Conflict-related mortality: an analysis of 37 datasets

Mortality rates are among the main indicators of the human impact of armed conflict and many surveys have assessed this impact both for targeting and evaluating humanitarian aid programmes. Almost no epidemiological analysis such as calculating relative risk was performed nor were reference values clearly described. Here the aim is to review published mortality rates for a better understanding of age-specific mortality in armed conflict. Published mortality rates from conflict situations were collected and pre-conflict reference rates composed. We calculated the relative risk of dying in conflict compared to pre-conflict for children under 5 and people older than five years old. Although limited by reporting inadequacies, the results confirm the high vulnerability of children < 5 but identify a higher relative risk of dying among the > or = 5 year olds. Although not entirely new, this observation is not fully understood. Further systematic epidemiological research is needed to estimate and understand the impact of armed conflict on mortality.     

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.     

Nutritional Assessments, Food Security and Famine

The widely held view that malnutrition is a late indicator of famine is challenged on the basis of evidence that people often deliberately reduce their food intake as an early response to inadequate food security. This broadens the possible interventions in response to high malnutrition rates to include measures to support livelihoods under threat of collapse. In the late stages of famine, social disruption and distress migration often result in a degraded health environment which may raise the threshold of nutritional status associated with an increased mortality risk. It is important to assess the underlying causes of malnutrition and the associated health risks. At present, the main objective of nutrition surveys is usually to obtain a reliable estimate of the prevalence of malnutrition among children under five years of age, with little analysis of the underlying causes of malnutrition. Experience from the 1984-85 famine in Darfur led to the development of an alternative approach to nutritional assessment which could be applicable elsewhere in Africa. The combination of quantitative and qualitative methods was particularly valuable as a means of gaining a wider and deeper understanding of the nature of the nutritional situation.     

Using design effects from previous cluster surveys to guide sample size calculation in emergency settings

A good estimate of the design effect is critical for calculating the most efficient sample size for cluster surveys. We reviewed the design effects for seven nutrition and health outcomes from nine population-based cluster surveys conducted in emergency settings. Most of the design effects for outcomes in children, and one-half of the design effects for crude mortality, were below two. A reassessment of mortality data from Kosovo and Badghis, Afghanistan revealed that, given the same number of clusters, changing sample size had a relatively small impact on the precision of the estimate of mortality. We concluded that, in most surveys, assuming a design effect of 1.5 for acute malnutrition in children and two or less for crude mortality would produce a more efficient sample size. In addition, enhancing the sample size in cluster surveys without increasing the number of clusters may not result in substantial improvements in precision.     

Livestock mortality in pastoralist herds in Ethiopia and implications for drought response

Participatory epidemiology methods were employed retrospectively in three pastoralist regions of Ethiopia to estimate the specific causes of excess livestock mortality during drought. The results showed that starvation/dehydration accounted for between 61.5 and 100 per cent of excess livestock mortality during drought, whereas disease‐related mortality accounted for between 0 and 28.1 per cent of excess mortality. Field observations indicate that, in livestock, disease risks and mortality increase in the immediate post‐drought period, during rain. The design of livelihoods‐based drought response programmes should include protection of core livestock assets, and it should take account of the specific causes of excess livestock mortality during drought and immediately afterwards. This study shows that, when comparing livestock feed supplementation and veterinary support, relatively more aid should be directed at the former if the objective is to protect core livestock during drought. Veterinary support should consider disease‐related mortality in the immediate post‐drought period, and tailor inputs accordingly.     

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.     

The application of geographic information systems and global positioning systems in humanitarian emergencies: lessons learned,programme implications and future research

Geographic information systems (GIS), global positioning systems and remote sensing have been increasingly used in public health settings since the 1990s, but application of these methods in humanitarian emergencies has been less documented. Recent areas of application of GIS methods in humanitarian emergencies include hazard, vulnerability, and risk assessments; rapid assessment and survey methods; disease distribution and outbreak investigations; planning and implementation of health information systems; data and programme integration; and programme monitoring and evaluation. The main use of GIS in these areas is to provide maps for decision-making and advocacy, which allow overlaying types of information that may not normally be linked. GIS is also used to improve data collection in the field (for example, for rapid health assessments or mortality surveys). Development of GIS methods requires further research. Although GIS methods may save resources and reduce error, initial investment in equipment and capacity building may be substantial. Especially in humanitarian emergencies, equipment and methodologies must be practical and appropriate for field use. Add-on software to process GIS data needs to be developed and modified. As equipment becomes more user-friendly and costs decrease, GIS will become more of a routine tool for humanitarian aid organisations in humanitarian emergencies, and new and innovative uses will evolve.     

