Public Nutrition from an Approach to a Discipline: Concern's Nutrition Case Studies in Complex Emergencies

The Public Nutrition approach, like that of Public Health, is context specific. It places an emphasis on populations rather than individuals and is inter-disciplinary in nature. Both approaches seek to understand the complex aetiology of a clinical outcome such as malnutrition within the widest possible framework. Public Nutrition uses the UNICEF conceptual framework and adapts and expands it. The authors of this article argue – through the examination of a number of case studies taken from the work of Concern Worldwide (hereafter referred to as Concern) in southern Sudan, Rwanda, Angola, Tanzania and DRC – that there are two critical constituents of the Public Nutrition approach. These are: a contextual analysis (including the use of surveillance information for programme design and advocacy) and community involvement at all stages of the project cycle. Some of the key obstacles to the adoption of the Public Nutrition approach are identified by illustrating two practical programme settings. For the Public Nutrition approach to be more widely used, the authors recommend a number of key strategies including the further dissemination of case studies and the clarification of the scope and boundaries of the approach. These strategies will enable Public Nutrition to evolve both as a practical programme framework as well as an academic discipline.     

Public nutrition in emergencies: an overview of debates, dilemmas and decision-making

This paper introduces and discusses the main themes and issues arising from the workshop 'International Public Nutrition in Emergencies: The Potential for Improving Practice'. Good co-ordination within the nutrition sector of the international humanitarian response system has led to a range of achievements in recent years. Major constraints to improving programme impact remain, however, including misconceptions about the scope of nutrition among the wider humanitarian system, which tends to give it a narrow focus on malnutrition and feeding people. In contrast to this limited view, the Public Nutrition approach brings a more broad-based emphasis to assessing and responding to nutritional problems in emergencies, and takes into account the wider social, economic and political causes of malnutrition. Six case study presentations illustrated the various components of a Public Nutrition approach, including in-depth assessment, analysis and tailoring programmes accordingly. Additional presentations considered the nature of vulnerability, the concept of Public Nutrition, the responsibilities for addressing nutritional problems and some of the operational tools and frameworks in current use. Participants agreed on the necessity of raising levels of awareness and understanding among all actors in the humanitarian sphere about the impact of their actions on nutrition. Strategies for achieving this included developing better multi-sectorial working relationships and also strengthening relationships with donors and key decision-makers in the humanitarian system. Other related strategies included institutional learning, training and capacity building, particularly in relation to institutions based in developing countries and building upon initiatives such as the Sphere Project, which has successfully brought together the various actors within the humanitarian system in order to improve quality of response.     

Public Nutrition in Emergencies: An Overview of Debates, Dilemmas and Decision-making

This paper introduces and discusses the main themes and issues arising from the workshop 'International Public Nutrition in Emergencies: The Potential for Improving Practice'.
Good co-ordination within the nutrition sector of the international humanitarian response system has led to a range of achievements in recent years. Major constraints to improving programme impact remain, however, including misconceptions about the scope of nutrition among the wider humanitarian system, which tends to give it a narrow focus on malnutrition and feeding people. In contrast to this limited view, the Public Nutrition approach brings a more broad-based emphasis to assessing and responding to nutritional problems in emergencies, and takes into account the wider social, economic and political causes of malnutrition.
Six case study presentations illustrated the various components of a Public Nutrition approach, including in-depth assessment, analysis and tailoring programmes accordingly. Additional presentations considered the nature of vulnerability, the concept of Public Nutrition, the responsibilities for addressing nutritional problems and some of the operational tools and frameworks in current use.
Participants agreed on the necessity of raising levels of awareness and understanding among all actors in the humanitarian sphere about the impact of their actions on nutrition. Strategies for achieving this included developing better multi-sectoral working relationships and also strengthening relationships with donors and key decision-makers in the humanitarian system. Other related strategies included institutional learning, training and capacity building, particularly in relation to institutions based in developing countries and building upon initiatives such as the Sphere Project, which has successfully brought together the various actors within the humanitarian system in order to improve quality of response.     

The Role of Food Aid in Drought and Recovery: Oxfam's North Turkana (Kenya) Drought Relief Programme, 1992–94

Regional droughts carry the seeds of catastrophe: the immediate risk is famine; the long-term risk is destitution. Preventing both situations is an appropriate, if not essential, goal for relief agencies. In the past, responses to hunger in Turkana District (north-west Kenya) have taken the form of traditional feeding programmes. A better understanding of the boom/bust cycles in pastoralist systems has, however, produced new relief strategies. A central tenet of these strategies is the acceptance that relief aid should assume two roles: humanitarian—to overcome food deficits—and economic—to overcome 'income' deficits. Arguments in favour of a broader role for food aid are tested with a case study of a drought relief programme in north Turkana between 1992–1994. Field studies confirmed that when food aid is integrated as an asset into household resources, it can strengthen economic recovery. Ultimately, the extent to which relief operations are able to protect both people's lives and their livelihoods is the key to more sustainable development in drought-prone areas.     

