Flooding: what is the impact on pregnancy and child health?

Floods are the most common type of natural disaster in both developed and developing countries and have led to extensive morbidity and mortality throughout the world. Worldwide, over the past 30 years, flooding has claimed the lives of more than 200,000 people and affected more than 2.8 billion others. The impact of flooding on health varies among populations and depends primarily on vulnerability and the kind of event experienced. It severely disrupts livelihoods and has a significant impact on the health of pregnant women and children. In addition, it may exacerbate a range of negative psychological and physiological child and reproductive health outcomes. Awareness‐raising, education, and the issuing of warnings appear to be key initiatives to mitigate or prevent flood morbidity and mortality, especially among people living in low‐ and middle‐income countries. Agencies responding to emergencies also need to be more cognisant of the dangers, specifically those engaged in healthcare, nutrition, and water safety programmes.     

Flooding and the ‘new normal’: what is the role of gender in experiences of post-disaster ontological security?

Disaster researchers have long analysed disruption to affected residents' ontological security, often represented by routines and familiar landmarks. Surprisingly little of this work, though, assesses who is most likely to experience feelings of disruption. Using a representative set of survey data, complemented by follow-up interview data from 40 residents affected by the Southern Alberta Flood of June 2013, this paper explores how demographic characteristics, such as gender and place attachment, impact on residents' sense of disruption and loss. The findings indicate that women and people with stronger emotional and social ties to their neighbourhoods are most likely to experience disrupted ontological security; home flooding and evacuation orders are also significant predictors. The qualitative interview data reveal that many participants felt unsettled and disrupted by myriad factors, such as ongoing construction, which prevented them from establishing a ‘new normal’. The paper concludes by discussing the implications of these findings for policymakers and service providers.     

Resilience from the ground up: how are local resilience perceptions and global frameworks aligned?

Numerous resilience measurement frameworks for climate programmes have emerged over the past decade to operationalise the concept and aggregate results within and between programmes. Proxies of resilience, including subjective measures using perception data, have been proposed to measure resilience, but there is limited evidence on their validity and use for policy and practice. This article draws on research on the Decentralising Climate Funds project of the Building Resilience and Adaptation to Climate Extremes and Disasters programme, which supports communities in Mali and Senegal to improve climate resilience through locally controlled adaptation funds. It explores attributes of resilience from this bottom‐up perspective to assess its predictors and alignment with food security, as a proxy of well‐being. We find different patterns when comparing resilience and the well‐being proxy, illustrating that the interplay between the two is still unclear. Results also point to the importance of contextualising resilience, raising implications for aggregating results.     

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

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

The Death of Humanitarianism?: An Anatomy of the Attack

Over recent years, the humanitarian community has been under increasing scrutiny and attracted harsh criticism. This mounting critique of humanitarianism has shifted from being concerned primarily with the poor functioning of the humanitarian system to one targeted on basic humanitarian values. This paper is concerned to understand the factors driving the attack on humanitarian values. It identifies four apparently disparate groups who are interested in attacking these values: the anti-imperialists, the realpolitikers, the developmentalists and the neo-peaceniks. It concludes that unless humanitarian actors are aware of these diverse threats to their values and operations, they risk being co-opted or marginalised.     

The impact of refugees on the health status and health services of host communities: Compounding bad with worse?

Although there have been a number of recent developments in our understanding of refugee health problems that have influenced policies and action, the effects of refugees on the health status and services of host communities remain relatively neglected. This article sets out to explain why this is an important issue with implications for policy, planning surveillance and evaluation, training and research.
The first sections outline some of the problems facing host governments and communities in Africa and discuss the changing rhetoric between the first and second International Conferences for Assistance to Refugees in Africa. A number of possible ways in which refugees could affect the individual, agent and environmental causes of disease are considered, as are the characteristics of the refugees, the host communities and the response which may all modify this impact.
Policy implications of the impact of the refugees, both negative and positive, are discussed, and detailed consideration is given to the pros and cons of integrated and parallel approaches to health care provision. The need to monitor carefully the health status and services of host communities is emphasized and recommendations are made for this and other essential developments relating to training and research.     

L'Aquila's reconstruction challenges: has Italy learned from its previous earthquake disasters?

Italy is an earthquake‐prone country and its disaster emergency response experiences over the past few decades have varied greatly, with some being much more successful than others. Overall, however, its reconstruction efforts have been criticised for being ad hoc, delayed, ineffective, and untargeted. In addition, while the emergency relief response to the L'Aquila earthquake of 6 April 2009—the primary case study in this evaluation—seems to have been successful, the reconstruction initiative got off to a very problematic start. To explore the root causes of this phenomenon, the paper argues that, owing to the way in which Italian Prime Minister Silvio Berlusconi has politicised the process, the L'Aquila reconstruction endeavour is likely to suffer problems with local ownership, national/regional/municipal coordination, and corruption. It concludes with a set of recommendations aimed at addressing the pitfalls that may confront the L'Aquila reconstruction process over the next few years.     

