns. This article focuses on the roles and responsibilities of the various parties involved in armed conflicts, especially those of private companies engaged in security, intelligence and interrogation work, and in the provision of water supply and health services. It highlights the need for humanitarian and development actors to grasp better the potential risks and opportunities related to privatisation and outsourcing with a view to supplying effective protection and assistance to communities affected by war.     

Health and social impacts of a flood disaster: responding to needs and implications for practice

Carlisle in northwest England suffered its worse floods for more than 180 years in 2005. A study, reported here, was undertaken to assess the health and social impacts of these floods via in‐depth, taped individual and focus‐group interviews with people whose homes had been flooded and with agency workers who helped them. Respondents spoke of physical health ailments, psychological stress, water health‐and‐safety issues related to the floods, and disputes with insurance and construction companies, which they felt had caused and exacerbated psychological health problems. Support workers also suffered from psychological stress. Furthermore, it was found that people had low expectations of a flood and were not prepared. The findings are presented in five sections covering flood risk awareness, water contamination issues, physical health, mental health, and impact on frontline support workers. The discussion focuses on the implications of the findings for policy and practice vis‐à‐vis psychological health provision, contamination issues, training and support for frontline support workers, matters relating to restoration, and preparation for flooding.     

Disaster mental health training programmes in New York City following September 11, 2001

The need for mental health resources to provide care to the community following large‐scale disasters is well documented. In the aftermath of the World Trade Center (WTC) disaster on September 11, 2001, many local agencies and organizations responded by providing informal mental health services, including disaster mental health training for practitioners. The quality of these programmes has not been assessed, however. The National Center for Disaster Preparedness at Columbia University's School of Public Health reviewed disaster mental health training programmes administered by community‐based organizations, professional associations, hospitals, and government agencies after September 11. Results indicate that the quality and the effectiveness of programmes are difficult to assess. A wide range of curricula and a widespread lack of recordkeeping and credentialing of trainers were noted. Most of the training programmes provided are no longer available. Recommendations for improving the quality of disaster mental health training programmes are provided.     

Providing health services during a civil war: the experience of a garrison town in South Sudan

The impact of conflict, particularly conflict arising during civil wars, on the provision of healthcare is a subject that has not been widely considered in conflict‐related research. Combatants often target health services to weaken or to defeat the enemy, while attempts to maintain or improve health systems also can comprise part of counter‐insurgency ‘hearts‐and‐minds’ strategies. This paper describes the dynamics associated with the provision of health services in Malakal, an important garrison town in South Sudan, during the second Sudanese civil war (1983–2005). Drawing on the concepts of opportunity hoarding and exploitation, it explores the social and political dynamics of service provision in and around the town during the war. These concepts provide a useful lens with which to understand better how health services are affected by conflict, while the empirical case study presented in the paper illustrates dynamics that may be repeated in other contexts. The concepts and case study set out in this paper should prove useful to healthcare providers working in conflict zones, including humanitarian aid agencies and their employees, increasing their understanding of the social and political dynamics that they are likely to face during future conflict‐related complex emergencies.     

Corruption in emergency procurement

Corruption in emergency procurement reduces the resources available for life‐saving operations, lowers the quality of products and services provided, and diverts aid from those who need it most. ¹ 1 The paper is based on a study for a project of the Chr Michelsen Institute (CMI)'s U4 Anti‐Corruption Resource Centre entitled ‘Corruption in Emergencies’ (see http://www.u4.no ).
It also negatively influences public support for humanitarian relief, both in the affected country and abroad. This paper aims to unpack and analyse the following question in order to mitigate risk: how and where does corruption typically occur, and what can be done? Suggested strategies reflect a multi‐layered approach that stresses internal agency control mechanisms, conflict‐sensitive management, and the need for common systems among operators.     

There's nowhere to go: counting the costs of extreme weather to the homeless community

People experiencing homelessness are vulnerable to extreme weather in unique ways. The entrenched inequalities that underpin disaster vulnerability are compounded by extreme isolation and the stress of transient living on mental and physical health. However, the impacts of extreme weather on the homeless in Australia are largely undocumented and rarely incorporated in emergency planning. Interviews with and surveys of emergency and homeless services and service users revealed that the primary ramifications of losing shelter and worsening mental health deepen the cycle of homelessness and trauma. Consequently, homeless shelter losses, such as tents, should be included in pre‐ and post‐event impact statistics and subsequent recovery support. Extreme weather response plans should include early triggers and strategies for ‘non‐severe’ weather events, as the homeless community is affected earlier and by a wider range of meteorological conditions. Moreover, this study also explores the benefits of a trauma‐informed response to extreme weather when working with the homeless.     

