The Humanitarian Situation in Syria: A Snapshot in the Third Year of the Crisis

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Between April and June 2014, International Orthodox Christian Charities (IOCC), an International NGO, and the Greek Orthodox Patriarchate of Antioch and All the East (GOPA) conducted a needs assessment of Syrians affected by the crisis with the objective of gaining a better understanding of humanitarian needs and assistance priorities. Findings suggest that interventions that increase access to non-food items, food, medication and education should be prioritized where cost was the primary barrier to accessing goods and services. Cash transfer programs and direct provision of material assistance should be considered, though the most appropriate assistance modality is likely to vary by sector, location and the preferences and prior experience of donors and implementing organizations. Renewed international commitment to funding humanitarian assistance efforts in Syria and neighboring countries where the burden of refugees is greatest is essential from both a human rights perspective and in terms of maintaining stability in the region.

Tehran Dust Storm Early Warning System: Corrective Measures

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On June 2, 2014 a sandstorm hit Tehran, the capital city of Iran which killed 5 and injured 44 people. The early warning system did not operate properly and the alarm was not transferred to at risk population and the related organizations in time and in a right manner. Additionally, people who were exposed to the winds didn’t know the appropriate safety measures. Focusing much more on establishing EWS to alert the risk prone population timely and public education for taking safety measures when exposed to the disastrous situation is recommended.

Performance Assessment of Communicable Disease Surveillance in Disasters: A Systematic Review

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Background: This study aimed to identify the indices and frameworks that have been used to assess the performance of communicable disease surveillance (CDS) in response to disasters and other emergencies, including infectious disease outbreaks.

Method: In this systematic review, PubMed, Google Scholar, Scopus, ScienceDirect, ProQuest databases and grey literature were searched until the end of 2013. All retrieved titles were examined in accordance with inclusion criteria. Abstracts of the relevant titles were reviewed and eligible abstracts were included in a list for data abstraction. Finally, the study variables were extracted.

Results: Sixteen articles and one book were found relevant to our study objectives. In these articles, 31 criteria and 35 indicators were used or suggested for the assessment/evaluation of the performance of surveillance systems in disasters. The Centers for Disease Control (CDC) updated guidelines for the evaluation of public health surveillance systems were the most widely used.

Conclusion: Despite the importance of performance assessment in improving CDS in response to disasters, there is a lack of clear and accepted frameworks. There is also no agreement on the use of existing criteria and indices. The only relevant framework is the CDC guideline, which is a common framework for assessing public health surveillance systems as a whole. There is an urgent need to develop appropriate frameworks, criteria, and indices for specifically assessing the performance of CDS in response to disasters and other emergencies, including infectious diseases outbreaks.

Key words: Disasters, Emergencies, Communicable Diseases, Surveillance System, Performance Assessment

Developing a Consensus-based Definition of “Kokoro-no Care” or Mental Health Services and Psychosocial Support: Drawing from Experiences of Mental Health Professionals Who Responded to the Great East Japan Earthquake

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Objectives: In this survey, we aimed to build consensus and gather opinions on ‘Kokoro-no care’ or mental health services and psychosocial support (MHSPSS) after a disaster, among mental health professionals who engaged in care after the Great East Japan Earthquake.

Methods: We recruited mental health professionals who engaged in support activities after the Great East Japan Earthquake, which included local health professionals in the affected areas and members of mental health care teams dispatched from outside (n = 131). Adopting the Delphi process, we proposed a definition of ‘Kokoro-no care’, and asked the participants to rate the appropriateness on a 5-point Likert scale. We also solicited free comments based on the participants’ experiences during the disaster. After Round 1, we presented the summary statistics and comments, and asked the participants to re-rate the definition that had been modified based on their comments. This process was repeated twice, until the consensus criterion of ≥ 80% of the participants scoring ≥ 4 on the statement was fulfilled.