Does ‘Manna from Heaven’ help? The role of cash transfers in disaster recovery—lessons from Fiji after Tropical Cyclone Winston

This paper contributes to the evidence on the effectiveness of shock-responsive social protection systems in helping affected households recover from the negative consequences of disasters. It evaluates the influence of the top-up cash transfers provided by the Government of Fiji to poor households in the wake of Tropical Cyclone Winston, which struck the Pacific Island country on 20 February 2016. The impact evaluation strategy incorporates a sharp regression discontinuity design to define treatment and control groups, based on the eligibility threshold of the poverty benefit scheme. The results indicate that treatment households—that is, those that received cash transfers—are significantly more likely to report quicker recovery from various shocks. Female-headed households are more likely to recover from the ramifications, whereas households with older heads are less likely to do so. The presence of a functioning market appears to be a major factor aiding the speed of recovery. Finally, the evidence points towards strong district effects on recovery.     

Then and now: A 30-year journey from the ‘leading edge’

A fledgling disaster management organization in 1984, Jamaica's Office of Disaster Preparedness (ODP) hosted the pioneering international disaster mitigation conference to share information and to contemplate how vulnerability to disasters from natural hazards could be reduced. Over the period 1979–2009, the overall focus of the agency was response, given the plethora of extreme events, and the priority of the Government of Jamaica. The organization was associated with several efforts at disaster mitigation, but the need for building the agency's capacity to lead national efforts to integrate mitigation planning into development did not seem to gain traction among the policy makers. Growing losses since 2004, the evidence of climate change and the need for adaptation, and the regional and international disaster risk management agenda have brought attention to the need for review and development of Jamaica's disaster risk management capacity. This paper examines highlights of the 30-year journey of disaster management in Jamaica, and highlights proposals for strengthening the national framework and the organizational structure of ODPEM.     

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

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

Humanitarianism,Pluralism and Ombudsmen: Do the Pieces Fit?

A variety of codes and standards for humanitarian assistance have been put forth in recent years. Many NGOs have agreed to abide by these codes. There is uncertainty, however, about if and how these codes are actually being put into practice. Have we moved from words to action? One response to this concern has been a proposal to establish a humanitarian ombudsman. This paper analyses two choices facing an eventual ombudsman: whether to attempt to take punitive actions to enforce the codes and standards, or whether instead to facilitate agencies' own internal efforts to improve accountability to their beneficiaries. It proposes a pluralistic approach, wherein a variety of methods, structures and local perceptions are accepted as potentially appropriate, but where a clear moral stance is still maintained. Some suggestions are outlined for how flexible forms of policy analysis may be used to combine an acceptance of the validity of a vast range of humanitarian actions while still retaining a strong stance against practices that may harm beneficiaries or feed the causes of conflict. Realism about each agency's room for manoeuvre is essential, especially local institutions. A modest but principled stance will involve helping actors to consider the impact of their work on conflict and to find ways to improve the quality of their interventions as perceived by beneficiaries.     

Gender and international crisis response: do we have the data,and does it matter?

For more than a decade the humanitarian community has been mandated to mainstream gender in its response to crises. One element of this mandate is a repeated call for sex-disaggregated data to help guide the response. This study examines available analyses, assessments and academic literature to gain insights into whether sex-disaggregated data are generated, accessible and utilised, and appraised what can be learned from existing data. It finds that there is a gap between policy and practice. Evaluations of humanitarian responses rarely refer to data by sex, and there seems to be little accountability to do so. Yet existing data yield important information, pointing at practical, locally-specific measures to reduce the vulnerability of both males and females. This complements population-level studies noting the tendency for higher female mortality. The study discusses some possible obstacles for the generation of data and hopes to spur debate on how to overcome them.     

Livelihoods,conflict and aid programming: is the evidence base good enough?

In conflict‐affected situations, aid‐funded livelihood interventions are often tasked with a dual imperative: to generate material welfare benefits and to contribute to peacebuilding outcomes. There may be some logic to such a transformative agenda, but does the reality square with the rhetoric? Through a review of the effectiveness of a range of livelihood promotion interventions—from job creation to microfinance—this paper finds that high quality empirical evidence is hard to come by in conflict‐affected situations. Many evaluations appear to conflate outputs with impacts and numerous studies fail to include adequate information on their methodologies and datasets, making it difficult to appraise the reliability of their conclusions. Given the primary purpose of this literature—to provide policy guidance on effective ways to promote livelihoods—this silence is particularly concerning. As such, there is a strong case to be made for a restrained and nuanced handling of such interventions in conflict‐affected settings.     

Malnutrition in emergencies: how can we do better and where do the responsibilities lie?

