Coping with Disaster: General Practitioners’ Perspectives on the Impact of the Canterbury Earthquakes


Aim – To explore the challenges for general practitioners (GPs) following the 2010/2011 Canterbury earthquakes and describe how these were met.
Methods – Qualitative study using semi-structured interviews with eight GPs from the Christchurch area exploring their experiences.
Results – The interviews revealed that the GPs faced a range of challenges both in the immediate aftermath of the earthquakes and in the following months. These included dealing with an increased and changed workload, and managing personal concerns. The GPs reflected on their coping behaviour and how their professional practice had changed as a result.
Conclusions – All GPs reported significant increases in workload raising questions about the need for coordination of locum support. GPs often found themselves working outside their area of accustomed expertise especially in relation to patients needing financial aid. GPs identified a number of coping behaviours though some only in hindsight. Greater awareness of self-care strategies would benefit GPs responding to disasters.

Health Sector Initiatives for Disaster Risk Management in Ethiopia: A Narrative Review


Background: Natural and man-made disasters are prevailing in Ethiopia mainly due to drought, floods, landslides, earthquake, volcanic eruptions, and disease epidemics. Few studies so far have critically reviewed about medical responses to disasters and little information exists pertaining to the initiatives being undertaken by health sector from the perspective of basic disaster management cycle. This article aimed to review emergency health responses to disasters and other related interventions which have been undertaken in the health sector.

Methods: Relevant documents were identified by searches in the websites of different sectors in Ethiopian and international non-governmental organizations and United Nations agencies. Using selected keywords, articles were also searched in the data bases of Medline, CINAHL, Scopus, and Google Scholar. In addition, pertinent articles from non-indexed journals were referred to.

Results: Disaster management system in Ethiopia focused on response, recovery, and rehabilitation from 1974 to 1988; while the period between 1988 and 1993 marked the transition phase towards a more comprehensive approach. Theoretically, from 1993 onwards, the disaster management system has fully integrated the mitigation, prevention, and preparedness phases into already existing response and recovery approach, particularly for drought. This policy has changed the emergency response practices and the health sector has taken some initiatives in the area of emergency health care. Hence, drought early warning system, therapeutic feeding program in hospitals, health centers and posts in drought prone areas to manage promptly acute malnutrition cases have all been put in place. In addition, public health disease emergencies have been responded to at all levels of health care system.

Conclusions: Emergency health responses to drought and its ramifications such as acute malnutrition and epidemics have become more comprehensive in the context of basic disaster management phases; and impacts of drought and epidemics seem to be declining. However, the remaining challenge is to address disasters arising from other hazards such as flooding in terms of mitigation, prevention, preparedness and integrating them in the health care system.

Key Words: Disaster, Emergency Health, Health System, Ethiopia

The Gender Analysis Tools Applied in Natural Disasters Management: A Systematic Literature Review


Background: Although natural disasters have caused considerable damages around the world, and gender analysis can improve community disaster preparedness or mitigation, there is little research about the gendered analytical tools and methods in communities exposed to natural disasters and hazards. These tools evaluate gender vulnerability and capacity in pre-disaster and post-disaster phases of the disaster management cycle.

Objectives: Identifying the analytical gender tools and the strengths and limitations of them as well as determining gender analysis studies which had emphasized on the importance of using gender analysis in disasters.

Methods: The literature search was conducted in June 2013 using PubMed, Web of Sciences, ProQuest Research Library, World Health Organization Library, Gender and Disaster Network (GDN) archive. All articles, guidelines, fact sheets and other materials that provided an analytical framework for a gender analysis approach in disasters were included and the non-English documents as well as gender studies of non-disasters area were excluded. Analysis of the included studies was done separately by descriptive and thematic analyses.

Results: A total of 207 documents were retrieved, of which only nine references were included. Of these, 45% were in form of checklist, 33% case study report, and the remaining 22% were article. All selected papers were published within the period 1994-2012.

Conclusions: A focus on women’s vulnerability in the related research and the lack of valid and reliable gender analysis tools were considerable issues identified by the literature review. Although non-English literatures with English abstract were included in the study, the possible exclusion of non-English ones was found as the limitation of this study.

The Prevalence of Sexual Violence among Female Refugees in Complex Humanitarian Emergencies: a Systematic Review and Meta-analysis


Importance: Refugees and internally displaced persons are highly vulnerable to sexual violence during conflict and subsequent displacement. However, accurate estimates of the prevalence of sexual violence among in these populations remain uncertain.

Objective: Our objective was to estimate the prevalence of sexual violence among refugees and displaced persons in complex humanitarian emergencies.

Data Source: We conducted systematic review of relevant literature in multiple databases (EMBASE, CINAHL, and MEDLINE) through February 2013 to identify studies. We also reviewed reference lists of included articles to identify any missing sources.

