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BT 26.250 541.623 Td /F1 9.8 Tf  [(indigenous health resources. Numerous governmental, non-governmental, national and international organizations and )] TJ ET
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BT 35.250 767.476 Td /F4 9.8 Tf  [(Fig. 1: Port-Au-Prince, Haiti 2010)] TJ ET
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BT 26.250 730.821 Td /F1 9.8 Tf  [(Complex Humanitarian Emergencies \(CHE\) constitute a multifaceted global public health threat. Contextually, there are multiple )] TJ ET
BT 26.250 718.917 Td /F1 9.8 Tf  [(interpretations of the term CHE. The United Nations \(UN\) Inter-Agency Steering Committee defines CHE as: �A humanitarian )] TJ ET
BT 26.250 707.012 Td /F1 9.8 Tf  [(crisis in a country, region or society where there is a total or significant breakdown of authority resulting from internal or external )] TJ ET
BT 26.250 695.107 Td /F1 9.8 Tf  [(conflict and which requires an international response that goes beyond the mandate or capacity of any single agency and/or the )] TJ ET
BT 26.250 683.202 Td /F1 9.8 Tf  [(ongoing UN country program. Common characteristics include: civilian casualties, and populations besieged or displaced; )] TJ ET
BT 26.250 671.298 Td /F1 9.8 Tf  [(serious political or conflict-related impediments to delivery of assistance; inability of people to pursue normal social, political or )] TJ ET
BT 26.250 659.393 Td /F1 9.8 Tf  [(economic activities; high security risks for relief workers; and international and cross-border operations affected by political )] TJ ET
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BT 84.713 647.488 Td /F1 9.8 Tf  [( CHE can result from natural or man-made events, including armed conflict. From 1990 to 1999, 38 major conflicts )] TJ ET
BT 26.250 635.583 Td /F1 9.8 Tf  [(with catastrophic public health consequences occurred causing the displacement of millions of people; 70% of which were )] TJ ET
BT 26.250 623.679 Td /F1 9.8 Tf  [(children and adolescents.)] TJ ET
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BT 136.805 625.186 Td /F4 8.7 Tf  [(2)] TJ ET
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BT 26.250 604.274 Td /F1 9.8 Tf  [(The Sphere Project, launched in 1997 by a group of humanitarian non-governmental organizations and the Red Cross and Red )] TJ ET
BT 26.250 592.369 Td /F1 9.8 Tf  [(Crescent movement, proposed a set of public health �Minimum Standards for Disaster Response� that need to be monitored )] TJ ET
BT 26.250 580.464 Td /F1 9.8 Tf  [(and addressed in various phases of disaster response. The four categories of minimum standards are health, food and nutrition, )] TJ ET
BT 26.250 568.560 Td /F1 9.8 Tf  [(shelter, water and sanitation. The Sphere Project is now in its third edition \(2011\), and is considered the foundation of public )] TJ ET
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BT 26.250 537.250 Td /F1 9.8 Tf  [(To evaluate the public health impact of CHE, in order to provide guidance for disaster relief efforts, organizations and agencies )] TJ ET
BT 26.250 525.345 Td /F1 9.8 Tf  [(have adopted a myriad of assessment tools. Currently, individual agencies conduct separate assessments utilizing a multiplicity )] TJ ET
BT 26.250 513.441 Td /F1 9.8 Tf  [(of methods for data-gathering and reporting.)] TJ ET
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BT 231.475 514.948 Td /F4 8.7 Tf  [(7)] TJ ET
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BT 236.293 513.441 Td /F1 9.8 Tf  [( For example, M�decins Sans Fronti�res \(Doctors Without Borders\) conducts )] TJ ET
BT 26.250 501.536 Td /F1 9.8 Tf  [(cross-sectional sample surveys, to obtain information on the most frequent diseases, mortality rates, nutritional status, and on )] TJ ET
BT 26.250 489.631 Td /F1 9.8 Tf  [(the vaccination status of the population affected.)] TJ ET
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BT 239.738 489.631 Td /F1 9.8 Tf  [( More recently, the Inter-Agency Standing Committee \(IASC\) proposed an )] TJ ET
BT 26.250 477.726 Td /F1 9.8 Tf  [(Initial Rapid Assessment Tool \(IRA\) which is a mixed \(qualitative and quantitative\) tool.)] TJ ET
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BT 400.133 479.234 Td /F4 8.7 Tf  [(6)] TJ ET
BT 404.952 479.234 Td /F4 8.7 Tf  [(7)] TJ ET
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BT 409.771 477.726 Td /F1 9.8 Tf  [( None of the tools proposed, however, )] TJ ET
BT 26.250 465.822 Td /F1 9.8 Tf  [(put forth an entirely quantitative public health severity scale based on The Sphere Project �Minimum Standards�, that would )] TJ ET
BT 26.250 453.917 Td /F1 9.8 Tf  [(complement qualitative analysis for the impact of the CHE. Following the 2010 Haiti earthquake, the initial assessment, named )] TJ ET
BT 26.250 442.012 Td /F1 9.8 Tf  [(the Multi-Cluster Rapid Initial Situational Assessment for Haiti, took over 25 days after the earthquake to be completed, and )] TJ ET
BT 26.250 430.107 Td /F1 9.8 Tf  [(over 40 days to be analyzed and distributed.)] TJ ET
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BT 222.383 430.107 Td /F1 9.8 Tf  [( The assessment methods and results in Haiti were criticized by the Centers for )] TJ ET
BT 26.250 418.203 Td /F1 9.8 Tf  [(Disease Control and Prevention.)] TJ ET
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BT 171.420 418.203 Td /F1 9.8 Tf  [( A quantitative assessment tool can be used by emergency response planners and policy )] TJ ET
BT 26.250 406.298 Td /F1 9.8 Tf  [(makers as a source of objective measures on each of the four categories of the �Minimum Standards�, in addition to an overall )] TJ ET
BT 26.250 394.393 Td /F1 9.8 Tf  [(measure of the �big picture� related to the public health impact of CHE. This would help quantify the magnitude of urgent needs, )] TJ ET
BT 26.250 382.488 Td /F1 9.8 Tf  [(improving the ability to respond expeditiously and appropriately, to measure progress across time, and to compare various )] TJ ET
BT 26.250 370.584 Td /F1 9.8 Tf  [(complex emergencies.)] TJ ET
BT 26.250 333.981 Td /F4 12.0 Tf  [(Objective)] TJ ET
BT 26.250 314.027 Td /F1 9.8 Tf  [(The objective of this study is to propose a conceptual quantitative assessment tool to measure the severity of the public health )] TJ ET
BT 26.250 302.122 Td /F1 9.8 Tf  [(impact resulting from Complex Humanitarian Emergencies \(CHE\), based on The Sphere Project �Minimum Standards�. Testing )] TJ ET
BT 26.250 290.217 Td /F1 9.8 Tf  [(the feasibility and validity of the proposed tool is not the objective of this manuscript. Acknowledging the importance of )] TJ ET
BT 26.250 278.313 Td /F1 9.8 Tf  [(qualitative analysis in conjunction with quantitative data, the proposed tool, henceforth referred to as the Public Health Impact )] TJ ET
BT 26.250 266.408 Td /F1 9.8 Tf  [(Severity Scale \(PHISS\), complements and builds upon existing tools and qualitative analyses by providing an objective, )] TJ ET
BT 26.250 254.503 Td /F1 9.8 Tf  [(quantitative and cumulative measures.)] TJ ET
BT 26.250 217.901 Td /F4 12.0 Tf  [(Methods)] TJ ET
BT 26.250 197.946 Td /F1 9.8 Tf  [(Based on the four �Minimum Standards� listed in The Sphere Project 2011 \(i.e. health, food and nutrition, shelter, water and )] TJ ET
BT 26.250 186.042 Td /F1 9.8 Tf  [(sanitation\), the authors identified relevant essential public health indicators in CHE. By consensus, the final group of indicators )] TJ ET
BT 26.250 174.137 Td /F1 9.8 Tf  [(\(parameters\) was selected, and the scoring rubric for each parameter was stochastically assigned. Whenever applicable, )] TJ ET
BT 26.250 162.232 Td /F1 9.8 Tf  [(already existing standardized parameters and scores were adopted. The baseline and ceiling scoring values for each )] TJ ET
BT 26.250 150.327 Td /F1 9.8 Tf  [(parameter, based on criteria available in the literature. Various examples from actual retrospective CHE were provided )] TJ ET
BT 26.250 138.423 Td /F1 9.8 Tf  [(illustrating how to utilize the scoring rubric for each parameter. Inclusion criteria for each parameter were quantifiability, and )] TJ ET
BT 26.250 126.518 Td /F1 9.8 Tf  [(being a public health indicator based on The Sphere Project.)] TJ ET
BT 26.250 89.915 Td /F4 12.0 Tf  [(Results)] TJ ET
BT 26.250 69.961 Td /F1 9.8 Tf  [(Twelve parameters were identified, representing the four categories of �Minimum Standards� according to The Sphere Project )] TJ ET
BT 26.250 58.056 Td /F1 9.8 Tf  [(2011; namely health, shelter, food and nutrition, in addition to water and sanitation. These parameters were: number of excess )] TJ ET
BT 26.250 46.152 Td /F1 9.8 Tf  [(deaths, number of under-5 excess deaths, number of cases with acute communicable diseases, number of cases with injuries )] TJ ET
Q
q
15.000 31.866 577.500 745.134 re W n
0.965 0.965 0.965 rg
26.250 747.845 555.000 29.155 re f
0.267 0.267 0.267 rg
0.267 0.267 0.267 RG
26.250 747.845 m 581.250 747.845 l 581.250 748.595 l 26.250 748.595 l  f
q
35.250 759.095 537.000 17.905 re W n
0.271 0.267 0.267 rg
BT 35.250 767.476 Td /F4 9.8 Tf  [(Fig. 1: Port-Au-Prince, Haiti 2010)] TJ ET
Q
BT 26.250 730.821 Td /F1 9.8 Tf  [(Complex Humanitarian Emergencies \(CHE\) constitute a multifaceted global public health threat. Contextually, there are multiple )] TJ ET
BT 26.250 718.917 Td /F1 9.8 Tf  [(interpretations of the term CHE. The United Nations \(UN\) Inter-Agency Steering Committee defines CHE as: �A humanitarian )] TJ ET
BT 26.250 707.012 Td /F1 9.8 Tf  [(crisis in a country, region or society where there is a total or significant breakdown of authority resulting from internal or external )] TJ ET
BT 26.250 695.107 Td /F1 9.8 Tf  [(conflict and which requires an international response that goes beyond the mandate or capacity of any single agency and/or the )] TJ ET
BT 26.250 683.202 Td /F1 9.8 Tf  [(ongoing UN country program. Common characteristics include: civilian casualties, and populations besieged or displaced; )] TJ ET
BT 26.250 671.298 Td /F1 9.8 Tf  [(serious political or conflict-related impediments to delivery of assistance; inability of people to pursue normal social, political or )] TJ ET
BT 26.250 659.393 Td /F1 9.8 Tf  [(economic activities; high security risks for relief workers; and international and cross-border operations affected by political )] TJ ET
BT 26.250 647.488 Td /F1 9.8 Tf  [(differences.�)] TJ ET
0.267 0.267 0.267 rg
BT 79.894 648.995 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 84.713 647.488 Td /F1 9.8 Tf  [( CHE can result from natural or man-made events, including armed conflict. From 1990 to 1999, 38 major conflicts )] TJ ET
BT 26.250 635.583 Td /F1 9.8 Tf  [(with catastrophic public health consequences occurred causing the displacement of millions of people; 70% of which were )] TJ ET
BT 26.250 623.679 Td /F1 9.8 Tf  [(children and adolescents.)] TJ ET
0.267 0.267 0.267 rg
BT 136.805 625.186 Td /F4 8.7 Tf  [(2)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 604.274 Td /F1 9.8 Tf  [(The Sphere Project, launched in 1997 by a group of humanitarian non-governmental organizations and the Red Cross and Red )] TJ ET
BT 26.250 592.369 Td /F1 9.8 Tf  [(Crescent movement, proposed a set of public health �Minimum Standards for Disaster Response� that need to be monitored )] TJ ET
BT 26.250 580.464 Td /F1 9.8 Tf  [(and addressed in various phases of disaster response. The four categories of minimum standards are health, food and nutrition, )] TJ ET
BT 26.250 568.560 Td /F1 9.8 Tf  [(shelter, water and sanitation. The Sphere Project is now in its third edition \(2011\), and is considered the foundation of public )] TJ ET
BT 26.250 556.655 Td /F1 9.8 Tf  [(health response in CHE.)] TJ ET
0.267 0.267 0.267 rg
BT 131.921 558.162 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 537.250 Td /F1 9.8 Tf  [(To evaluate the public health impact of CHE, in order to provide guidance for disaster relief efforts, organizations and agencies )] TJ ET
BT 26.250 525.345 Td /F1 9.8 Tf  [(have adopted a myriad of assessment tools. Currently, individual agencies conduct separate assessments utilizing a multiplicity )] TJ ET
BT 26.250 513.441 Td /F1 9.8 Tf  [(of methods for data-gathering and reporting.)] TJ ET
0.267 0.267 0.267 rg
BT 217.018 514.948 Td /F4 8.7 Tf  [(4)] TJ ET
BT 221.837 514.948 Td /F4 8.7 Tf  [(5)] TJ ET
BT 226.656 514.948 Td /F4 8.7 Tf  [(6)] TJ ET
BT 231.475 514.948 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 236.293 513.441 Td /F1 9.8 Tf  [( For example, M�decins Sans Fronti�res \(Doctors Without Borders\) conducts )] TJ ET
BT 26.250 501.536 Td /F1 9.8 Tf  [(cross-sectional sample surveys, to obtain information on the most frequent diseases, mortality rates, nutritional status, and on )] TJ ET
BT 26.250 489.631 Td /F1 9.8 Tf  [(the vaccination status of the population affected.)] TJ ET
0.267 0.267 0.267 rg
BT 234.919 491.138 Td /F4 8.7 Tf  [(4)] TJ ET
0.271 0.267 0.267 rg
BT 239.738 489.631 Td /F1 9.8 Tf  [( More recently, the Inter-Agency Standing Committee \(IASC\) proposed an )] TJ ET
BT 26.250 477.726 Td /F1 9.8 Tf  [(Initial Rapid Assessment Tool \(IRA\) which is a mixed \(qualitative and quantitative\) tool.)] TJ ET
0.267 0.267 0.267 rg
BT 400.133 479.234 Td /F4 8.7 Tf  [(6)] TJ ET
BT 404.952 479.234 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 409.771 477.726 Td /F1 9.8 Tf  [( None of the tools proposed, however, )] TJ ET
BT 26.250 465.822 Td /F1 9.8 Tf  [(put forth an entirely quantitative public health severity scale based on The Sphere Project �Minimum Standards�, that would )] TJ ET
BT 26.250 453.917 Td /F1 9.8 Tf  [(complement qualitative analysis for the impact of the CHE. Following the 2010 Haiti earthquake, the initial assessment, named )] TJ ET
BT 26.250 442.012 Td /F1 9.8 Tf  [(the Multi-Cluster Rapid Initial Situational Assessment for Haiti, took over 25 days after the earthquake to be completed, and )] TJ ET
BT 26.250 430.107 Td /F1 9.8 Tf  [(over 40 days to be analyzed and distributed.)] TJ ET
0.267 0.267 0.267 rg
BT 217.565 431.615 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 222.383 430.107 Td /F1 9.8 Tf  [( The assessment methods and results in Haiti were criticized by the Centers for )] TJ ET
BT 26.250 418.203 Td /F1 9.8 Tf  [(Disease Control and Prevention.)] TJ ET
0.267 0.267 0.267 rg
BT 166.601 419.710 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 171.420 418.203 Td /F1 9.8 Tf  [( A quantitative assessment tool can be used by emergency response planners and policy )] TJ ET
BT 26.250 406.298 Td /F1 9.8 Tf  [(makers as a source of objective measures on each of the four categories of the �Minimum Standards�, in addition to an overall )] TJ ET
BT 26.250 394.393 Td /F1 9.8 Tf  [(measure of the �big picture� related to the public health impact of CHE. This would help quantify the magnitude of urgent needs, )] TJ ET
BT 26.250 382.488 Td /F1 9.8 Tf  [(improving the ability to respond expeditiously and appropriately, to measure progress across time, and to compare various )] TJ ET
BT 26.250 370.584 Td /F1 9.8 Tf  [(complex emergencies.)] TJ ET
BT 26.250 333.981 Td /F4 12.0 Tf  [(Objective)] TJ ET
BT 26.250 314.027 Td /F1 9.8 Tf  [(The objective of this study is to propose a conceptual quantitative assessment tool to measure the severity of the public health )] TJ ET
BT 26.250 302.122 Td /F1 9.8 Tf  [(impact resulting from Complex Humanitarian Emergencies \(CHE\), based on The Sphere Project �Minimum Standards�. Testing )] TJ ET
BT 26.250 290.217 Td /F1 9.8 Tf  [(the feasibility and validity of the proposed tool is not the objective of this manuscript. Acknowledging the importance of )] TJ ET
BT 26.250 278.313 Td /F1 9.8 Tf  [(qualitative analysis in conjunction with quantitative data, the proposed tool, henceforth referred to as the Public Health Impact )] TJ ET
BT 26.250 266.408 Td /F1 9.8 Tf  [(Severity Scale \(PHISS\), complements and builds upon existing tools and qualitative analyses by providing an objective, )] TJ ET
BT 26.250 254.503 Td /F1 9.8 Tf  [(quantitative and cumulative measures.)] TJ ET
BT 26.250 217.901 Td /F4 12.0 Tf  [(Methods)] TJ ET
BT 26.250 197.946 Td /F1 9.8 Tf  [(Based on the four �Minimum Standards� listed in The Sphere Project 2011 \(i.e. health, food and nutrition, shelter, water and )] TJ ET
BT 26.250 186.042 Td /F1 9.8 Tf  [(sanitation\), the authors identified relevant essential public health indicators in CHE. By consensus, the final group of indicators )] TJ ET
BT 26.250 174.137 Td /F1 9.8 Tf  [(\(parameters\) was selected, and the scoring rubric for each parameter was stochastically assigned. Whenever applicable, )] TJ ET
BT 26.250 162.232 Td /F1 9.8 Tf  [(already existing standardized parameters and scores were adopted. The baseline and ceiling scoring values for each )] TJ ET
BT 26.250 150.327 Td /F1 9.8 Tf  [(parameter, based on criteria available in the literature. Various examples from actual retrospective CHE were provided )] TJ ET
BT 26.250 138.423 Td /F1 9.8 Tf  [(illustrating how to utilize the scoring rubric for each parameter. Inclusion criteria for each parameter were quantifiability, and )] TJ ET
BT 26.250 126.518 Td /F1 9.8 Tf  [(being a public health indicator based on The Sphere Project.)] TJ ET
BT 26.250 89.915 Td /F4 12.0 Tf  [(Results)] TJ ET
BT 26.250 69.961 Td /F1 9.8 Tf  [(Twelve parameters were identified, representing the four categories of �Minimum Standards� according to The Sphere Project )] TJ ET
BT 26.250 58.056 Td /F1 9.8 Tf  [(2011; namely health, shelter, food and nutrition, in addition to water and sanitation. These parameters were: number of excess )] TJ ET
BT 26.250 46.152 Td /F1 9.8 Tf  [(deaths, number of under-5 excess deaths, number of cases with acute communicable diseases, number of cases with injuries )] TJ ET
Q
q
15.000 31.866 577.500 745.134 re W n
0.965 0.965 0.965 rg
26.250 747.845 555.000 29.155 re f
0.267 0.267 0.267 rg
0.267 0.267 0.267 RG
26.250 747.845 m 581.250 747.845 l 581.250 748.595 l 26.250 748.595 l  f
q
35.250 759.095 537.000 17.905 re W n
0.271 0.267 0.267 rg
BT 35.250 767.476 Td /F4 9.8 Tf  [(Fig. 1: Port-Au-Prince, Haiti 2010)] TJ ET
Q
BT 26.250 730.821 Td /F1 9.8 Tf  [(Complex Humanitarian Emergencies \(CHE\) constitute a multifaceted global public health threat. Contextually, there are multiple )] TJ ET
BT 26.250 718.917 Td /F1 9.8 Tf  [(interpretations of the term CHE. The United Nations \(UN\) Inter-Agency Steering Committee defines CHE as: �A humanitarian )] TJ ET
BT 26.250 707.012 Td /F1 9.8 Tf  [(crisis in a country, region or society where there is a total or significant breakdown of authority resulting from internal or external )] TJ ET
BT 26.250 695.107 Td /F1 9.8 Tf  [(conflict and which requires an international response that goes beyond the mandate or capacity of any single agency and/or the )] TJ ET
BT 26.250 683.202 Td /F1 9.8 Tf  [(ongoing UN country program. Common characteristics include: civilian casualties, and populations besieged or displaced; )] TJ ET
BT 26.250 671.298 Td /F1 9.8 Tf  [(serious political or conflict-related impediments to delivery of assistance; inability of people to pursue normal social, political or )] TJ ET
BT 26.250 659.393 Td /F1 9.8 Tf  [(economic activities; high security risks for relief workers; and international and cross-border operations affected by political )] TJ ET
BT 26.250 647.488 Td /F1 9.8 Tf  [(differences.�)] TJ ET
0.267 0.267 0.267 rg
BT 79.894 648.995 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 84.713 647.488 Td /F1 9.8 Tf  [( CHE can result from natural or man-made events, including armed conflict. From 1990 to 1999, 38 major conflicts )] TJ ET
BT 26.250 635.583 Td /F1 9.8 Tf  [(with catastrophic public health consequences occurred causing the displacement of millions of people; 70% of which were )] TJ ET
BT 26.250 623.679 Td /F1 9.8 Tf  [(children and adolescents.)] TJ ET
0.267 0.267 0.267 rg
BT 136.805 625.186 Td /F4 8.7 Tf  [(2)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 604.274 Td /F1 9.8 Tf  [(The Sphere Project, launched in 1997 by a group of humanitarian non-governmental organizations and the Red Cross and Red )] TJ ET
BT 26.250 592.369 Td /F1 9.8 Tf  [(Crescent movement, proposed a set of public health �Minimum Standards for Disaster Response� that need to be monitored )] TJ ET
BT 26.250 580.464 Td /F1 9.8 Tf  [(and addressed in various phases of disaster response. The four categories of minimum standards are health, food and nutrition, )] TJ ET
BT 26.250 568.560 Td /F1 9.8 Tf  [(shelter, water and sanitation. The Sphere Project is now in its third edition \(2011\), and is considered the foundation of public )] TJ ET
BT 26.250 556.655 Td /F1 9.8 Tf  [(health response in CHE.)] TJ ET
0.267 0.267 0.267 rg
BT 131.921 558.162 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 537.250 Td /F1 9.8 Tf  [(To evaluate the public health impact of CHE, in order to provide guidance for disaster relief efforts, organizations and agencies )] TJ ET
BT 26.250 525.345 Td /F1 9.8 Tf  [(have adopted a myriad of assessment tools. Currently, individual agencies conduct separate assessments utilizing a multiplicity )] TJ ET
BT 26.250 513.441 Td /F1 9.8 Tf  [(of methods for data-gathering and reporting.)] TJ ET
0.267 0.267 0.267 rg
BT 217.018 514.948 Td /F4 8.7 Tf  [(4)] TJ ET
BT 221.837 514.948 Td /F4 8.7 Tf  [(5)] TJ ET
BT 226.656 514.948 Td /F4 8.7 Tf  [(6)] TJ ET
BT 231.475 514.948 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 236.293 513.441 Td /F1 9.8 Tf  [( For example, M�decins Sans Fronti�res \(Doctors Without Borders\) conducts )] TJ ET
BT 26.250 501.536 Td /F1 9.8 Tf  [(cross-sectional sample surveys, to obtain information on the most frequent diseases, mortality rates, nutritional status, and on )] TJ ET
BT 26.250 489.631 Td /F1 9.8 Tf  [(the vaccination status of the population affected.)] TJ ET
0.267 0.267 0.267 rg
BT 234.919 491.138 Td /F4 8.7 Tf  [(4)] TJ ET
0.271 0.267 0.267 rg
BT 239.738 489.631 Td /F1 9.8 Tf  [( More recently, the Inter-Agency Standing Committee \(IASC\) proposed an )] TJ ET
BT 26.250 477.726 Td /F1 9.8 Tf  [(Initial Rapid Assessment Tool \(IRA\) which is a mixed \(qualitative and quantitative\) tool.)] TJ ET
0.267 0.267 0.267 rg
BT 400.133 479.234 Td /F4 8.7 Tf  [(6)] TJ ET
BT 404.952 479.234 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 409.771 477.726 Td /F1 9.8 Tf  [( None of the tools proposed, however, )] TJ ET
BT 26.250 465.822 Td /F1 9.8 Tf  [(put forth an entirely quantitative public health severity scale based on The Sphere Project �Minimum Standards�, that would )] TJ ET
BT 26.250 453.917 Td /F1 9.8 Tf  [(complement qualitative analysis for the impact of the CHE. Following the 2010 Haiti earthquake, the initial assessment, named )] TJ ET
BT 26.250 442.012 Td /F1 9.8 Tf  [(the Multi-Cluster Rapid Initial Situational Assessment for Haiti, took over 25 days after the earthquake to be completed, and )] TJ ET
BT 26.250 430.107 Td /F1 9.8 Tf  [(over 40 days to be analyzed and distributed.)] TJ ET
0.267 0.267 0.267 rg
BT 217.565 431.615 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 222.383 430.107 Td /F1 9.8 Tf  [( The assessment methods and results in Haiti were criticized by the Centers for )] TJ ET
BT 26.250 418.203 Td /F1 9.8 Tf  [(Disease Control and Prevention.)] TJ ET
0.267 0.267 0.267 rg
BT 166.601 419.710 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 171.420 418.203 Td /F1 9.8 Tf  [( A quantitative assessment tool can be used by emergency response planners and policy )] TJ ET
BT 26.250 406.298 Td /F1 9.8 Tf  [(makers as a source of objective measures on each of the four categories of the �Minimum Standards�, in addition to an overall )] TJ ET
BT 26.250 394.393 Td /F1 9.8 Tf  [(measure of the �big picture� related to the public health impact of CHE. This would help quantify the magnitude of urgent needs, )] TJ ET
BT 26.250 382.488 Td /F1 9.8 Tf  [(improving the ability to respond expeditiously and appropriately, to measure progress across time, and to compare various )] TJ ET
BT 26.250 370.584 Td /F1 9.8 Tf  [(complex emergencies.)] TJ ET
BT 26.250 333.981 Td /F4 12.0 Tf  [(Objective)] TJ ET
BT 26.250 314.027 Td /F1 9.8 Tf  [(The objective of this study is to propose a conceptual quantitative assessment tool to measure the severity of the public health )] TJ ET
BT 26.250 302.122 Td /F1 9.8 Tf  [(impact resulting from Complex Humanitarian Emergencies \(CHE\), based on The Sphere Project �Minimum Standards�. Testing )] TJ ET
BT 26.250 290.217 Td /F1 9.8 Tf  [(the feasibility and validity of the proposed tool is not the objective of this manuscript. Acknowledging the importance of )] TJ ET
BT 26.250 278.313 Td /F1 9.8 Tf  [(qualitative analysis in conjunction with quantitative data, the proposed tool, henceforth referred to as the Public Health Impact )] TJ ET
BT 26.250 266.408 Td /F1 9.8 Tf  [(Severity Scale \(PHISS\), complements and builds upon existing tools and qualitative analyses by providing an objective, )] TJ ET
BT 26.250 254.503 Td /F1 9.8 Tf  [(quantitative and cumulative measures.)] TJ ET
BT 26.250 217.901 Td /F4 12.0 Tf  [(Methods)] TJ ET
BT 26.250 197.946 Td /F1 9.8 Tf  [(Based on the four �Minimum Standards� listed in The Sphere Project 2011 \(i.e. health, food and nutrition, shelter, water and )] TJ ET
BT 26.250 186.042 Td /F1 9.8 Tf  [(sanitation\), the authors identified relevant essential public health indicators in CHE. By consensus, the final group of indicators )] TJ ET
BT 26.250 174.137 Td /F1 9.8 Tf  [(\(parameters\) was selected, and the scoring rubric for each parameter was stochastically assigned. Whenever applicable, )] TJ ET
BT 26.250 162.232 Td /F1 9.8 Tf  [(already existing standardized parameters and scores were adopted. The baseline and ceiling scoring values for each )] TJ ET
BT 26.250 150.327 Td /F1 9.8 Tf  [(parameter, based on criteria available in the literature. Various examples from actual retrospective CHE were provided )] TJ ET
BT 26.250 138.423 Td /F1 9.8 Tf  [(illustrating how to utilize the scoring rubric for each parameter. Inclusion criteria for each parameter were quantifiability, and )] TJ ET
BT 26.250 126.518 Td /F1 9.8 Tf  [(being a public health indicator based on The Sphere Project.)] TJ ET
BT 26.250 89.915 Td /F4 12.0 Tf  [(Results)] TJ ET
BT 26.250 69.961 Td /F1 9.8 Tf  [(Twelve parameters were identified, representing the four categories of �Minimum Standards� according to The Sphere Project )] TJ ET
BT 26.250 58.056 Td /F1 9.8 Tf  [(2011; namely health, shelter, food and nutrition, in addition to water and sanitation. These parameters were: number of excess )] TJ ET
BT 26.250 46.152 Td /F1 9.8 Tf  [(deaths, number of under-5 excess deaths, number of cases with acute communicable diseases, number of cases with injuries )] TJ ET
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q
15.000 78.197 577.500 698.803 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(due to the CHE, levels of healthcare services, number of young children with acute malnutrition, level of healthcare services, )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(number of displaced persons, number of persons with inadequate living space, water quantity, water quality, level of sanitation )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(facilities, and gender-based violence. The cumulative scale \(PHISS\) is quantitative, with a score ranging from a minimum of 0 to )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(a maximum of 100. Below is a detailed description of each parameter selected, the basis for parameter selection, and their )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(suggested scoring rubric, with representative examples.)] TJ ET
BT 26.250 700.452 Td /F4 9.8 Tf  [(1. Number of Excess Deaths \(Excess Mortality\):)] TJ ET
BT 246.775 700.452 Td /F1 9.8 Tf  [( Excess mortality is defined as the mortality attributable to the crisis )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(conditions, above and beyond deaths that would have occurred in normal conditions, and is expressed as total number of )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(excess deaths.)] TJ ET
0.267 0.267 0.267 rg
BT 91.282 678.150 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 100.920 676.643 Td /F1 9.8 Tf  [( It is calculated by multiplying the difference between the observed Crude Mortality rate \(CMR\) and the )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(baseline CMR, by the number of the population affected during a certain period of time [\(observed CMR � baseline non-crisis )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(CMR\) x population at risk x period of time]. Since this tool is utilized in the context of assessment, the period of time need to be )] TJ ET
BT 26.250 640.929 Td /F1 9.8 Tf  [(clarified, for example it can be set from the onset of the CHE until the assessment is conducted, or during the last month. The )] TJ ET
BT 26.250 629.024 Td /F1 9.8 Tf  [(reason excess mortality is used as the mortality parameter, rather than the CMR, is to depict the overall mortality burden )] TJ ET
BT 26.250 617.119 Td /F1 9.8 Tf  [(attributed to the CHE. rates can be very high but the affected population maybe very small. Excess mortality incorporates the )] TJ ET
BT 26.250 605.214 Td /F1 9.8 Tf  [(mortality rate \(CMR\) which is the single most important indicator of serious stress \(e.g. illness and malnutrition\) on affected )] TJ ET
BT 26.250 593.310 Td /F1 9.8 Tf  [(populations, and has long been a prime public health indicator of the severity of CHE. Of note, both the United Nations High )] TJ ET
BT 26.250 581.405 Td /F1 9.8 Tf  [(Commissioner for Refugees \(UNHCR\) and M�decins Sans Fronti�res \(MSF\)-Epicentre have determined that the emergency )] TJ ET
BT 26.250 569.500 Td /F1 9.8 Tf  [(benchmark for CMR is 1 per 10,000 per day.)] TJ ET
0.267 0.267 0.267 rg
BT 218.618 571.007 Td /F4 8.7 Tf  [(11)] TJ ET
BT 228.255 571.007 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 550.095 Td /F1 9.8 Tf  [(The floor of the scoring rubric for this parameter was chosen to be 10 deaths. This number stems from the criteria adopted by )] TJ ET
BT 26.250 538.191 Td /F1 9.8 Tf  [(the Centre for Research on the Epidemiology of Disasters \(CRED\); a collaborative initiative established in 1988 by the WHO )] TJ ET
BT 26.250 526.286 Td /F1 9.8 Tf  [(and the Belgian government that has been maintaining a database on international disasters named EM-DAT.)] TJ ET
0.267 0.267 0.267 rg
BT 499.905 527.793 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 509.542 526.286 Td /F1 9.8 Tf  [( For a �disaster� )] TJ ET
BT 26.250 514.381 Td /F1 9.8 Tf  [(to be entered into the database, at least one of the following criteria must be fulfilled: Ten \(10\) or more people reported killed, )] TJ ET
BT 26.250 502.476 Td /F1 9.8 Tf  [(one hundred \(100\) or more people reported affected, declaration of a state of emergency, or call for international assistance. )] TJ ET
BT 26.250 490.572 Td /F1 9.8 Tf  [(The 1970 Bangladesh meteorological disaster \(cyclone\) killed more than 300,000 persons.)] TJ ET
0.267 0.267 0.267 rg
BT 416.425 492.079 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 426.063 490.572 Td /F1 9.8 Tf  [( According to the CRED database )] TJ ET
BT 26.250 478.667 Td /F1 9.8 Tf  [(\(EM-DAT\), it constitutes a CHE that caused the highest number of deaths recorded from 1900 to 2011.)] TJ ET
0.267 0.267 0.267 rg
BT 468.998 480.174 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 478.635 478.667 Td /F1 9.8 Tf  [( Based on this data, )] TJ ET
BT 26.250 466.762 Td /F1 9.8 Tf  [(the ceiling of the scoring rubric is therefore chosen to be 300,000. Below is a table showing multiple examples \(some CHE and )] TJ ET
BT 26.250 454.857 Td /F1 9.8 Tf  [(others not\), with their corresponding scores.)] TJ ET
q
26.250 431.240 555.000 13.736 re W n
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BT 26.250 433.987 Td /F1 9.8 Tf  [(Table 1. Total Number of Excess Deaths)] TJ ET
Q
1.000 1.000 1.000 rg