An adaptive governance approach to disaster-related behavioural health services

This paper explores the provision of disaster-related behavioural and mental health (DBH) services as a problem of institutional collective action in the United States. This study reviews the challenges that providers have in surmounting multi-organizational disconnects, unstable professional legitimacy, ambiguous information, and shifting disaster needs in developing a system for delivering DBH services. Based on the adaptive governance framework, it argues that existing protocols such as the National Incident Management System (NIMS) and Incident Command System (ICS) may be helpful in advancing collective action, but that real progress will depend on a recognition of norms, expectations, and credentials across many spheres-in other words, on the ability of responders to continuously adjust their procedures and administrative boundaries for behavioural health institutions.     

Citizen feedback in a fragile setting: social accountability interventions in the primary healthcare sector in Sierra Leone

Fragile and conflict‐affected states are frequently characterised by their inability to fulfil three core governance functions: provision of security, effective delivery of basic public goods and services, and managing political participation and accountability. This article explores the utility of social accountability interventions in fragile environments. Successful social accountability interventions can lead to joint examinations of public service standards by service‐users and providers, resulting in collaborative improvement efforts. The few available studies of such interventions implemented in fragile or conflict‐affected states show reasons for optimism as well as challenges. This article advocates the continued use of social accountability methods in fragile settings and provides examples of social accountability interventions in the health sector in Sierra Leone. The study suggests that social accountability can improve interaction between citizens and public service providers. Successful social accountability interventions can also lead to better quality and more accessible public services, which, in turn, can enhance state legitimacy.     

Women, Health and Humanitarian Aid in Conflict

The burden of political conflict on civilian populations has increased significantly over the last few decades. Increasingly, the provision of resources and services to these populations is coming under scrutiny; we highlight here the limited attention to gender in their provision. Women and men have different exposures to situations that affect health and access to health-care and have differential power to influence decisions regarding the provision of health services. We argue that the role of women in planning is central to the provision of effective, efficient and sensitive health-care to conflict-affected populations.     

The 2004 tsunami and mental health in Thailand: a longitudinal analysis of one‐and two‐year post‐disaster data

Some 280,000 people died in the Indian Ocean tsunami on 26 December 2004. This cohort study examined its impact on mental health one and two years later. It did so by investigating the association between six consequent variables (personal injury, loss of home, loss of business, death of a family member, injury to a family member, or loss of a family member's business) and mental health, as measured by the 36‐item Short Form Health Survey (SF‐36), among residents in four provinces of Thailand. One year later, participants who suffered a personal injury, the loss of a business, or the loss of a family member reported poorer mental health than those who were unaffected. Two years later, participants who experienced the loss of a family member reported poorer mental health than those who were unaffected. This research shows that such a disaster may have long‐lasting ramifications for mental health, and that diverse losses may influence mental health differently.     

Of timelines and timeliness: lessons from Typhoon Haiyan in early disaster response

Typhoon Haiyan struck the Philippines on 8 November 2013 with maximum sustained winds of 235 kilometres per hour, adversely affecting at least 11 million people and displacing some 673,000 in the central regions of the country. The disaster clearly overwhelmed the Philippine government despite its seemingly well‐crafted disaster management plan. Using timelines of different organisations, this paper identifies gaps in the government's response, mainly due to its failure in coordinating and managing relief operations, which adversely affected its effectiveness and efficiency in the delivery of critical goods and services following the disaster. The paper also demonstrates how non‐governmental organisations (NGOs), the United Nations, foreign governments and other organisations provided assistance, mainly through aid niching, to cover the government's shortcomings. The paper recommends a paradigm shift in the government's disaster response by integrating collaborative arrangements between government agencies and NGOs, and giving local governments the lead role, with the national government as support, in disaster planning and response.     

Challenges to mobilising resources for disaster recovery and reconstruction: perspectives of the Haitian diaspora

Diasporas and diaspora non‐governmental organisations (NGOs) are increasingly important as resource lifelines to their home countries, yet the resources that they mobilise, the types of challenges that they face, and their coping mechanisms are not well explored or understood in the context of disaster recovery. To fill this knowledge gap, this study employed an inductive qualitative methodological approach, using interviews to comprehend the role played by Haitian diaspora NGOs after the catastrophic earthquake in 2010. It found that resources take four common forms: event fundraisers; financial and material donations from supporters; remittances; and volunteer labour. Challenges include an overreliance on diaspora donors, competition among NGOs, and what is perceived as inequitable funding practices towards diaspora NGOs. The findings provide insights centred on better coordination among diaspora NGOs, as well as between diaspora NGOs and other local and international NGOs and local governments and international institutions, to ensure more efficient delivery of services to survivors.     