A 'Principled' Approach to Complex Emergencies: Testing a New Aid Delivery Model in the Nuba Mountains

This paper provides an analysis of the Nuba Mountains Programme Advancing Conflict Trans-formation (NMPACT) as an example of an operational response in a complex emergency that innovatively addressed an incipient food security crisis. NMPACT is notable for having brought together an array of actors around a common principled agenda and for being the only operational programme in the Sudan to which both warring parties subscribed during the conflict. The key features of the programme are presented and the main innovative elements are reviewed, including the role of the principles of engagement and the 'political humanitarianism' of NMPACT. The paper looks at how NMPACT broke from traditional externally driven responses to food insecurity, and, drawing on lessons from Operation Lifeline Sudan, adopted an approach that focuses on capacity building, sustainable agriculture and market revitalisation, alongside conflict transformation and peace-building. The limitations of the model are also assessed, and preliminary lessons regarding its replication in other complex emergency contexts are presented.     

Cyclone preparedness and response: an analysis of lessons identified using an adapted military planning framework

The United Kingdom uses the Defence Lines of Development (DLOD) framework to analyse and understand the key components and costs of a military capability. Rooted in the Resource Based View (RBV) of a firm, an adapted DLOD approach is employed to explore, analyse and discuss the preparedness, planning and response strategies of two markedly different countries (Australia and Bangladesh) when faced with a major cyclone event of a comparable size. Given the numerous similarities in the challenges facing military forces in a complex emergency and humanitarian agencies in a natural disaster, the paper demonstrates the applicability of the DLOD framework as an analysis and planning tool in the cyclone preparedness planning and response phases, and more broadly within the disaster management area. In addition, the paper highlights the benefit to disaster managers, policymakers and researchers of exploiting comparative cross-learning opportunities from disaster events, drawn from different sectors and countries.     

A proposed framework of key activities and processes in the preparedness and recovery phases of disaster management

This paper proposes an empirically grounded framework for examining the preparedness and recovery phases of disaster management activities and processes pertaining to predictable disasters within a developed country. The two‐stage framework provides a single model composed of important preparedness and recovery initiatives, as well as activities and processes derived from empirical data collected for case studies from Australia: the ‘Black Saturday’ bushfires in the state of Victoria in February 2009; and Cyclone Larry in March 2006. The framework enables a variety of analyses, including the generation of insights into disaster management preparedness and recovery in the context of events in wealthy developed countries. The paper combines two empirical examples, a series of bushfires and a severe tropical cyclone, to enhance understanding of, and to contribute to better, disaster preparedness and recovery in the future. The paper contributes to the growing literature on disasters, preparedness, recovery and associated logistics, and other issues.     

Flood vulnerability and commercial activities: the case of the city of Girona, Spain

This paper is based on a case study of the city of Girona in Catalonia, Spain, and analyses the vulnerability of commercial establishments to floods caused by the Onyar River. A mapping and statistical approach (cluster analysis) was applied to the information obtained from 568 questionnaires answered by the shops and the workshops located in the flood risk area. The results obtained allowed the authors to determine five different flood vulnerability profiles of the commercial establishments analysed. These profiles paint a picture of little individual adaptation to the risk and the possibility of suffering, sooner or later, large economic losses due to overflowing of the Onyar River. The authors established a methodology for carrying out a detailed multidimensional analysis of the flood vulnerability of the city's commercial establishments in order to provide the foundations for local government policies and for strategies for shop owners to reduce flood vulnerability.     

The creation of vulnerability to natural disaster: Case studies from the Dominican Republic*

This paper argues that natural disasters are not a category of events which can be separated from the broader Issues of development, since economic change can create vulnerability to natural disaster. The analysis of case studies from the Dominican Republic shows how the development of large scale commercialized agricultural production has created such vulnerability by reducing or restricting the resource base of certain sectors of the population. It b suggested that the vulnerable state of a population should be considered as much a cause of natural disaster as the extreme physical phenomena Involved. Therefore there Is a need both for a broader framework for analysis of disasters and for strategies to reduce such vulnerability to be an Integral part of long term development planning.     

Emergency relief,crop diversification and institution building: the case of sesame in The Gambia

This article examines the case of the Catholic Relief Service's (CRS) sesame support programme in The Gambia which has spanned more than 25 years. It outlines the transformation process from relief to development and the role that the production of an agricultural commodity, sesame, has played as a key building block. Following the drought of the 1980s, concerns to move away from dependence on food aid first led to agronomic trials of imported oilseed, then to the selection and dissemination of improved sesame varieties accompanied by an elaborate and costly support programme. This gradually developed into a long-term development-oriented intervention, paving the way for the development of a national women's farmers' organisation. The paper provides a case study of an intervention that has gone beyond the provision of seed to address agronomic research and extension, policy, marketing and institutional issues necessary for successful crop diversification.     