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0.965 0.965 0.965 rg
27.000 398.806 160.304 24.184 re f
0.267 0.267 0.267 rg
26.625 422.615 160.679 0.750 re f
26.625 398.431 0.750 24.934 re f
0.271 0.267 0.267 rg
BT 31.500 413.466 Td /F4 9.8 Tf  [(Total number of excess)] TJ ET
BT 31.500 401.562 Td /F4 9.8 Tf  [(deaths)] TJ ET
0.965 0.965 0.965 rg
187.304 398.806 84.799 24.184 re f
0.267 0.267 0.267 rg
187.304 422.615 84.799 0.750 re f
0.271 0.267 0.267 rg
BT 191.804 413.466 Td /F4 9.8 Tf  [(Severity)] TJ ET
BT 191.804 401.562 Td /F4 9.8 Tf  [(score)] TJ ET
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272.103 398.806 216.453 24.184 re f
0.267 0.267 0.267 rg
272.103 422.615 216.453 0.750 re f
0.271 0.267 0.267 rg
BT 276.603 413.466 Td /F4 9.8 Tf  [(Country, year, type)] TJ ET
0.965 0.965 0.965 rg
488.556 398.806 91.944 24.184 re f
0.267 0.267 0.267 rg
488.556 422.615 92.319 0.750 re f
580.125 398.431 0.750 24.934 re f
0.271 0.267 0.267 rg
BT 493.056 413.466 Td /F4 9.8 Tf  [(Number of)] TJ ET
BT 493.056 401.562 Td /F4 9.8 Tf  [(deaths)] TJ ET
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26.625 398.431 161.054 0.750 re f
26.625 382.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 388.576 Td /F1 9.8 Tf  [(<10)] TJ ET
0.267 0.267 0.267 rg
186.929 398.431 85.549 0.750 re f
186.929 382.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 388.576 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
271.728 398.431 217.203 0.750 re f
271.728 382.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 388.576 Td /F1 9.8 Tf  [(None recorded by EM-DAT)] TJ ET
0.267 0.267 0.267 rg
488.181 398.431 92.694 0.750 re f
488.181 382.549 0.750 16.631 re f
580.125 382.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 388.576 Td /F1 9.8 Tf  [(N/A)] TJ ET
0.267 0.267 0.267 rg
26.625 382.549 161.054 0.750 re f
26.625 366.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 372.694 Td /F1 9.8 Tf  [(10-99)] TJ ET
0.267 0.267 0.267 rg
186.929 382.549 85.549 0.750 re f
186.929 366.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 372.694 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
271.728 382.549 217.203 0.750 re f
271.728 366.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 372.694 Td /F1 9.8 Tf  [(Greece, 2007, forest fire)] TJ ET
0.267 0.267 0.267 rg
488.181 382.549 92.694 0.750 re f
488.181 366.668 0.750 16.631 re f
580.125 366.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 372.694 Td /F1 9.8 Tf  [(67)] TJ ET
0.267 0.267 0.267 rg
26.625 366.668 161.054 0.750 re f
26.625 350.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 356.813 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
186.929 366.668 85.549 0.750 re f
186.929 350.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 356.813 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
271.728 366.668 217.203 0.750 re f
271.728 350.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 356.813 Td /F1 9.8 Tf  [(United States, 1947, explosion)] TJ ET
0.267 0.267 0.267 rg
488.181 366.668 92.694 0.750 re f
488.181 350.787 0.750 16.631 re f
580.125 350.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 356.813 Td /F1 9.8 Tf  [(561)] TJ ET
0.267 0.267 0.267 rg
26.625 350.787 161.054 0.750 re f
26.625 334.906 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 340.932 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
186.929 350.787 85.549 0.750 re f
186.929 334.906 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 340.932 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
271.728 350.787 217.203 0.750 re f
271.728 334.906 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 340.932 Td /F1 9.8 Tf  [(Papua New Guinea, 1951, volcanic eruption)] TJ ET
0.267 0.267 0.267 rg
488.181 350.787 92.694 0.750 re f
488.181 334.906 0.750 16.631 re f
580.125 334.906 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 340.932 Td /F1 9.8 Tf  [(3,000)] TJ ET
0.267 0.267 0.267 rg
26.625 334.906 161.054 0.750 re f
26.625 319.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 325.051 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
186.929 334.906 85.549 0.750 re f
186.929 319.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 325.051 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
271.728 334.906 217.203 0.750 re f
271.728 319.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 325.051 Td /F1 9.8 Tf  [(Germany 2003, heatwave)] TJ ET
0.267 0.267 0.267 rg
488.181 334.906 92.694 0.750 re f
488.181 319.024 0.750 16.631 re f
580.125 319.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 325.051 Td /F1 9.8 Tf  [(9,355)] TJ ET
0.267 0.267 0.267 rg
26.625 319.024 161.054 0.750 re f
26.625 303.143 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 309.169 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
186.929 319.024 85.549 0.750 re f
186.929 303.143 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 309.169 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
271.728 319.024 217.203 0.750 re f
271.728 303.143 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 309.169 Td /F1 9.8 Tf  [(Soviet Union, 1949, landslide)] TJ ET
0.267 0.267 0.267 rg
488.181 319.024 92.694 0.750 re f
488.181 303.143 0.750 16.631 re f
580.125 303.143 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 309.169 Td /F1 9.8 Tf  [(12,000)] TJ ET
0.267 0.267 0.267 rg
26.625 303.143 161.054 0.750 re f
26.625 287.262 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 293.288 Td /F1 9.8 Tf  [(20,000-49,999)] TJ ET
0.267 0.267 0.267 rg
186.929 303.143 85.549 0.750 re f
186.929 287.262 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 293.288 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
271.728 303.143 217.203 0.750 re f
271.728 287.262 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 293.288 Td /F1 9.8 Tf  [(India, 1942, tropical storm)] TJ ET
0.267 0.267 0.267 rg
488.181 303.143 92.694 0.750 re f
488.181 287.262 0.750 16.631 re f
580.125 287.262 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 293.288 Td /F1 9.8 Tf  [(40,000)] TJ ET
0.267 0.267 0.267 rg
26.625 287.262 161.054 0.750 re f
26.625 271.381 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 277.407 Td /F1 9.8 Tf  [(50,000-99,999)] TJ ET
0.267 0.267 0.267 rg
186.929 287.262 85.549 0.750 re f
186.929 271.381 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 277.407 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
271.728 287.262 217.203 0.750 re f
271.728 271.381 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 277.407 Td /F1 9.8 Tf  [(Pakistan, 2005, earthquake)] TJ ET
0.267 0.267 0.267 rg
488.181 287.262 92.694 0.750 re f
488.181 271.381 0.750 16.631 re f
580.125 271.381 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 277.407 Td /F1 9.8 Tf  [(73,338)] TJ ET
0.267 0.267 0.267 rg
26.625 271.381 161.054 0.750 re f
26.625 255.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 261.526 Td /F1 9.8 Tf  [(100,000-199,999)] TJ ET
0.267 0.267 0.267 rg
186.929 271.381 85.549 0.750 re f
186.929 255.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 261.526 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
271.728 271.381 217.203 0.750 re f
271.728 255.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 261.526 Td /F1 9.8 Tf  [(Japan, 1945, atomic bomb)] TJ ET
0.267 0.267 0.267 rg
488.181 271.381 92.694 0.750 re f
488.181 255.499 0.750 16.631 re f
580.125 255.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 261.526 Td /F1 9.8 Tf  [(105,000)] TJ ET
0.267 0.267 0.267 rg
26.625 255.499 161.054 0.750 re f
26.625 239.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 245.644 Td /F1 9.8 Tf  [(200,000-299,999)] TJ ET
0.267 0.267 0.267 rg
186.929 255.499 85.549 0.750 re f
186.929 239.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 245.644 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
271.728 255.499 217.203 0.750 re f
271.728 239.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 245.644 Td /F1 9.8 Tf  [(Haiti, 2010, earthquake)] TJ ET
0.267 0.267 0.267 rg
488.181 255.499 92.694 0.750 re f
488.181 239.618 0.750 16.631 re f
580.125 239.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 245.644 Td /F1 9.8 Tf  [(222,570)] TJ ET
0.267 0.267 0.267 rg
26.625 239.618 161.054 0.750 re f
26.625 223.737 161.054 0.750 re f
26.625 223.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 229.763 Td /F1 9.8 Tf  [(Greater than or equal to 300,000)] TJ ET
0.267 0.267 0.267 rg
186.929 239.618 85.549 0.750 re f
186.929 223.737 85.549 0.750 re f
186.929 223.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 229.763 Td /F1 9.8 Tf  [(10)] TJ ET
0.267 0.267 0.267 rg
271.728 239.618 217.203 0.750 re f
271.728 223.737 217.203 0.750 re f
271.728 223.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 229.763 Td /F1 9.8 Tf  [(Bangladesh, 1970, tropical cyclone)] TJ ET
0.267 0.267 0.267 rg
488.181 239.618 92.694 0.750 re f
488.181 223.737 92.694 0.750 re f
488.181 223.737 0.750 16.631 re f
580.125 223.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 229.763 Td /F1 9.8 Tf  [(300,000)] TJ ET
BT 26.250 168.838 Td /F4 9.8 Tf  [(2. Number of Under-5 Excess Deaths:)] TJ ET
BT 200.171 168.838 Td /F1 9.8 Tf  [( Under-five \(year old\) excess mortality rate \(U5MR\) is calculated in the same way as )] TJ ET
BT 26.250 156.933 Td /F1 9.8 Tf  [(the parameter above, using the difference between the observed and baseline under-5 mortality rates, and multiplying the result )] TJ ET
BT 26.250 145.029 Td /F1 9.8 Tf  [(by the estimated affected population of that age group per the time period since the onset of CHE. The reason to include this )] TJ ET
BT 26.250 133.124 Td /F1 9.8 Tf  [(parameter, having already included the one above \(total number of excess deaths\), is because it better reflects the most )] TJ ET
BT 26.250 121.219 Td /F1 9.8 Tf  [(vulnerable group, since the under-5 mortality rate is an early sensitive indicator of the mortality impact of CHE. Both UNHCR )] TJ ET
BT 26.250 109.314 Td /F1 9.8 Tf  [(and MSF have determined that the emergency benchmark for U5MR is 2 per 10,000 per day.)] TJ ET
0.267 0.267 0.267 rg
BT 427.804 110.822 Td /F4 8.7 Tf  [(11)] TJ ET
BT 437.441 110.822 Td /F4 8.7 Tf  [(12)] TJ ET
Q
q
15.000 78.197 577.500 698.803 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(due to the CHE, levels of healthcare services, number of young children with acute malnutrition, level of healthcare services, )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(number of displaced persons, number of persons with inadequate living space, water quantity, water quality, level of sanitation )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(facilities, and gender-based violence. The cumulative scale \(PHISS\) is quantitative, with a score ranging from a minimum of 0 to )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(a maximum of 100. Below is a detailed description of each parameter selected, the basis for parameter selection, and their )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(suggested scoring rubric, with representative examples.)] TJ ET
BT 26.250 700.452 Td /F4 9.8 Tf  [(1. Number of Excess Deaths \(Excess Mortality\):)] TJ ET
BT 246.775 700.452 Td /F1 9.8 Tf  [( Excess mortality is defined as the mortality attributable to the crisis )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(conditions, above and beyond deaths that would have occurred in normal conditions, and is expressed as total number of )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(excess deaths.)] TJ ET
0.267 0.267 0.267 rg
BT 91.282 678.150 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 100.920 676.643 Td /F1 9.8 Tf  [( It is calculated by multiplying the difference between the observed Crude Mortality rate \(CMR\) and the )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(baseline CMR, by the number of the population affected during a certain period of time [\(observed CMR � baseline non-crisis )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(CMR\) x population at risk x period of time]. Since this tool is utilized in the context of assessment, the period of time need to be )] TJ ET
BT 26.250 640.929 Td /F1 9.8 Tf  [(clarified, for example it can be set from the onset of the CHE until the assessment is conducted, or during the last month. The )] TJ ET
BT 26.250 629.024 Td /F1 9.8 Tf  [(reason excess mortality is used as the mortality parameter, rather than the CMR, is to depict the overall mortality burden )] TJ ET
BT 26.250 617.119 Td /F1 9.8 Tf  [(attributed to the CHE. rates can be very high but the affected population maybe very small. Excess mortality incorporates the )] TJ ET
BT 26.250 605.214 Td /F1 9.8 Tf  [(mortality rate \(CMR\) which is the single most important indicator of serious stress \(e.g. illness and malnutrition\) on affected )] TJ ET
BT 26.250 593.310 Td /F1 9.8 Tf  [(populations, and has long been a prime public health indicator of the severity of CHE. Of note, both the United Nations High )] TJ ET
BT 26.250 581.405 Td /F1 9.8 Tf  [(Commissioner for Refugees \(UNHCR\) and M�decins Sans Fronti�res \(MSF\)-Epicentre have determined that the emergency )] TJ ET
BT 26.250 569.500 Td /F1 9.8 Tf  [(benchmark for CMR is 1 per 10,000 per day.)] TJ ET
0.267 0.267 0.267 rg
BT 218.618 571.007 Td /F4 8.7 Tf  [(11)] TJ ET
BT 228.255 571.007 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 550.095 Td /F1 9.8 Tf  [(The floor of the scoring rubric for this parameter was chosen to be 10 deaths. This number stems from the criteria adopted by )] TJ ET
BT 26.250 538.191 Td /F1 9.8 Tf  [(the Centre for Research on the Epidemiology of Disasters \(CRED\); a collaborative initiative established in 1988 by the WHO )] TJ ET
BT 26.250 526.286 Td /F1 9.8 Tf  [(and the Belgian government that has been maintaining a database on international disasters named EM-DAT.)] TJ ET
0.267 0.267 0.267 rg
BT 499.905 527.793 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 509.542 526.286 Td /F1 9.8 Tf  [( For a �disaster� )] TJ ET
BT 26.250 514.381 Td /F1 9.8 Tf  [(to be entered into the database, at least one of the following criteria must be fulfilled: Ten \(10\) or more people reported killed, )] TJ ET
BT 26.250 502.476 Td /F1 9.8 Tf  [(one hundred \(100\) or more people reported affected, declaration of a state of emergency, or call for international assistance. )] TJ ET
BT 26.250 490.572 Td /F1 9.8 Tf  [(The 1970 Bangladesh meteorological disaster \(cyclone\) killed more than 300,000 persons.)] TJ ET
0.267 0.267 0.267 rg
BT 416.425 492.079 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 426.063 490.572 Td /F1 9.8 Tf  [( According to the CRED database )] TJ ET
BT 26.250 478.667 Td /F1 9.8 Tf  [(\(EM-DAT\), it constitutes a CHE that caused the highest number of deaths recorded from 1900 to 2011.)] TJ ET
0.267 0.267 0.267 rg
BT 468.998 480.174 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 478.635 478.667 Td /F1 9.8 Tf  [( Based on this data, )] TJ ET
BT 26.250 466.762 Td /F1 9.8 Tf  [(the ceiling of the scoring rubric is therefore chosen to be 300,000. Below is a table showing multiple examples \(some CHE and )] TJ ET
BT 26.250 454.857 Td /F1 9.8 Tf  [(others not\), with their corresponding scores.)] TJ ET
q
26.250 431.240 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 433.987 Td /F1 9.8 Tf  [(Table 1. Total Number of Excess Deaths)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 223.362 555.000 200.378 re f
0.965 0.965 0.965 rg
27.000 398.806 160.304 24.184 re f
0.267 0.267 0.267 rg
26.625 422.615 160.679 0.750 re f
26.625 398.431 0.750 24.934 re f
0.271 0.267 0.267 rg
BT 31.500 413.466 Td /F4 9.8 Tf  [(Total number of excess)] TJ ET
BT 31.500 401.562 Td /F4 9.8 Tf  [(deaths)] TJ ET
0.965 0.965 0.965 rg
187.304 398.806 84.799 24.184 re f
0.267 0.267 0.267 rg
187.304 422.615 84.799 0.750 re f
0.271 0.267 0.267 rg
BT 191.804 413.466 Td /F4 9.8 Tf  [(Severity)] TJ ET
BT 191.804 401.562 Td /F4 9.8 Tf  [(score)] TJ ET
0.965 0.965 0.965 rg
272.103 398.806 216.453 24.184 re f
0.267 0.267 0.267 rg
272.103 422.615 216.453 0.750 re f
0.271 0.267 0.267 rg
BT 276.603 413.466 Td /F4 9.8 Tf  [(Country, year, type)] TJ ET
0.965 0.965 0.965 rg
488.556 398.806 91.944 24.184 re f
0.267 0.267 0.267 rg
488.556 422.615 92.319 0.750 re f
580.125 398.431 0.750 24.934 re f
0.271 0.267 0.267 rg
BT 493.056 413.466 Td /F4 9.8 Tf  [(Number of)] TJ ET
BT 493.056 401.562 Td /F4 9.8 Tf  [(deaths)] TJ ET
0.267 0.267 0.267 rg
26.625 398.431 161.054 0.750 re f
26.625 382.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 388.576 Td /F1 9.8 Tf  [(<10)] TJ ET
0.267 0.267 0.267 rg
186.929 398.431 85.549 0.750 re f
186.929 382.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 388.576 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
271.728 398.431 217.203 0.750 re f
271.728 382.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 388.576 Td /F1 9.8 Tf  [(None recorded by EM-DAT)] TJ ET
0.267 0.267 0.267 rg
488.181 398.431 92.694 0.750 re f
488.181 382.549 0.750 16.631 re f
580.125 382.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 388.576 Td /F1 9.8 Tf  [(N/A)] TJ ET
0.267 0.267 0.267 rg
26.625 382.549 161.054 0.750 re f
26.625 366.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 372.694 Td /F1 9.8 Tf  [(10-99)] TJ ET
0.267 0.267 0.267 rg
186.929 382.549 85.549 0.750 re f
186.929 366.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 372.694 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
271.728 382.549 217.203 0.750 re f
271.728 366.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 372.694 Td /F1 9.8 Tf  [(Greece, 2007, forest fire)] TJ ET
0.267 0.267 0.267 rg
488.181 382.549 92.694 0.750 re f
488.181 366.668 0.750 16.631 re f
580.125 366.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 372.694 Td /F1 9.8 Tf  [(67)] TJ ET
0.267 0.267 0.267 rg
26.625 366.668 161.054 0.750 re f
26.625 350.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 356.813 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
186.929 366.668 85.549 0.750 re f
186.929 350.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 356.813 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
271.728 366.668 217.203 0.750 re f
271.728 350.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 356.813 Td /F1 9.8 Tf  [(United States, 1947, explosion)] TJ ET
0.267 0.267 0.267 rg
488.181 366.668 92.694 0.750 re f
488.181 350.787 0.750 16.631 re f
580.125 350.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 356.813 Td /F1 9.8 Tf  [(561)] TJ ET
0.267 0.267 0.267 rg
26.625 350.787 161.054 0.750 re f
26.625 334.906 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 340.932 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
186.929 350.787 85.549 0.750 re f
186.929 334.906 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 340.932 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
271.728 350.787 217.203 0.750 re f
271.728 334.906 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 340.932 Td /F1 9.8 Tf  [(Papua New Guinea, 1951, volcanic eruption)] TJ ET
0.267 0.267 0.267 rg
488.181 350.787 92.694 0.750 re f
488.181 334.906 0.750 16.631 re f
580.125 334.906 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 340.932 Td /F1 9.8 Tf  [(3,000)] TJ ET
0.267 0.267 0.267 rg
26.625 334.906 161.054 0.750 re f
26.625 319.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 325.051 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
186.929 334.906 85.549 0.750 re f
186.929 319.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 325.051 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
271.728 334.906 217.203 0.750 re f
271.728 319.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 325.051 Td /F1 9.8 Tf  [(Germany 2003, heatwave)] TJ ET
0.267 0.267 0.267 rg
488.181 334.906 92.694 0.750 re f
488.181 319.024 0.750 16.631 re f
580.125 319.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 325.051 Td /F1 9.8 Tf  [(9,355)] TJ ET
0.267 0.267 0.267 rg
26.625 319.024 161.054 0.750 re f
26.625 303.143 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 309.169 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
186.929 319.024 85.549 0.750 re f
186.929 303.143 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 309.169 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
271.728 319.024 217.203 0.750 re f
271.728 303.143 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 309.169 Td /F1 9.8 Tf  [(Soviet Union, 1949, landslide)] TJ ET
0.267 0.267 0.267 rg
488.181 319.024 92.694 0.750 re f
488.181 303.143 0.750 16.631 re f
580.125 303.143 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 309.169 Td /F1 9.8 Tf  [(12,000)] TJ ET
0.267 0.267 0.267 rg
26.625 303.143 161.054 0.750 re f
26.625 287.262 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 293.288 Td /F1 9.8 Tf  [(20,000-49,999)] TJ ET
0.267 0.267 0.267 rg
186.929 303.143 85.549 0.750 re f
186.929 287.262 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 293.288 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
271.728 303.143 217.203 0.750 re f
271.728 287.262 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 293.288 Td /F1 9.8 Tf  [(India, 1942, tropical storm)] TJ ET
0.267 0.267 0.267 rg
488.181 303.143 92.694 0.750 re f
488.181 287.262 0.750 16.631 re f
580.125 287.262 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 293.288 Td /F1 9.8 Tf  [(40,000)] TJ ET
0.267 0.267 0.267 rg
26.625 287.262 161.054 0.750 re f
26.625 271.381 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 277.407 Td /F1 9.8 Tf  [(50,000-99,999)] TJ ET
0.267 0.267 0.267 rg
186.929 287.262 85.549 0.750 re f
186.929 271.381 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 277.407 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
271.728 287.262 217.203 0.750 re f
271.728 271.381 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 277.407 Td /F1 9.8 Tf  [(Pakistan, 2005, earthquake)] TJ ET
0.267 0.267 0.267 rg
488.181 287.262 92.694 0.750 re f
488.181 271.381 0.750 16.631 re f
580.125 271.381 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 277.407 Td /F1 9.8 Tf  [(73,338)] TJ ET
0.267 0.267 0.267 rg
26.625 271.381 161.054 0.750 re f
26.625 255.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 261.526 Td /F1 9.8 Tf  [(100,000-199,999)] TJ ET
0.267 0.267 0.267 rg
186.929 271.381 85.549 0.750 re f
186.929 255.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 261.526 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
271.728 271.381 217.203 0.750 re f
271.728 255.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 261.526 Td /F1 9.8 Tf  [(Japan, 1945, atomic bomb)] TJ ET
0.267 0.267 0.267 rg
488.181 271.381 92.694 0.750 re f
488.181 255.499 0.750 16.631 re f
580.125 255.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 261.526 Td /F1 9.8 Tf  [(105,000)] TJ ET
0.267 0.267 0.267 rg
26.625 255.499 161.054 0.750 re f
26.625 239.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 245.644 Td /F1 9.8 Tf  [(200,000-299,999)] TJ ET
0.267 0.267 0.267 rg
186.929 255.499 85.549 0.750 re f
186.929 239.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 245.644 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
271.728 255.499 217.203 0.750 re f
271.728 239.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 245.644 Td /F1 9.8 Tf  [(Haiti, 2010, earthquake)] TJ ET
0.267 0.267 0.267 rg
488.181 255.499 92.694 0.750 re f
488.181 239.618 0.750 16.631 re f
580.125 239.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 245.644 Td /F1 9.8 Tf  [(222,570)] TJ ET
0.267 0.267 0.267 rg
26.625 239.618 161.054 0.750 re f
26.625 223.737 161.054 0.750 re f
26.625 223.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 229.763 Td /F1 9.8 Tf  [(Greater than or equal to 300,000)] TJ ET
0.267 0.267 0.267 rg
186.929 239.618 85.549 0.750 re f
186.929 223.737 85.549 0.750 re f
186.929 223.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 229.763 Td /F1 9.8 Tf  [(10)] TJ ET
0.267 0.267 0.267 rg
271.728 239.618 217.203 0.750 re f
271.728 223.737 217.203 0.750 re f
271.728 223.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 229.763 Td /F1 9.8 Tf  [(Bangladesh, 1970, tropical cyclone)] TJ ET
0.267 0.267 0.267 rg
488.181 239.618 92.694 0.750 re f
488.181 223.737 92.694 0.750 re f
488.181 223.737 0.750 16.631 re f
580.125 223.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 229.763 Td /F1 9.8 Tf  [(300,000)] TJ ET
BT 26.250 168.838 Td /F4 9.8 Tf  [(2. Number of Under-5 Excess Deaths:)] TJ ET
BT 200.171 168.838 Td /F1 9.8 Tf  [( Under-five \(year old\) excess mortality rate \(U5MR\) is calculated in the same way as )] TJ ET
BT 26.250 156.933 Td /F1 9.8 Tf  [(the parameter above, using the difference between the observed and baseline under-5 mortality rates, and multiplying the result )] TJ ET
BT 26.250 145.029 Td /F1 9.8 Tf  [(by the estimated affected population of that age group per the time period since the onset of CHE. The reason to include this )] TJ ET
BT 26.250 133.124 Td /F1 9.8 Tf  [(parameter, having already included the one above \(total number of excess deaths\), is because it better reflects the most )] TJ ET
BT 26.250 121.219 Td /F1 9.8 Tf  [(vulnerable group, since the under-5 mortality rate is an early sensitive indicator of the mortality impact of CHE. Both UNHCR )] TJ ET
BT 26.250 109.314 Td /F1 9.8 Tf  [(and MSF have determined that the emergency benchmark for U5MR is 2 per 10,000 per day.)] TJ ET
0.267 0.267 0.267 rg
BT 427.804 110.822 Td /F4 8.7 Tf  [(11)] TJ ET
BT 437.441 110.822 Td /F4 8.7 Tf  [(12)] TJ ET
Q
q
15.000 78.197 577.500 698.803 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(due to the CHE, levels of healthcare services, number of young children with acute malnutrition, level of healthcare services, )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(number of displaced persons, number of persons with inadequate living space, water quantity, water quality, level of sanitation )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(facilities, and gender-based violence. The cumulative scale \(PHISS\) is quantitative, with a score ranging from a minimum of 0 to )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(a maximum of 100. Below is a detailed description of each parameter selected, the basis for parameter selection, and their )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(suggested scoring rubric, with representative examples.)] TJ ET
BT 26.250 700.452 Td /F4 9.8 Tf  [(1. Number of Excess Deaths \(Excess Mortality\):)] TJ ET
BT 246.775 700.452 Td /F1 9.8 Tf  [( Excess mortality is defined as the mortality attributable to the crisis )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(conditions, above and beyond deaths that would have occurred in normal conditions, and is expressed as total number of )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(excess deaths.)] TJ ET
0.267 0.267 0.267 rg
BT 91.282 678.150 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 100.920 676.643 Td /F1 9.8 Tf  [( It is calculated by multiplying the difference between the observed Crude Mortality rate \(CMR\) and the )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(baseline CMR, by the number of the population affected during a certain period of time [\(observed CMR � baseline non-crisis )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(CMR\) x population at risk x period of time]. Since this tool is utilized in the context of assessment, the period of time need to be )] TJ ET
BT 26.250 640.929 Td /F1 9.8 Tf  [(clarified, for example it can be set from the onset of the CHE until the assessment is conducted, or during the last month. The )] TJ ET
BT 26.250 629.024 Td /F1 9.8 Tf  [(reason excess mortality is used as the mortality parameter, rather than the CMR, is to depict the overall mortality burden )] TJ ET
BT 26.250 617.119 Td /F1 9.8 Tf  [(attributed to the CHE. rates can be very high but the affected population maybe very small. Excess mortality incorporates the )] TJ ET
BT 26.250 605.214 Td /F1 9.8 Tf  [(mortality rate \(CMR\) which is the single most important indicator of serious stress \(e.g. illness and malnutrition\) on affected )] TJ ET
BT 26.250 593.310 Td /F1 9.8 Tf  [(populations, and has long been a prime public health indicator of the severity of CHE. Of note, both the United Nations High )] TJ ET
BT 26.250 581.405 Td /F1 9.8 Tf  [(Commissioner for Refugees \(UNHCR\) and M�decins Sans Fronti�res \(MSF\)-Epicentre have determined that the emergency )] TJ ET
BT 26.250 569.500 Td /F1 9.8 Tf  [(benchmark for CMR is 1 per 10,000 per day.)] TJ ET
0.267 0.267 0.267 rg
BT 218.618 571.007 Td /F4 8.7 Tf  [(11)] TJ ET
BT 228.255 571.007 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 550.095 Td /F1 9.8 Tf  [(The floor of the scoring rubric for this parameter was chosen to be 10 deaths. This number stems from the criteria adopted by )] TJ ET
BT 26.250 538.191 Td /F1 9.8 Tf  [(the Centre for Research on the Epidemiology of Disasters \(CRED\); a collaborative initiative established in 1988 by the WHO )] TJ ET
BT 26.250 526.286 Td /F1 9.8 Tf  [(and the Belgian government that has been maintaining a database on international disasters named EM-DAT.)] TJ ET
0.267 0.267 0.267 rg
BT 499.905 527.793 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 509.542 526.286 Td /F1 9.8 Tf  [( For a �disaster� )] TJ ET
BT 26.250 514.381 Td /F1 9.8 Tf  [(to be entered into the database, at least one of the following criteria must be fulfilled: Ten \(10\) or more people reported killed, )] TJ ET
BT 26.250 502.476 Td /F1 9.8 Tf  [(one hundred \(100\) or more people reported affected, declaration of a state of emergency, or call for international assistance. )] TJ ET
BT 26.250 490.572 Td /F1 9.8 Tf  [(The 1970 Bangladesh meteorological disaster \(cyclone\) killed more than 300,000 persons.)] TJ ET
0.267 0.267 0.267 rg
BT 416.425 492.079 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 426.063 490.572 Td /F1 9.8 Tf  [( According to the CRED database )] TJ ET
BT 26.250 478.667 Td /F1 9.8 Tf  [(\(EM-DAT\), it constitutes a CHE that caused the highest number of deaths recorded from 1900 to 2011.)] TJ ET
0.267 0.267 0.267 rg
BT 468.998 480.174 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 478.635 478.667 Td /F1 9.8 Tf  [( Based on this data, )] TJ ET
BT 26.250 466.762 Td /F1 9.8 Tf  [(the ceiling of the scoring rubric is therefore chosen to be 300,000. Below is a table showing multiple examples \(some CHE and )] TJ ET
BT 26.250 454.857 Td /F1 9.8 Tf  [(others not\), with their corresponding scores.)] TJ ET
q
26.250 431.240 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 433.987 Td /F1 9.8 Tf  [(Table 1. Total Number of Excess Deaths)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 223.362 555.000 200.378 re f
0.965 0.965 0.965 rg
27.000 398.806 160.304 24.184 re f
0.267 0.267 0.267 rg
26.625 422.615 160.679 0.750 re f
26.625 398.431 0.750 24.934 re f
0.271 0.267 0.267 rg
BT 31.500 413.466 Td /F4 9.8 Tf  [(Total number of excess)] TJ ET
BT 31.500 401.562 Td /F4 9.8 Tf  [(deaths)] TJ ET
0.965 0.965 0.965 rg
187.304 398.806 84.799 24.184 re f
0.267 0.267 0.267 rg
187.304 422.615 84.799 0.750 re f
0.271 0.267 0.267 rg
BT 191.804 413.466 Td /F4 9.8 Tf  [(Severity)] TJ ET
BT 191.804 401.562 Td /F4 9.8 Tf  [(score)] TJ ET
0.965 0.965 0.965 rg
272.103 398.806 216.453 24.184 re f
0.267 0.267 0.267 rg
272.103 422.615 216.453 0.750 re f
0.271 0.267 0.267 rg
BT 276.603 413.466 Td /F4 9.8 Tf  [(Country, year, type)] TJ ET
0.965 0.965 0.965 rg
488.556 398.806 91.944 24.184 re f
0.267 0.267 0.267 rg
488.556 422.615 92.319 0.750 re f
580.125 398.431 0.750 24.934 re f
0.271 0.267 0.267 rg
BT 493.056 413.466 Td /F4 9.8 Tf  [(Number of)] TJ ET
BT 493.056 401.562 Td /F4 9.8 Tf  [(deaths)] TJ ET
0.267 0.267 0.267 rg
26.625 398.431 161.054 0.750 re f
26.625 382.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 388.576 Td /F1 9.8 Tf  [(<10)] TJ ET
0.267 0.267 0.267 rg
186.929 398.431 85.549 0.750 re f
186.929 382.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 388.576 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
271.728 398.431 217.203 0.750 re f