Over many years, the international relief system has been repeatedly criticised in terms of slowness of response, poor inter-agency co-ordination, and technical incompetence on a larger or smaller scale. Notwithstanding many initiatives to improve co-ordination and other aspects of international relief performance, relief failures, including epidemic malnutrition, continue to occur. The reasons for these failures are discussed from the perspective of the characteristics of the international system, and the way in which this would be expected to perform under different conditions. The chief limitations of the international system identified are: the lack of any focus for imposing co-ordination, other than governments of affected countries; the lack of any requirement for donor nations to ensure that adequate resources are supplied; and a tendency for the system to respond uncritically to the international media. A broad typology of international responses is proposed. It is suggested that relief failure can be recast in terms of the lack of any system which can ensure the correct allocation of food and other resources between emergencies, and ensure the systematic distribution of such resources as are supplied. It concludes that the scope for further improvement in the performance of the international relief system is now limited, but that the most promising area for investment would, where possible, support governments in affected countries to take greater control of the management of the international relief system.     

Malnutrition in Emergencies: How Can We Do Better and Where Do the Responsibilities Lie?

Over many years, the international relief system has been repeatedly criticised in terms of slowness of response, poor inter-agency co-ordination, and technical incompetence on a larger or smaller scale. Notwithstanding many initiatives to improve co-ordination and other aspects of international relief performance, relief failures, including epidemic malnutrition, continue to occur. The reasons for these failures are discussed from the perspective of the characteristics of the international system, and the way in which this would be expected to perform under different conditions. The chief limitations of the international system identified are: the lack of any focus for imposing co-ordination, other than governments of affected countries; the lack of any requirement for donor nations to ensure that adequate resources are supplied; and a tendency for the system to respond uncritically to the international media. A broad typology of international responses is proposed. It is suggested that relief failure can be recast in terms of the lack of any system which can ensure the correct allocation of food and other resources between emergencies, and ensure the systematic distribution of such resources as are supplied. It concludes that the scope for further improvement in the performance of the international relief system is now limited, but that the most promising area for investment would, where possible, support governments in affected countries to take greater control of the management of the international relief system.     

The Yellow Fever Epidemic in Western Mali,September—November 1987: Why Did Epidemiological Surveillance Fail?

Recent yellow fever epidemics in West Africa have underlined the discrepancy between the official number of cases and deaths and those estimated by a retrospective epidemiological investigation. During the yellow fever epidemic that broke out in western Mali in September 1987, a total of 305 cases and 145 deaths were officially notified, but estimates revealed true figures abut five times higher. This paper attempts to discuss the factors that hindered early case detection and more complete reporting. They were, first, the insufficient training on the clinical diagnosis, the blood sampling method for laboratory confirmation, and the curative treatment of patients (resulting in low utilization of services); second, the lack of an action plan to prepare in advance a quick response to the epidemic, affecting reporting procedures at the peripheral level and active case-finding during the outbreak; and third, the lack of laboratory facilities for a quick confirmation of the disease.
The difficulties experienced during the yellow fever epidemic in Mali demonstrated the importance of a preparedness strategy for epidemic control, based on an integrated approach of epidemiological surveillance within basic health service activities. The need for regional collaboration and for institutionalized funds in the donor community that could be mobilized for epidemic preparedness activities is also emphasized.     

Insurance and flood risk reduction in Ghana: do insurers penalise homeowners who take precautionary measures?

Today, many advocate insurance as a tool for coping with natural disasters. Beyond providing prompt financial relief to victims of disasters, insurance can also incentivise individuals to invest in preventive measures if insurers reward such efforts with reduced premiums. However, insurers might be unable to reward investments in precautionary measures with lower premiums if they are ill-informed about individual-level risks. Here, we explore how Ghanaian home insurers respond to investments in flood risk reduction by asking them to quote premiums for four identical buildings; two had investments in flood risk reduction, while the other two had none. We find that insurers did not reward investments in risk reduction, with some charging higher premiums for elevated buildings, suggesting they have interpreted such preventive measures as a sign of high flood risk. This failure to reward investments in precautionary measures may discourage insured homeowners from investing in risk reduction.     

Rights,Standards and Quality in a Complex Humanitarian Space: Is Sphere the Right Tool?

The Sphere Project (consisting of both the Humanitarian Charter and Minimum Standards for Disaster Response) has made prominent contributions to the debates, thinking and work on the quality of assistance and accountability of aid agencies. However, since its inception in 1997, several agencies expressed concerns regarding Sphere's approach, many of which were confirmed by the Sphere evaluation (2002/3). The present article restates these concerns, and addresses more fundamental issues regarding Sphere's cornerstone. It questions the validity of Sphere's rights-based approach, which consists of a tenuous link between the rights of affected populations and standards for technical interventions. Sphere is founded on "the right to assistance", although this right does not exist in international law. Its elaboration would entail solving several complex legal and political issues, which Sphere fails to address. This article also questions the validity and usefulness of universal standards for technical performance in helping relief agencies provide adapted assistance to disaster-affected populations, in line with their mandates and principles. It suggests that Sphere's approach and content largely reflect the concerns, priorities and values of technical professionals in Northern agencies, leaving limited space to genuine "participation" by affected populations and partners from the South.