Results: In Round 1, 68.7% of the respondents rated the proposed definition ≥ 4 for its appropriateness, and 88.4% did so in Round 2. The comments were grouped into categories (and subcategories) based on those related to the definition in general (Appropriate, Continuum of MHSPSS, Cautions in operation, Alternative categorisation of care components, Whether the care component should be categorised according to the professional involved, Ambiguous use of psychology, and Others), to mental health services (Appropriate, More specification within mental health services, More explicit remarks on mental health services, and Others), and to psychosocial support (Whether the care component should be categorised according to the professional involved, Raising concerns about the terms, and Others), and others.

Conclusion: We achieved a consensus on the definition of ‘Kokoro-no care’, and systematically obtained suggestions on the concept, and practical advice on operation, based on the participants’ experiences from the Great East Japan Earthquake. This collective knowledge will serve as reference to prepare and respond to future disasters.

What’s the Big Deal? Responder Experiences of Large Animal Rescue in Australia

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Background: The management of large animals during disasters and emergencies creates difficult operational environments for responders. The aims of this study were to identify the exact challenges faced by Australian emergency response personnel in their interactions with large animals and their owners, and to determine the readiness for large animal rescue (LAR) in Australia.

Methods: A survey tool collected the views and experiences of a broad cross section of emergency services personnel operating across Australia and across all hazards. Data were collected from 156 responders including Australian emergency services personnel, emergency managers such as federal agricultural departments, and local government.

Results: Overall, many of the respondents had serious concerns, and felt that there were significant issues in relation to LAR in Australia. These included the coordination of emergency care for animals, physical management of large animals, inter-agency coordination, and dealing with animal owners. Very few respondents had received any formal training in LAR, with an overwhelming majority indicating they would attend formal training if it were made available.

Discussion: Results help to guide the development of evidence-informed support tools to assist operational response and community engagement, and the production of professional development resources.

Snow Tweets: Emergency Information Dissemination in a US County During 2014 Winter Storms

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Introduction: This paper describes how American federal, state, and local organizations created, sourced, and disseminated emergency information via social media in preparation for several winter storms in one county in the state of New Jersey (USA).

Methods: Postings submitted to Twitter for three winter storm periods were collected from selected organizations, along with a purposeful sample of select private local users. Storm-related posts were analyzed for stylistic features (hashtags, retweet mentions, embedded URLs). Sharing and re-tweeting patterns were also mapped using NodeXL.

Results: Results indicate emergency management entities were active in providing preparedness and response information during the selected winter weather events. A large number of posts, however, did not include unique Twitter features that maximize dissemination and discovery by users. Visual representations of interactions illustrate opportunities for developing stronger relationships among agencies.

Discussion: Whereas previous research predominantly focuses on large-scale national or international disaster contexts, the current study instead provides needed analysis in a small-scale context. With practice during localized events like extreme weather, effective information dissemination in large events can be enhanced.

Art of Disaster Preparedness in European Union: a Survey on the Health Systems

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Introduction: Naturally occurring and man-made disasters have been increasing in the world, including Europe, over the past several decades. Health systems are a key part of any community disaster management system. The success of preparedness and prevention depends on the success of activities such as disaster planning, organization and training. The aim of this study is to evaluate health system preparedness for disasters in the 27 European Union member countries.

Method: A cross-sectional analysis study was completed between June-September 2012. The checklist used for this survey was a modified from the World Health Organization toolkit for assessing health-system capacity for crisis management. Three specialists from each of the 27 European Union countries were included in the survey. Responses to each survey question were scored and the range of preparedness level was defined as 0-100%, categorized in three levels as follows: Acceptable; Transitional; or Insufficient.

Results: Response rate was 79.1%. The average level of disaster management preparedness in the health systems of 27 European Union member states was 68% (Acceptable). The highest level of preparedness was seen in the United Kingdom, Luxemburg, and Lithuania. Considering the elements of disaster management system, the highest level of preparedness score was at health information elements (86%), and the lowest level was for hospitals, and educational elements (54%).

Conclusion: This survey study suggests that preparedness level of European Union countries in 2012 is at an acceptable level but could be improved. Elements such as hospitals and education and training suffer from insufficient levels of preparedness. The European Union health systems need a collective strategic plan, as well as enough resources, to establish a comprehensive and standardized disaster management strategy plan. A competency based training curriculum for managers and first responders is basic to accomplishing this goal.