271.728 382.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 388.576 Td /F1 9.8 Tf  [(None recorded by EM-DAT)] TJ ET
0.267 0.267 0.267 rg
488.181 398.431 92.694 0.750 re f
488.181 382.549 0.750 16.631 re f
580.125 382.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 388.576 Td /F1 9.8 Tf  [(N/A)] TJ ET
0.267 0.267 0.267 rg
26.625 382.549 161.054 0.750 re f
26.625 366.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 372.694 Td /F1 9.8 Tf  [(10-99)] TJ ET
0.267 0.267 0.267 rg
186.929 382.549 85.549 0.750 re f
186.929 366.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 372.694 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
271.728 382.549 217.203 0.750 re f
271.728 366.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 372.694 Td /F1 9.8 Tf  [(Greece, 2007, forest fire)] TJ ET
0.267 0.267 0.267 rg
488.181 382.549 92.694 0.750 re f
488.181 366.668 0.750 16.631 re f
580.125 366.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 372.694 Td /F1 9.8 Tf  [(67)] TJ ET
0.267 0.267 0.267 rg
26.625 366.668 161.054 0.750 re f
26.625 350.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 356.813 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
186.929 366.668 85.549 0.750 re f
186.929 350.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 356.813 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
271.728 366.668 217.203 0.750 re f
271.728 350.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 356.813 Td /F1 9.8 Tf  [(United States, 1947, explosion)] TJ ET
0.267 0.267 0.267 rg
488.181 366.668 92.694 0.750 re f
488.181 350.787 0.750 16.631 re f
580.125 350.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 356.813 Td /F1 9.8 Tf  [(561)] TJ ET
0.267 0.267 0.267 rg
26.625 350.787 161.054 0.750 re f
26.625 334.906 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 340.932 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
186.929 350.787 85.549 0.750 re f
186.929 334.906 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 340.932 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
271.728 350.787 217.203 0.750 re f
271.728 334.906 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 340.932 Td /F1 9.8 Tf  [(Papua New Guinea, 1951, volcanic eruption)] TJ ET
0.267 0.267 0.267 rg
488.181 350.787 92.694 0.750 re f
488.181 334.906 0.750 16.631 re f
580.125 334.906 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 340.932 Td /F1 9.8 Tf  [(3,000)] TJ ET
0.267 0.267 0.267 rg
26.625 334.906 161.054 0.750 re f
26.625 319.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 325.051 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
186.929 334.906 85.549 0.750 re f
186.929 319.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 325.051 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
271.728 334.906 217.203 0.750 re f
271.728 319.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 325.051 Td /F1 9.8 Tf  [(Germany 2003, heatwave)] TJ ET
0.267 0.267 0.267 rg
488.181 334.906 92.694 0.750 re f
488.181 319.024 0.750 16.631 re f
580.125 319.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 325.051 Td /F1 9.8 Tf  [(9,355)] TJ ET
0.267 0.267 0.267 rg
26.625 319.024 161.054 0.750 re f
26.625 303.143 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 309.169 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
186.929 319.024 85.549 0.750 re f
186.929 303.143 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 309.169 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
271.728 319.024 217.203 0.750 re f
271.728 303.143 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 309.169 Td /F1 9.8 Tf  [(Soviet Union, 1949, landslide)] TJ ET
0.267 0.267 0.267 rg
488.181 319.024 92.694 0.750 re f
488.181 303.143 0.750 16.631 re f
580.125 303.143 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 309.169 Td /F1 9.8 Tf  [(12,000)] TJ ET
0.267 0.267 0.267 rg
26.625 303.143 161.054 0.750 re f
26.625 287.262 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 293.288 Td /F1 9.8 Tf  [(20,000-49,999)] TJ ET
0.267 0.267 0.267 rg
186.929 303.143 85.549 0.750 re f
186.929 287.262 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 293.288 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
271.728 303.143 217.203 0.750 re f
271.728 287.262 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 293.288 Td /F1 9.8 Tf  [(India, 1942, tropical storm)] TJ ET
0.267 0.267 0.267 rg
488.181 303.143 92.694 0.750 re f
488.181 287.262 0.750 16.631 re f
580.125 287.262 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 293.288 Td /F1 9.8 Tf  [(40,000)] TJ ET
0.267 0.267 0.267 rg
26.625 287.262 161.054 0.750 re f
26.625 271.381 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 277.407 Td /F1 9.8 Tf  [(50,000-99,999)] TJ ET
0.267 0.267 0.267 rg
186.929 287.262 85.549 0.750 re f
186.929 271.381 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 277.407 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
271.728 287.262 217.203 0.750 re f
271.728 271.381 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 277.407 Td /F1 9.8 Tf  [(Pakistan, 2005, earthquake)] TJ ET
0.267 0.267 0.267 rg
488.181 287.262 92.694 0.750 re f
488.181 271.381 0.750 16.631 re f
580.125 271.381 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 277.407 Td /F1 9.8 Tf  [(73,338)] TJ ET
0.267 0.267 0.267 rg
26.625 271.381 161.054 0.750 re f
26.625 255.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 261.526 Td /F1 9.8 Tf  [(100,000-199,999)] TJ ET
0.267 0.267 0.267 rg
186.929 271.381 85.549 0.750 re f
186.929 255.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 261.526 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
271.728 271.381 217.203 0.750 re f
271.728 255.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 261.526 Td /F1 9.8 Tf  [(Japan, 1945, atomic bomb)] TJ ET
0.267 0.267 0.267 rg
488.181 271.381 92.694 0.750 re f
488.181 255.499 0.750 16.631 re f
580.125 255.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 261.526 Td /F1 9.8 Tf  [(105,000)] TJ ET
0.267 0.267 0.267 rg
26.625 255.499 161.054 0.750 re f
26.625 239.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 245.644 Td /F1 9.8 Tf  [(200,000-299,999)] TJ ET
0.267 0.267 0.267 rg
186.929 255.499 85.549 0.750 re f
186.929 239.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 245.644 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
271.728 255.499 217.203 0.750 re f
271.728 239.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 245.644 Td /F1 9.8 Tf  [(Haiti, 2010, earthquake)] TJ ET
0.267 0.267 0.267 rg
488.181 255.499 92.694 0.750 re f
488.181 239.618 0.750 16.631 re f
580.125 239.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 245.644 Td /F1 9.8 Tf  [(222,570)] TJ ET
0.267 0.267 0.267 rg
26.625 239.618 161.054 0.750 re f
26.625 223.737 161.054 0.750 re f
26.625 223.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 229.763 Td /F1 9.8 Tf  [(Greater than or equal to 300,000)] TJ ET
0.267 0.267 0.267 rg
186.929 239.618 85.549 0.750 re f
186.929 223.737 85.549 0.750 re f
186.929 223.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 192.179 229.763 Td /F1 9.8 Tf  [(10)] TJ ET
0.267 0.267 0.267 rg
271.728 239.618 217.203 0.750 re f
271.728 223.737 217.203 0.750 re f
271.728 223.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 276.978 229.763 Td /F1 9.8 Tf  [(Bangladesh, 1970, tropical cyclone)] TJ ET
0.267 0.267 0.267 rg
488.181 239.618 92.694 0.750 re f
488.181 223.737 92.694 0.750 re f
488.181 223.737 0.750 16.631 re f
580.125 223.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 493.431 229.763 Td /F1 9.8 Tf  [(300,000)] TJ ET
BT 26.250 168.838 Td /F4 9.8 Tf  [(2. Number of Under-5 Excess Deaths:)] TJ ET
BT 200.171 168.838 Td /F1 9.8 Tf  [( Under-five \(year old\) excess mortality rate \(U5MR\) is calculated in the same way as )] TJ ET
BT 26.250 156.933 Td /F1 9.8 Tf  [(the parameter above, using the difference between the observed and baseline under-5 mortality rates, and multiplying the result )] TJ ET
BT 26.250 145.029 Td /F1 9.8 Tf  [(by the estimated affected population of that age group per the time period since the onset of CHE. The reason to include this )] TJ ET
BT 26.250 133.124 Td /F1 9.8 Tf  [(parameter, having already included the one above \(total number of excess deaths\), is because it better reflects the most )] TJ ET
BT 26.250 121.219 Td /F1 9.8 Tf  [(vulnerable group, since the under-5 mortality rate is an early sensitive indicator of the mortality impact of CHE. Both UNHCR )] TJ ET
BT 26.250 109.314 Td /F1 9.8 Tf  [(and MSF have determined that the emergency benchmark for U5MR is 2 per 10,000 per day.)] TJ ET
0.267 0.267 0.267 rg
BT 427.804 110.822 Td /F4 8.7 Tf  [(11)] TJ ET
BT 437.441 110.822 Td /F4 8.7 Tf  [(12)] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(3)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

Q
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stream

0.267 0.267 0.267 rg
q
15.000 180.935 577.500 596.065 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 2. Number of Under-5 Excess Deaths)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 567.290 555.000 188.473 re f
0.965 0.965 0.965 rg
27.000 742.734 362.067 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 362.442 0.750 re f
26.625 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 745.490 Td /F4 9.8 Tf  [(Number of under-5 excess deaths)] TJ ET
0.965 0.965 0.965 rg
389.067 742.734 191.433 12.280 re f
0.267 0.267 0.267 rg
389.067 754.639 191.808 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 393.567 745.490 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 362.817 0.750 re f
26.625 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 732.504 Td /F1 9.8 Tf  [(<10)] TJ ET
0.267 0.267 0.267 rg
388.692 742.359 192.183 0.750 re f
388.692 726.478 0.750 16.631 re f
580.125 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 732.504 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 726.478 362.817 0.750 re f
26.625 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 716.623 Td /F1 9.8 Tf  [(10-99)] TJ ET
0.267 0.267 0.267 rg
388.692 726.478 192.183 0.750 re f
388.692 710.596 0.750 16.631 re f
580.125 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 716.623 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 710.596 362.817 0.750 re f
26.625 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 700.741 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
388.692 710.596 192.183 0.750 re f
388.692 694.715 0.750 16.631 re f
580.125 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 700.741 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 694.715 362.817 0.750 re f
26.625 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 684.860 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
388.692 694.715 192.183 0.750 re f
388.692 678.834 0.750 16.631 re f
580.125 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 684.860 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 678.834 362.817 0.750 re f
26.625 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 668.979 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
388.692 678.834 192.183 0.750 re f
388.692 662.953 0.750 16.631 re f
580.125 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 668.979 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 662.953 362.817 0.750 re f
26.625 647.071 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 653.098 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
388.692 662.953 192.183 0.750 re f
388.692 647.071 0.750 16.631 re f
580.125 647.071 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 653.098 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 647.071 362.817 0.750 re f
26.625 631.190 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 637.216 Td /F1 9.8 Tf  [(20,000-29,999)] TJ ET
0.267 0.267 0.267 rg
388.692 647.071 192.183 0.750 re f
388.692 631.190 0.750 16.631 re f
580.125 631.190 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 637.216 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 631.190 362.817 0.750 re f
26.625 615.309 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 621.335 Td /F1 9.8 Tf  [(30,000-39,999)] TJ ET
0.267 0.267 0.267 rg
388.692 631.190 192.183 0.750 re f
388.692 615.309 0.750 16.631 re f
580.125 615.309 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 621.335 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 615.309 362.817 0.750 re f
26.625 599.428 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 605.454 Td /F1 9.8 Tf  [(40,000-49,999)] TJ ET
0.267 0.267 0.267 rg
388.692 615.309 192.183 0.750 re f
388.692 599.428 0.750 16.631 re f
580.125 599.428 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 605.454 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 599.428 362.817 0.750 re f
26.625 583.546 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 589.573 Td /F1 9.8 Tf  [(50,000-59,999)] TJ ET
0.267 0.267 0.267 rg
388.692 599.428 192.183 0.750 re f
388.692 583.546 0.750 16.631 re f
580.125 583.546 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 589.573 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
26.625 583.546 362.817 0.750 re f
26.625 567.665 362.817 0.750 re f
26.625 567.665 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 573.691 Td /F1 9.8 Tf  [(Greater than or equal to 60,000)] TJ ET
0.267 0.267 0.267 rg
388.692 583.546 192.183 0.750 re f
388.692 567.665 192.183 0.750 re f
388.692 567.665 0.750 16.631 re f
580.125 567.665 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 573.691 Td /F1 9.8 Tf  [(10)] TJ ET
BT 26.250 512.766 Td /F1 9.8 Tf  [(The floor of the scoring rubric for this parameter was chosen to be 10 deaths, based on CRED criteria. The remainder of this )] TJ ET
BT 26.250 500.862 Td /F1 9.8 Tf  [(scoring rubric, beyond the baseline, is stochastic. For illustration purposes, it was estimated that 46,900 excess deaths among )] TJ ET
BT 26.250 488.957 Td /F1 9.8 Tf  [(young Iraqi children \(under-5 years old\) occurred from January 1991 through August 1991, due to the Gulf War and subsequent )] TJ ET
BT 26.250 477.052 Td /F1 9.8 Tf  [(sanctions.)] TJ ET
0.267 0.267 0.267 rg
BT 70.144 478.559 Td /F4 8.7 Tf  [(14)] TJ ET
0.271 0.267 0.267 rg
BT 79.782 477.052 Td /F1 9.8 Tf  [( Based on this parameter, this particular CHE would be assigned a score of 8.)] TJ ET
BT 26.250 457.647 Td /F4 9.8 Tf  [(3. Number of Cases with Acute Communicable Diseases:)] TJ ET
BT 290.114 457.647 Td /F1 9.8 Tf  [( Following a CHE, the risk of infectious diseases outbreaks )] TJ ET
BT 26.250 445.743 Td /F1 9.8 Tf  [(increases.)] TJ ET
0.267 0.267 0.267 rg
BT 70.681 447.250 Td /F4 8.7 Tf  [(15)] TJ ET
0.271 0.267 0.267 rg
BT 80.318 445.743 Td /F1 9.8 Tf  [( Many factors contribute to the outbreak and transmission of such diseases, including: overcrowding, scarcity of )] TJ ET
BT 26.250 433.838 Td /F1 9.8 Tf  [(safe water, poor sanitation and waste management, poor immunization levels and nutritional status, inadequate access to )] TJ ET
BT 26.250 421.933 Td /F1 9.8 Tf  [(health care, in addition to the collapse of public health infrastructure hampering prevention and control programs. Since acute )] TJ ET
BT 26.250 410.028 Td /F1 9.8 Tf  [(communicable diseases present an active major threat, the most common acute communicable diseases in CHE were chosen )] TJ ET
BT 26.250 398.124 Td /F1 9.8 Tf  [(for this parameter; namely diarrheal illnesses, acute respiratory infections, measles, malaria, in addition to meningitis and )] TJ ET
BT 26.250 386.219 Td /F1 9.8 Tf  [(hepatitis A. Naturally-emerging infectious diseases \(like the Ebola virus outbreak in Zaire 1995\) would be included, as would )] TJ ET
BT 26.250 374.314 Td /F1 9.8 Tf  [(outbreaks due to biological weapons. In 2002, 207 outbreak events of international public health importance were verified, and )] TJ ET
BT 26.250 362.409 Td /F1 9.8 Tf  [(29% of them were recorded in countries affected by complex emergencies.)] TJ ET
0.267 0.267 0.267 rg
BT 349.219 363.917 Td /F4 8.7 Tf  [(16)] TJ ET
0.271 0.267 0.267 rg
BT 358.856 362.409 Td /F1 9.8 Tf  [( As of 25 October 2010, the Haitian Ministry of )] TJ ET
BT 26.250 350.505 Td /F1 9.8 Tf  [(Health reported 3,342 confirmed cases of cholera, with many suspected cases that are being investigated.)] TJ ET
0.267 0.267 0.267 rg
BT 484.178 352.012 Td /F4 8.7 Tf  [(17)] TJ ET
0.271 0.267 0.267 rg
BT 493.816 350.505 Td /F1 9.8 Tf  [( In 1994, after the )] TJ ET
BT 26.250 338.600 Td /F1 9.8 Tf  [(influx of 800,000 Rwandan refugees into North Kivu, Democratic Republic of the Congo, 43,000 deaths that were recorded in )] TJ ET
BT 26.250 326.695 Td /F1 9.8 Tf  [(the first month were caused by diarrheal diseases; 60% of which were a result of cholera, and 40% were caused by shigella )] TJ ET
BT 26.250 314.790 Td /F1 9.8 Tf  [(dysentery.)] TJ ET
0.267 0.267 0.267 rg
BT 71.227 316.298 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 80.864 314.790 Td /F1 9.8 Tf  [( Acute respiratory infections caused 63% of the morbidity in Nicaraguan refugees in Costa Rica in 1989.)] TJ ET
0.267 0.267 0.267 rg
BT 528.477 316.298 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 295.386 Td /F1 9.8 Tf  [(The estimated absolute number of cases with acute communicable disease cases is used in this parameter. In addition to this )] TJ ET
BT 26.250 283.481 Td /F1 9.8 Tf  [(parameter, four out of the 12 parameters also utilize absolute numbers for affected persons \(other than dead\). These other )] TJ ET
BT 26.250 271.576 Td /F1 9.8 Tf  [(parameters are: number of cases with traumatic/chemical/radiological injuries; number of children with acute malnutrition; )] TJ ET
BT 26.250 259.671 Td /F1 9.8 Tf  [(number of displaced persons; and number of persons with inadequate living space. The baseline for these parameters is set at )] TJ ET
BT 26.250 247.767 Td /F1 9.8 Tf  [(20 so the cumulative total would add to a minimum of 100. This was purposefully designed since CRED lists �more than 100 )] TJ ET
BT 26.250 235.862 Td /F1 9.8 Tf  [(affected persons� as one of its criteria to enter a disaster in its registry. For example, a CHE that causes 19 cases in each of )] TJ ET
BT 26.250 223.957 Td /F1 9.8 Tf  [(these 5 parameters \(a total of 95 affected persons\) would get a score of 0 on each parameter, and would not qualify to enter the )] TJ ET
BT 26.250 212.052 Td /F1 9.8 Tf  [(CRED registry.)] TJ ET
Q
q
15.000 180.935 577.500 596.065 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 2. Number of Under-5 Excess Deaths)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 567.290 555.000 188.473 re f
0.965 0.965 0.965 rg
27.000 742.734 362.067 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 362.442 0.750 re f
26.625 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 745.490 Td /F4 9.8 Tf  [(Number of under-5 excess deaths)] TJ ET
0.965 0.965 0.965 rg
389.067 742.734 191.433 12.280 re f
0.267 0.267 0.267 rg
389.067 754.639 191.808 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 393.567 745.490 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 362.817 0.750 re f
26.625 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 732.504 Td /F1 9.8 Tf  [(<10)] TJ ET
0.267 0.267 0.267 rg
388.692 742.359 192.183 0.750 re f
388.692 726.478 0.750 16.631 re f
580.125 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 732.504 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 726.478 362.817 0.750 re f
26.625 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 716.623 Td /F1 9.8 Tf  [(10-99)] TJ ET
0.267 0.267 0.267 rg
388.692 726.478 192.183 0.750 re f
388.692 710.596 0.750 16.631 re f
580.125 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 716.623 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 710.596 362.817 0.750 re f
26.625 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 700.741 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
388.692 710.596 192.183 0.750 re f
388.692 694.715 0.750 16.631 re f
580.125 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 700.741 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 694.715 362.817 0.750 re f
26.625 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 684.860 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
388.692 694.715 192.183 0.750 re f
388.692 678.834 0.750 16.631 re f
580.125 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 684.860 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 678.834 362.817 0.750 re f
26.625 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 668.979 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
388.692 678.834 192.183 0.750 re f
388.692 662.953 0.750 16.631 re f
580.125 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 668.979 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 662.953 362.817 0.750 re f
26.625 647.071 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 653.098 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
388.692 662.953 192.183 0.750 re f
388.692 647.071 0.750 16.631 re f
580.125 647.071 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 653.098 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 647.071 362.817 0.750 re f
26.625 631.190 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 637.216 Td /F1 9.8 Tf  [(20,000-29,999)] TJ ET
0.267 0.267 0.267 rg
388.692 647.071 192.183 0.750 re f
388.692 631.190 0.750 16.631 re f
580.125 631.190 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 637.216 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 631.190 362.817 0.750 re f
26.625 615.309 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 621.335 Td /F1 9.8 Tf  [(30,000-39,999)] TJ ET
0.267 0.267 0.267 rg
388.692 631.190 192.183 0.750 re f
388.692 615.309 0.750 16.631 re f
580.125 615.309 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 621.335 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 615.309 362.817 0.750 re f
26.625 599.428 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 605.454 Td /F1 9.8 Tf  [(40,000-49,999)] TJ ET
0.267 0.267 0.267 rg
388.692 615.309 192.183 0.750 re f
388.692 599.428 0.750 16.631 re f
580.125 599.428 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 605.454 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 599.428 362.817 0.750 re f
26.625 583.546 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 589.573 Td /F1 9.8 Tf  [(50,000-59,999)] TJ ET
0.267 0.267 0.267 rg
388.692 599.428 192.183 0.750 re f
388.692 583.546 0.750 16.631 re f
580.125 583.546 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 589.573 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
26.625 583.546 362.817 0.750 re f
26.625 567.665 362.817 0.750 re f
26.625 567.665 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 573.691 Td /F1 9.8 Tf  [(Greater than or equal to 60,000)] TJ ET
0.267 0.267 0.267 rg
388.692 583.546 192.183 0.750 re f
388.692 567.665 192.183 0.750 re f
388.692 567.665 0.750 16.631 re f
580.125 567.665 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 573.691 Td /F1 9.8 Tf  [(10)] TJ ET
BT 26.250 512.766 Td /F1 9.8 Tf  [(The floor of the scoring rubric for this parameter was chosen to be 10 deaths, based on CRED criteria. The remainder of this )] TJ ET
BT 26.250 500.862 Td /F1 9.8 Tf  [(scoring rubric, beyond the baseline, is stochastic. For illustration purposes, it was estimated that 46,900 excess deaths among )] TJ ET
BT 26.250 488.957 Td /F1 9.8 Tf  [(young Iraqi children \(under-5 years old\) occurred from January 1991 through August 1991, due to the Gulf War and subsequent )] TJ ET
BT 26.250 477.052 Td /F1 9.8 Tf  [(sanctions.)] TJ ET
0.267 0.267 0.267 rg
BT 70.144 478.559 Td /F4 8.7 Tf  [(14)] TJ ET
0.271 0.267 0.267 rg
BT 79.782 477.052 Td /F1 9.8 Tf  [( Based on this parameter, this particular CHE would be assigned a score of 8.)] TJ ET
BT 26.250 457.647 Td /F4 9.8 Tf  [(3. Number of Cases with Acute Communicable Diseases:)] TJ ET
BT 290.114 457.647 Td /F1 9.8 Tf  [( Following a CHE, the risk of infectious diseases outbreaks )] TJ ET
BT 26.250 445.743 Td /F1 9.8 Tf  [(increases.)] TJ ET
0.267 0.267 0.267 rg
BT 70.681 447.250 Td /F4 8.7 Tf  [(15)] TJ ET
0.271 0.267 0.267 rg
BT 80.318 445.743 Td /F1 9.8 Tf  [( Many factors contribute to the outbreak and transmission of such diseases, including: overcrowding, scarcity of )] TJ ET
BT 26.250 433.838 Td /F1 9.8 Tf  [(safe water, poor sanitation and waste management, poor immunization levels and nutritional status, inadequate access to )] TJ ET
BT 26.250 421.933 Td /F1 9.8 Tf  [(health care, in addition to the collapse of public health infrastructure hampering prevention and control programs. Since acute )] TJ ET
BT 26.250 410.028 Td /F1 9.8 Tf  [(communicable diseases present an active major threat, the most common acute communicable diseases in CHE were chosen )] TJ ET
BT 26.250 398.124 Td /F1 9.8 Tf  [(for this parameter; namely diarrheal illnesses, acute respiratory infections, measles, malaria, in addition to meningitis and )] TJ ET
BT 26.250 386.219 Td /F1 9.8 Tf  [(hepatitis A. Naturally-emerging infectious diseases \(like the Ebola virus outbreak in Zaire 1995\) would be included, as would )] TJ ET
BT 26.250 374.314 Td /F1 9.8 Tf  [(outbreaks due to biological weapons. In 2002, 207 outbreak events of international public health importance were verified, and )] TJ ET
BT 26.250 362.409 Td /F1 9.8 Tf  [(29% of them were recorded in countries affected by complex emergencies.)] TJ ET
0.267 0.267 0.267 rg
BT 349.219 363.917 Td /F4 8.7 Tf  [(16)] TJ ET
0.271 0.267 0.267 rg
BT 358.856 362.409 Td /F1 9.8 Tf  [( As of 25 October 2010, the Haitian Ministry of )] TJ ET
BT 26.250 350.505 Td /F1 9.8 Tf  [(Health reported 3,342 confirmed cases of cholera, with many suspected cases that are being investigated.)] TJ ET
0.267 0.267 0.267 rg
BT 484.178 352.012 Td /F4 8.7 Tf  [(17)] TJ ET
0.271 0.267 0.267 rg
BT 493.816 350.505 Td /F1 9.8 Tf  [( In 1994, after the )] TJ ET
BT 26.250 338.600 Td /F1 9.8 Tf  [(influx of 800,000 Rwandan refugees into North Kivu, Democratic Republic of the Congo, 43,000 deaths that were recorded in )] TJ ET
BT 26.250 326.695 Td /F1 9.8 Tf  [(the first month were caused by diarrheal diseases; 60% of which were a result of cholera, and 40% were caused by shigella )] TJ ET
BT 26.250 314.790 Td /F1 9.8 Tf  [(dysentery.)] TJ ET
0.267 0.267 0.267 rg
BT 71.227 316.298 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 80.864 314.790 Td /F1 9.8 Tf  [( Acute respiratory infections caused 63% of the morbidity in Nicaraguan refugees in Costa Rica in 1989.)] TJ ET
0.267 0.267 0.267 rg
BT 528.477 316.298 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 295.386 Td /F1 9.8 Tf  [(The estimated absolute number of cases with acute communicable disease cases is used in this parameter. In addition to this )] TJ ET
BT 26.250 283.481 Td /F1 9.8 Tf  [(parameter, four out of the 12 parameters also utilize absolute numbers for affected persons \(other than dead\). These other )] TJ ET
BT 26.250 271.576 Td /F1 9.8 Tf  [(parameters are: number of cases with traumatic/chemical/radiological injuries; number of children with acute malnutrition; )] TJ ET
BT 26.250 259.671 Td /F1 9.8 Tf  [(number of displaced persons; and number of persons with inadequate living space. The baseline for these parameters is set at )] TJ ET
BT 26.250 247.767 Td /F1 9.8 Tf  [(20 so the cumulative total would add to a minimum of 100. This was purposefully designed since CRED lists �more than 100 )] TJ ET
BT 26.250 235.862 Td /F1 9.8 Tf  [(affected persons� as one of its criteria to enter a disaster in its registry. For example, a CHE that causes 19 cases in each of )] TJ ET
BT 26.250 223.957 Td /F1 9.8 Tf  [(these 5 parameters \(a total of 95 affected persons\) would get a score of 0 on each parameter, and would not qualify to enter the )] TJ ET
BT 26.250 212.052 Td /F1 9.8 Tf  [(CRED registry.)] TJ ET
Q
q
15.000 180.935 577.500 596.065 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 2. Number of Under-5 Excess Deaths)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 567.290 555.000 188.473 re f
0.965 0.965 0.965 rg
27.000 742.734 362.067 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 362.442 0.750 re f
26.625 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 745.490 Td /F4 9.8 Tf  [(Number of under-5 excess deaths)] TJ ET
0.965 0.965 0.965 rg
389.067 742.734 191.433 12.280 re f
0.267 0.267 0.267 rg
389.067 754.639 191.808 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 393.567 745.490 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 362.817 0.750 re f
26.625 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 732.504 Td /F1 9.8 Tf  [(<10)] TJ ET
0.267 0.267 0.267 rg
388.692 742.359 192.183 0.750 re f
388.692 726.478 0.750 16.631 re f
580.125 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 732.504 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 726.478 362.817 0.750 re f
26.625 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 716.623 Td /F1 9.8 Tf  [(10-99)] TJ ET
0.267 0.267 0.267 rg
388.692 726.478 192.183 0.750 re f
388.692 710.596 0.750 16.631 re f
580.125 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 716.623 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 710.596 362.817 0.750 re f
26.625 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 700.741 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
388.692 710.596 192.183 0.750 re f
388.692 694.715 0.750 16.631 re f
580.125 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 700.741 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 694.715 362.817 0.750 re f
26.625 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 684.860 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
388.692 694.715 192.183 0.750 re f
388.692 678.834 0.750 16.631 re f
580.125 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 684.860 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 678.834 362.817 0.750 re f
26.625 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 668.979 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
388.692 678.834 192.183 0.750 re f
388.692 662.953 0.750 16.631 re f
580.125 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 668.979 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 662.953 362.817 0.750 re f
26.625 647.071 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 653.098 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
388.692 662.953 192.183 0.750 re f
388.692 647.071 0.750 16.631 re f
580.125 647.071 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 653.098 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 647.071 362.817 0.750 re f
26.625 631.190 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 637.216 Td /F1 9.8 Tf  [(20,000-29,999)] TJ ET
0.267 0.267 0.267 rg
388.692 647.071 192.183 0.750 re f
388.692 631.190 0.750 16.631 re f
580.125 631.190 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 637.216 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 631.190 362.817 0.750 re f
26.625 615.309 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 621.335 Td /F1 9.8 Tf  [(30,000-39,999)] TJ ET
0.267 0.267 0.267 rg
388.692 631.190 192.183 0.750 re f
388.692 615.309 0.750 16.631 re f
580.125 615.309 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 621.335 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 615.309 362.817 0.750 re f
26.625 599.428 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 605.454 Td /F1 9.8 Tf  [(40,000-49,999)] TJ ET
0.267 0.267 0.267 rg
388.692 615.309 192.183 0.750 re f
388.692 599.428 0.750 16.631 re f
580.125 599.428 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 605.454 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 599.428 362.817 0.750 re f
26.625 583.546 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 589.573 Td /F1 9.8 Tf  [(50,000-59,999)] TJ ET
0.267 0.267 0.267 rg
388.692 599.428 192.183 0.750 re f
388.692 583.546 0.750 16.631 re f
580.125 583.546 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 589.573 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
26.625 583.546 362.817 0.750 re f
26.625 567.665 362.817 0.750 re f