Strategic planning for post-disaster temporary housing

Temporary housing programmes suffer from excessively high cost, late delivery, poor location, improper unit designs and other inherent issues. These issues can be attributed in part to a prevalence of ad hoc tactical planning, rather than pre-disaster strategic planning, for reconstruction undertaken by governments and non-governmental organisations (NGOs) in the chaotic post-disaster environment. An analysis of the process and outcomes from six case studies of temporary housing programmes after disasters in Turkey and Colombia in 1999, Japan in 1995, Greece in 1986, Mexico in 1985, and Italy in 1976 yields information about the extent to which strategic planning is employed in temporary housing programmes, as well as common issues in temporary housing. Based on an understanding of these common issues, this paper proposes a framework for strategic planning for temporary housing that identifies organisational designs and available resources for temporary housing before the disaster, but allows modifications to fit the specific post-disaster situation.     

Selective feeding programmes in Ethiopia and East Sudan–1985/1986

A survey of thirty-four feeding programmes in Ethiopia and East Sudan was undertaken. Wie differences were found between the two countries and also within Ethiopia. Irrelugar general ration distribution was commonplace in Ethiopia, thus placing an extra strain on selective feeding programmes. The principal admission criteria to Selected Feeding Programmes (SFPs) were weight for height categories. The cut-off stages of the emergency. Useful compasirions between programmes were hampered by such differences, as well as by the different methods of reporting data.
The types of food usd in programmes depended on availability and included high energyu drinks, poridges, take-home pre-mixes and sometimes indigenous foods. A large number of foods e.g. cornedbedef, chicken paté, noodles, da4tes etc. Some added interesting variety and added nutritional value to the diet, while others caused more problems than they solved due to their low acceptability, inappropriate packaging, limited accompanying information and complex an costly preparation. The imlementation of food dination policies by donors and consignees regarding appropriate foodstuffs and their recommended use was considered to be the major solution to this problem.     

Cross-sectional survey methods to assess retrospectively mortality in humanitarian emergencies

Since the rates and causes of mortality are critical indicators of the overall health of a population, it is important to evaluate mortality even where no complete vital statistics reporting exists. Such settings include humanitarian emergencies. Experience in cross-sectional survey methods to assess retrospectively crude, age-specific, and maternal mortality in stable settings has been gained over the past 40 years, and methods appropriate to humanitarian emergencies have been developed. In humanitarian emergencies, crude and age-specific mortality can be gauged using methods based on the enumeration of individuals resident in randomly selected households—frequently referred to as a household census. Under-five mortality can also be assessed through a modified prior birth history method in which a representative sample of reproductive-aged women are questioned about dates of child births and deaths. Maternal mortality can be appraised via the initial identification of maternal deaths in the study population and a subsequent investigation to determine the cause of each death.     

The effectiveness of forecast-based humanitarian assistance in anticipation of extreme winters: a case study of vulnerable herders in Mongolia

This paper presents evidence relating to a forecast-based cash and non-food item distribution among vulnerable herder households during the 2017–18 dzud (extreme winter) season in Mongolia, and analyses the results of a quasi-experimental study evaluating its impacts. An innovative approach in disaster risk reduction, forecast-based financing (FbF) can have short- and long-term benefits to vulnerable households but remains understudied. The paper contributes information on a multimodal FbF programme offering one-off cash grants and in-kind veterinary kits. The data found significant effects of reduced mortality and increased offspring survival in some types of livestock, and that the timing of FbF assistance is crucial, as reported early assistance correlated to positive outcomes in terms of reduced animal mortality. These findings can be used to design more effective FbF interventions, to understand better the appropriateness of FbF designs, and to use early warnings and early actions to help people prepare and withstand disasters such as dzuds.     

Implementation of a medical command and control team in Switzerland

In case of a major incident or disaster, the advance medical rescue command needs to manage several essential tasks simultaneously. These include the rapid deployment of ambulance, police, fire and evacuation services, and their coordinated activity, as well as triage and emergency medical care on site. The structure of such a medical rescue command is crucial for the successful outcome of medical evacuation at major incidents. However, little data has been published on the nature and structure of the command itself. This study presents a flexible approach to command structure, with two command heads: one emergency physician and one experienced paramedic. This approach is especially suitable for Switzerland, whose federal system allows for different structures in each canton. This article examines the development of these structures and their efficiency, adaptability and limitations with respect to major incident response in the French‐speaking part of the country.     

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.     

The application of seismic risk-benefit analysis to land use planning in Taipei City

In the developing countries of Asia local authorities rarely use risk analysis instruments as a decision-making support mechanism during planning and development procedures. The main purpose of this paper is to provide a methodology to enable planners to undertake such analyses. We illustrate a case study of seismic risk-benefit analysis for the city of Taipei, Taiwan, using available land use maps and surveys as well as a new tool developed by the National Science Council in Taiwan--the HAZ-Taiwan earthquake loss estimation system. We use three hypothetical earthquakes to estimate casualties and total and annualised direct economic losses, and to show their spatial distribution. We also characterise the distribution of vulnerability over the study area using cluster analysis. A risk-benefit ratio is calculated to express the levels of seismic risk attached to alternative land use plans. This paper suggests ways to perform earthquake risk evaluations and the authors intend to assist city planners to evaluate the appropriateness of their planning decisions.     