Study Selection: Inclusion criteria required identification of sexual violence among refugees and internally displaced persons or those displaced by conflict in complex humanitarian settings. Studies were excluded if they did not provide female sexual violence prevalence, or that included only single case reports, anecdotes, and those that focused on displacement associated with natural disasters. After a review of 1175 citations 19 unique studies were selected.

Data Extraction: Two reviewers worked independently to identify final selection and a third reviewer adjudicated any differences. Descriptive and quantitative information was extracted; prevalence estimates were synthesized. Heterogeneity was assessed using I2.

Main Outcomes: The main outcome of interest was sexual violence among female refugees and internally displaced persons in complex humanitarian settings.

Results: The prevalence of sexual violence was estimated at 21.4% (95% CI, 14.9-28.7; I2=98.3%), using a random effects model. Statistical heterogeneity was noted with studies using probability sampling designs reporting lower prevalence of sexual violence (21.0%, 95% CI, 13.2-30.1; I2=98.6%), compared to lower quality studies (21.7%, 95% CI, 11.5-34.2; I2=97.4%). We could not rule out the presence of publication bias.

Conclusions: The findings suggest that approximately one in five refugees or displaced women in complex humanitarian settings experienced sexual violence. However, this is likely an underestimation of the true prevalence given the multiple existing barriers associated with disclosure. The long-term health and social consequences of sexual violence for women and their families necessitate strategies to improve identification of survivors of sexual violence and increase prevention and response interventions in these complex settings.

Hospitals Safety from Disasters in I.R.Iran: The Results from Assessment of 224 Hospitals


Background and objective: Iran’s hospitals have been considerably affected by disasters during last decade. To address this, health system of I.R.Iran has taken an initiative to assess disaster safety of the hospitals using an adopted version of Hospital Safety Index (HSI). This article presents the results of disaster safety assessment in 224 Iran’s hospitals.

Methods: A self-assessment approach was applied to assess the disaster safety in 145 items categorized in 3 components including structural, non-structural and functional capacity. For each item, safety level was categorized to 3 levels: not safe (0), average safe (1) and high safe (2). A raw score was tallied for each safety component and its elements by a simple sum of all the corresponding scores. All scores were normalized on a 100 point scale. Hospitals were classified to three safety classes according to their normalized total score: low (≤34.0), average (34.01-66.0) and high (>66.0).

Results: The average score of all safety components were 32.4 out of 100 (± 12.7 SD). 122 hospitals (54.5%) were classified as low safe and 102 hospitals (45.5%) were classified as average safe. No hospital was placed in the high safe category. Average safety scores out of 100 were 27.3 (±14.2 SD) for functional capacity, 36.0 (±13.9 SD) for non-structural component and 36.0 (±19.0 SD) for structural component. Neither the safety classes nor the scores of safety components were significantly associated with types of hospitals in terms of affiliation, function and size (P>0.05).

Conclusions: To enhance the hospitals safety for disaster in Iran, we recommend: 1) establishment of a national committee for hospital safety in disasters; 2) supervision on implementation of the safety standards in construction of new hospitals; 3) enhancement of functional readiness and safety of non-structural components while structural retrofitting of the existing hospitals is being taken into consideration, whenever is cost-effective; 4) considering the disaster safety status as the criteria for licensing and accreditation of the hospitals.

Key words: Hospital, safety, disaster, emergency, Iran

Correspondence to: Ali Ardalan MD, PhD. Tehran University of Medical Sciences, Harvard Humanitarian Initiative, Email:,

A Fire Department Community Health Intervention to Prevent Carbon Monoxide Poisoning Following a Hurricane


Portable generators are commonly used during electrical service interruptions that occur following large storms such as hurricanes. Nearly all portable generators use carbon based fuels and produce deadly carbon monoxide gas. Despite universal warnings to operate these generators outside only, the improper placement of generators makes these devices the leading cause of engine related carbon monoxide deaths in the United States. The medical literature reports many cases of Carbon Monoxide (CO) toxicity associated with generator use following hurricanes and other weather events.

This paper describes how Howard County, Maryland Fire and Rescue (HCFR) Services implemented a public education program that focused on prevention of Carbon Monoxide poisoning from portable generator use in the wake of events where electrical service interruptions occurred or had the potential to occur. A major challenge faced was communication with those members of the population who were almost completely dependent upon electronic and wireless technologies and were without redundancies. HCFR utilized several tactics to overcome this challenge including helicopter based surveillance and the use of geocoded information from the electrical service provider to identify outage areas. Once outage areas were identified, HCFR personnel conducted a door-to-door canvasing of effected communities, assessing for hazards and distributing information flyers about the dangers of generator use.

This effort represents one of the first reported examples of a community-based endeavor by a fire department to provide proactive interventions designed to prevent carbon monoxide illness.