26.625 567.665 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 573.691 Td /F1 9.8 Tf  [(Greater than or equal to 60,000)] TJ ET
0.267 0.267 0.267 rg
388.692 583.546 192.183 0.750 re f
388.692 567.665 192.183 0.750 re f
388.692 567.665 0.750 16.631 re f
580.125 567.665 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 393.942 573.691 Td /F1 9.8 Tf  [(10)] TJ ET
BT 26.250 512.766 Td /F1 9.8 Tf  [(The floor of the scoring rubric for this parameter was chosen to be 10 deaths, based on CRED criteria. The remainder of this )] TJ ET
BT 26.250 500.862 Td /F1 9.8 Tf  [(scoring rubric, beyond the baseline, is stochastic. For illustration purposes, it was estimated that 46,900 excess deaths among )] TJ ET
BT 26.250 488.957 Td /F1 9.8 Tf  [(young Iraqi children \(under-5 years old\) occurred from January 1991 through August 1991, due to the Gulf War and subsequent )] TJ ET
BT 26.250 477.052 Td /F1 9.8 Tf  [(sanctions.)] TJ ET
0.267 0.267 0.267 rg
BT 70.144 478.559 Td /F4 8.7 Tf  [(14)] TJ ET
0.271 0.267 0.267 rg
BT 79.782 477.052 Td /F1 9.8 Tf  [( Based on this parameter, this particular CHE would be assigned a score of 8.)] TJ ET
BT 26.250 457.647 Td /F4 9.8 Tf  [(3. Number of Cases with Acute Communicable Diseases:)] TJ ET
BT 290.114 457.647 Td /F1 9.8 Tf  [( Following a CHE, the risk of infectious diseases outbreaks )] TJ ET
BT 26.250 445.743 Td /F1 9.8 Tf  [(increases.)] TJ ET
0.267 0.267 0.267 rg
BT 70.681 447.250 Td /F4 8.7 Tf  [(15)] TJ ET
0.271 0.267 0.267 rg
BT 80.318 445.743 Td /F1 9.8 Tf  [( Many factors contribute to the outbreak and transmission of such diseases, including: overcrowding, scarcity of )] TJ ET
BT 26.250 433.838 Td /F1 9.8 Tf  [(safe water, poor sanitation and waste management, poor immunization levels and nutritional status, inadequate access to )] TJ ET
BT 26.250 421.933 Td /F1 9.8 Tf  [(health care, in addition to the collapse of public health infrastructure hampering prevention and control programs. Since acute )] TJ ET
BT 26.250 410.028 Td /F1 9.8 Tf  [(communicable diseases present an active major threat, the most common acute communicable diseases in CHE were chosen )] TJ ET
BT 26.250 398.124 Td /F1 9.8 Tf  [(for this parameter; namely diarrheal illnesses, acute respiratory infections, measles, malaria, in addition to meningitis and )] TJ ET
BT 26.250 386.219 Td /F1 9.8 Tf  [(hepatitis A. Naturally-emerging infectious diseases \(like the Ebola virus outbreak in Zaire 1995\) would be included, as would )] TJ ET
BT 26.250 374.314 Td /F1 9.8 Tf  [(outbreaks due to biological weapons. In 2002, 207 outbreak events of international public health importance were verified, and )] TJ ET
BT 26.250 362.409 Td /F1 9.8 Tf  [(29% of them were recorded in countries affected by complex emergencies.)] TJ ET
0.267 0.267 0.267 rg
BT 349.219 363.917 Td /F4 8.7 Tf  [(16)] TJ ET
0.271 0.267 0.267 rg
BT 358.856 362.409 Td /F1 9.8 Tf  [( As of 25 October 2010, the Haitian Ministry of )] TJ ET
BT 26.250 350.505 Td /F1 9.8 Tf  [(Health reported 3,342 confirmed cases of cholera, with many suspected cases that are being investigated.)] TJ ET
0.267 0.267 0.267 rg
BT 484.178 352.012 Td /F4 8.7 Tf  [(17)] TJ ET
0.271 0.267 0.267 rg
BT 493.816 350.505 Td /F1 9.8 Tf  [( In 1994, after the )] TJ ET
BT 26.250 338.600 Td /F1 9.8 Tf  [(influx of 800,000 Rwandan refugees into North Kivu, Democratic Republic of the Congo, 43,000 deaths that were recorded in )] TJ ET
BT 26.250 326.695 Td /F1 9.8 Tf  [(the first month were caused by diarrheal diseases; 60% of which were a result of cholera, and 40% were caused by shigella )] TJ ET
BT 26.250 314.790 Td /F1 9.8 Tf  [(dysentery.)] TJ ET
0.267 0.267 0.267 rg
BT 71.227 316.298 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 80.864 314.790 Td /F1 9.8 Tf  [( Acute respiratory infections caused 63% of the morbidity in Nicaraguan refugees in Costa Rica in 1989.)] TJ ET
0.267 0.267 0.267 rg
BT 528.477 316.298 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 295.386 Td /F1 9.8 Tf  [(The estimated absolute number of cases with acute communicable disease cases is used in this parameter. In addition to this )] TJ ET
BT 26.250 283.481 Td /F1 9.8 Tf  [(parameter, four out of the 12 parameters also utilize absolute numbers for affected persons \(other than dead\). These other )] TJ ET
BT 26.250 271.576 Td /F1 9.8 Tf  [(parameters are: number of cases with traumatic/chemical/radiological injuries; number of children with acute malnutrition; )] TJ ET
BT 26.250 259.671 Td /F1 9.8 Tf  [(number of displaced persons; and number of persons with inadequate living space. The baseline for these parameters is set at )] TJ ET
BT 26.250 247.767 Td /F1 9.8 Tf  [(20 so the cumulative total would add to a minimum of 100. This was purposefully designed since CRED lists �more than 100 )] TJ ET
BT 26.250 235.862 Td /F1 9.8 Tf  [(affected persons� as one of its criteria to enter a disaster in its registry. For example, a CHE that causes 19 cases in each of )] TJ ET
BT 26.250 223.957 Td /F1 9.8 Tf  [(these 5 parameters \(a total of 95 affected persons\) would get a score of 0 on each parameter, and would not qualify to enter the )] TJ ET
BT 26.250 212.052 Td /F1 9.8 Tf  [(CRED registry.)] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(4)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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0.271 0.267 0.267 rg
q
15.000 254.710 577.500 522.290 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 3. Number of Cases with Acute Communicable Diseases)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 422.362 555.000 333.402 re f
0.965 0.965 0.965 rg
27.000 742.734 407.687 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 408.062 0.750 re f
26.625 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 745.490 Td /F4 9.8 Tf  [(Number of cases with acute communicable diseases)] TJ ET
0.965 0.965 0.965 rg
434.687 742.734 145.813 12.280 re f
0.267 0.267 0.267 rg
434.687 754.639 146.188 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 439.187 745.490 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 408.437 0.750 re f
26.625 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 732.504 Td /F1 9.8 Tf  [(<20)] TJ ET
0.267 0.267 0.267 rg
434.312 742.359 146.563 0.750 re f
434.312 726.478 0.750 16.631 re f
580.125 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 732.504 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 726.478 408.437 0.750 re f
26.625 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 716.623 Td /F1 9.8 Tf  [(20-99)] TJ ET
0.267 0.267 0.267 rg
434.312 726.478 146.563 0.750 re f
434.312 710.596 0.750 16.631 re f
580.125 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 716.623 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 710.596 408.437 0.750 re f
26.625 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 700.741 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
434.312 710.596 146.563 0.750 re f
434.312 694.715 0.750 16.631 re f
580.125 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 700.741 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 694.715 408.437 0.750 re f
26.625 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 684.860 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
434.312 694.715 146.563 0.750 re f
434.312 678.834 0.750 16.631 re f
580.125 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 684.860 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 678.834 408.437 0.750 re f
26.625 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 668.979 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
434.312 678.834 146.563 0.750 re f
434.312 662.953 0.750 16.631 re f
580.125 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 668.979 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 662.953 408.437 0.750 re f
26.625 647.071 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 653.098 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
434.312 662.953 146.563 0.750 re f
434.312 647.071 0.750 16.631 re f
580.125 647.071 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 653.098 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 647.071 408.437 0.750 re f
26.625 486.262 0.750 161.560 re f
0.271 0.267 0.267 rg
BT 31.875 637.216 Td /F1 9.8 Tf  [(20,000-29,999)] TJ ET
0.267 0.267 0.267 rg
434.312 647.071 146.563 0.750 re f
434.312 486.262 0.750 161.560 re f
580.125 486.262 0.750 161.560 re f
0.271 0.267 0.267 rg
BT 439.562 637.216 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 486.262 408.437 0.750 re f
26.625 470.380 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 476.407 Td /F1 9.8 Tf  [(30,000-39,999)] TJ ET
0.267 0.267 0.267 rg
434.312 486.262 146.563 0.750 re f
434.312 470.380 0.750 16.631 re f
580.125 470.380 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 476.407 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 470.380 408.437 0.750 re f
26.625 454.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 460.525 Td /F1 9.8 Tf  [(40,000-49,999)] TJ ET
0.267 0.267 0.267 rg
434.312 470.380 146.563 0.750 re f
434.312 454.499 0.750 16.631 re f
580.125 454.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 460.525 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 454.499 408.437 0.750 re f
26.625 438.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 444.644 Td /F1 9.8 Tf  [(50,000-59,999)] TJ ET
0.267 0.267 0.267 rg
434.312 454.499 146.563 0.750 re f
434.312 438.618 0.750 16.631 re f
580.125 438.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 444.644 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
26.625 438.618 408.437 0.750 re f
26.625 422.737 408.437 0.750 re f
26.625 422.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 428.763 Td /F1 9.8 Tf  [(Greater than or equal to 60,000)] TJ ET
0.267 0.267 0.267 rg
434.312 438.618 146.563 0.750 re f
434.312 422.737 146.563 0.750 re f
434.312 422.737 0.750 16.631 re f
580.125 422.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 428.763 Td /F1 9.8 Tf  [(10)] TJ ET
BT 26.250 367.838 Td /F4 9.8 Tf  [(4. Number of Cases with Traumatic/Chemical/Radiological Injuries:)] TJ ET
BT 336.173 367.838 Td /F1 9.8 Tf  [( The absolute number of people with traumatic injuries )] TJ ET
BT 26.250 355.933 Td /F1 9.8 Tf  [(attributable to CHE \(blunt or penetrating, directly or indirectly\) is another important indicator of the magnitude of emergencies. It )] TJ ET
BT 26.250 344.028 Td /F1 9.8 Tf  [(adds another level of complexity facing the medical system and humanitarian response. In addition, chemical and radiological )] TJ ET
BT 26.250 332.124 Td /F1 9.8 Tf  [(CHE also present an acute burden of disease requiring special capacities. The baseline of the scoring rubric in this parameter )] TJ ET
BT 26.250 320.219 Td /F1 9.8 Tf  [(\(<20 would get a zero\) also stems from CRED criteria, as explained in parameter 3. The ceiling for this parameter is chosen to )] TJ ET
BT 26.250 308.314 Td /F1 9.8 Tf  [(be 300,000 because the 2010 Haitian earthquake has also caused one of the highest numbers of documented acute injuries in )] TJ ET
BT 26.250 296.409 Td /F1 9.8 Tf  [(the setting of CHE.)] TJ ET
0.267 0.267 0.267 rg
BT 108.082 297.917 Td /F4 8.7 Tf  [(19)] TJ ET
0.271 0.267 0.267 rg
BT 117.719 296.409 Td /F1 9.8 Tf  [( Below is a table showing multiple examples \(some CHE and others not\), with their corresponding scores.)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 286.012 Td /F4 8.7 Tf  [(13)] TJ ET
BT 35.887 286.012 Td /F4 8.7 Tf  [(19)] TJ ET
BT 45.525 286.012 Td /F4 8.7 Tf  [(20)] TJ ET
BT 55.162 286.012 Td /F4 8.7 Tf  [(21)] TJ ET
Q
q
15.000 254.710 577.500 522.290 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 3. Number of Cases with Acute Communicable Diseases)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 422.362 555.000 333.402 re f
0.965 0.965 0.965 rg
27.000 742.734 407.687 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 408.062 0.750 re f
26.625 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 745.490 Td /F4 9.8 Tf  [(Number of cases with acute communicable diseases)] TJ ET
0.965 0.965 0.965 rg
434.687 742.734 145.813 12.280 re f
0.267 0.267 0.267 rg
434.687 754.639 146.188 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 439.187 745.490 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 408.437 0.750 re f
26.625 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 732.504 Td /F1 9.8 Tf  [(<20)] TJ ET
0.267 0.267 0.267 rg
434.312 742.359 146.563 0.750 re f
434.312 726.478 0.750 16.631 re f
580.125 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 732.504 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 726.478 408.437 0.750 re f
26.625 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 716.623 Td /F1 9.8 Tf  [(20-99)] TJ ET
0.267 0.267 0.267 rg
434.312 726.478 146.563 0.750 re f
434.312 710.596 0.750 16.631 re f
580.125 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 716.623 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 710.596 408.437 0.750 re f
26.625 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 700.741 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
434.312 710.596 146.563 0.750 re f
434.312 694.715 0.750 16.631 re f
580.125 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 700.741 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 694.715 408.437 0.750 re f
26.625 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 684.860 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
434.312 694.715 146.563 0.750 re f
434.312 678.834 0.750 16.631 re f
580.125 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 684.860 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 678.834 408.437 0.750 re f
26.625 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 668.979 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
434.312 678.834 146.563 0.750 re f
434.312 662.953 0.750 16.631 re f
580.125 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 668.979 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 662.953 408.437 0.750 re f
26.625 647.071 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 653.098 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
434.312 662.953 146.563 0.750 re f
434.312 647.071 0.750 16.631 re f
580.125 647.071 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 653.098 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 647.071 408.437 0.750 re f
26.625 486.262 0.750 161.560 re f
0.271 0.267 0.267 rg
BT 31.875 637.216 Td /F1 9.8 Tf  [(20,000-29,999)] TJ ET
0.267 0.267 0.267 rg
434.312 647.071 146.563 0.750 re f
434.312 486.262 0.750 161.560 re f
580.125 486.262 0.750 161.560 re f
0.271 0.267 0.267 rg
BT 439.562 637.216 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 486.262 408.437 0.750 re f
26.625 470.380 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 476.407 Td /F1 9.8 Tf  [(30,000-39,999)] TJ ET
0.267 0.267 0.267 rg
434.312 486.262 146.563 0.750 re f
434.312 470.380 0.750 16.631 re f
580.125 470.380 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 476.407 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 470.380 408.437 0.750 re f
26.625 454.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 460.525 Td /F1 9.8 Tf  [(40,000-49,999)] TJ ET
0.267 0.267 0.267 rg
434.312 470.380 146.563 0.750 re f
434.312 454.499 0.750 16.631 re f
580.125 454.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 460.525 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 454.499 408.437 0.750 re f
26.625 438.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 444.644 Td /F1 9.8 Tf  [(50,000-59,999)] TJ ET
0.267 0.267 0.267 rg
434.312 454.499 146.563 0.750 re f
434.312 438.618 0.750 16.631 re f
580.125 438.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 444.644 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
26.625 438.618 408.437 0.750 re f
26.625 422.737 408.437 0.750 re f
26.625 422.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 428.763 Td /F1 9.8 Tf  [(Greater than or equal to 60,000)] TJ ET
0.267 0.267 0.267 rg
434.312 438.618 146.563 0.750 re f
434.312 422.737 146.563 0.750 re f
434.312 422.737 0.750 16.631 re f
580.125 422.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 428.763 Td /F1 9.8 Tf  [(10)] TJ ET
BT 26.250 367.838 Td /F4 9.8 Tf  [(4. Number of Cases with Traumatic/Chemical/Radiological Injuries:)] TJ ET
BT 336.173 367.838 Td /F1 9.8 Tf  [( The absolute number of people with traumatic injuries )] TJ ET
BT 26.250 355.933 Td /F1 9.8 Tf  [(attributable to CHE \(blunt or penetrating, directly or indirectly\) is another important indicator of the magnitude of emergencies. It )] TJ ET
BT 26.250 344.028 Td /F1 9.8 Tf  [(adds another level of complexity facing the medical system and humanitarian response. In addition, chemical and radiological )] TJ ET
BT 26.250 332.124 Td /F1 9.8 Tf  [(CHE also present an acute burden of disease requiring special capacities. The baseline of the scoring rubric in this parameter )] TJ ET
BT 26.250 320.219 Td /F1 9.8 Tf  [(\(<20 would get a zero\) also stems from CRED criteria, as explained in parameter 3. The ceiling for this parameter is chosen to )] TJ ET
BT 26.250 308.314 Td /F1 9.8 Tf  [(be 300,000 because the 2010 Haitian earthquake has also caused one of the highest numbers of documented acute injuries in )] TJ ET
BT 26.250 296.409 Td /F1 9.8 Tf  [(the setting of CHE.)] TJ ET
0.267 0.267 0.267 rg
BT 108.082 297.917 Td /F4 8.7 Tf  [(19)] TJ ET
0.271 0.267 0.267 rg
BT 117.719 296.409 Td /F1 9.8 Tf  [( Below is a table showing multiple examples \(some CHE and others not\), with their corresponding scores.)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 286.012 Td /F4 8.7 Tf  [(13)] TJ ET
BT 35.887 286.012 Td /F4 8.7 Tf  [(19)] TJ ET
BT 45.525 286.012 Td /F4 8.7 Tf  [(20)] TJ ET
BT 55.162 286.012 Td /F4 8.7 Tf  [(21)] TJ ET
Q
q
15.000 254.710 577.500 522.290 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 3. Number of Cases with Acute Communicable Diseases)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 422.362 555.000 333.402 re f
0.965 0.965 0.965 rg
27.000 742.734 407.687 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 408.062 0.750 re f
26.625 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 745.490 Td /F4 9.8 Tf  [(Number of cases with acute communicable diseases)] TJ ET
0.965 0.965 0.965 rg
434.687 742.734 145.813 12.280 re f
0.267 0.267 0.267 rg
434.687 754.639 146.188 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 439.187 745.490 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 408.437 0.750 re f
26.625 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 732.504 Td /F1 9.8 Tf  [(<20)] TJ ET
0.267 0.267 0.267 rg
434.312 742.359 146.563 0.750 re f
434.312 726.478 0.750 16.631 re f
580.125 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 732.504 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 726.478 408.437 0.750 re f
26.625 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 716.623 Td /F1 9.8 Tf  [(20-99)] TJ ET
0.267 0.267 0.267 rg
434.312 726.478 146.563 0.750 re f
434.312 710.596 0.750 16.631 re f
580.125 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 716.623 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 710.596 408.437 0.750 re f
26.625 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 700.741 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
434.312 710.596 146.563 0.750 re f
434.312 694.715 0.750 16.631 re f
580.125 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 700.741 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 694.715 408.437 0.750 re f
26.625 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 684.860 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
434.312 694.715 146.563 0.750 re f
434.312 678.834 0.750 16.631 re f
580.125 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 684.860 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 678.834 408.437 0.750 re f
26.625 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 668.979 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
434.312 678.834 146.563 0.750 re f
434.312 662.953 0.750 16.631 re f
580.125 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 668.979 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 662.953 408.437 0.750 re f
26.625 647.071 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 653.098 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
434.312 662.953 146.563 0.750 re f
434.312 647.071 0.750 16.631 re f
580.125 647.071 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 653.098 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 647.071 408.437 0.750 re f
26.625 486.262 0.750 161.560 re f
0.271 0.267 0.267 rg
BT 31.875 637.216 Td /F1 9.8 Tf  [(20,000-29,999)] TJ ET
0.267 0.267 0.267 rg
434.312 647.071 146.563 0.750 re f
434.312 486.262 0.750 161.560 re f
580.125 486.262 0.750 161.560 re f
0.271 0.267 0.267 rg
BT 439.562 637.216 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 486.262 408.437 0.750 re f
26.625 470.380 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 476.407 Td /F1 9.8 Tf  [(30,000-39,999)] TJ ET
0.267 0.267 0.267 rg
434.312 486.262 146.563 0.750 re f
434.312 470.380 0.750 16.631 re f
580.125 470.380 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 476.407 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 470.380 408.437 0.750 re f
26.625 454.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 460.525 Td /F1 9.8 Tf  [(40,000-49,999)] TJ ET
0.267 0.267 0.267 rg
434.312 470.380 146.563 0.750 re f
434.312 454.499 0.750 16.631 re f
580.125 454.499 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 460.525 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 454.499 408.437 0.750 re f
26.625 438.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 444.644 Td /F1 9.8 Tf  [(50,000-59,999)] TJ ET
0.267 0.267 0.267 rg
434.312 454.499 146.563 0.750 re f
434.312 438.618 0.750 16.631 re f
580.125 438.618 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 444.644 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
26.625 438.618 408.437 0.750 re f
26.625 422.737 408.437 0.750 re f
26.625 422.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 428.763 Td /F1 9.8 Tf  [(Greater than or equal to 60,000)] TJ ET
0.267 0.267 0.267 rg
434.312 438.618 146.563 0.750 re f
434.312 422.737 146.563 0.750 re f
434.312 422.737 0.750 16.631 re f
580.125 422.737 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 439.562 428.763 Td /F1 9.8 Tf  [(10)] TJ ET
BT 26.250 367.838 Td /F4 9.8 Tf  [(4. Number of Cases with Traumatic/Chemical/Radiological Injuries:)] TJ ET
BT 336.173 367.838 Td /F1 9.8 Tf  [( The absolute number of people with traumatic injuries )] TJ ET
BT 26.250 355.933 Td /F1 9.8 Tf  [(attributable to CHE \(blunt or penetrating, directly or indirectly\) is another important indicator of the magnitude of emergencies. It )] TJ ET
BT 26.250 344.028 Td /F1 9.8 Tf  [(adds another level of complexity facing the medical system and humanitarian response. In addition, chemical and radiological )] TJ ET
BT 26.250 332.124 Td /F1 9.8 Tf  [(CHE also present an acute burden of disease requiring special capacities. The baseline of the scoring rubric in this parameter )] TJ ET
BT 26.250 320.219 Td /F1 9.8 Tf  [(\(<20 would get a zero\) also stems from CRED criteria, as explained in parameter 3. The ceiling for this parameter is chosen to )] TJ ET
BT 26.250 308.314 Td /F1 9.8 Tf  [(be 300,000 because the 2010 Haitian earthquake has also caused one of the highest numbers of documented acute injuries in )] TJ ET
BT 26.250 296.409 Td /F1 9.8 Tf  [(the setting of CHE.)] TJ ET
0.267 0.267 0.267 rg
BT 108.082 297.917 Td /F4 8.7 Tf  [(19)] TJ ET
0.271 0.267 0.267 rg
BT 117.719 296.409 Td /F1 9.8 Tf  [( Below is a table showing multiple examples \(some CHE and others not\), with their corresponding scores.)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 286.012 Td /F4 8.7 Tf  [(13)] TJ ET
BT 35.887 286.012 Td /F4 8.7 Tf  [(19)] TJ ET
BT 45.525 286.012 Td /F4 8.7 Tf  [(20)] TJ ET
BT 55.162 286.012 Td /F4 8.7 Tf  [(21)] TJ ET
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BT 291.710 19.825 Td /F1 11.0 Tf  [(5)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 4. Number of Cases with Traumatic/Chemical/Radiological Injuries)] TJ ET
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26.250 305.740 555.000 450.024 re f
0.965 0.965 0.965 rg
27.000 730.829 273.509 24.184 re f
0.267 0.267 0.267 rg
26.625 754.639 273.884 0.750 re f
26.625 730.454 0.750 24.934 re f
0.271 0.267 0.267 rg
BT 31.500 745.490 Td /F4 9.8 Tf  [(Number of cases with traumatic/chemical/radiological )] TJ ET
BT 31.500 733.585 Td /F4 9.8 Tf  [(injuries)] TJ ET
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300.509 730.829 77.327 24.184 re f
0.267 0.267 0.267 rg
300.509 754.639 77.327 0.750 re f
0.271 0.267 0.267 rg
BT 305.009 745.490 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.965 0.965 0.965 rg
377.835 730.829 121.658 24.184 re f
0.267 0.267 0.267 rg
377.835 754.639 121.658 0.750 re f
0.271 0.267 0.267 rg
BT 382.335 745.490 Td /F4 9.8 Tf  [(Country, year, type)] TJ ET
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499.493 730.829 81.007 24.184 re f
0.267 0.267 0.267 rg
499.493 754.639 81.382 0.750 re f
580.125 730.454 0.750 24.934 re f
0.271 0.267 0.267 rg
BT 503.993 745.490 Td /F4 9.8 Tf  [(Number of )] TJ ET
BT 503.993 733.585 Td /F4 9.8 Tf  [(cases)] TJ ET
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26.625 730.454 274.259 0.750 re f
26.625 706.942 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 31.875 720.599 Td /F1 9.8 Tf  [(<20)] TJ ET
0.267 0.267 0.267 rg
300.134 730.454 78.077 0.750 re f
300.134 706.942 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 305.384 720.599 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
377.460 730.454 122.408 0.750 re f
377.460 706.942 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 382.710 720.599 Td /F1 9.8 Tf  [(None recorded by EM-)] TJ ET
BT 382.710 712.968 Td /F1 9.8 Tf  [(DAT)] TJ ET
0.267 0.267 0.267 rg
499.118 730.454 81.757 0.750 re f
499.118 706.942 0.750 24.263 re f
580.125 706.942 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 504.368 720.599 Td /F1 9.8 Tf  [(N/A)] TJ ET
0.267 0.267 0.267 rg
26.625 706.942 274.259 0.750 re f
26.625 683.429 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 31.875 697.087 Td /F1 9.8 Tf  [(20-99)] TJ ET
0.267 0.267 0.267 rg
300.134 706.942 78.077 0.750 re f
300.134 683.429 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 305.384 697.087 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
377.460 706.942 122.408 0.750 re f
377.460 683.429 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 382.710 697.087 Td /F1 9.8 Tf  [(Indonesia, 1928, )] TJ ET
BT 382.710 689.455 Td /F1 9.8 Tf  [(earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 706.942 81.757 0.750 re f
499.118 683.429 0.750 24.263 re f
580.125 683.429 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 504.368 697.087 Td /F1 9.8 Tf  [(40)] TJ ET
0.267 0.267 0.267 rg
26.625 683.429 274.259 0.750 re f
26.625 659.917 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 31.875 673.574 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
300.134 683.429 78.077 0.750 re f
300.134 659.917 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 305.384 673.574 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
377.460 683.429 122.408 0.750 re f
377.460 659.917 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 382.710 673.574 Td /F1 9.8 Tf  [(Sakhalin Island, 1927, )] TJ ET
BT 382.710 665.943 Td /F1 9.8 Tf  [(earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 683.429 81.757 0.750 re f
499.118 659.917 0.750 24.263 re f
580.125 659.917 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 504.368 673.574 Td /F1 9.8 Tf  [(750)] TJ ET
0.267 0.267 0.267 rg
26.625 659.917 274.259 0.750 re f
26.625 644.035 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 650.062 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
300.134 659.917 78.077 0.750 re f
300.134 644.035 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 650.062 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
377.460 659.917 122.408 0.750 re f
377.460 644.035 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 650.062 Td /F1 9.8 Tf  [(Vietnam, 2006, typhoon)] TJ ET
0.267 0.267 0.267 rg
499.118 659.917 81.757 0.750 re f
499.118 644.035 0.750 16.631 re f
580.125 644.035 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 650.062 Td /F1 9.8 Tf  [(2,000)] TJ ET
0.267 0.267 0.267 rg
26.625 644.035 274.259 0.750 re f
26.625 628.154 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 634.180 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
300.134 644.035 78.077 0.750 re f
300.134 628.154 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 634.180 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
377.460 644.035 122.408 0.750 re f
377.460 628.154 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 634.180 Td /F1 9.8 Tf  [(Nepal, 1920, earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 644.035 81.757 0.750 re f
499.118 628.154 0.750 16.631 re f
580.125 628.154 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 634.180 Td /F1 9.8 Tf  [(6,553)] TJ ET
0.267 0.267 0.267 rg
26.625 628.154 274.259 0.750 re f
26.625 612.273 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 618.299 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
300.134 628.154 78.077 0.750 re f
300.134 612.273 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 618.299 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
377.460 628.154 122.408 0.750 re f
377.460 612.273 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 618.299 Td /F1 9.8 Tf  [(Chile, 2010, 12,000)] TJ ET
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499.118 628.154 81.757 0.750 re f
499.118 612.273 0.750 16.631 re f
580.125 612.273 0.750 16.631 re f
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BT 504.368 618.299 Td /F1 9.8 Tf  [(12,000)] TJ ET
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26.625 612.273 274.259 0.750 re f
26.625 596.392 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 602.418 Td /F1 9.8 Tf  [(20,000-49,999)] TJ ET
0.267 0.267 0.267 rg
300.134 612.273 78.077 0.750 re f
300.134 596.392 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 602.418 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
377.460 612.273 122.408 0.750 re f
377.460 596.392 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 602.418 Td /F1 9.8 Tf  [(Iran, 1926, earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 612.273 81.757 0.750 re f
499.118 596.392 0.750 16.631 re f
580.125 596.392 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 602.418 Td /F1 9.8 Tf  [(30,000)] TJ ET
0.267 0.267 0.267 rg
26.625 596.392 274.259 0.750 re f
26.625 572.879 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 586.537 Td /F1 9.8 Tf  [(50,000-99,999)] TJ ET
0.267 0.267 0.267 rg
300.134 596.392 78.077 0.750 re f
300.134 572.879 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 305.384 586.537 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
377.460 596.392 122.408 0.750 re f
377.460 572.879 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 382.710 586.537 Td /F1 9.8 Tf  [(Pakistan, 2008, )] TJ ET
BT 382.710 578.905 Td /F1 9.8 Tf  [(earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 596.392 81.757 0.750 re f
499.118 572.879 0.750 24.262 re f
580.125 572.879 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 504.368 586.537 Td /F1 9.8 Tf  [(69,000)] TJ ET
0.267 0.267 0.267 rg
26.625 572.879 274.259 0.750 re f
26.625 337.877 0.750 235.752 re f
0.271 0.267 0.267 rg
BT 31.875 563.024 Td /F1 9.8 Tf  [(100,000-199,999)] TJ ET
0.267 0.267 0.267 rg
300.134 572.879 78.077 0.750 re f
300.134 337.877 0.750 235.752 re f
0.271 0.267 0.267 rg
BT 305.384 563.024 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
377.460 572.879 122.408 0.750 re f
377.460 337.877 0.750 235.752 re f
0.271 0.267 0.267 rg
BT 382.710 563.024 Td /F1 9.8 Tf  [(Japan, 1945, atomic )] TJ ET