Effective Emergency Management: Reconsidering the Bureaucratic Approach

The command and control approach is compared with the Emergent Human Resources Model (EHRM) approach to emergency management. Four decades of systematic research shows that a rigid, bureaucratic command and control approach to emergency management generally leads to an ineffective emergency response. Previous studies and our own research suggest that flexible, malleable, loosely coupled, organizational configurations can create a more effective disaster response.     

Determinants of coverage in Community‐based Therapeutic Care programmes: towards a joint quantitative and qualitative analysis

One of the most important elements behind the success of Community‐based Therapeutic Care (CTC) programmes for the treatment of severe acute malnutrition has been their ability to achieve high levels of coverage. In CTC, coverage is measured using the Centric System Area Sampling (CSAS) method, which provides accurate and reliable estimates of programme coverage as well as information on the primary reasons for non‐attendance. Another important feature of CTC programmes is their use of socio‐cultural assessments to determine potential barriers to access and to develop context‐specific responses. By analysing data on non‐attendance provided by CSAS surveys, in conjunction with data from socio‐cultural assessments, it is possible to identify common factors responsible for failures in programme coverage. This paper focuses on an analysis of data from 12 CTC programmes across five African countries. It pinpoints three common factors (distance to sites, community awareness of the programme, and the way in which rejections are handled at the sites) that, together, account for approximately 75 per cent of non‐attendance.     

物联网技术在地震救灾中的应用

研究了物联网技术在地震救灾中的应用。在体系结构设计中主要针对无线传感器网络节点、自组网技术、数据采集与灾情分析软件、多源信息融合等几个方面开展研究,构造出基于物联网技术的信息处理平台,在此基础上组建一个地震监测、预警及救灾部署控制中心,并实现信息处理平台与城市基础设施的互连接口。最终,在地震救灾中能够利用多源信息融合技术为控制中心实现决策和指挥提供科学、高效的服务。     

Targeting the Vulnerable: A Review of the Necessity and Feasibility of Targeting Vulnerable Households

This article examines whether it is possible to target vulnerable households within a geographically defined area. It looks first at the justification for targeting and then reviews recent practical experience in actually trying to reach vulnerable groups. As complex emergencies increasingly last longer, strategies to target vulnerable households are common in the protracted phase of the emergency. While this is often necessary because of a decline in resources, it is not always justified by an improvement in nutritional status or food security of the beneficiary population.
Common target groups are the poor and the malnourished, but in complex emergencies these are not always the most vulnerable. Moreover, recent practical experience has shown considerable difficulties in targeting the poor. Methods to target the poor rely on community-based relief committees, whose priorities are not necessarily the same as those of external agencies. This paper gives examples of such targeted assistance programmes in Kenya, south Sudan and Tanzania. The paper concludes that situations where targeting vulnerable households is justified and feasible are extremely limited. It is suggested that if targeting has to be done because of scarce resources, this should be done on a geographical basis and on the basis of nutritional status. Case-study material shows that it is essential to understand the political determinants of vulnerability and to design methods that will reach the most vulnerable.     

Targeting the vulnerable: a review of the necessity and feasibility of targeting vulnerable households

This article examines whether it is possible to target vulnerable households within a geographically defined area. It looks first at the justification for targeting and then reviews recent practical experience in actually trying to reach vulnerable groups. As complex emergencies increasingly last longer, strategies to target vulnerable households are common in the protracted phase of the emergency. While this is often necessary because of a decline in resources, it is not always justified by an improvement in nutritional status or food security of the beneficiary population. Common target groups are the poor and the malnourished, but in complex emergencies these are not always the most vulnerable. Moreover, recent practical experience has shown considerable difficulties in targeting the poor. Methods to target the poor rely on community-based relief committees, whose priorities are not necessarily the same as those of external agencies. This paper gives examples of such targeted assistance programmes in Kenya, south Sudan and Tanzania. The paper concludes that situations where targeting vulnerable households is justified and feasible are extremely limited. It is suggested that if targeting has to be done because of scarce resources, this should be done on a geographical basis and on the basis of nutritional status. Case-study material shows that it is essential to understand the political determinants of vulnerability and to design methods that will reach the most vulnerable.     

地震波数值模拟方法研究综述

地震波场数值模拟不仅是研究复杂地区地震资料采集、处理和解释的有效辅助手段,而且是研究地球深部精细构造的有效工具。地震波场数值模拟的主要方法包括3大类,即几何射线法、积分方程法和波动方程法。首先介绍了地震波数值模拟方法的理论基础和内容及特点,然后概括介绍了20世纪90年代以来几何射线法和各种波动方程数值模拟方法的新进展。因为波动方程数值模拟包含了丰富的波动信息,可为研究地震波的传播机理和复杂地层的解释提供更多的佐证,所以重点介绍波动方程数值模拟方法。最后,对各种数值模拟方法进行了评述,并给出了地震波传播理论和数值模拟方法发展的展望。