Barriers to the long‐term recovery of individuals with disabilities following a disaster

This study examines how pre‐existing disabling conditions influenced the recovery process of survivors of Hurricane Katrina. It focuses specifically on the barriers that hindered the recovery process in these individuals. Focus groups were convened in four Gulf Coast states with 31 individuals with disabilities who lived in or around New Orleans, Louisiana, prior to Hurricane Katrina in August 2005. Qualitative data were analysed using grounded theory methodology. Five themes emerged as the most significant barriers to recovery: housing; transportation; employment; physical and mental health; and accessing recovery services. While these barriers to recovery were probably common to most survivors of the disaster, the research results suggest that disability status enhanced the challenges that participants experienced in negotiating the recovery process and in acquiring resources that accommodated their disabilities. The findings indicate that, when disaster recovery services and resources did not accommodate the needs of individuals with disabilities, recovery was hindered. Recovery efforts should include building accessible infrastructure and services that will allow for participation by all.     

The use of cluster sampling to determine aid needs in Grozny, Chechnya in 1995

War broke out in Chechnya in November 1994 following a three-year economic blockade. It caused widespread destruction in the capital Grozny. In April 1995 Medical Relief International--or Merlin, a British medical non-governmental organisation (NGO)--began a programme to provide medical supplies, support health centres, control communicable disease and promote preventive health-care in Grozny. In July 1995 the agency undertook a city-wide needs assessment using a modification of the cluster sampling technique developed by the Expanded Programme on Immunisation. This showed that most people had enough drinking-water, food and fuel but that provision of medical care was inadequate. The survey allowed Merlin to redirect resources earmarked for a clean water programme towards health education and improving primary health-care services. It also showed that rapid assessment by a statistically satisfactory method is both possible and useful in such a situation.     

The responses of professional fire-fighters to disaster

This paper reports the results of a survey of the physical and mental reactions of a group ( N = 72) of members of the South Australian Metropolitan Fire Service (MFS) who were engaged in fighting the bushfires close to Adelaide, 16th-19th February 1983. A questionnaire, designed to elicit reports on both physical and mental reactions to exposure to the fire, as well as perceptions of several measures of social strain and social support, was administered to the firefighters when they came off duty. The results reported show the possible influence of role strain factors in predicting mental reactions, and also demonstrate what may be mediating effects of perceived social support. The paper also discusses methodological problems affecting this and other studies of the reactions of emergency service personnel to disaster.     

Predicting support for non‐pharmaceutical interventions during infectious outbreaks: a four region analysis

Non‐pharmaceutical interventions (NPIs) are an important public health tool for responding to infectious disease outbreaks, including pandemics. However, little is known about the individual characteristics associated with support for NPIs, or whether they are consistent across regions. This study draws on survey data from four regions—Hong Kong, Singapore, Taiwan, and the United States—collected following the Severe Acute Respiratory Syndrome (SARS) outbreak of 2002–03, and employs regression techniques to estimate predictors of NPI support. It finds that characteristics associated with NPI support vary widely by region, possibly because of cultural variation and prior experience, and that minority groups tend to be less supportive of NPIs when arrest is the consequence of noncompliance. Prior experience of face‐mask usage also results in increased support for future usage, as well as other NPIs. Policymakers should be attentive to local preferences and to the application of compulsory interventions. It is speculated here that some public health interventions may serve as ‘gateway’ exposures to future public health interventions.     

Kabrit ki gen twòp mèt: understanding gaps in WASH services in Haiti's IDP camps

Despite the enormous infusion of post‐quake aid to Haiti, cholera had killed more than 8,000 people by January 2013. Based on two mixed‐method studies of a random sample of 108 internally displaced person (IDP) camps and 168 interviews with agency representatives and recipients, this article examines the prevalence of factors that have proven most relevant to the rapid spread of cholera, particularly the provision of water and sanitation services in IDP camps. The study reveals that 30% of IDP camps had no toilets and 40% had no access to water before the outbreak, with only minimal progress after three months. Using bivariate and multivariate statistical analyses, this article explores patterns in the gaps of services with a range of variables such as NGO camp management, municipality and landowners. It offers several theoretical and policy explanations for low level of services, concluding with a series of recommendations for better coordination and management.