BT 382.710 555.393 Td /F1 9.8 Tf  [(bomb)] TJ ET
0.267 0.267 0.267 rg
499.118 572.879 81.757 0.750 re f
499.118 337.877 0.750 235.752 re f
580.125 337.877 0.750 235.752 re f
0.271 0.267 0.267 rg
BT 504.368 563.024 Td /F1 9.8 Tf  [(110,000)] TJ ET
0.267 0.267 0.267 rg
26.625 337.877 274.259 0.750 re f
26.625 321.996 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 328.022 Td /F1 9.8 Tf  [(200,000-299,999)] TJ ET
0.267 0.267 0.267 rg
300.134 337.877 78.077 0.750 re f
300.134 321.996 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 328.022 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
377.460 337.877 122.408 0.750 re f
377.460 321.996 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 328.022 Td /F1 9.8 Tf  [(India, 1984, chemical)] TJ ET
0.267 0.267 0.267 rg
499.118 337.877 81.757 0.750 re f
499.118 321.996 0.750 16.631 re f
580.125 321.996 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 328.022 Td /F1 9.8 Tf  [(200,000)] TJ ET
0.267 0.267 0.267 rg
26.625 321.996 274.259 0.750 re f
26.625 306.115 274.259 0.750 re f
26.625 306.115 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 312.141 Td /F1 9.8 Tf  [(Greater than or equal to 300,000)] TJ ET
0.267 0.267 0.267 rg
300.134 321.996 78.077 0.750 re f
300.134 306.115 78.077 0.750 re f
300.134 306.115 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 312.141 Td /F1 9.8 Tf  [(10)] TJ ET
0.267 0.267 0.267 rg
377.460 321.996 122.408 0.750 re f
377.460 306.115 122.408 0.750 re f
377.460 306.115 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 312.141 Td /F1 9.8 Tf  [(Haiti, 2010, earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 321.996 81.757 0.750 re f
499.118 306.115 81.757 0.750 re f
499.118 306.115 0.750 16.631 re f
580.125 306.115 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 312.141 Td /F1 9.8 Tf  [(300,000)] TJ ET
BT 26.250 251.216 Td /F4 9.8 Tf  [(5. Level of Health Care Services:)] TJ ET
BT 176.897 251.216 Td /F1 9.8 Tf  [( Evaluating the residual capacity of the healthcare system in the aftermath of a CHE is )] TJ ET
BT 26.250 239.311 Td /F1 9.8 Tf  [(important to determine the scope of outside resources needed for a response. The 2004 Sphere Project)] TJ ET
0.267 0.267 0.267 rg
BT 473.356 240.818 Td /F4 8.7 Tf  [(22)] TJ ET
0.271 0.267 0.267 rg
BT 482.993 239.311 Td /F1 9.8 Tf  [( described minimum )] TJ ET
BT 26.250 227.406 Td /F1 9.8 Tf  [(standards required for healthcare provision in emergency settings, and was used as a template for the scoring of this )] TJ ET
BT 26.250 215.502 Td /F1 9.8 Tf  [(parameter: \(a\) The first level of healthcare system is the community healthcare level. This level requires a minimum of one )] TJ ET
BT 26.250 203.597 Td /F1 9.8 Tf  [(community health worker per 500-1,000 population; one skilled/traditional birth attendant per 2,000 persons; one supervisor per )] TJ ET
BT 26.250 191.692 Td /F1 9.8 Tf  [(10 home visitors; and one senior supervisor. \(b\) The second level of healthcare system is a peripheral health facility \(for )] TJ ET
BT 26.250 179.787 Td /F1 9.8 Tf  [(approximately 10,000 population\) requiring a total of two to five staff with: minimum of one qualified health worker, based on one )] TJ ET
BT 26.250 167.883 Td /F1 9.8 Tf  [(clinician per 50 consultations per day; and non-qualified staff for administering oral rehydration therapy \(ORT\), dressings, )] TJ ET
BT 26.250 155.978 Td /F1 9.8 Tf  [(registration, administration, among other tasks. \(c\) The third level of healthcare system is a central health facility \(for )] TJ ET
BT 26.250 144.073 Td /F1 9.8 Tf  [(approximately 50,000 population\) requiring a minimum of five qualified health workers; minimum of one doctor; one qualified )] TJ ET
BT 26.250 132.168 Td /F1 9.8 Tf  [(health worker per 50 consultations per day \(out-patient care\); one qualified health worker per 20-30 beds, 24-hour services \(in-)] TJ ET
BT 26.250 120.264 Td /F1 9.8 Tf  [(patient care\); one non-qualified health worker for administering oral rehydration therapy; one/two for pharmacy; one/two for )] TJ ET
BT 26.250 108.359 Td /F1 9.8 Tf  [(dressings, injections, sterilization; one lab technician; and non-qualified staff for registration, security, among other tasks. \(d\) )] TJ ET
BT 26.250 96.454 Td /F1 9.8 Tf  [(The fourth level of healthcare is a referral hospital with surgical capacity, with at least one doctor with surgical skills, and one )] TJ ET
BT 26.250 84.549 Td /F1 9.8 Tf  [(nurse for 20-30 beds per shift.)] TJ ET
0.267 0.267 0.267 rg
BT 156.315 86.057 Td /F4 8.7 Tf  [(22)] TJ ET
Q
q
15.000 53.432 577.500 723.568 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 4. Number of Cases with Traumatic/Chemical/Radiological Injuries)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 305.740 555.000 450.024 re f
0.965 0.965 0.965 rg
27.000 730.829 273.509 24.184 re f
0.267 0.267 0.267 rg
26.625 754.639 273.884 0.750 re f
26.625 730.454 0.750 24.934 re f
0.271 0.267 0.267 rg
BT 31.500 745.490 Td /F4 9.8 Tf  [(Number of cases with traumatic/chemical/radiological )] TJ ET
BT 31.500 733.585 Td /F4 9.8 Tf  [(injuries)] TJ ET
0.965 0.965 0.965 rg
300.509 730.829 77.327 24.184 re f
0.267 0.267 0.267 rg
300.509 754.639 77.327 0.750 re f
0.271 0.267 0.267 rg
BT 305.009 745.490 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.965 0.965 0.965 rg
377.835 730.829 121.658 24.184 re f
0.267 0.267 0.267 rg
377.835 754.639 121.658 0.750 re f
0.271 0.267 0.267 rg
BT 382.335 745.490 Td /F4 9.8 Tf  [(Country, year, type)] TJ ET
0.965 0.965 0.965 rg
499.493 730.829 81.007 24.184 re f
0.267 0.267 0.267 rg
499.493 754.639 81.382 0.750 re f
580.125 730.454 0.750 24.934 re f
0.271 0.267 0.267 rg
BT 503.993 745.490 Td /F4 9.8 Tf  [(Number of )] TJ ET
BT 503.993 733.585 Td /F4 9.8 Tf  [(cases)] TJ ET
0.267 0.267 0.267 rg
26.625 730.454 274.259 0.750 re f
26.625 706.942 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 31.875 720.599 Td /F1 9.8 Tf  [(<20)] TJ ET
0.267 0.267 0.267 rg
300.134 730.454 78.077 0.750 re f
300.134 706.942 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 305.384 720.599 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
377.460 730.454 122.408 0.750 re f
377.460 706.942 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 382.710 720.599 Td /F1 9.8 Tf  [(None recorded by EM-)] TJ ET
BT 382.710 712.968 Td /F1 9.8 Tf  [(DAT)] TJ ET
0.267 0.267 0.267 rg
499.118 730.454 81.757 0.750 re f
499.118 706.942 0.750 24.263 re f
580.125 706.942 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 504.368 720.599 Td /F1 9.8 Tf  [(N/A)] TJ ET
0.267 0.267 0.267 rg
26.625 706.942 274.259 0.750 re f
26.625 683.429 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 31.875 697.087 Td /F1 9.8 Tf  [(20-99)] TJ ET
0.267 0.267 0.267 rg
300.134 706.942 78.077 0.750 re f
300.134 683.429 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 305.384 697.087 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
377.460 706.942 122.408 0.750 re f
377.460 683.429 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 382.710 697.087 Td /F1 9.8 Tf  [(Indonesia, 1928, )] TJ ET
BT 382.710 689.455 Td /F1 9.8 Tf  [(earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 706.942 81.757 0.750 re f
499.118 683.429 0.750 24.263 re f
580.125 683.429 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 504.368 697.087 Td /F1 9.8 Tf  [(40)] TJ ET
0.267 0.267 0.267 rg
26.625 683.429 274.259 0.750 re f
26.625 659.917 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 31.875 673.574 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
300.134 683.429 78.077 0.750 re f
300.134 659.917 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 305.384 673.574 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
377.460 683.429 122.408 0.750 re f
377.460 659.917 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 382.710 673.574 Td /F1 9.8 Tf  [(Sakhalin Island, 1927, )] TJ ET
BT 382.710 665.943 Td /F1 9.8 Tf  [(earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 683.429 81.757 0.750 re f
499.118 659.917 0.750 24.263 re f
580.125 659.917 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 504.368 673.574 Td /F1 9.8 Tf  [(750)] TJ ET
0.267 0.267 0.267 rg
26.625 659.917 274.259 0.750 re f
26.625 644.035 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 650.062 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
300.134 659.917 78.077 0.750 re f
300.134 644.035 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 650.062 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
377.460 659.917 122.408 0.750 re f
377.460 644.035 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 650.062 Td /F1 9.8 Tf  [(Vietnam, 2006, typhoon)] TJ ET
0.267 0.267 0.267 rg
499.118 659.917 81.757 0.750 re f
499.118 644.035 0.750 16.631 re f
580.125 644.035 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 650.062 Td /F1 9.8 Tf  [(2,000)] TJ ET
0.267 0.267 0.267 rg
26.625 644.035 274.259 0.750 re f
26.625 628.154 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 634.180 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
300.134 644.035 78.077 0.750 re f
300.134 628.154 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 634.180 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
377.460 644.035 122.408 0.750 re f
377.460 628.154 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 634.180 Td /F1 9.8 Tf  [(Nepal, 1920, earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 644.035 81.757 0.750 re f
499.118 628.154 0.750 16.631 re f
580.125 628.154 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 634.180 Td /F1 9.8 Tf  [(6,553)] TJ ET
0.267 0.267 0.267 rg
26.625 628.154 274.259 0.750 re f
26.625 612.273 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 618.299 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
300.134 628.154 78.077 0.750 re f
300.134 612.273 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 618.299 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
377.460 628.154 122.408 0.750 re f
377.460 612.273 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 618.299 Td /F1 9.8 Tf  [(Chile, 2010, 12,000)] TJ ET
0.267 0.267 0.267 rg
499.118 628.154 81.757 0.750 re f
499.118 612.273 0.750 16.631 re f
580.125 612.273 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 618.299 Td /F1 9.8 Tf  [(12,000)] TJ ET
0.267 0.267 0.267 rg
26.625 612.273 274.259 0.750 re f
26.625 596.392 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 602.418 Td /F1 9.8 Tf  [(20,000-49,999)] TJ ET
0.267 0.267 0.267 rg
300.134 612.273 78.077 0.750 re f
300.134 596.392 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 602.418 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
377.460 612.273 122.408 0.750 re f
377.460 596.392 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 602.418 Td /F1 9.8 Tf  [(Iran, 1926, earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 612.273 81.757 0.750 re f
499.118 596.392 0.750 16.631 re f
580.125 596.392 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 602.418 Td /F1 9.8 Tf  [(30,000)] TJ ET
0.267 0.267 0.267 rg
26.625 596.392 274.259 0.750 re f
26.625 572.879 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 586.537 Td /F1 9.8 Tf  [(50,000-99,999)] TJ ET
0.267 0.267 0.267 rg
300.134 596.392 78.077 0.750 re f
300.134 572.879 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 305.384 586.537 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
377.460 596.392 122.408 0.750 re f
377.460 572.879 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 382.710 586.537 Td /F1 9.8 Tf  [(Pakistan, 2008, )] TJ ET
BT 382.710 578.905 Td /F1 9.8 Tf  [(earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 596.392 81.757 0.750 re f
499.118 572.879 0.750 24.262 re f
580.125 572.879 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 504.368 586.537 Td /F1 9.8 Tf  [(69,000)] TJ ET
0.267 0.267 0.267 rg
26.625 572.879 274.259 0.750 re f
26.625 337.877 0.750 235.752 re f
0.271 0.267 0.267 rg
BT 31.875 563.024 Td /F1 9.8 Tf  [(100,000-199,999)] TJ ET
0.267 0.267 0.267 rg
300.134 572.879 78.077 0.750 re f
300.134 337.877 0.750 235.752 re f
0.271 0.267 0.267 rg
BT 305.384 563.024 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
377.460 572.879 122.408 0.750 re f
377.460 337.877 0.750 235.752 re f
0.271 0.267 0.267 rg
BT 382.710 563.024 Td /F1 9.8 Tf  [(Japan, 1945, atomic )] TJ ET
BT 382.710 555.393 Td /F1 9.8 Tf  [(bomb)] TJ ET
0.267 0.267 0.267 rg
499.118 572.879 81.757 0.750 re f
499.118 337.877 0.750 235.752 re f
580.125 337.877 0.750 235.752 re f
0.271 0.267 0.267 rg
BT 504.368 563.024 Td /F1 9.8 Tf  [(110,000)] TJ ET
0.267 0.267 0.267 rg
26.625 337.877 274.259 0.750 re f
26.625 321.996 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 328.022 Td /F1 9.8 Tf  [(200,000-299,999)] TJ ET
0.267 0.267 0.267 rg
300.134 337.877 78.077 0.750 re f
300.134 321.996 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 328.022 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
377.460 337.877 122.408 0.750 re f
377.460 321.996 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 328.022 Td /F1 9.8 Tf  [(India, 1984, chemical)] TJ ET
0.267 0.267 0.267 rg
499.118 337.877 81.757 0.750 re f
499.118 321.996 0.750 16.631 re f
580.125 321.996 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 328.022 Td /F1 9.8 Tf  [(200,000)] TJ ET
0.267 0.267 0.267 rg
26.625 321.996 274.259 0.750 re f
26.625 306.115 274.259 0.750 re f
26.625 306.115 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 312.141 Td /F1 9.8 Tf  [(Greater than or equal to 300,000)] TJ ET
0.267 0.267 0.267 rg
300.134 321.996 78.077 0.750 re f
300.134 306.115 78.077 0.750 re f
300.134 306.115 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 312.141 Td /F1 9.8 Tf  [(10)] TJ ET
0.267 0.267 0.267 rg
377.460 321.996 122.408 0.750 re f
377.460 306.115 122.408 0.750 re f
377.460 306.115 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 312.141 Td /F1 9.8 Tf  [(Haiti, 2010, earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 321.996 81.757 0.750 re f
499.118 306.115 81.757 0.750 re f
499.118 306.115 0.750 16.631 re f
580.125 306.115 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 312.141 Td /F1 9.8 Tf  [(300,000)] TJ ET
BT 26.250 251.216 Td /F4 9.8 Tf  [(5. Level of Health Care Services:)] TJ ET
BT 176.897 251.216 Td /F1 9.8 Tf  [( Evaluating the residual capacity of the healthcare system in the aftermath of a CHE is )] TJ ET
BT 26.250 239.311 Td /F1 9.8 Tf  [(important to determine the scope of outside resources needed for a response. The 2004 Sphere Project)] TJ ET
0.267 0.267 0.267 rg
BT 473.356 240.818 Td /F4 8.7 Tf  [(22)] TJ ET
0.271 0.267 0.267 rg
BT 482.993 239.311 Td /F1 9.8 Tf  [( described minimum )] TJ ET
BT 26.250 227.406 Td /F1 9.8 Tf  [(standards required for healthcare provision in emergency settings, and was used as a template for the scoring of this )] TJ ET
BT 26.250 215.502 Td /F1 9.8 Tf  [(parameter: \(a\) The first level of healthcare system is the community healthcare level. This level requires a minimum of one )] TJ ET
BT 26.250 203.597 Td /F1 9.8 Tf  [(community health worker per 500-1,000 population; one skilled/traditional birth attendant per 2,000 persons; one supervisor per )] TJ ET
BT 26.250 191.692 Td /F1 9.8 Tf  [(10 home visitors; and one senior supervisor. \(b\) The second level of healthcare system is a peripheral health facility \(for )] TJ ET
BT 26.250 179.787 Td /F1 9.8 Tf  [(approximately 10,000 population\) requiring a total of two to five staff with: minimum of one qualified health worker, based on one )] TJ ET
BT 26.250 167.883 Td /F1 9.8 Tf  [(clinician per 50 consultations per day; and non-qualified staff for administering oral rehydration therapy \(ORT\), dressings, )] TJ ET
BT 26.250 155.978 Td /F1 9.8 Tf  [(registration, administration, among other tasks. \(c\) The third level of healthcare system is a central health facility \(for )] TJ ET
BT 26.250 144.073 Td /F1 9.8 Tf  [(approximately 50,000 population\) requiring a minimum of five qualified health workers; minimum of one doctor; one qualified )] TJ ET
BT 26.250 132.168 Td /F1 9.8 Tf  [(health worker per 50 consultations per day \(out-patient care\); one qualified health worker per 20-30 beds, 24-hour services \(in-)] TJ ET
BT 26.250 120.264 Td /F1 9.8 Tf  [(patient care\); one non-qualified health worker for administering oral rehydration therapy; one/two for pharmacy; one/two for )] TJ ET
BT 26.250 108.359 Td /F1 9.8 Tf  [(dressings, injections, sterilization; one lab technician; and non-qualified staff for registration, security, among other tasks. \(d\) )] TJ ET
BT 26.250 96.454 Td /F1 9.8 Tf  [(The fourth level of healthcare is a referral hospital with surgical capacity, with at least one doctor with surgical skills, and one )] TJ ET
BT 26.250 84.549 Td /F1 9.8 Tf  [(nurse for 20-30 beds per shift.)] TJ ET
0.267 0.267 0.267 rg
BT 156.315 86.057 Td /F4 8.7 Tf  [(22)] TJ ET
Q
q
15.000 53.432 577.500 723.568 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 4. Number of Cases with Traumatic/Chemical/Radiological Injuries)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 305.740 555.000 450.024 re f
0.965 0.965 0.965 rg
27.000 730.829 273.509 24.184 re f
0.267 0.267 0.267 rg
26.625 754.639 273.884 0.750 re f
26.625 730.454 0.750 24.934 re f
0.271 0.267 0.267 rg
BT 31.500 745.490 Td /F4 9.8 Tf  [(Number of cases with traumatic/chemical/radiological )] TJ ET
BT 31.500 733.585 Td /F4 9.8 Tf  [(injuries)] TJ ET
0.965 0.965 0.965 rg
300.509 730.829 77.327 24.184 re f
0.267 0.267 0.267 rg
300.509 754.639 77.327 0.750 re f
0.271 0.267 0.267 rg
BT 305.009 745.490 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.965 0.965 0.965 rg
377.835 730.829 121.658 24.184 re f
0.267 0.267 0.267 rg
377.835 754.639 121.658 0.750 re f
0.271 0.267 0.267 rg
BT 382.335 745.490 Td /F4 9.8 Tf  [(Country, year, type)] TJ ET
0.965 0.965 0.965 rg
499.493 730.829 81.007 24.184 re f
0.267 0.267 0.267 rg
499.493 754.639 81.382 0.750 re f
580.125 730.454 0.750 24.934 re f
0.271 0.267 0.267 rg
BT 503.993 745.490 Td /F4 9.8 Tf  [(Number of )] TJ ET
BT 503.993 733.585 Td /F4 9.8 Tf  [(cases)] TJ ET
0.267 0.267 0.267 rg
26.625 730.454 274.259 0.750 re f
26.625 706.942 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 31.875 720.599 Td /F1 9.8 Tf  [(<20)] TJ ET
0.267 0.267 0.267 rg
300.134 730.454 78.077 0.750 re f
300.134 706.942 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 305.384 720.599 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
377.460 730.454 122.408 0.750 re f
377.460 706.942 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 382.710 720.599 Td /F1 9.8 Tf  [(None recorded by EM-)] TJ ET
BT 382.710 712.968 Td /F1 9.8 Tf  [(DAT)] TJ ET
0.267 0.267 0.267 rg
499.118 730.454 81.757 0.750 re f
499.118 706.942 0.750 24.263 re f
580.125 706.942 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 504.368 720.599 Td /F1 9.8 Tf  [(N/A)] TJ ET
0.267 0.267 0.267 rg
26.625 706.942 274.259 0.750 re f
26.625 683.429 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 31.875 697.087 Td /F1 9.8 Tf  [(20-99)] TJ ET
0.267 0.267 0.267 rg
300.134 706.942 78.077 0.750 re f
300.134 683.429 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 305.384 697.087 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
377.460 706.942 122.408 0.750 re f
377.460 683.429 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 382.710 697.087 Td /F1 9.8 Tf  [(Indonesia, 1928, )] TJ ET
BT 382.710 689.455 Td /F1 9.8 Tf  [(earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 706.942 81.757 0.750 re f
499.118 683.429 0.750 24.263 re f
580.125 683.429 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 504.368 697.087 Td /F1 9.8 Tf  [(40)] TJ ET
0.267 0.267 0.267 rg
26.625 683.429 274.259 0.750 re f
26.625 659.917 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 31.875 673.574 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
300.134 683.429 78.077 0.750 re f
300.134 659.917 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 305.384 673.574 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
377.460 683.429 122.408 0.750 re f
377.460 659.917 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 382.710 673.574 Td /F1 9.8 Tf  [(Sakhalin Island, 1927, )] TJ ET
BT 382.710 665.943 Td /F1 9.8 Tf  [(earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 683.429 81.757 0.750 re f
499.118 659.917 0.750 24.263 re f
580.125 659.917 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 504.368 673.574 Td /F1 9.8 Tf  [(750)] TJ ET
0.267 0.267 0.267 rg
26.625 659.917 274.259 0.750 re f
26.625 644.035 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 650.062 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
300.134 659.917 78.077 0.750 re f
300.134 644.035 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 650.062 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
377.460 659.917 122.408 0.750 re f
377.460 644.035 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 650.062 Td /F1 9.8 Tf  [(Vietnam, 2006, typhoon)] TJ ET
0.267 0.267 0.267 rg
499.118 659.917 81.757 0.750 re f
499.118 644.035 0.750 16.631 re f
580.125 644.035 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 650.062 Td /F1 9.8 Tf  [(2,000)] TJ ET
0.267 0.267 0.267 rg
26.625 644.035 274.259 0.750 re f
26.625 628.154 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 634.180 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
300.134 644.035 78.077 0.750 re f
300.134 628.154 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 634.180 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
377.460 644.035 122.408 0.750 re f
377.460 628.154 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 634.180 Td /F1 9.8 Tf  [(Nepal, 1920, earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 644.035 81.757 0.750 re f
499.118 628.154 0.750 16.631 re f
580.125 628.154 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 634.180 Td /F1 9.8 Tf  [(6,553)] TJ ET
0.267 0.267 0.267 rg
26.625 628.154 274.259 0.750 re f
26.625 612.273 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 618.299 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
300.134 628.154 78.077 0.750 re f
300.134 612.273 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 618.299 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
377.460 628.154 122.408 0.750 re f
377.460 612.273 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 618.299 Td /F1 9.8 Tf  [(Chile, 2010, 12,000)] TJ ET
0.267 0.267 0.267 rg
499.118 628.154 81.757 0.750 re f
499.118 612.273 0.750 16.631 re f
580.125 612.273 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 618.299 Td /F1 9.8 Tf  [(12,000)] TJ ET
0.267 0.267 0.267 rg
26.625 612.273 274.259 0.750 re f
26.625 596.392 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 602.418 Td /F1 9.8 Tf  [(20,000-49,999)] TJ ET
0.267 0.267 0.267 rg
300.134 612.273 78.077 0.750 re f
300.134 596.392 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 602.418 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
377.460 612.273 122.408 0.750 re f
377.460 596.392 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 602.418 Td /F1 9.8 Tf  [(Iran, 1926, earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 612.273 81.757 0.750 re f
499.118 596.392 0.750 16.631 re f
580.125 596.392 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 602.418 Td /F1 9.8 Tf  [(30,000)] TJ ET
0.267 0.267 0.267 rg
26.625 596.392 274.259 0.750 re f
26.625 572.879 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 586.537 Td /F1 9.8 Tf  [(50,000-99,999)] TJ ET
0.267 0.267 0.267 rg
300.134 596.392 78.077 0.750 re f
300.134 572.879 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 305.384 586.537 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
377.460 596.392 122.408 0.750 re f
377.460 572.879 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 382.710 586.537 Td /F1 9.8 Tf  [(Pakistan, 2008, )] TJ ET
BT 382.710 578.905 Td /F1 9.8 Tf  [(earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 596.392 81.757 0.750 re f
499.118 572.879 0.750 24.262 re f
580.125 572.879 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 504.368 586.537 Td /F1 9.8 Tf  [(69,000)] TJ ET
0.267 0.267 0.267 rg
26.625 572.879 274.259 0.750 re f
26.625 337.877 0.750 235.752 re f
0.271 0.267 0.267 rg
BT 31.875 563.024 Td /F1 9.8 Tf  [(100,000-199,999)] TJ ET
0.267 0.267 0.267 rg
300.134 572.879 78.077 0.750 re f
300.134 337.877 0.750 235.752 re f
0.271 0.267 0.267 rg
BT 305.384 563.024 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
377.460 572.879 122.408 0.750 re f
377.460 337.877 0.750 235.752 re f
0.271 0.267 0.267 rg
BT 382.710 563.024 Td /F1 9.8 Tf  [(Japan, 1945, atomic )] TJ ET
BT 382.710 555.393 Td /F1 9.8 Tf  [(bomb)] TJ ET
0.267 0.267 0.267 rg
499.118 572.879 81.757 0.750 re f
499.118 337.877 0.750 235.752 re f
580.125 337.877 0.750 235.752 re f
0.271 0.267 0.267 rg
BT 504.368 563.024 Td /F1 9.8 Tf  [(110,000)] TJ ET
0.267 0.267 0.267 rg
26.625 337.877 274.259 0.750 re f
26.625 321.996 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 328.022 Td /F1 9.8 Tf  [(200,000-299,999)] TJ ET
0.267 0.267 0.267 rg
300.134 337.877 78.077 0.750 re f
300.134 321.996 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 328.022 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
377.460 337.877 122.408 0.750 re f
377.460 321.996 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 328.022 Td /F1 9.8 Tf  [(India, 1984, chemical)] TJ ET
0.267 0.267 0.267 rg
499.118 337.877 81.757 0.750 re f
499.118 321.996 0.750 16.631 re f
580.125 321.996 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 328.022 Td /F1 9.8 Tf  [(200,000)] TJ ET
0.267 0.267 0.267 rg
26.625 321.996 274.259 0.750 re f
26.625 306.115 274.259 0.750 re f
26.625 306.115 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 312.141 Td /F1 9.8 Tf  [(Greater than or equal to 300,000)] TJ ET
0.267 0.267 0.267 rg
300.134 321.996 78.077 0.750 re f
300.134 306.115 78.077 0.750 re f
300.134 306.115 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 305.384 312.141 Td /F1 9.8 Tf  [(10)] TJ ET
0.267 0.267 0.267 rg
377.460 321.996 122.408 0.750 re f
377.460 306.115 122.408 0.750 re f
377.460 306.115 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 382.710 312.141 Td /F1 9.8 Tf  [(Haiti, 2010, earthquake)] TJ ET
0.267 0.267 0.267 rg
499.118 321.996 81.757 0.750 re f
499.118 306.115 81.757 0.750 re f
499.118 306.115 0.750 16.631 re f
580.125 306.115 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 504.368 312.141 Td /F1 9.8 Tf  [(300,000)] TJ ET
BT 26.250 251.216 Td /F4 9.8 Tf  [(5. Level of Health Care Services:)] TJ ET
BT 176.897 251.216 Td /F1 9.8 Tf  [( Evaluating the residual capacity of the healthcare system in the aftermath of a CHE is )] TJ ET
BT 26.250 239.311 Td /F1 9.8 Tf  [(important to determine the scope of outside resources needed for a response. The 2004 Sphere Project)] TJ ET
0.267 0.267 0.267 rg
BT 473.356 240.818 Td /F4 8.7 Tf  [(22)] TJ ET
0.271 0.267 0.267 rg
BT 482.993 239.311 Td /F1 9.8 Tf  [( described minimum )] TJ ET
BT 26.250 227.406 Td /F1 9.8 Tf  [(standards required for healthcare provision in emergency settings, and was used as a template for the scoring of this )] TJ ET
BT 26.250 215.502 Td /F1 9.8 Tf  [(parameter: \(a\) The first level of healthcare system is the community healthcare level. This level requires a minimum of one )] TJ ET
BT 26.250 203.597 Td /F1 9.8 Tf  [(community health worker per 500-1,000 population; one skilled/traditional birth attendant per 2,000 persons; one supervisor per )] TJ ET
BT 26.250 191.692 Td /F1 9.8 Tf  [(10 home visitors; and one senior supervisor. \(b\) The second level of healthcare system is a peripheral health facility \(for )] TJ ET
BT 26.250 179.787 Td /F1 9.8 Tf  [(approximately 10,000 population\) requiring a total of two to five staff with: minimum of one qualified health worker, based on one )] TJ ET
BT 26.250 167.883 Td /F1 9.8 Tf  [(clinician per 50 consultations per day; and non-qualified staff for administering oral rehydration therapy \(ORT\), dressings, )] TJ ET
BT 26.250 155.978 Td /F1 9.8 Tf  [(registration, administration, among other tasks. \(c\) The third level of healthcare system is a central health facility \(for )] TJ ET
BT 26.250 144.073 Td /F1 9.8 Tf  [(approximately 50,000 population\) requiring a minimum of five qualified health workers; minimum of one doctor; one qualified )] TJ ET
BT 26.250 132.168 Td /F1 9.8 Tf  [(health worker per 50 consultations per day \(out-patient care\); one qualified health worker per 20-30 beds, 24-hour services \(in-)] TJ ET
BT 26.250 120.264 Td /F1 9.8 Tf  [(patient care\); one non-qualified health worker for administering oral rehydration therapy; one/two for pharmacy; one/two for )] TJ ET
BT 26.250 108.359 Td /F1 9.8 Tf  [(dressings, injections, sterilization; one lab technician; and non-qualified staff for registration, security, among other tasks. \(d\) )] TJ ET
BT 26.250 96.454 Td /F1 9.8 Tf  [(The fourth level of healthcare is a referral hospital with surgical capacity, with at least one doctor with surgical skills, and one )] TJ ET
BT 26.250 84.549 Td /F1 9.8 Tf  [(nurse for 20-30 beds per shift.)] TJ ET
0.267 0.267 0.267 rg
BT 156.315 86.057 Td /F4 8.7 Tf  [(22)] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(6)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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0.267 0.267 0.267 rg
q
15.000 26.440 577.500 750.560 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 5. Levels of Health Care Services)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 662.578 555.000 93.186 re f
0.965 0.965 0.965 rg
27.000 742.734 424.330 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 424.705 0.750 re f
26.625 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 745.490 Td /F4 9.8 Tf  [(Levels of health care services)] TJ ET
0.965 0.965 0.965 rg
451.330 742.734 129.170 12.280 re f
0.267 0.267 0.267 rg
451.330 754.639 129.545 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 455.830 745.490 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 425.080 0.750 re f
26.625 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 732.504 Td /F1 9.8 Tf  [(All levels of heath care system are intact)] TJ ET
0.267 0.267 0.267 rg
450.955 742.359 129.920 0.750 re f
450.955 726.478 0.750 16.631 re f
580.125 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 456.205 732.504 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 726.478 425.080 0.750 re f
26.625 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 716.623 Td /F1 9.8 Tf  [(Disrupted fourth level of health care; intact third, second and first levels)] TJ ET
0.267 0.267 0.267 rg
450.955 726.478 129.920 0.750 re f
450.955 710.596 0.750 16.631 re f
580.125 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 456.205 716.623 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 710.596 425.080 0.750 re f
26.625 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 700.741 Td /F1 9.8 Tf  [(Disrupted fourth and third levels of health care; intact second and first levels)] TJ ET
0.267 0.267 0.267 rg
450.955 710.596 129.920 0.750 re f
450.955 694.715 0.750 16.631 re f
580.125 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 456.205 700.741 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 694.715 425.080 0.750 re f
26.625 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 684.860 Td /F1 9.8 Tf  [(Disrupted second, third and fourth levels of healthcare; intact first level)] TJ ET
0.267 0.267 0.267 rg
450.955 694.715 129.920 0.750 re f
450.955 678.834 0.750 16.631 re f
580.125 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 456.205 684.860 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 678.834 425.080 0.750 re f
26.625 662.953 425.080 0.750 re f
26.625 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 668.979 Td /F1 9.8 Tf  [(All levels of health care disrupted)] TJ ET
0.267 0.267 0.267 rg
450.955 678.834 129.920 0.750 re f
450.955 662.953 129.920 0.750 re f
450.955 662.953 0.750 16.631 re f
580.125 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 456.205 668.979 Td /F1 9.8 Tf  [(4)] TJ ET