Keywords: Disaster medicine; Disaster preparedness; Disaster epidemiology; Health systems; European Union

Validating Indicators of Disaster Recovery with Qualitative Research

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Introduction: Recovery from disasters is a critical function of federal, state, and local governments, yet measurable, validated indicators of community recovery remain unidentified. A list of potential recovery indicators was developed by the authors through a literature review, recovery plan review, and case study of two disaster impacted communities.

Methods: To validate the indicators, qualitative data was collected from experts on disaster recovery. Twenty-one key informant interviews and two focus groups were conducted between January and April of 2014 to solicit feedback from disaster recovery practitioners and academics.

Results: Five major themes emerged from the qualitative data. These included: the flexibility of the indicators to serve multiple purposes for communities and individuals both pre- and post- disaster; the focus areas are comprehensive, but content and organization can be improved; the importance of seeing the indicators as a self-assessment, rather than a tool for comparing communities; the potential challenges of collecting data for some indicators; and the identification of potential measurement issues with the indicators.

Discussion: The proposed recovery indicators can be utilized by both practitioners and researchers to effectively track post-disaster recovery. They capture many of the complexities of community disaster recovery and provide potential opportunities for linkages to the development of disaster recovery plans and other activities that could increase community resilience in the future.

Communicable Diseases Surveillance System in East Azerbaijan Earthquake: Strengths and Weaknesses

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Background: A Surveillance System was established for 19 diseases/syndromes in order to prevent and control communicable diseases after 2012 East Azerbaijan earthquakes. This study was conducted to investigate the strengths and weaknesses of the established SS.

Methods: This study was carried out on an interview-based qualitative study using content analysis in 2012. Data was collected by semi-structured deep interviews and surveillance data. Fifteen interviews were conducted with experts and health system managers who were engaged in implementing the communicable disease surveillance system in the affected areas. The selection of participants was purposeful. Data saturation supported the sample size. The collected data was analyzed using the principles suggested by Strauss and Corbin.

Results: Establishment of the disease surveillance system was rapid and inexpensive. It collected the required data fast. It also increased confidence in health authorities that the diseases would be under control in earthquake-stricken regions. Non estimated denominator for calculating the rates (incidence & prevalence), non-participation of the private sector and hospitals, rapid turnover of health staff and unfamiliarity with the definitions of the diseases were the weak points of the established disease SS.

Conclusion: During the time when surveillance system was active, no significant outbreak of communicable diseases was reported. However, the surveillance system had some weaknesses. Thus, considering Iran’s susceptibility to various natural hazards, repeated exercises should be conducted in the preparedness phase to decrease the weaknesses. In addition, other types of surveillance system such as web-based or mobile-based systems should be piloted in disaster situations for future.

Variables Associated with Effects on Morbidity in Older Adults Following Disasters

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Introduction: Older adults are vulnerable to disproportionately higher morbidity following disasters. Reasons for this vulnerability are multifaceted and vary by disaster type as well as patient comorbidities. Efforts to mitigate this increased morbidity require identification of at-risk older adults who can be targeted for intervention.

Methods: A PubMed search was performed using the search terms “geriatric, disaster” and “morbidity, disaster” to identify published articles that reported variables associated with increased morbidity of older adults during and after disasters. A review of article titles and abstracts was then conducted to identify those articles that contained evidence-based variables that render older adults vulnerable to poor health outcomes during disasters.

Results: A total of 233 studies was initially identified. After applying exclusion criteria, nine studies were chosen for the comprehensive review. Based on the synthesis of the literature, factors were identified that were repeatedly associated with morbidity and mortality among older adults during and shortly after disasters.

Conclusion: Older adults, especially those with multiple co-morbidities, are at risk of increased morbidity after disasters and catastrophic events. Factors such as the need for prescription medications, low social support, visual and hearing impairment, impaired mobility, and poor economic status are associated with an increased risk of morbidity.