Surveillance and Epidemiology in Natural Disasters: A Novel Framework and Assessment of Reliability


Objective: To create a framework and methodology for organizing relevant disaster epidemiology literature. The target audience for the framework is local public health practitioners conducting emergency surveillance in the setting of preparedness or response to natural disasters.
Methods: The approach to developing the framework involved utilizing the public health and emergency management literature. It was created along four axes. The first was the type of natural disaster; second was according to phase of disaster cycle; third was the impact of the disaster (health, infrastructure, economic); and fourth was related to the main outcome of the study (ie. injuries or infectious diseases). A literature review was conducted and subsequently the current literature was utilized to perform a reliability test of the established framework, using two independent reviewers.
Results: Using existing disaster classification systems and risk analysis tools, a framework was developed along the four axes. The final literature search resulted in 85 articles on surveillance in natural disaster settings. The majority of studies are on the subject of hurricanes with a catastrophic impact rating. The phase of testing reliability of the framework resulted in percent agreement of 74%.
Conclusions: A reliable framework was developed that enables local public health practitioners to easily access appropriate and previously utilized surveillance methods for a natural disaster emergency. This framework contributes to an evidence-informed approach to surveillance in natural disasters with public health impacts.

Integrating Climate Change Adaptation into Disaster Risk Reduction in Urban Contexts: Perceptions and Practice


This paper analyses the perceptions of disaster risk reduction (DRR) practitioners concerning the on-going integration of climate change adaptation (CCA) into their practices in urban contexts in Nicaragua. Understanding their perceptions is important as this will provide information on how this integration can be improved. Exploring the perceptions of practitioners in Nicaragua is important as the country has a long history of disasters, and practitioners have been developing the current DRR planning framework for more than a decade. The analysis is based on semi-structured interviews designed to collect information about practitioners’ understanding of: (a) CCA, (b) the current level of integration of CCA into DRR and urban planning, (c) the opportunities and constraints of this integration, and (d) the potential to adapt cities to climate change. The results revealed that practitioners’ perception is that the integration of CCA into their practice is at an early stage, and that they need to improve their understanding of CCA in terms of a development issue. Three main constraints on improved integration were identified: (a) a recognized lack of understanding of CCA, (b) insufficient guidance on how to integrate it, and (c) the limited opportunities to integrate it into urban planning due to a lack of instruments and capacity in this field. Three opportunities were also identified: (a) practitioners’ awareness of the need to integrate CCA into their practices, (b) the robust structure of the DRR planning framework in the country, which provides a suitable channel for facilitating integration, and (c) the fact that CCA is receiving more attention and financial and technical support from the international community.

The National Heatwave Plan – A Brief Evaluation of Issues for Frontline Health Staff


Background: The adverse effects of heatwaves on mortality are well recognised. Heatwaves are predicted to become more frequent and severe in coming decades. England’s National Heatwave Plan (NHP) aims to prepare the country for periods of extreme heat and thereby limit adverse health effects. The central aim of this study is to understand how effectively the NHP is disseminated within an acute hospital and to identify any barriers to its use.

Methods: Qualitative data was collected through semi-structured interviews and focus groups with key hospital managers, nurses and healthcare assistants. All participants were recruited from a single hospital in the South East of England. Data were analysed using Framework Analysis.

Results: We conducted two focus groups with frontline clinical staff and five interviews with senior managers, all of whom deemed the NHP a low priority. Hospital managers showed good awareness of the plan, which was lacking amongst frontline staff. Nevertheless front line staff were familiar with the dangers of excess heat and felt that they individualised care accordingly. Communication of information between managers and frontline staff was highlighted as a problem during heatwaves. Additionally, issues with inadequate building stock and equipment limited effective implementation of the plan. Participants were able to suggest novel improvements to the plan.

Conclusions: Increased awareness and improved communication could help better integrate the NHP into the clinical practice of English hospital-based healthcare professionals. Further evaluation of the NHP in acute care trusts and other health care settings is warranted to expand upon these initial findings.

Supports for Health and Social Service Providers from Canada Responding to the Disaster in Haiti


In January 12, 2010, a 7.0 magnitude earthquake shook Port-au-Prince, Haiti. The massive disaster made it difficult for local Haitian community officials to respond immediately, leaving the country reliant on foreign aid and international and non-governmental relief organizations. This study explores the effectiveness of various supports that were made available to health and social service providers in Haiti, by focusing on their lived experiences pre-deployment, on-site and post-deployment. The paper provides a qualitative exploration of participant perceptions with respect to the success of their performance in response, and relevant literature describing the various supports provided to health and social service providers responding to disasters. Methods: A single, semi-structured interview was conducted with Canadian health professionals (n=21) who deployed to Haiti during the time of, or after, the 2010 earthquake. The study uses Strauss and Corbin’s structured approach to grounded theory to identify main themes and relationships in the interviews. Results: The interviews indicate that training, and psychological and emotional supports for health and social service providers require improvement to enhance the experience and effectiveness of their work. Conclusions: Findings indicate that supports are most effective when they are tailored to the volunteers. The paper highlights future research stemming from the grounded theory findings.