BT 26.250 608.054 Td /F1 9.8 Tf  [(The 2010 Haiti earthquake, all levels of healthcare were disrupted in the acute phase, and hence this CHE would get a score of )] TJ ET
BT 26.250 596.149 Td /F1 9.8 Tf  [(4 at that time. Note that a retrospective evaluation of the pre-earthquake health system in Haiti using the above parameters )] TJ ET
BT 26.250 584.244 Td /F1 9.8 Tf  [(indicates disrupted third and fourth levels of healthcare services.)] TJ ET
BT 26.250 564.840 Td /F4 9.8 Tf  [(6. Number of Young Children \(6-59 months\) with Acute Malnutrition:)] TJ ET
BT 341.526 564.840 Td /F1 9.8 Tf  [( Malnutrition contributes to up to 55% of all children�s )] TJ ET
BT 26.250 552.935 Td /F1 9.8 Tf  [(deaths in developing countries.)] TJ ET
0.267 0.267 0.267 rg
BT 160.654 554.442 Td /F4 8.7 Tf  [(23)] TJ ET
BT 170.291 554.442 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 179.928 552.935 Td /F1 9.8 Tf  [( This percentage increases in acute emergency situations. Malnutrition and infections are )] TJ ET
BT 26.250 541.030 Td /F1 9.8 Tf  [(intimately related; a malnourished child is more susceptible to disease, and a sick child is more likely to become malnourished. )] TJ ET
BT 26.250 529.125 Td /F1 9.8 Tf  [(In order to measure the level of acute malnutrition in CHE, several methods are used, however, Weight for Height \(WfH\) for )] TJ ET
BT 26.250 517.221 Td /F1 9.8 Tf  [(children between 6-59 months is recommended as the main indicator of malnutrition by most UN agencies, governments, and )] TJ ET
BT 26.250 505.316 Td /F1 9.8 Tf  [(nongovernmental agencies. By convention, children with WfH of less than -2 standard deviations, or -2 Z scores below the )] TJ ET
BT 26.250 493.411 Td /F1 9.8 Tf  [(median of reference \(or edema\), are considered acutely malnourished.)] TJ ET
0.267 0.267 0.267 rg
BT 330.791 494.918 Td /F4 8.7 Tf  [(25)] TJ ET
BT 340.429 494.918 Td /F4 8.7 Tf  [(26)] TJ ET
BT 350.066 494.918 Td /F4 8.7 Tf  [(27)] TJ ET
BT 359.703 494.918 Td /F4 8.7 Tf  [(28)] TJ ET
BT 369.341 494.918 Td /F4 8.7 Tf  [(29)] TJ ET
BT 378.978 494.918 Td /F4 8.7 Tf  [(30)] TJ ET
BT 388.615 494.918 Td /F4 8.7 Tf  [(31)] TJ ET
0.271 0.267 0.267 rg
BT 398.253 493.411 Td /F1 9.8 Tf  [( The estimated absolute number of )] TJ ET
BT 26.250 481.506 Td /F1 9.8 Tf  [(children with Z score of -2 or less \(or with edema\) is the basis of this parameter. This can be obtained by estimating the total )] TJ ET
BT 26.250 469.602 Td /F1 9.8 Tf  [(number of children age 6-59 months affected, multiplied by the percentage of children who are categorized as acutely )] TJ ET
BT 26.250 457.697 Td /F1 9.8 Tf  [(malnourished. Some regions in the world might have existing endemic malnutrition before the onset of CHE; however, this )] TJ ET
BT 26.250 445.792 Td /F1 9.8 Tf  [(parameter would still require intervention whether acute or endemic. Evaluation of number of young children with acute )] TJ ET
BT 26.250 433.887 Td /F1 9.8 Tf  [(malnutrition is also used routinely by various agencies and tools conducting assessments, which are included in this scale. The )] TJ ET
BT 26.250 421.983 Td /F1 9.8 Tf  [(baseline of this parameter is chosen to be 20 and the remainder is stochastic. In the 2005 food crisis in Niger, MSF treated )] TJ ET
BT 26.250 410.078 Td /F1 9.8 Tf  [(63,000 children with acute malnutrition.)] TJ ET
0.267 0.267 0.267 rg
BT 195.325 411.585 Td /F4 8.7 Tf  [(32)] TJ ET
0.271 0.267 0.267 rg
BT 204.962 410.078 Td /F1 9.8 Tf  [( This parameter would have a score of 10 under the proposed scoring rubric.)] TJ ET
q
26.250 386.461 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 389.208 Td /F1 9.8 Tf  [(Table 6. Number of Young Children with Acute Malnutrition)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 190.487 555.000 188.474 re f
0.965 0.965 0.965 rg
27.000 365.931 423.433 12.280 re f
0.267 0.267 0.267 rg
26.625 377.836 423.808 0.750 re f
26.625 365.556 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 368.687 Td /F4 9.8 Tf  [(Number of young children \(age 6-59 months\) with acute malnutrition)] TJ ET
0.965 0.965 0.965 rg
450.433 365.931 130.067 12.280 re f
0.267 0.267 0.267 rg
450.433 377.836 130.442 0.750 re f
580.125 365.556 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 454.933 368.687 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 365.556 424.183 0.750 re f
26.625 349.675 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 355.701 Td /F1 9.8 Tf  [(<20)] TJ ET
0.267 0.267 0.267 rg
450.058 365.556 130.817 0.750 re f
450.058 349.675 0.750 16.631 re f
580.125 349.675 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 355.701 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 349.675 424.183 0.750 re f
26.625 333.793 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 339.820 Td /F1 9.8 Tf  [(20-99)] TJ ET
0.267 0.267 0.267 rg
450.058 349.675 130.817 0.750 re f
450.058 333.793 0.750 16.631 re f
580.125 333.793 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 339.820 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 333.793 424.183 0.750 re f
26.625 317.912 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 323.938 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
450.058 333.793 130.817 0.750 re f
450.058 317.912 0.750 16.631 re f
580.125 317.912 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 323.938 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 317.912 424.183 0.750 re f
26.625 302.031 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 308.057 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
450.058 317.912 130.817 0.750 re f
450.058 302.031 0.750 16.631 re f
580.125 302.031 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 308.057 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 302.031 424.183 0.750 re f
26.625 286.150 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 292.176 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
450.058 302.031 130.817 0.750 re f
450.058 286.150 0.750 16.631 re f
580.125 286.150 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 292.176 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 286.150 424.183 0.750 re f
26.625 270.268 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 276.295 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
450.058 286.150 130.817 0.750 re f
450.058 270.268 0.750 16.631 re f
580.125 270.268 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 276.295 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 270.268 424.183 0.750 re f
26.625 254.387 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 260.413 Td /F1 9.8 Tf  [(20,000-29,999)] TJ ET
0.267 0.267 0.267 rg
450.058 270.268 130.817 0.750 re f
450.058 254.387 0.750 16.631 re f
580.125 254.387 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 260.413 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 254.387 424.183 0.750 re f
26.625 238.506 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 244.532 Td /F1 9.8 Tf  [(30,000-39,999)] TJ ET
0.267 0.267 0.267 rg
450.058 254.387 130.817 0.750 re f
450.058 238.506 0.750 16.631 re f
580.125 238.506 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 244.532 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 238.506 424.183 0.750 re f
26.625 222.625 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 228.651 Td /F1 9.8 Tf  [(40,000-49,999)] TJ ET
0.267 0.267 0.267 rg
450.058 238.506 130.817 0.750 re f
450.058 222.625 0.750 16.631 re f
580.125 222.625 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 228.651 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 222.625 424.183 0.750 re f
26.625 206.743 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 212.770 Td /F1 9.8 Tf  [(50,000-59,999)] TJ ET
0.267 0.267 0.267 rg
450.058 222.625 130.817 0.750 re f
450.058 206.743 0.750 16.631 re f
580.125 206.743 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 212.770 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
26.625 206.743 424.183 0.750 re f
26.625 190.862 424.183 0.750 re f
26.625 190.862 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 196.888 Td /F1 9.8 Tf  [(Greater than or equal to 60,000)] TJ ET
0.267 0.267 0.267 rg
450.058 206.743 130.817 0.750 re f
450.058 190.862 130.817 0.750 re f
450.058 190.862 0.750 16.631 re f
580.125 190.862 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 196.888 Td /F1 9.8 Tf  [(10)] TJ ET
BT 26.250 135.963 Td /F4 9.8 Tf  [(7. Number of Displaced Persons \(internally displaced or refugees\):)] TJ ET
BT 335.091 135.963 Td /F1 9.8 Tf  [( The displacement of people is a well recognized )] TJ ET
BT 26.250 124.059 Td /F1 9.8 Tf  [(consequence of complex humanitarian emergencies. Displacement is either internal within countries \(internally displaced )] TJ ET
BT 26.250 112.154 Td /F1 9.8 Tf  [(person or IDP\), or external across country borders referred to as �refugee� according to the Geneva Convention.)] TJ ET
0.267 0.267 0.267 rg
BT 509.626 113.661 Td /F4 8.7 Tf  [(33)] TJ ET
0.271 0.267 0.267 rg
BT 519.263 112.154 Td /F1 9.8 Tf  [( According to )] TJ ET
BT 26.250 100.249 Td /F1 9.8 Tf  [(the Internal Displacement Monitoring Centre \(IDMC\) , internally displaced persons are �persons or groups of persons who have )] TJ ET
BT 26.250 88.344 Td /F1 9.8 Tf  [(been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to )] TJ ET
BT 26.250 76.440 Td /F1 9.8 Tf  [(avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made )] TJ ET
BT 26.250 64.535 Td /F1 9.8 Tf  [(disasters, and who have not crossed an internationally recognized State border.�)] TJ ET
0.267 0.267 0.267 rg
BT 373.623 66.042 Td /F4 8.7 Tf  [(34)] TJ ET
0.271 0.267 0.267 rg
BT 383.260 64.535 Td /F1 9.8 Tf  [( Those who are displaced need a set of )] TJ ET
BT 26.250 52.630 Td /F1 9.8 Tf  [(complex of services including shelter, food, water, sanitation, healthcare, among others. The higher the absolute number of )] TJ ET
BT 26.250 40.725 Td /F1 9.8 Tf  [(displaced, the more severe the humanitarian crisis is, and thus the more complex the needs and the response. This parameter )] TJ ET
Q
q
15.000 26.440 577.500 750.560 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 5. Levels of Health Care Services)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 662.578 555.000 93.186 re f
0.965 0.965 0.965 rg
27.000 742.734 424.330 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 424.705 0.750 re f
26.625 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 745.490 Td /F4 9.8 Tf  [(Levels of health care services)] TJ ET
0.965 0.965 0.965 rg
451.330 742.734 129.170 12.280 re f
0.267 0.267 0.267 rg
451.330 754.639 129.545 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 455.830 745.490 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 425.080 0.750 re f
26.625 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 732.504 Td /F1 9.8 Tf  [(All levels of heath care system are intact)] TJ ET
0.267 0.267 0.267 rg
450.955 742.359 129.920 0.750 re f
450.955 726.478 0.750 16.631 re f
580.125 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 456.205 732.504 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 726.478 425.080 0.750 re f
26.625 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 716.623 Td /F1 9.8 Tf  [(Disrupted fourth level of health care; intact third, second and first levels)] TJ ET
0.267 0.267 0.267 rg
450.955 726.478 129.920 0.750 re f
450.955 710.596 0.750 16.631 re f
580.125 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 456.205 716.623 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 710.596 425.080 0.750 re f
26.625 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 700.741 Td /F1 9.8 Tf  [(Disrupted fourth and third levels of health care; intact second and first levels)] TJ ET
0.267 0.267 0.267 rg
450.955 710.596 129.920 0.750 re f
450.955 694.715 0.750 16.631 re f
580.125 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 456.205 700.741 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 694.715 425.080 0.750 re f
26.625 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 684.860 Td /F1 9.8 Tf  [(Disrupted second, third and fourth levels of healthcare; intact first level)] TJ ET
0.267 0.267 0.267 rg
450.955 694.715 129.920 0.750 re f
450.955 678.834 0.750 16.631 re f
580.125 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 456.205 684.860 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 678.834 425.080 0.750 re f
26.625 662.953 425.080 0.750 re f
26.625 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 668.979 Td /F1 9.8 Tf  [(All levels of health care disrupted)] TJ ET
0.267 0.267 0.267 rg
450.955 678.834 129.920 0.750 re f
450.955 662.953 129.920 0.750 re f
450.955 662.953 0.750 16.631 re f
580.125 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 456.205 668.979 Td /F1 9.8 Tf  [(4)] TJ ET
BT 26.250 608.054 Td /F1 9.8 Tf  [(The 2010 Haiti earthquake, all levels of healthcare were disrupted in the acute phase, and hence this CHE would get a score of )] TJ ET
BT 26.250 596.149 Td /F1 9.8 Tf  [(4 at that time. Note that a retrospective evaluation of the pre-earthquake health system in Haiti using the above parameters )] TJ ET
BT 26.250 584.244 Td /F1 9.8 Tf  [(indicates disrupted third and fourth levels of healthcare services.)] TJ ET
BT 26.250 564.840 Td /F4 9.8 Tf  [(6. Number of Young Children \(6-59 months\) with Acute Malnutrition:)] TJ ET
BT 341.526 564.840 Td /F1 9.8 Tf  [( Malnutrition contributes to up to 55% of all children�s )] TJ ET
BT 26.250 552.935 Td /F1 9.8 Tf  [(deaths in developing countries.)] TJ ET
0.267 0.267 0.267 rg
BT 160.654 554.442 Td /F4 8.7 Tf  [(23)] TJ ET
BT 170.291 554.442 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 179.928 552.935 Td /F1 9.8 Tf  [( This percentage increases in acute emergency situations. Malnutrition and infections are )] TJ ET
BT 26.250 541.030 Td /F1 9.8 Tf  [(intimately related; a malnourished child is more susceptible to disease, and a sick child is more likely to become malnourished. )] TJ ET
BT 26.250 529.125 Td /F1 9.8 Tf  [(In order to measure the level of acute malnutrition in CHE, several methods are used, however, Weight for Height \(WfH\) for )] TJ ET
BT 26.250 517.221 Td /F1 9.8 Tf  [(children between 6-59 months is recommended as the main indicator of malnutrition by most UN agencies, governments, and )] TJ ET
BT 26.250 505.316 Td /F1 9.8 Tf  [(nongovernmental agencies. By convention, children with WfH of less than -2 standard deviations, or -2 Z scores below the )] TJ ET
BT 26.250 493.411 Td /F1 9.8 Tf  [(median of reference \(or edema\), are considered acutely malnourished.)] TJ ET
0.267 0.267 0.267 rg
BT 330.791 494.918 Td /F4 8.7 Tf  [(25)] TJ ET
BT 340.429 494.918 Td /F4 8.7 Tf  [(26)] TJ ET
BT 350.066 494.918 Td /F4 8.7 Tf  [(27)] TJ ET
BT 359.703 494.918 Td /F4 8.7 Tf  [(28)] TJ ET
BT 369.341 494.918 Td /F4 8.7 Tf  [(29)] TJ ET
BT 378.978 494.918 Td /F4 8.7 Tf  [(30)] TJ ET
BT 388.615 494.918 Td /F4 8.7 Tf  [(31)] TJ ET
0.271 0.267 0.267 rg
BT 398.253 493.411 Td /F1 9.8 Tf  [( The estimated absolute number of )] TJ ET
BT 26.250 481.506 Td /F1 9.8 Tf  [(children with Z score of -2 or less \(or with edema\) is the basis of this parameter. This can be obtained by estimating the total )] TJ ET
BT 26.250 469.602 Td /F1 9.8 Tf  [(number of children age 6-59 months affected, multiplied by the percentage of children who are categorized as acutely )] TJ ET
BT 26.250 457.697 Td /F1 9.8 Tf  [(malnourished. Some regions in the world might have existing endemic malnutrition before the onset of CHE; however, this )] TJ ET
BT 26.250 445.792 Td /F1 9.8 Tf  [(parameter would still require intervention whether acute or endemic. Evaluation of number of young children with acute )] TJ ET
BT 26.250 433.887 Td /F1 9.8 Tf  [(malnutrition is also used routinely by various agencies and tools conducting assessments, which are included in this scale. The )] TJ ET
BT 26.250 421.983 Td /F1 9.8 Tf  [(baseline of this parameter is chosen to be 20 and the remainder is stochastic. In the 2005 food crisis in Niger, MSF treated )] TJ ET
BT 26.250 410.078 Td /F1 9.8 Tf  [(63,000 children with acute malnutrition.)] TJ ET
0.267 0.267 0.267 rg
BT 195.325 411.585 Td /F4 8.7 Tf  [(32)] TJ ET
0.271 0.267 0.267 rg
BT 204.962 410.078 Td /F1 9.8 Tf  [( This parameter would have a score of 10 under the proposed scoring rubric.)] TJ ET
q
26.250 386.461 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 389.208 Td /F1 9.8 Tf  [(Table 6. Number of Young Children with Acute Malnutrition)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 190.487 555.000 188.474 re f
0.965 0.965 0.965 rg
27.000 365.931 423.433 12.280 re f
0.267 0.267 0.267 rg
26.625 377.836 423.808 0.750 re f
26.625 365.556 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 368.687 Td /F4 9.8 Tf  [(Number of young children \(age 6-59 months\) with acute malnutrition)] TJ ET
0.965 0.965 0.965 rg
450.433 365.931 130.067 12.280 re f
0.267 0.267 0.267 rg
450.433 377.836 130.442 0.750 re f
580.125 365.556 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 454.933 368.687 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 365.556 424.183 0.750 re f
26.625 349.675 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 355.701 Td /F1 9.8 Tf  [(<20)] TJ ET
0.267 0.267 0.267 rg
450.058 365.556 130.817 0.750 re f
450.058 349.675 0.750 16.631 re f
580.125 349.675 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 355.701 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 349.675 424.183 0.750 re f
26.625 333.793 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 339.820 Td /F1 9.8 Tf  [(20-99)] TJ ET
0.267 0.267 0.267 rg
450.058 349.675 130.817 0.750 re f
450.058 333.793 0.750 16.631 re f
580.125 333.793 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 339.820 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 333.793 424.183 0.750 re f
26.625 317.912 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 323.938 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
450.058 333.793 130.817 0.750 re f
450.058 317.912 0.750 16.631 re f
580.125 317.912 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 323.938 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 317.912 424.183 0.750 re f
26.625 302.031 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 308.057 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
450.058 317.912 130.817 0.750 re f
450.058 302.031 0.750 16.631 re f
580.125 302.031 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 308.057 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 302.031 424.183 0.750 re f
26.625 286.150 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 292.176 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
450.058 302.031 130.817 0.750 re f
450.058 286.150 0.750 16.631 re f
580.125 286.150 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 292.176 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 286.150 424.183 0.750 re f
26.625 270.268 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 276.295 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
450.058 286.150 130.817 0.750 re f
450.058 270.268 0.750 16.631 re f
580.125 270.268 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 276.295 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 270.268 424.183 0.750 re f
26.625 254.387 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 260.413 Td /F1 9.8 Tf  [(20,000-29,999)] TJ ET
0.267 0.267 0.267 rg
450.058 270.268 130.817 0.750 re f
450.058 254.387 0.750 16.631 re f
580.125 254.387 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 260.413 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 254.387 424.183 0.750 re f
26.625 238.506 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 244.532 Td /F1 9.8 Tf  [(30,000-39,999)] TJ ET
0.267 0.267 0.267 rg
450.058 254.387 130.817 0.750 re f
450.058 238.506 0.750 16.631 re f
580.125 238.506 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 244.532 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 238.506 424.183 0.750 re f
26.625 222.625 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 228.651 Td /F1 9.8 Tf  [(40,000-49,999)] TJ ET
0.267 0.267 0.267 rg
450.058 238.506 130.817 0.750 re f
450.058 222.625 0.750 16.631 re f
580.125 222.625 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 228.651 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 222.625 424.183 0.750 re f
26.625 206.743 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 212.770 Td /F1 9.8 Tf  [(50,000-59,999)] TJ ET
0.267 0.267 0.267 rg
450.058 222.625 130.817 0.750 re f
450.058 206.743 0.750 16.631 re f
580.125 206.743 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 212.770 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
26.625 206.743 424.183 0.750 re f
26.625 190.862 424.183 0.750 re f
26.625 190.862 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 196.888 Td /F1 9.8 Tf  [(Greater than or equal to 60,000)] TJ ET
0.267 0.267 0.267 rg
450.058 206.743 130.817 0.750 re f
450.058 190.862 130.817 0.750 re f
450.058 190.862 0.750 16.631 re f
580.125 190.862 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 196.888 Td /F1 9.8 Tf  [(10)] TJ ET
BT 26.250 135.963 Td /F4 9.8 Tf  [(7. Number of Displaced Persons \(internally displaced or refugees\):)] TJ ET
BT 335.091 135.963 Td /F1 9.8 Tf  [( The displacement of people is a well recognized )] TJ ET
BT 26.250 124.059 Td /F1 9.8 Tf  [(consequence of complex humanitarian emergencies. Displacement is either internal within countries \(internally displaced )] TJ ET
BT 26.250 112.154 Td /F1 9.8 Tf  [(person or IDP\), or external across country borders referred to as �refugee� according to the Geneva Convention.)] TJ ET
0.267 0.267 0.267 rg
BT 509.626 113.661 Td /F4 8.7 Tf  [(33)] TJ ET
0.271 0.267 0.267 rg
BT 519.263 112.154 Td /F1 9.8 Tf  [( According to )] TJ ET
BT 26.250 100.249 Td /F1 9.8 Tf  [(the Internal Displacement Monitoring Centre \(IDMC\) , internally displaced persons are �persons or groups of persons who have )] TJ ET
BT 26.250 88.344 Td /F1 9.8 Tf  [(been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to )] TJ ET
BT 26.250 76.440 Td /F1 9.8 Tf  [(avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made )] TJ ET
BT 26.250 64.535 Td /F1 9.8 Tf  [(disasters, and who have not crossed an internationally recognized State border.�)] TJ ET
0.267 0.267 0.267 rg
BT 373.623 66.042 Td /F4 8.7 Tf  [(34)] TJ ET
0.271 0.267 0.267 rg
BT 383.260 64.535 Td /F1 9.8 Tf  [( Those who are displaced need a set of )] TJ ET
BT 26.250 52.630 Td /F1 9.8 Tf  [(complex of services including shelter, food, water, sanitation, healthcare, among others. The higher the absolute number of )] TJ ET
BT 26.250 40.725 Td /F1 9.8 Tf  [(displaced, the more severe the humanitarian crisis is, and thus the more complex the needs and the response. This parameter )] TJ ET
Q
q
15.000 26.440 577.500 750.560 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 5. Levels of Health Care Services)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 662.578 555.000 93.186 re f
0.965 0.965 0.965 rg
27.000 742.734 424.330 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 424.705 0.750 re f
26.625 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 745.490 Td /F4 9.8 Tf  [(Levels of health care services)] TJ ET
0.965 0.965 0.965 rg
451.330 742.734 129.170 12.280 re f
0.267 0.267 0.267 rg
451.330 754.639 129.545 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 455.830 745.490 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 425.080 0.750 re f
26.625 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 732.504 Td /F1 9.8 Tf  [(All levels of heath care system are intact)] TJ ET
0.267 0.267 0.267 rg
450.955 742.359 129.920 0.750 re f
450.955 726.478 0.750 16.631 re f
580.125 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 456.205 732.504 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 726.478 425.080 0.750 re f
26.625 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 716.623 Td /F1 9.8 Tf  [(Disrupted fourth level of health care; intact third, second and first levels)] TJ ET
0.267 0.267 0.267 rg
450.955 726.478 129.920 0.750 re f
450.955 710.596 0.750 16.631 re f
580.125 710.596 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 456.205 716.623 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 710.596 425.080 0.750 re f
26.625 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 700.741 Td /F1 9.8 Tf  [(Disrupted fourth and third levels of health care; intact second and first levels)] TJ ET
0.267 0.267 0.267 rg
450.955 710.596 129.920 0.750 re f
450.955 694.715 0.750 16.631 re f
580.125 694.715 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 456.205 700.741 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 694.715 425.080 0.750 re f
26.625 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 684.860 Td /F1 9.8 Tf  [(Disrupted second, third and fourth levels of healthcare; intact first level)] TJ ET
0.267 0.267 0.267 rg
450.955 694.715 129.920 0.750 re f
450.955 678.834 0.750 16.631 re f
580.125 678.834 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 456.205 684.860 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 678.834 425.080 0.750 re f
26.625 662.953 425.080 0.750 re f
26.625 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 668.979 Td /F1 9.8 Tf  [(All levels of health care disrupted)] TJ ET
0.267 0.267 0.267 rg
450.955 678.834 129.920 0.750 re f
450.955 662.953 129.920 0.750 re f
450.955 662.953 0.750 16.631 re f
580.125 662.953 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 456.205 668.979 Td /F1 9.8 Tf  [(4)] TJ ET
BT 26.250 608.054 Td /F1 9.8 Tf  [(The 2010 Haiti earthquake, all levels of healthcare were disrupted in the acute phase, and hence this CHE would get a score of )] TJ ET
BT 26.250 596.149 Td /F1 9.8 Tf  [(4 at that time. Note that a retrospective evaluation of the pre-earthquake health system in Haiti using the above parameters )] TJ ET
BT 26.250 584.244 Td /F1 9.8 Tf  [(indicates disrupted third and fourth levels of healthcare services.)] TJ ET
BT 26.250 564.840 Td /F4 9.8 Tf  [(6. Number of Young Children \(6-59 months\) with Acute Malnutrition:)] TJ ET
BT 341.526 564.840 Td /F1 9.8 Tf  [( Malnutrition contributes to up to 55% of all children�s )] TJ ET
BT 26.250 552.935 Td /F1 9.8 Tf  [(deaths in developing countries.)] TJ ET
0.267 0.267 0.267 rg
BT 160.654 554.442 Td /F4 8.7 Tf  [(23)] TJ ET
BT 170.291 554.442 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 179.928 552.935 Td /F1 9.8 Tf  [( This percentage increases in acute emergency situations. Malnutrition and infections are )] TJ ET
BT 26.250 541.030 Td /F1 9.8 Tf  [(intimately related; a malnourished child is more susceptible to disease, and a sick child is more likely to become malnourished. )] TJ ET
BT 26.250 529.125 Td /F1 9.8 Tf  [(In order to measure the level of acute malnutrition in CHE, several methods are used, however, Weight for Height \(WfH\) for )] TJ ET
BT 26.250 517.221 Td /F1 9.8 Tf  [(children between 6-59 months is recommended as the main indicator of malnutrition by most UN agencies, governments, and )] TJ ET
BT 26.250 505.316 Td /F1 9.8 Tf  [(nongovernmental agencies. By convention, children with WfH of less than -2 standard deviations, or -2 Z scores below the )] TJ ET
BT 26.250 493.411 Td /F1 9.8 Tf  [(median of reference \(or edema\), are considered acutely malnourished.)] TJ ET
0.267 0.267 0.267 rg
BT 330.791 494.918 Td /F4 8.7 Tf  [(25)] TJ ET
BT 340.429 494.918 Td /F4 8.7 Tf  [(26)] TJ ET
BT 350.066 494.918 Td /F4 8.7 Tf  [(27)] TJ ET
BT 359.703 494.918 Td /F4 8.7 Tf  [(28)] TJ ET
BT 369.341 494.918 Td /F4 8.7 Tf  [(29)] TJ ET
BT 378.978 494.918 Td /F4 8.7 Tf  [(30)] TJ ET
BT 388.615 494.918 Td /F4 8.7 Tf  [(31)] TJ ET
0.271 0.267 0.267 rg
BT 398.253 493.411 Td /F1 9.8 Tf  [( The estimated absolute number of )] TJ ET
BT 26.250 481.506 Td /F1 9.8 Tf  [(children with Z score of -2 or less \(or with edema\) is the basis of this parameter. This can be obtained by estimating the total )] TJ ET
BT 26.250 469.602 Td /F1 9.8 Tf  [(number of children age 6-59 months affected, multiplied by the percentage of children who are categorized as acutely )] TJ ET
BT 26.250 457.697 Td /F1 9.8 Tf  [(malnourished. Some regions in the world might have existing endemic malnutrition before the onset of CHE; however, this )] TJ ET
BT 26.250 445.792 Td /F1 9.8 Tf  [(parameter would still require intervention whether acute or endemic. Evaluation of number of young children with acute )] TJ ET
BT 26.250 433.887 Td /F1 9.8 Tf  [(malnutrition is also used routinely by various agencies and tools conducting assessments, which are included in this scale. The )] TJ ET
BT 26.250 421.983 Td /F1 9.8 Tf  [(baseline of this parameter is chosen to be 20 and the remainder is stochastic. In the 2005 food crisis in Niger, MSF treated )] TJ ET
BT 26.250 410.078 Td /F1 9.8 Tf  [(63,000 children with acute malnutrition.)] TJ ET
0.267 0.267 0.267 rg
BT 195.325 411.585 Td /F4 8.7 Tf  [(32)] TJ ET
0.271 0.267 0.267 rg
BT 204.962 410.078 Td /F1 9.8 Tf  [( This parameter would have a score of 10 under the proposed scoring rubric.)] TJ ET
q
26.250 386.461 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 389.208 Td /F1 9.8 Tf  [(Table 6. Number of Young Children with Acute Malnutrition)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 190.487 555.000 188.474 re f
0.965 0.965 0.965 rg
27.000 365.931 423.433 12.280 re f
0.267 0.267 0.267 rg
26.625 377.836 423.808 0.750 re f
26.625 365.556 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 368.687 Td /F4 9.8 Tf  [(Number of young children \(age 6-59 months\) with acute malnutrition)] TJ ET
0.965 0.965 0.965 rg
450.433 365.931 130.067 12.280 re f
0.267 0.267 0.267 rg
450.433 377.836 130.442 0.750 re f
580.125 365.556 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 454.933 368.687 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 365.556 424.183 0.750 re f
26.625 349.675 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 355.701 Td /F1 9.8 Tf  [(<20)] TJ ET
0.267 0.267 0.267 rg
450.058 365.556 130.817 0.750 re f
450.058 349.675 0.750 16.631 re f
580.125 349.675 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 355.701 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 349.675 424.183 0.750 re f
26.625 333.793 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 339.820 Td /F1 9.8 Tf  [(20-99)] TJ ET
0.267 0.267 0.267 rg
450.058 349.675 130.817 0.750 re f
450.058 333.793 0.750 16.631 re f
580.125 333.793 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 339.820 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 333.793 424.183 0.750 re f
26.625 317.912 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 323.938 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
450.058 333.793 130.817 0.750 re f
450.058 317.912 0.750 16.631 re f
580.125 317.912 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 323.938 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 317.912 424.183 0.750 re f
26.625 302.031 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 308.057 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
450.058 317.912 130.817 0.750 re f
450.058 302.031 0.750 16.631 re f
580.125 302.031 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 308.057 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 302.031 424.183 0.750 re f
26.625 286.150 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 292.176 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
450.058 302.031 130.817 0.750 re f
450.058 286.150 0.750 16.631 re f
580.125 286.150 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 292.176 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 286.150 424.183 0.750 re f
26.625 270.268 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 276.295 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
450.058 286.150 130.817 0.750 re f
450.058 270.268 0.750 16.631 re f
580.125 270.268 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 276.295 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 270.268 424.183 0.750 re f