Speed or deliberation: a comparison of post‐disaster recovery in Japan,Turkey, and Chile

This paper compares recovery in the wake of three recent earthquakes: the Great East Japan Earthquake in March 2011; the Van earthquake in Turkey in October 2011; and the Maule earthquake in Chile in February 2010. The authors visited all three locations approximately 12–18 months after the incidents and interviewed earthquake specialists, disaster managers, urban planners, and local authorities. A key challenge to post‐disaster recovery planning is balancing speed and deliberation. While affected communities must rebuild as quickly as possible, they must also seek to maximise the opportunities for improvement that disasters provide. The three case studies bring this dilemma into stark relief, as recovery was respectively slow, fast, and just right in the aftermath of the events: the Government of Japan adopted a deliberate approach to recovery and reconstruction; speed was of the essence in Turkey; and an effective balance between speed and deliberation was achieved in Chile.     

Planning environmental sanitation programmes in emergencies

Environmental sanitation programmes are vital for tackling environmental-related disease and ensuring human dignity in emergency situations. If they are to have maximum impact they must be planned in a rapid but systematic manner. An appropriate planning process comprises five key stages: rapid assessment and priority setting; outline programme design; immediate action; detailed programme design; and implementation. The assessment should be based on carefully selected data, which are analysed via comparison with suitable minimum objectives. How the intervention should be prioritised is determined through objective ranking of different environmental sanitation sector needs. Next, a programme design outline is produced to identify immediate and longer-term intervention activities and to guarantee that apposite resources are made available. Immediate action is taken to meet acute emergency needs while the detailed programme design takes shape. This entails in-depth consultation with the affected community and comprehensive planning of activities and resource requirements. Implementation can then begin, which should involve pertinent management and monitoring strategies.     

Constructing a holistic approach to disaster risk reduction: the significance of focusing on vulnerability reduction

As a result of the increase in natural disaster losses, policy‐makers, practitioners, and members of the research community around the world are seeking effective and efficient means of overcoming or minimising them. Although various theoretical constructs are beneficial to understanding the disaster phenomenon and the means of minimising losses, the disaster risk management process becomes less effective if theory and practice are set apart from one another. Consequently, this paper seeks to establish a relationship between two theoretical constructs, ‘disaster risk reduction (DRR)’ and ‘vulnerability reduction’, and to develop a holistic approach to DRR with particular reference to improving its applicability in practical settings. It is based on a literature review and on an overall understanding gained through two case studies of post‐disaster infrastructure reconstruction projects in Sri Lanka and three expert interviews in Sri Lanka and the United Kingdom.     

城市地震次生火灾的潜在危险性--基于城市地理信息系统网格的评价

从地震次生火灾发生与蔓延的两个阶段入手，将城市地震次生火灾潜在危险性评价问题划分为地震火灾起火危险性评价和蔓延危险性评价两个部分。针对这两部分评价，仔细分析、提取了与火灾发生和蔓延相关的重要因子，完整构建了地震次生火灾潜在危险性评价的指标体系，并利用层次分析法计算出各级指标之间的危险性权重。此外，为了获取城市不同区域上地震次生火灾危险性的变化规律，利用规则网格单元作为基本的评价单元，结合城市地理信息系统获取网格中各种空间信息计算各项指标值，克服了以往利用街区作为评价单元而导致评价结果过于粗糙的缺点。通过评价，我们可以准确地获得城市区域上地震火灾的高危险区和时域上的高危险时段。评价结果可供城市防治地震次生火灾规划决策参考。     

Immediate and long-term assistance following the bombing of the US Embassies in Kenya and Tanzania

On 7 August 1998 truck bombs destroyed the US Embassies in Kenya and Tanzania.(1) The response in both countries was characterised by an absence of incident command, limited pre-hospital care, a disorganised hospital response and a lack of transportation for those injured. In the next five years USD 50 million was provided by the United States Agency for International Development (USAID) to alleviate the resulting suffering, support reconstruction and strengthen disaster preparedness capacity in the two countries. These two programmes have enhanced awareness of disaster management issues, improved training capacity, built response structures and provided material resources. Their design and implementation provide lessons for future disasters in developing countries. The assistance programmes evolved very differently. In Kenya the programme largely excluded the public sector and the potential for government coordination, while the Tanzanian programme concentrated heavily on central government and regional hospital structures-largely omitting the non-governmental or civil society sector. Excluding key stakeholders raises concerns about programme sustainability and the ability to respond effectively to future emergencies.     