26.625 254.387 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 260.413 Td /F1 9.8 Tf  [(20,000-29,999)] TJ ET
0.267 0.267 0.267 rg
450.058 270.268 130.817 0.750 re f
450.058 254.387 0.750 16.631 re f
580.125 254.387 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 260.413 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 254.387 424.183 0.750 re f
26.625 238.506 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 244.532 Td /F1 9.8 Tf  [(30,000-39,999)] TJ ET
0.267 0.267 0.267 rg
450.058 254.387 130.817 0.750 re f
450.058 238.506 0.750 16.631 re f
580.125 238.506 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 244.532 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 238.506 424.183 0.750 re f
26.625 222.625 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 228.651 Td /F1 9.8 Tf  [(40,000-49,999)] TJ ET
0.267 0.267 0.267 rg
450.058 238.506 130.817 0.750 re f
450.058 222.625 0.750 16.631 re f
580.125 222.625 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 228.651 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 222.625 424.183 0.750 re f
26.625 206.743 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 212.770 Td /F1 9.8 Tf  [(50,000-59,999)] TJ ET
0.267 0.267 0.267 rg
450.058 222.625 130.817 0.750 re f
450.058 206.743 0.750 16.631 re f
580.125 206.743 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 212.770 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
26.625 206.743 424.183 0.750 re f
26.625 190.862 424.183 0.750 re f
26.625 190.862 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 196.888 Td /F1 9.8 Tf  [(Greater than or equal to 60,000)] TJ ET
0.267 0.267 0.267 rg
450.058 206.743 130.817 0.750 re f
450.058 190.862 130.817 0.750 re f
450.058 190.862 0.750 16.631 re f
580.125 190.862 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 455.308 196.888 Td /F1 9.8 Tf  [(10)] TJ ET
BT 26.250 135.963 Td /F4 9.8 Tf  [(7. Number of Displaced Persons \(internally displaced or refugees\):)] TJ ET
BT 335.091 135.963 Td /F1 9.8 Tf  [( The displacement of people is a well recognized )] TJ ET
BT 26.250 124.059 Td /F1 9.8 Tf  [(consequence of complex humanitarian emergencies. Displacement is either internal within countries \(internally displaced )] TJ ET
BT 26.250 112.154 Td /F1 9.8 Tf  [(person or IDP\), or external across country borders referred to as �refugee� according to the Geneva Convention.)] TJ ET
0.267 0.267 0.267 rg
BT 509.626 113.661 Td /F4 8.7 Tf  [(33)] TJ ET
0.271 0.267 0.267 rg
BT 519.263 112.154 Td /F1 9.8 Tf  [( According to )] TJ ET
BT 26.250 100.249 Td /F1 9.8 Tf  [(the Internal Displacement Monitoring Centre \(IDMC\) , internally displaced persons are �persons or groups of persons who have )] TJ ET
BT 26.250 88.344 Td /F1 9.8 Tf  [(been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to )] TJ ET
BT 26.250 76.440 Td /F1 9.8 Tf  [(avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made )] TJ ET
BT 26.250 64.535 Td /F1 9.8 Tf  [(disasters, and who have not crossed an internationally recognized State border.�)] TJ ET
0.267 0.267 0.267 rg
BT 373.623 66.042 Td /F4 8.7 Tf  [(34)] TJ ET
0.271 0.267 0.267 rg
BT 383.260 64.535 Td /F1 9.8 Tf  [( Those who are displaced need a set of )] TJ ET
BT 26.250 52.630 Td /F1 9.8 Tf  [(complex of services including shelter, food, water, sanitation, healthcare, among others. The higher the absolute number of )] TJ ET
BT 26.250 40.725 Td /F1 9.8 Tf  [(displaced, the more severe the humanitarian crisis is, and thus the more complex the needs and the response. This parameter )] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(7)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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0.271 0.267 0.267 rg
q
15.000 22.438 577.500 754.562 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(includes both IDPs and refugees. The floor of this scoring rubric is set at 20, while the ceiling is set at 1,000,000. Several days )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(after the Pakistan floods from the Indus River in August 2010, the UNICEF estimated that more than 3 million were in need of )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(emergency assistance including shelter.)] TJ ET
0.267 0.267 0.267 rg
BT 199.108 745.174 Td /F4 8.7 Tf  [(35)] TJ ET
0.271 0.267 0.267 rg
BT 208.745 743.667 Td /F1 9.8 Tf  [( This crisis would also translate to a score of 10 on this parameter.)] TJ ET
q
26.250 720.049 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 722.797 Td /F1 9.8 Tf  [(Table 7. Number of Displaced Persons)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 539.957 555.000 172.592 re f
0.965 0.965 0.965 rg
27.000 699.520 360.851 12.280 re f
0.267 0.267 0.267 rg
26.625 711.424 361.226 0.750 re f
26.625 699.145 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 702.276 Td /F4 9.8 Tf  [(Number of displaced persons)] TJ ET
0.965 0.965 0.965 rg
387.851 699.520 192.649 12.280 re f
0.267 0.267 0.267 rg
387.851 711.424 193.024 0.750 re f
580.125 699.145 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 392.351 702.276 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 699.145 361.601 0.750 re f
26.625 683.263 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 689.290 Td /F1 9.8 Tf  [(<20)] TJ ET
0.267 0.267 0.267 rg
387.476 699.145 193.399 0.750 re f
387.476 683.263 0.750 16.631 re f
580.125 683.263 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 689.290 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 683.263 361.601 0.750 re f
26.625 667.382 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 673.408 Td /F1 9.8 Tf  [(20-99)] TJ ET
0.267 0.267 0.267 rg
387.476 683.263 193.399 0.750 re f
387.476 667.382 0.750 16.631 re f
580.125 667.382 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 673.408 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 667.382 361.601 0.750 re f
26.625 651.501 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 657.527 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
387.476 667.382 193.399 0.750 re f
387.476 651.501 0.750 16.631 re f
580.125 651.501 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 657.527 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 651.501 361.601 0.750 re f
26.625 635.620 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 641.646 Td /F1 9.8 Tf  [(1,000-9,999)] TJ ET
0.267 0.267 0.267 rg
387.476 651.501 193.399 0.750 re f
387.476 635.620 0.750 16.631 re f
580.125 635.620 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 641.646 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 635.620 361.601 0.750 re f
26.625 619.738 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 625.765 Td /F1 9.8 Tf  [(10,000-49,000)] TJ ET
0.267 0.267 0.267 rg
387.476 635.620 193.399 0.750 re f
387.476 619.738 0.750 16.631 re f
580.125 619.738 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 625.765 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 619.738 361.601 0.750 re f
26.625 603.857 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 609.883 Td /F1 9.8 Tf  [(50,000-99,999)] TJ ET
0.267 0.267 0.267 rg
387.476 619.738 193.399 0.750 re f
387.476 603.857 0.750 16.631 re f
580.125 603.857 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 609.883 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 603.857 361.601 0.750 re f
26.625 587.976 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 594.002 Td /F1 9.8 Tf  [(100,000-199,999)] TJ ET
0.267 0.267 0.267 rg
387.476 603.857 193.399 0.750 re f
387.476 587.976 0.750 16.631 re f
580.125 587.976 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 594.002 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 587.976 361.601 0.750 re f
26.625 572.095 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 578.121 Td /F1 9.8 Tf  [(200,000-499,999)] TJ ET
0.267 0.267 0.267 rg
387.476 587.976 193.399 0.750 re f
387.476 572.095 0.750 16.631 re f
580.125 572.095 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 578.121 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 572.095 361.601 0.750 re f
26.625 556.213 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 562.240 Td /F1 9.8 Tf  [(500,000-999,999)] TJ ET
0.267 0.267 0.267 rg
387.476 572.095 193.399 0.750 re f
387.476 556.213 0.750 16.631 re f
580.125 556.213 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 562.240 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 556.213 361.601 0.750 re f
26.625 540.332 361.601 0.750 re f
26.625 540.332 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 546.358 Td /F1 9.8 Tf  [(Greater than or equal to 1,000,000)] TJ ET
0.267 0.267 0.267 rg
387.476 556.213 193.399 0.750 re f
387.476 540.332 193.399 0.750 re f
387.476 540.332 0.750 16.631 re f
580.125 540.332 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 546.358 Td /F1 9.8 Tf  [(9)] TJ ET
BT 26.250 485.433 Td /F4 9.8 Tf  [(8. Number of Persons with Inadequate Living Space:)] TJ ET
BT 269.522 485.433 Td /F1 9.8 Tf  [( Shortage of space is a common problem in CHE, especially in )] TJ ET
BT 26.250 473.529 Td /F1 9.8 Tf  [(temporary shelters for IDPs and refugees. Humanitarian assistance organizations should obtain, as quickly as possible, an )] TJ ET
BT 26.250 461.624 Td /F1 9.8 Tf  [(estimate of the absolute number of people without adequate living space because of the risk of infectious outbreaks and )] TJ ET
BT 26.250 449.719 Td /F1 9.8 Tf  [(violence. Early estimates are also necessary since providing temporary shelters require well-organized and time consuming )] TJ ET
BT 26.250 437.814 Td /F1 9.8 Tf  [(logistical preparation measures. According to the Sphere Project, temporary planned or self-settled camps require a minimum )] TJ ET
BT 26.250 425.910 Td /F1 9.8 Tf  [(surface area of 45 m)] TJ ET
BT 115.667 429.798 Td /F1 8.7 Tf  [(2)] TJ ET
BT 120.486 425.910 Td /F1 9.8 Tf  [( per person, with a covered shelter area of not less than 3.5 m)] TJ ET
BT 388.201 429.798 Td /F1 8.7 Tf  [(2)] TJ ET
BT 393.020 425.910 Td /F1 9.8 Tf  [( per person.)] TJ ET
0.267 0.267 0.267 rg
BT 445.046 427.417 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 449.865 425.910 Td /F1 9.8 Tf  [( The floor of this scoring )] TJ ET
BT 26.250 414.005 Td /F1 9.8 Tf  [(rubric was set at 20. The number 200,000 was used as the ceiling since, according to Human Rights Watch, the Somali refugee )] TJ ET
BT 26.250 402.100 Td /F1 9.8 Tf  [(camp in Dadaab, Kenya, is home to the largest population of refugees in the world, estimated at more than 200,000 refugees.)] TJ ET
0.267 0.267 0.267 rg
BT 567.121 403.607 Td /F4 8.7 Tf  [(36)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 390.195 Td /F1 9.8 Tf  [(In the aftermath of the Rwandan genocide in 1994, the Kibeho camp had a surface area of 9 km)] TJ ET
BT 439.777 394.084 Td /F1 8.7 Tf  [(2)] TJ ET
BT 444.595 390.195 Td /F1 9.8 Tf  [( with up to 120,000 IDPs. In )] TJ ET
BT 26.250 378.291 Td /F1 9.8 Tf  [(this scenario, the average surface area per person is about 75 m)] TJ ET
BT 305.344 382.179 Td /F1 8.7 Tf  [(2)] TJ ET
BT 310.162 378.291 Td /F1 9.8 Tf  [(, and the score on this parameter �for illustration purposes- )] TJ ET
BT 26.250 366.386 Td /F1 9.8 Tf  [(would be zero.)] TJ ET
0.267 0.267 0.267 rg
BT 89.654 367.893 Td /F4 8.7 Tf  [(37)] TJ ET
0.271 0.267 0.267 rg
BT 99.292 366.386 Td /F1 9.8 Tf  [( A more detailed survey within the camp may reveal a certain number with inadequate living space, and a )] TJ ET
BT 26.250 354.481 Td /F1 9.8 Tf  [(higher score on this parameter.)] TJ ET
q
26.250 330.864 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 333.611 Td /F1 9.8 Tf  [(Table 8. Number of Persons with Inadequate Living Space)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 150.772 555.000 172.592 re f
0.965 0.965 0.965 rg
27.000 310.334 438.070 12.280 re f
0.267 0.267 0.267 rg
26.625 322.239 438.445 0.750 re f
26.625 309.959 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 313.090 Td /F4 9.8 Tf  [(Number of persons with surface area of less than 45 m)] TJ ET
BT 285.078 313.090 Td /F4 8.7 Tf  [(2)] TJ ET
BT 289.897 313.090 Td /F4 9.8 Tf  [( or covered area of less than 3.5 m)] TJ ET
BT 449.758 313.090 Td /F4 8.7 Tf  [(2)] TJ ET
0.965 0.965 0.965 rg
465.070 310.334 115.430 12.280 re f
0.267 0.267 0.267 rg
465.070 322.239 115.805 0.750 re f
580.125 309.959 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 469.570 313.090 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 309.959 438.820 0.750 re f
26.625 294.078 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 300.104 Td /F1 9.8 Tf  [(<20)] TJ ET
0.267 0.267 0.267 rg
464.695 309.959 116.180 0.750 re f
464.695 294.078 0.750 16.631 re f
580.125 294.078 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 300.104 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 294.078 438.820 0.750 re f
26.625 278.197 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 284.223 Td /F1 9.8 Tf  [(20-99)] TJ ET
0.267 0.267 0.267 rg
464.695 294.078 116.180 0.750 re f
464.695 278.197 0.750 16.631 re f
580.125 278.197 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 284.223 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 278.197 438.820 0.750 re f
26.625 262.315 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 268.342 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
464.695 278.197 116.180 0.750 re f
464.695 262.315 0.750 16.631 re f
580.125 262.315 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 268.342 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 262.315 438.820 0.750 re f
26.625 246.434 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 252.460 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
464.695 262.315 116.180 0.750 re f
464.695 246.434 0.750 16.631 re f
580.125 246.434 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 252.460 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 246.434 438.820 0.750 re f
26.625 230.553 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 236.579 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
464.695 246.434 116.180 0.750 re f
464.695 230.553 0.750 16.631 re f
580.125 230.553 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 236.579 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 230.553 438.820 0.750 re f
26.625 214.672 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 220.698 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
464.695 230.553 116.180 0.750 re f
464.695 214.672 0.750 16.631 re f
580.125 214.672 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 220.698 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 214.672 438.820 0.750 re f
26.625 198.790 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 204.817 Td /F1 9.8 Tf  [(20,000-49,999)] TJ ET
0.267 0.267 0.267 rg
464.695 214.672 116.180 0.750 re f
464.695 198.790 0.750 16.631 re f
580.125 198.790 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 204.817 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 198.790 438.820 0.750 re f
26.625 182.909 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 188.935 Td /F1 9.8 Tf  [(50,000-99,999)] TJ ET
0.267 0.267 0.267 rg
464.695 198.790 116.180 0.750 re f
464.695 182.909 0.750 16.631 re f
580.125 182.909 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 188.935 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 182.909 438.820 0.750 re f
26.625 167.028 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 173.054 Td /F1 9.8 Tf  [(100,000-199,999)] TJ ET
0.267 0.267 0.267 rg
464.695 182.909 116.180 0.750 re f
464.695 167.028 0.750 16.631 re f
580.125 167.028 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 173.054 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 167.028 438.820 0.750 re f
26.625 151.147 438.820 0.750 re f
26.625 151.147 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 157.173 Td /F1 9.8 Tf  [(Greater than or equal to 200,000)] TJ ET
0.267 0.267 0.267 rg
464.695 167.028 116.180 0.750 re f
464.695 151.147 116.180 0.750 re f
464.695 151.147 0.750 16.631 re f
580.125 151.147 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 157.173 Td /F1 9.8 Tf  [(9)] TJ ET
BT 26.250 96.248 Td /F4 9.8 Tf  [(9. Water Quantity:)] TJ ET
BT 109.681 96.248 Td /F1 9.8 Tf  [( People can survive much longer without food than without water. In extreme situations, there may not be )] TJ ET
BT 26.250 84.343 Td /F1 9.8 Tf  [(sufficient water available to meet basic needs, and in these cases supplying a survival level of safe drinking water is of critical )] TJ ET
BT 26.250 72.438 Td /F1 9.8 Tf  [(importance. In addition, health problems are caused by poor hygiene due to insufficient water and by the consumption of )] TJ ET
BT 26.250 60.534 Td /F1 9.8 Tf  [(contaminated water. Although water quantity is more important than water quality especially in the initial phase of CHE, quality )] TJ ET
BT 26.250 48.629 Td /F1 9.8 Tf  [(is tightly linked to diarrheal diseases which are a major type of morbidity and mortality. The parameter of water quantity implies )] TJ ET
BT 26.250 36.724 Td /F1 9.8 Tf  [(accessibility. Not only is it important to have available sources of water, but access to these sources is pivotal. The provision of )] TJ ET
Q
q
15.000 22.438 577.500 754.562 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(includes both IDPs and refugees. The floor of this scoring rubric is set at 20, while the ceiling is set at 1,000,000. Several days )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(after the Pakistan floods from the Indus River in August 2010, the UNICEF estimated that more than 3 million were in need of )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(emergency assistance including shelter.)] TJ ET
0.267 0.267 0.267 rg
BT 199.108 745.174 Td /F4 8.7 Tf  [(35)] TJ ET
0.271 0.267 0.267 rg
BT 208.745 743.667 Td /F1 9.8 Tf  [( This crisis would also translate to a score of 10 on this parameter.)] TJ ET
q
26.250 720.049 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 722.797 Td /F1 9.8 Tf  [(Table 7. Number of Displaced Persons)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 539.957 555.000 172.592 re f
0.965 0.965 0.965 rg
27.000 699.520 360.851 12.280 re f
0.267 0.267 0.267 rg
26.625 711.424 361.226 0.750 re f
26.625 699.145 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 702.276 Td /F4 9.8 Tf  [(Number of displaced persons)] TJ ET
0.965 0.965 0.965 rg
387.851 699.520 192.649 12.280 re f
0.267 0.267 0.267 rg
387.851 711.424 193.024 0.750 re f
580.125 699.145 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 392.351 702.276 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 699.145 361.601 0.750 re f
26.625 683.263 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 689.290 Td /F1 9.8 Tf  [(<20)] TJ ET
0.267 0.267 0.267 rg
387.476 699.145 193.399 0.750 re f
387.476 683.263 0.750 16.631 re f
580.125 683.263 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 689.290 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 683.263 361.601 0.750 re f
26.625 667.382 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 673.408 Td /F1 9.8 Tf  [(20-99)] TJ ET
0.267 0.267 0.267 rg
387.476 683.263 193.399 0.750 re f
387.476 667.382 0.750 16.631 re f
580.125 667.382 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 673.408 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 667.382 361.601 0.750 re f
26.625 651.501 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 657.527 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
387.476 667.382 193.399 0.750 re f
387.476 651.501 0.750 16.631 re f
580.125 651.501 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 657.527 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 651.501 361.601 0.750 re f
26.625 635.620 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 641.646 Td /F1 9.8 Tf  [(1,000-9,999)] TJ ET
0.267 0.267 0.267 rg
387.476 651.501 193.399 0.750 re f
387.476 635.620 0.750 16.631 re f
580.125 635.620 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 641.646 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 635.620 361.601 0.750 re f
26.625 619.738 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 625.765 Td /F1 9.8 Tf  [(10,000-49,000)] TJ ET
0.267 0.267 0.267 rg
387.476 635.620 193.399 0.750 re f
387.476 619.738 0.750 16.631 re f
580.125 619.738 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 625.765 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 619.738 361.601 0.750 re f
26.625 603.857 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 609.883 Td /F1 9.8 Tf  [(50,000-99,999)] TJ ET
0.267 0.267 0.267 rg
387.476 619.738 193.399 0.750 re f
387.476 603.857 0.750 16.631 re f
580.125 603.857 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 609.883 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 603.857 361.601 0.750 re f
26.625 587.976 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 594.002 Td /F1 9.8 Tf  [(100,000-199,999)] TJ ET
0.267 0.267 0.267 rg
387.476 603.857 193.399 0.750 re f
387.476 587.976 0.750 16.631 re f
580.125 587.976 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 594.002 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 587.976 361.601 0.750 re f
26.625 572.095 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 578.121 Td /F1 9.8 Tf  [(200,000-499,999)] TJ ET
0.267 0.267 0.267 rg
387.476 587.976 193.399 0.750 re f
387.476 572.095 0.750 16.631 re f
580.125 572.095 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 578.121 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 572.095 361.601 0.750 re f
26.625 556.213 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 562.240 Td /F1 9.8 Tf  [(500,000-999,999)] TJ ET
0.267 0.267 0.267 rg
387.476 572.095 193.399 0.750 re f
387.476 556.213 0.750 16.631 re f
580.125 556.213 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 562.240 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 556.213 361.601 0.750 re f
26.625 540.332 361.601 0.750 re f
26.625 540.332 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 546.358 Td /F1 9.8 Tf  [(Greater than or equal to 1,000,000)] TJ ET
0.267 0.267 0.267 rg
387.476 556.213 193.399 0.750 re f
387.476 540.332 193.399 0.750 re f
387.476 540.332 0.750 16.631 re f
580.125 540.332 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 546.358 Td /F1 9.8 Tf  [(9)] TJ ET
BT 26.250 485.433 Td /F4 9.8 Tf  [(8. Number of Persons with Inadequate Living Space:)] TJ ET
BT 269.522 485.433 Td /F1 9.8 Tf  [( Shortage of space is a common problem in CHE, especially in )] TJ ET
BT 26.250 473.529 Td /F1 9.8 Tf  [(temporary shelters for IDPs and refugees. Humanitarian assistance organizations should obtain, as quickly as possible, an )] TJ ET
BT 26.250 461.624 Td /F1 9.8 Tf  [(estimate of the absolute number of people without adequate living space because of the risk of infectious outbreaks and )] TJ ET
BT 26.250 449.719 Td /F1 9.8 Tf  [(violence. Early estimates are also necessary since providing temporary shelters require well-organized and time consuming )] TJ ET
BT 26.250 437.814 Td /F1 9.8 Tf  [(logistical preparation measures. According to the Sphere Project, temporary planned or self-settled camps require a minimum )] TJ ET
BT 26.250 425.910 Td /F1 9.8 Tf  [(surface area of 45 m)] TJ ET
BT 115.667 429.798 Td /F1 8.7 Tf  [(2)] TJ ET
BT 120.486 425.910 Td /F1 9.8 Tf  [( per person, with a covered shelter area of not less than 3.5 m)] TJ ET
BT 388.201 429.798 Td /F1 8.7 Tf  [(2)] TJ ET
BT 393.020 425.910 Td /F1 9.8 Tf  [( per person.)] TJ ET
0.267 0.267 0.267 rg
BT 445.046 427.417 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 449.865 425.910 Td /F1 9.8 Tf  [( The floor of this scoring )] TJ ET
BT 26.250 414.005 Td /F1 9.8 Tf  [(rubric was set at 20. The number 200,000 was used as the ceiling since, according to Human Rights Watch, the Somali refugee )] TJ ET
BT 26.250 402.100 Td /F1 9.8 Tf  [(camp in Dadaab, Kenya, is home to the largest population of refugees in the world, estimated at more than 200,000 refugees.)] TJ ET
0.267 0.267 0.267 rg
BT 567.121 403.607 Td /F4 8.7 Tf  [(36)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 390.195 Td /F1 9.8 Tf  [(In the aftermath of the Rwandan genocide in 1994, the Kibeho camp had a surface area of 9 km)] TJ ET
BT 439.777 394.084 Td /F1 8.7 Tf  [(2)] TJ ET
BT 444.595 390.195 Td /F1 9.8 Tf  [( with up to 120,000 IDPs. In )] TJ ET
BT 26.250 378.291 Td /F1 9.8 Tf  [(this scenario, the average surface area per person is about 75 m)] TJ ET
BT 305.344 382.179 Td /F1 8.7 Tf  [(2)] TJ ET
BT 310.162 378.291 Td /F1 9.8 Tf  [(, and the score on this parameter �for illustration purposes- )] TJ ET
BT 26.250 366.386 Td /F1 9.8 Tf  [(would be zero.)] TJ ET
0.267 0.267 0.267 rg
BT 89.654 367.893 Td /F4 8.7 Tf  [(37)] TJ ET
0.271 0.267 0.267 rg
BT 99.292 366.386 Td /F1 9.8 Tf  [( A more detailed survey within the camp may reveal a certain number with inadequate living space, and a )] TJ ET
BT 26.250 354.481 Td /F1 9.8 Tf  [(higher score on this parameter.)] TJ ET
q
26.250 330.864 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 333.611 Td /F1 9.8 Tf  [(Table 8. Number of Persons with Inadequate Living Space)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 150.772 555.000 172.592 re f
0.965 0.965 0.965 rg
27.000 310.334 438.070 12.280 re f
0.267 0.267 0.267 rg
26.625 322.239 438.445 0.750 re f
26.625 309.959 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 313.090 Td /F4 9.8 Tf  [(Number of persons with surface area of less than 45 m)] TJ ET
BT 285.078 313.090 Td /F4 8.7 Tf  [(2)] TJ ET
BT 289.897 313.090 Td /F4 9.8 Tf  [( or covered area of less than 3.5 m)] TJ ET
BT 449.758 313.090 Td /F4 8.7 Tf  [(2)] TJ ET
0.965 0.965 0.965 rg
465.070 310.334 115.430 12.280 re f
0.267 0.267 0.267 rg
465.070 322.239 115.805 0.750 re f
580.125 309.959 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 469.570 313.090 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 309.959 438.820 0.750 re f
26.625 294.078 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 300.104 Td /F1 9.8 Tf  [(<20)] TJ ET
0.267 0.267 0.267 rg
464.695 309.959 116.180 0.750 re f
464.695 294.078 0.750 16.631 re f
580.125 294.078 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 300.104 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 294.078 438.820 0.750 re f
26.625 278.197 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 284.223 Td /F1 9.8 Tf  [(20-99)] TJ ET
0.267 0.267 0.267 rg
464.695 294.078 116.180 0.750 re f
464.695 278.197 0.750 16.631 re f
580.125 278.197 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 284.223 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 278.197 438.820 0.750 re f
26.625 262.315 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 268.342 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
464.695 278.197 116.180 0.750 re f
464.695 262.315 0.750 16.631 re f
580.125 262.315 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 268.342 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 262.315 438.820 0.750 re f
26.625 246.434 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 252.460 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
464.695 262.315 116.180 0.750 re f
464.695 246.434 0.750 16.631 re f
580.125 246.434 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 252.460 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 246.434 438.820 0.750 re f
26.625 230.553 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 236.579 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
464.695 246.434 116.180 0.750 re f
464.695 230.553 0.750 16.631 re f
580.125 230.553 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 236.579 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 230.553 438.820 0.750 re f
26.625 214.672 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 220.698 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
464.695 230.553 116.180 0.750 re f
464.695 214.672 0.750 16.631 re f
580.125 214.672 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 220.698 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 214.672 438.820 0.750 re f
26.625 198.790 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 204.817 Td /F1 9.8 Tf  [(20,000-49,999)] TJ ET
0.267 0.267 0.267 rg
464.695 214.672 116.180 0.750 re f
464.695 198.790 0.750 16.631 re f
580.125 198.790 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 204.817 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 198.790 438.820 0.750 re f
26.625 182.909 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 188.935 Td /F1 9.8 Tf  [(50,000-99,999)] TJ ET
0.267 0.267 0.267 rg
464.695 198.790 116.180 0.750 re f
464.695 182.909 0.750 16.631 re f
580.125 182.909 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 188.935 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 182.909 438.820 0.750 re f
26.625 167.028 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 173.054 Td /F1 9.8 Tf  [(100,000-199,999)] TJ ET
0.267 0.267 0.267 rg
464.695 182.909 116.180 0.750 re f
464.695 167.028 0.750 16.631 re f
580.125 167.028 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 173.054 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 167.028 438.820 0.750 re f
26.625 151.147 438.820 0.750 re f
26.625 151.147 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 157.173 Td /F1 9.8 Tf  [(Greater than or equal to 200,000)] TJ ET
0.267 0.267 0.267 rg
464.695 167.028 116.180 0.750 re f
464.695 151.147 116.180 0.750 re f
464.695 151.147 0.750 16.631 re f
580.125 151.147 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 157.173 Td /F1 9.8 Tf  [(9)] TJ ET
BT 26.250 96.248 Td /F4 9.8 Tf  [(9. Water Quantity:)] TJ ET
BT 109.681 96.248 Td /F1 9.8 Tf  [( People can survive much longer without food than without water. In extreme situations, there may not be )] TJ ET
BT 26.250 84.343 Td /F1 9.8 Tf  [(sufficient water available to meet basic needs, and in these cases supplying a survival level of safe drinking water is of critical )] TJ ET
BT 26.250 72.438 Td /F1 9.8 Tf  [(importance. In addition, health problems are caused by poor hygiene due to insufficient water and by the consumption of )] TJ ET
BT 26.250 60.534 Td /F1 9.8 Tf  [(contaminated water. Although water quantity is more important than water quality especially in the initial phase of CHE, quality )] TJ ET
BT 26.250 48.629 Td /F1 9.8 Tf  [(is tightly linked to diarrheal diseases which are a major type of morbidity and mortality. The parameter of water quantity implies )] TJ ET
BT 26.250 36.724 Td /F1 9.8 Tf  [(accessibility. Not only is it important to have available sources of water, but access to these sources is pivotal. The provision of )] TJ ET
Q
q
15.000 22.438 577.500 754.562 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(includes both IDPs and refugees. The floor of this scoring rubric is set at 20, while the ceiling is set at 1,000,000. Several days )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(after the Pakistan floods from the Indus River in August 2010, the UNICEF estimated that more than 3 million were in need of )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(emergency assistance including shelter.)] TJ ET
0.267 0.267 0.267 rg
BT 199.108 745.174 Td /F4 8.7 Tf  [(35)] TJ ET
0.271 0.267 0.267 rg
BT 208.745 743.667 Td /F1 9.8 Tf  [( This crisis would also translate to a score of 10 on this parameter.)] TJ ET
q
26.250 720.049 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 722.797 Td /F1 9.8 Tf  [(Table 7. Number of Displaced Persons)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 539.957 555.000 172.592 re f
0.965 0.965 0.965 rg
27.000 699.520 360.851 12.280 re f
0.267 0.267 0.267 rg
26.625 711.424 361.226 0.750 re f
26.625 699.145 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 702.276 Td /F4 9.8 Tf  [(Number of displaced persons)] TJ ET
0.965 0.965 0.965 rg
387.851 699.520 192.649 12.280 re f
0.267 0.267 0.267 rg
387.851 711.424 193.024 0.750 re f
580.125 699.145 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 392.351 702.276 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 699.145 361.601 0.750 re f
26.625 683.263 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 689.290 Td /F1 9.8 Tf  [(<20)] TJ ET