Climate change and disaster management

Climate change, although a natural phenomenon, is accelerated by human activities. Disaster policy response to climate change is dependent on a number of factors, such as readiness to accept the reality of climate change, institutions and capacity, as well as willingness to embed climate change risk assessment and management in development strategies. These conditions do not yet exist universally. A focus that neglects to enhance capacity-building and resilience as a prerequisite for managing climate change risks will, in all likelihood, do little to reduce vulnerability to those risks. Reducing vulnerability is a key aspect of reducing climate change risk. To do so requires a new approach to climate change risk and a change in institutional structures and relationships. A focus on development that neglects to enhance governance and resilience as a prerequisite for managing climate change risks will, in all likelihood, do little to reduce vulnerability to those risks.     

Disaster mitigation and preparedness: the case of NGOs in the Philippines

The Philippines is very vulnerable to natural disasters because of its natural setting, as well as its socio-economic, political and environmental context--especially its widespread poverty. The Philippines has a well-established institutional and legal framework for disaster management, including built-in mechanisms for participation of the people and NGOs in decision-making and programme implementation. The nature and extent of collaboration with government in disaster preparedness and mitigation issues varies greatly according to their roots, either in past confrontation and political struggles or traditional charity activities. The growing NGO involvement in disaster management has been influenced by this history. Some agencies work well with local government and there is an increasing trend for collaborative work in disaster mitigation and preparedness. Some NGOs, however, retain critical positions. These organisations tend to engage more in advocacy and legal support for communities facing increased risk because of development projects and environmental destruction. Entry points into disaster mitigation and preparedness vary as well. Development-oriented agencies are drawn into these issues when the community members with whom they work face disaster. Relief organisations, too, realise the need for community mobilisation, and are thus drawn towards development roles.     

Review of Policies and Guidelines on Infant Feeding in Emergencies: Common Ground and Gaps

Recent crises in regions where exclusive breastfeeding is not the norm have highlighted the importance of effective policies and guidelines on infant feeding in emergencies. In 1993, UNICEF compiled a collection of policy and guideline documents relating to the feeding of infants in emergency situations. In June 2000 Save the Children, UK, UNICEF and the Institute of Child Health undertook a review of those documents, updating the list and identifying the common ground that exists among the different policies. The review also analysed the consistency of the policy framework, and highlighted important areas where guidelines are missing or unclear. This article is an attempt to share more widely the main issues arising from this review. The key conclusions were that, in general, there is consensus on what constitutes best practice in infant feeding, however, the lack of clarity in the respective responsibilities of key UN agencies (in particular UNICEF, UNHCR and WFP) over issues relating to co-ordination of activities which affect infant-feeding interventions constrains the implementation of systems to support best practice. Furthermore, the weak evidence base on effective and appropriate intervention strategies for supporting optimal infant feeding in emergencies means that there is poor understanding of the practical tasks needed to support mothers and minimise infant morbidity and mortality. We, therefore, have two key recommendations: first that the operational UN agencies, primarily UNICEF, examine the options for improving co-ordination on a range of activities to uphold best practice of infant feeding in emergencies; second, that urgent attention be given to developing and supporting operational research on the promotion of optimal infant-feeding interventions.     

Building safety in humanitarian programmes that support post-disaster shelter self-recovery: an evidence review

The humanitarian sector is increasingly aware of the role that good quality evidence plays in the underpinning of effective and accountable practice. This review addresses the need for reliable evidence by evaluating current knowledge about the intersection of two key outcome targets of post-disaster shelter response: supporting shelter self-recovery and building back safer. Evidence about post-disaster shelter programmes that aim to improve hazard resistance while supporting shelter self-recovery has been systematically analysed and evaluated. Technical support, especially training in safer construction techniques, was found to be a central programme feature, but the impact of this and other programme attributes on building safety was largely not ascertainable. Programme reports and studies lack sufficient detail, especially on the hazard resistance of repaired houses. Accounts of shelter programmes need to include more reliable reporting of key activities and assessment of outcomes, in order to contribute to the growing evidence base in this field.     

Reconstruction under siege: the Gaza Strip since 2007

This paper examines the siege of the Gaza Strip, a self-governing Palestinian territory, since 2007. Research on sieges tends to concentrate on the coping strategies of besieged communities, humanitarian issues associated with the impacts, humanitarian access, and the prioritisation of needs, with little or no attention paid to reconstruction. However, Gaza is unusual as a siege environment within which reconstruction has become a high priority in the aftermath of its three destructive wars with Israel. Following an overview of research on sieges in contemporary warfare and a brief contextualisation of Gaza, this paper examines why reconstruction outcomes have varied over time through the application of a theoretical framework that stipulates the importance of four key factors: time; needs; scarcity; and political context. Based on an analysis of these variables, Gaza was found to be a most-likely case for reconstruction under siege. Nonetheless, the large-scale reconstruction necessary to transform Gaza has not been actualised.