0.267 0.267 0.267 rg
387.476 699.145 193.399 0.750 re f
387.476 683.263 0.750 16.631 re f
580.125 683.263 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 689.290 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 683.263 361.601 0.750 re f
26.625 667.382 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 673.408 Td /F1 9.8 Tf  [(20-99)] TJ ET
0.267 0.267 0.267 rg
387.476 683.263 193.399 0.750 re f
387.476 667.382 0.750 16.631 re f
580.125 667.382 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 673.408 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 667.382 361.601 0.750 re f
26.625 651.501 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 657.527 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
387.476 667.382 193.399 0.750 re f
387.476 651.501 0.750 16.631 re f
580.125 651.501 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 657.527 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 651.501 361.601 0.750 re f
26.625 635.620 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 641.646 Td /F1 9.8 Tf  [(1,000-9,999)] TJ ET
0.267 0.267 0.267 rg
387.476 651.501 193.399 0.750 re f
387.476 635.620 0.750 16.631 re f
580.125 635.620 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 641.646 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 635.620 361.601 0.750 re f
26.625 619.738 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 625.765 Td /F1 9.8 Tf  [(10,000-49,000)] TJ ET
0.267 0.267 0.267 rg
387.476 635.620 193.399 0.750 re f
387.476 619.738 0.750 16.631 re f
580.125 619.738 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 625.765 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 619.738 361.601 0.750 re f
26.625 603.857 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 609.883 Td /F1 9.8 Tf  [(50,000-99,999)] TJ ET
0.267 0.267 0.267 rg
387.476 619.738 193.399 0.750 re f
387.476 603.857 0.750 16.631 re f
580.125 603.857 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 609.883 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 603.857 361.601 0.750 re f
26.625 587.976 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 594.002 Td /F1 9.8 Tf  [(100,000-199,999)] TJ ET
0.267 0.267 0.267 rg
387.476 603.857 193.399 0.750 re f
387.476 587.976 0.750 16.631 re f
580.125 587.976 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 594.002 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 587.976 361.601 0.750 re f
26.625 572.095 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 578.121 Td /F1 9.8 Tf  [(200,000-499,999)] TJ ET
0.267 0.267 0.267 rg
387.476 587.976 193.399 0.750 re f
387.476 572.095 0.750 16.631 re f
580.125 572.095 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 578.121 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 572.095 361.601 0.750 re f
26.625 556.213 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 562.240 Td /F1 9.8 Tf  [(500,000-999,999)] TJ ET
0.267 0.267 0.267 rg
387.476 572.095 193.399 0.750 re f
387.476 556.213 0.750 16.631 re f
580.125 556.213 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 562.240 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 556.213 361.601 0.750 re f
26.625 540.332 361.601 0.750 re f
26.625 540.332 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 546.358 Td /F1 9.8 Tf  [(Greater than or equal to 1,000,000)] TJ ET
0.267 0.267 0.267 rg
387.476 556.213 193.399 0.750 re f
387.476 540.332 193.399 0.750 re f
387.476 540.332 0.750 16.631 re f
580.125 540.332 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 392.726 546.358 Td /F1 9.8 Tf  [(9)] TJ ET
BT 26.250 485.433 Td /F4 9.8 Tf  [(8. Number of Persons with Inadequate Living Space:)] TJ ET
BT 269.522 485.433 Td /F1 9.8 Tf  [( Shortage of space is a common problem in CHE, especially in )] TJ ET
BT 26.250 473.529 Td /F1 9.8 Tf  [(temporary shelters for IDPs and refugees. Humanitarian assistance organizations should obtain, as quickly as possible, an )] TJ ET
BT 26.250 461.624 Td /F1 9.8 Tf  [(estimate of the absolute number of people without adequate living space because of the risk of infectious outbreaks and )] TJ ET
BT 26.250 449.719 Td /F1 9.8 Tf  [(violence. Early estimates are also necessary since providing temporary shelters require well-organized and time consuming )] TJ ET
BT 26.250 437.814 Td /F1 9.8 Tf  [(logistical preparation measures. According to the Sphere Project, temporary planned or self-settled camps require a minimum )] TJ ET
BT 26.250 425.910 Td /F1 9.8 Tf  [(surface area of 45 m)] TJ ET
BT 115.667 429.798 Td /F1 8.7 Tf  [(2)] TJ ET
BT 120.486 425.910 Td /F1 9.8 Tf  [( per person, with a covered shelter area of not less than 3.5 m)] TJ ET
BT 388.201 429.798 Td /F1 8.7 Tf  [(2)] TJ ET
BT 393.020 425.910 Td /F1 9.8 Tf  [( per person.)] TJ ET
0.267 0.267 0.267 rg
BT 445.046 427.417 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 449.865 425.910 Td /F1 9.8 Tf  [( The floor of this scoring )] TJ ET
BT 26.250 414.005 Td /F1 9.8 Tf  [(rubric was set at 20. The number 200,000 was used as the ceiling since, according to Human Rights Watch, the Somali refugee )] TJ ET
BT 26.250 402.100 Td /F1 9.8 Tf  [(camp in Dadaab, Kenya, is home to the largest population of refugees in the world, estimated at more than 200,000 refugees.)] TJ ET
0.267 0.267 0.267 rg
BT 567.121 403.607 Td /F4 8.7 Tf  [(36)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 390.195 Td /F1 9.8 Tf  [(In the aftermath of the Rwandan genocide in 1994, the Kibeho camp had a surface area of 9 km)] TJ ET
BT 439.777 394.084 Td /F1 8.7 Tf  [(2)] TJ ET
BT 444.595 390.195 Td /F1 9.8 Tf  [( with up to 120,000 IDPs. In )] TJ ET
BT 26.250 378.291 Td /F1 9.8 Tf  [(this scenario, the average surface area per person is about 75 m)] TJ ET
BT 305.344 382.179 Td /F1 8.7 Tf  [(2)] TJ ET
BT 310.162 378.291 Td /F1 9.8 Tf  [(, and the score on this parameter �for illustration purposes- )] TJ ET
BT 26.250 366.386 Td /F1 9.8 Tf  [(would be zero.)] TJ ET
0.267 0.267 0.267 rg
BT 89.654 367.893 Td /F4 8.7 Tf  [(37)] TJ ET
0.271 0.267 0.267 rg
BT 99.292 366.386 Td /F1 9.8 Tf  [( A more detailed survey within the camp may reveal a certain number with inadequate living space, and a )] TJ ET
BT 26.250 354.481 Td /F1 9.8 Tf  [(higher score on this parameter.)] TJ ET
q
26.250 330.864 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 333.611 Td /F1 9.8 Tf  [(Table 8. Number of Persons with Inadequate Living Space)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 150.772 555.000 172.592 re f
0.965 0.965 0.965 rg
27.000 310.334 438.070 12.280 re f
0.267 0.267 0.267 rg
26.625 322.239 438.445 0.750 re f
26.625 309.959 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 313.090 Td /F4 9.8 Tf  [(Number of persons with surface area of less than 45 m)] TJ ET
BT 285.078 313.090 Td /F4 8.7 Tf  [(2)] TJ ET
BT 289.897 313.090 Td /F4 9.8 Tf  [( or covered area of less than 3.5 m)] TJ ET
BT 449.758 313.090 Td /F4 8.7 Tf  [(2)] TJ ET
0.965 0.965 0.965 rg
465.070 310.334 115.430 12.280 re f
0.267 0.267 0.267 rg
465.070 322.239 115.805 0.750 re f
580.125 309.959 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 469.570 313.090 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 309.959 438.820 0.750 re f
26.625 294.078 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 300.104 Td /F1 9.8 Tf  [(<20)] TJ ET
0.267 0.267 0.267 rg
464.695 309.959 116.180 0.750 re f
464.695 294.078 0.750 16.631 re f
580.125 294.078 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 300.104 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 294.078 438.820 0.750 re f
26.625 278.197 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 284.223 Td /F1 9.8 Tf  [(20-99)] TJ ET
0.267 0.267 0.267 rg
464.695 294.078 116.180 0.750 re f
464.695 278.197 0.750 16.631 re f
580.125 278.197 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 284.223 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 278.197 438.820 0.750 re f
26.625 262.315 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 268.342 Td /F1 9.8 Tf  [(100-999)] TJ ET
0.267 0.267 0.267 rg
464.695 278.197 116.180 0.750 re f
464.695 262.315 0.750 16.631 re f
580.125 262.315 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 268.342 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 262.315 438.820 0.750 re f
26.625 246.434 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 252.460 Td /F1 9.8 Tf  [(1,000-4,999)] TJ ET
0.267 0.267 0.267 rg
464.695 262.315 116.180 0.750 re f
464.695 246.434 0.750 16.631 re f
580.125 246.434 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 252.460 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 246.434 438.820 0.750 re f
26.625 230.553 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 236.579 Td /F1 9.8 Tf  [(5,000-9,999)] TJ ET
0.267 0.267 0.267 rg
464.695 246.434 116.180 0.750 re f
464.695 230.553 0.750 16.631 re f
580.125 230.553 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 236.579 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 230.553 438.820 0.750 re f
26.625 214.672 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 220.698 Td /F1 9.8 Tf  [(10,000-19,999)] TJ ET
0.267 0.267 0.267 rg
464.695 230.553 116.180 0.750 re f
464.695 214.672 0.750 16.631 re f
580.125 214.672 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 220.698 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 214.672 438.820 0.750 re f
26.625 198.790 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 204.817 Td /F1 9.8 Tf  [(20,000-49,999)] TJ ET
0.267 0.267 0.267 rg
464.695 214.672 116.180 0.750 re f
464.695 198.790 0.750 16.631 re f
580.125 198.790 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 204.817 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 198.790 438.820 0.750 re f
26.625 182.909 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 188.935 Td /F1 9.8 Tf  [(50,000-99,999)] TJ ET
0.267 0.267 0.267 rg
464.695 198.790 116.180 0.750 re f
464.695 182.909 0.750 16.631 re f
580.125 182.909 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 188.935 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 182.909 438.820 0.750 re f
26.625 167.028 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 173.054 Td /F1 9.8 Tf  [(100,000-199,999)] TJ ET
0.267 0.267 0.267 rg
464.695 182.909 116.180 0.750 re f
464.695 167.028 0.750 16.631 re f
580.125 167.028 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 173.054 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 167.028 438.820 0.750 re f
26.625 151.147 438.820 0.750 re f
26.625 151.147 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 157.173 Td /F1 9.8 Tf  [(Greater than or equal to 200,000)] TJ ET
0.267 0.267 0.267 rg
464.695 167.028 116.180 0.750 re f
464.695 151.147 116.180 0.750 re f
464.695 151.147 0.750 16.631 re f
580.125 151.147 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 469.945 157.173 Td /F1 9.8 Tf  [(9)] TJ ET
BT 26.250 96.248 Td /F4 9.8 Tf  [(9. Water Quantity:)] TJ ET
BT 109.681 96.248 Td /F1 9.8 Tf  [( People can survive much longer without food than without water. In extreme situations, there may not be )] TJ ET
BT 26.250 84.343 Td /F1 9.8 Tf  [(sufficient water available to meet basic needs, and in these cases supplying a survival level of safe drinking water is of critical )] TJ ET
BT 26.250 72.438 Td /F1 9.8 Tf  [(importance. In addition, health problems are caused by poor hygiene due to insufficient water and by the consumption of )] TJ ET
BT 26.250 60.534 Td /F1 9.8 Tf  [(contaminated water. Although water quantity is more important than water quality especially in the initial phase of CHE, quality )] TJ ET
BT 26.250 48.629 Td /F1 9.8 Tf  [(is tightly linked to diarrheal diseases which are a major type of morbidity and mortality. The parameter of water quantity implies )] TJ ET
BT 26.250 36.724 Td /F1 9.8 Tf  [(accessibility. Not only is it important to have available sources of water, but access to these sources is pivotal. The provision of )] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(8)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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0.271 0.267 0.267 rg
q
15.000 30.367 577.500 746.633 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(water demands immediate attention from the start of a CHE. According to The Sphere Project 2011, the total basic water need )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(is 7.5-15 liters per person per day \(l/p/d\).)] TJ ET
0.267 0.267 0.267 rg
BT 201.818 757.079 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 206.637 755.571 Td /F1 9.8 Tf  [( The minimum water quantity needed for survival is 2.5-3 l/p/d.)] TJ ET
0.267 0.267 0.267 rg
BT 475.405 757.079 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 480.224 755.571 Td /F1 9.8 Tf  [( Basic hygienic )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(practices require 2-6 l/p/d, and basic cooking needs are 3-6 l/p/d.)] TJ ET
0.267 0.267 0.267 rg
BT 306.426 745.174 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 311.245 743.667 Td /F1 9.8 Tf  [( Based on the above guidelines for water requirements, a )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(scoring rubric for water quantity is proposed in table 9. In 1994 in Rwanda, there were about 800,000 refugees, and the water )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(availability for the first few weeks was only 0.2 liters/person/day. This would get a score of 9 on this parameter.)] TJ ET
0.267 0.267 0.267 rg
BT 502.567 721.364 Td /F4 8.7 Tf  [(37)] TJ ET
q
26.250 696.240 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 698.987 Td /F1 9.8 Tf  [(Table 9. Water Quantity)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 516.148 555.000 172.592 re f
0.965 0.965 0.965 rg
27.000 675.710 376.137 12.280 re f
0.267 0.267 0.267 rg
26.625 687.615 376.512 0.750 re f
26.625 675.335 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 678.466 Td /F4 9.8 Tf  [(Water quantity \(liters/person/day\))] TJ ET
0.965 0.965 0.965 rg
403.137 675.710 177.363 12.280 re f
0.267 0.267 0.267 rg
403.137 687.615 177.738 0.750 re f
580.125 675.335 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 407.637 678.466 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 675.335 376.887 0.750 re f
26.625 659.454 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 665.480 Td /F1 9.8 Tf  [(>15)] TJ ET
0.267 0.267 0.267 rg
402.762 675.335 178.113 0.750 re f
402.762 659.454 0.750 16.631 re f
580.125 659.454 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 665.480 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 659.454 376.887 0.750 re f
26.625 643.573 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 649.599 Td /F1 9.8 Tf  [(12.5-15)] TJ ET
0.267 0.267 0.267 rg
402.762 659.454 178.113 0.750 re f
402.762 643.573 0.750 16.631 re f
580.125 643.573 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 649.599 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 643.573 376.887 0.750 re f
26.625 627.691 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 633.718 Td /F1 9.8 Tf  [(10-12.4)] TJ ET
0.267 0.267 0.267 rg
402.762 643.573 178.113 0.750 re f
402.762 627.691 0.750 16.631 re f
580.125 627.691 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 633.718 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 627.691 376.887 0.750 re f
26.625 611.810 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 617.836 Td /F1 9.8 Tf  [(7.5-9.9)] TJ ET
0.267 0.267 0.267 rg
402.762 627.691 178.113 0.750 re f
402.762 611.810 0.750 16.631 re f
580.125 611.810 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 617.836 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 611.810 376.887 0.750 re f
26.625 595.929 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 601.955 Td /F1 9.8 Tf  [(6.5-7.4)] TJ ET
0.267 0.267 0.267 rg
402.762 611.810 178.113 0.750 re f
402.762 595.929 0.750 16.631 re f
580.125 595.929 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 601.955 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 595.929 376.887 0.750 re f
26.625 580.048 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 586.074 Td /F1 9.8 Tf  [(5.5-6.4)] TJ ET
0.267 0.267 0.267 rg
402.762 595.929 178.113 0.750 re f
402.762 580.048 0.750 16.631 re f
580.125 580.048 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 586.074 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 580.048 376.887 0.750 re f
26.625 564.166 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 570.193 Td /F1 9.8 Tf  [(4.5-5.4)] TJ ET
0.267 0.267 0.267 rg
402.762 580.048 178.113 0.750 re f
402.762 564.166 0.750 16.631 re f
580.125 564.166 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 570.193 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 564.166 376.887 0.750 re f
26.625 548.285 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 554.311 Td /F1 9.8 Tf  [(3.5-4.4)] TJ ET
0.267 0.267 0.267 rg
402.762 564.166 178.113 0.750 re f
402.762 548.285 0.750 16.631 re f
580.125 548.285 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 554.311 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 548.285 376.887 0.750 re f
26.625 532.404 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 538.430 Td /F1 9.8 Tf  [(2.5-3.4)] TJ ET
0.267 0.267 0.267 rg
402.762 548.285 178.113 0.750 re f
402.762 532.404 0.750 16.631 re f
580.125 532.404 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 538.430 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 532.404 376.887 0.750 re f
26.625 516.523 376.887 0.750 re f
26.625 516.523 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 522.549 Td /F1 9.8 Tf  [(<2.5)] TJ ET
0.267 0.267 0.267 rg
402.762 532.404 178.113 0.750 re f
402.762 516.523 178.113 0.750 re f
402.762 516.523 0.750 16.631 re f
580.125 516.523 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 522.549 Td /F1 9.8 Tf  [(9)] TJ ET
BT 26.250 461.624 Td /F4 9.8 Tf  [(10. Water Quality:)] TJ ET
BT 108.608 461.624 Td /F1 9.8 Tf  [( Testing water quality in the field may not be an easy task. It depends on the resources available to the )] TJ ET
BT 26.250 449.719 Td /F1 9.8 Tf  [(assessment team. The most widely used tests detect and enumerate common fecal bacteria, such as fecal coliforms \(mostly )] TJ ET
BT 26.250 437.814 Td /F1 9.8 Tf  [(Escherichia coli\). The presence of fecal coliform bacteria indicates that the water has been contaminated by feces of humans or )] TJ ET
BT 26.250 425.910 Td /F1 9.8 Tf  [(other warm-blooded animals. Concentrations of fecal coliforms are usually expressed as the fecal coliform count per 100 )] TJ ET
BT 26.250 414.005 Td /F1 9.8 Tf  [(milliliters \(ml\) of water. The OFDA guidelines categorize the water fecal coliform counts as reasonable quality if the count is 1-10 )] TJ ET
BT 26.250 402.100 Td /F1 9.8 Tf  [(fecal coliforms/100 ml water, and polluted if more than 10 per 100 ml.)] TJ ET
0.267 0.267 0.267 rg
BT 324.834 403.607 Td /F4 8.7 Tf  [(4)] TJ ET
0.271 0.267 0.267 rg
BT 329.653 402.100 Td /F1 9.8 Tf  [( Based on those guidelines, the following is the )] TJ ET
BT 26.250 390.195 Td /F1 9.8 Tf  [(suggested scoring rubric for this parameter: The number of collected water samples depends on multiple factors including the )] TJ ET
BT 26.250 378.291 Td /F1 9.8 Tf  [(number of water sources, accessibility to water sources, time limitation, and resources available \(human and technical\). More )] TJ ET
BT 26.250 366.386 Td /F1 9.8 Tf  [(samples and better sampling techniques increase the accuracy of the water quality results. In 2009, a sample of 240 drinking )] TJ ET
BT 26.250 354.481 Td /F1 9.8 Tf  [(water sources in Nyala City in South Darfur, Sudan, found 45.2% of sources contaminated with fecal coliforms. This CHE would )] TJ ET
BT 26.250 342.576 Td /F1 9.8 Tf  [(get a score of 5 on this parameter.)] TJ ET
0.267 0.267 0.267 rg
BT 174.743 344.084 Td /F4 8.7 Tf  [(38)] TJ ET
q
26.250 318.959 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 321.706 Td /F1 9.8 Tf  [(Table 10. Water Quality)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 122.986 555.000 188.474 re f
0.965 0.965 0.965 rg
27.000 298.429 426.194 12.280 re f
0.267 0.267 0.267 rg
26.625 310.334 426.569 0.750 re f
26.625 298.054 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 301.185 Td /F4 9.8 Tf  [(Percentage of water samples with more than 10 fecal coliforms/100 ml)] TJ ET
0.965 0.965 0.965 rg
453.194 298.429 127.306 12.280 re f
0.267 0.267 0.267 rg
453.194 310.334 127.681 0.750 re f
580.125 298.054 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 457.694 301.185 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 298.054 426.944 0.750 re f
26.625 282.173 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 288.199 Td /F1 9.8 Tf  [(0%)] TJ ET
0.267 0.267 0.267 rg
452.819 298.054 128.056 0.750 re f
452.819 282.173 0.750 16.631 re f
580.125 282.173 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 288.199 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 282.173 426.944 0.750 re f
26.625 266.292 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 272.318 Td /F1 9.8 Tf  [(>0-9.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 282.173 128.056 0.750 re f
452.819 266.292 0.750 16.631 re f
580.125 266.292 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 272.318 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 266.292 426.944 0.750 re f
26.625 250.411 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 256.437 Td /F1 9.8 Tf  [(10-19.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 266.292 128.056 0.750 re f
452.819 250.411 0.750 16.631 re f
580.125 250.411 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 256.437 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 250.411 426.944 0.750 re f
26.625 234.529 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 240.556 Td /F1 9.8 Tf  [(20-29.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 250.411 128.056 0.750 re f
452.819 234.529 0.750 16.631 re f
580.125 234.529 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 240.556 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 234.529 426.944 0.750 re f
26.625 218.648 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 224.674 Td /F1 9.8 Tf  [(30-39.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 234.529 128.056 0.750 re f
452.819 218.648 0.750 16.631 re f
580.125 218.648 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 224.674 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 218.648 426.944 0.750 re f
26.625 202.767 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 208.793 Td /F1 9.8 Tf  [(40-49.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 218.648 128.056 0.750 re f
452.819 202.767 0.750 16.631 re f
580.125 202.767 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 208.793 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 202.767 426.944 0.750 re f
26.625 186.886 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 192.912 Td /F1 9.8 Tf  [(50-59.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 202.767 128.056 0.750 re f
452.819 186.886 0.750 16.631 re f
580.125 186.886 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 192.912 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 186.886 426.944 0.750 re f
26.625 171.004 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 177.031 Td /F1 9.8 Tf  [(60-69.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 186.886 128.056 0.750 re f
452.819 171.004 0.750 16.631 re f
580.125 171.004 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 177.031 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 171.004 426.944 0.750 re f
26.625 155.123 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 161.149 Td /F1 9.8 Tf  [(70-79.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 171.004 128.056 0.750 re f
452.819 155.123 0.750 16.631 re f
580.125 155.123 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 161.149 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 155.123 426.944 0.750 re f
26.625 139.242 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 145.268 Td /F1 9.8 Tf  [(80-89.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 155.123 128.056 0.750 re f
452.819 139.242 0.750 16.631 re f
580.125 139.242 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 145.268 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
26.625 139.242 426.944 0.750 re f
26.625 123.361 426.944 0.750 re f
26.625 123.361 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 129.387 Td /F1 9.8 Tf  [(>90%)] TJ ET
0.267 0.267 0.267 rg
452.819 139.242 128.056 0.750 re f
452.819 123.361 128.056 0.750 re f
452.819 123.361 0.750 16.631 re f
580.125 123.361 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 129.387 Td /F1 9.8 Tf  [(10)] TJ ET
BT 26.250 68.462 Td /F4 9.8 Tf  [(11. Level of Sanitation Facilities:)] TJ ET
BT 176.887 68.462 Td /F1 9.8 Tf  [( Sanitation is a concern to all communities impacted by complex emergencies. The )] TJ ET
BT 26.250 56.557 Td /F1 9.8 Tf  [(disruption and overcrowding of people accustomed to living in less crowded conditions in their own homes makes sanitation a )] TJ ET
BT 26.250 44.652 Td /F1 9.8 Tf  [(critical issue. The minimum standards for available sewage systems or temporary sanitation facilities are considered the basis )] TJ ET
Q
q
15.000 30.367 577.500 746.633 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(water demands immediate attention from the start of a CHE. According to The Sphere Project 2011, the total basic water need )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(is 7.5-15 liters per person per day \(l/p/d\).)] TJ ET
0.267 0.267 0.267 rg
BT 201.818 757.079 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 206.637 755.571 Td /F1 9.8 Tf  [( The minimum water quantity needed for survival is 2.5-3 l/p/d.)] TJ ET
0.267 0.267 0.267 rg
BT 475.405 757.079 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 480.224 755.571 Td /F1 9.8 Tf  [( Basic hygienic )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(practices require 2-6 l/p/d, and basic cooking needs are 3-6 l/p/d.)] TJ ET
0.267 0.267 0.267 rg
BT 306.426 745.174 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 311.245 743.667 Td /F1 9.8 Tf  [( Based on the above guidelines for water requirements, a )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(scoring rubric for water quantity is proposed in table 9. In 1994 in Rwanda, there were about 800,000 refugees, and the water )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(availability for the first few weeks was only 0.2 liters/person/day. This would get a score of 9 on this parameter.)] TJ ET
0.267 0.267 0.267 rg
BT 502.567 721.364 Td /F4 8.7 Tf  [(37)] TJ ET
q
26.250 696.240 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 698.987 Td /F1 9.8 Tf  [(Table 9. Water Quantity)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 516.148 555.000 172.592 re f
0.965 0.965 0.965 rg
27.000 675.710 376.137 12.280 re f
0.267 0.267 0.267 rg
26.625 687.615 376.512 0.750 re f
26.625 675.335 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 678.466 Td /F4 9.8 Tf  [(Water quantity \(liters/person/day\))] TJ ET
0.965 0.965 0.965 rg
403.137 675.710 177.363 12.280 re f
0.267 0.267 0.267 rg
403.137 687.615 177.738 0.750 re f
580.125 675.335 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 407.637 678.466 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 675.335 376.887 0.750 re f
26.625 659.454 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 665.480 Td /F1 9.8 Tf  [(>15)] TJ ET
0.267 0.267 0.267 rg
402.762 675.335 178.113 0.750 re f
402.762 659.454 0.750 16.631 re f
580.125 659.454 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 665.480 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 659.454 376.887 0.750 re f
26.625 643.573 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 649.599 Td /F1 9.8 Tf  [(12.5-15)] TJ ET
0.267 0.267 0.267 rg
402.762 659.454 178.113 0.750 re f
402.762 643.573 0.750 16.631 re f
580.125 643.573 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 649.599 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 643.573 376.887 0.750 re f
26.625 627.691 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 633.718 Td /F1 9.8 Tf  [(10-12.4)] TJ ET
0.267 0.267 0.267 rg
402.762 643.573 178.113 0.750 re f
402.762 627.691 0.750 16.631 re f
580.125 627.691 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 633.718 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 627.691 376.887 0.750 re f
26.625 611.810 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 617.836 Td /F1 9.8 Tf  [(7.5-9.9)] TJ ET
0.267 0.267 0.267 rg
402.762 627.691 178.113 0.750 re f
402.762 611.810 0.750 16.631 re f
580.125 611.810 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 617.836 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 611.810 376.887 0.750 re f
26.625 595.929 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 601.955 Td /F1 9.8 Tf  [(6.5-7.4)] TJ ET
0.267 0.267 0.267 rg
402.762 611.810 178.113 0.750 re f
402.762 595.929 0.750 16.631 re f
580.125 595.929 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 601.955 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 595.929 376.887 0.750 re f
26.625 580.048 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 586.074 Td /F1 9.8 Tf  [(5.5-6.4)] TJ ET
0.267 0.267 0.267 rg
402.762 595.929 178.113 0.750 re f
402.762 580.048 0.750 16.631 re f
580.125 580.048 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 586.074 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 580.048 376.887 0.750 re f
26.625 564.166 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 570.193 Td /F1 9.8 Tf  [(4.5-5.4)] TJ ET
0.267 0.267 0.267 rg
402.762 580.048 178.113 0.750 re f
402.762 564.166 0.750 16.631 re f
580.125 564.166 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 570.193 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 564.166 376.887 0.750 re f
26.625 548.285 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 554.311 Td /F1 9.8 Tf  [(3.5-4.4)] TJ ET
0.267 0.267 0.267 rg
402.762 564.166 178.113 0.750 re f
402.762 548.285 0.750 16.631 re f
580.125 548.285 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 554.311 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 548.285 376.887 0.750 re f
26.625 532.404 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 538.430 Td /F1 9.8 Tf  [(2.5-3.4)] TJ ET
0.267 0.267 0.267 rg
402.762 548.285 178.113 0.750 re f
402.762 532.404 0.750 16.631 re f
580.125 532.404 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 538.430 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 532.404 376.887 0.750 re f
26.625 516.523 376.887 0.750 re f
26.625 516.523 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 522.549 Td /F1 9.8 Tf  [(<2.5)] TJ ET
0.267 0.267 0.267 rg
402.762 532.404 178.113 0.750 re f
402.762 516.523 178.113 0.750 re f
402.762 516.523 0.750 16.631 re f
580.125 516.523 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 522.549 Td /F1 9.8 Tf  [(9)] TJ ET
BT 26.250 461.624 Td /F4 9.8 Tf  [(10. Water Quality:)] TJ ET
BT 108.608 461.624 Td /F1 9.8 Tf  [( Testing water quality in the field may not be an easy task. It depends on the resources available to the )] TJ ET
BT 26.250 449.719 Td /F1 9.8 Tf  [(assessment team. The most widely used tests detect and enumerate common fecal bacteria, such as fecal coliforms \(mostly )] TJ ET
BT 26.250 437.814 Td /F1 9.8 Tf  [(Escherichia coli\). The presence of fecal coliform bacteria indicates that the water has been contaminated by feces of humans or )] TJ ET
BT 26.250 425.910 Td /F1 9.8 Tf  [(other warm-blooded animals. Concentrations of fecal coliforms are usually expressed as the fecal coliform count per 100 )] TJ ET
BT 26.250 414.005 Td /F1 9.8 Tf  [(milliliters \(ml\) of water. The OFDA guidelines categorize the water fecal coliform counts as reasonable quality if the count is 1-10 )] TJ ET
BT 26.250 402.100 Td /F1 9.8 Tf  [(fecal coliforms/100 ml water, and polluted if more than 10 per 100 ml.)] TJ ET
0.267 0.267 0.267 rg
BT 324.834 403.607 Td /F4 8.7 Tf  [(4)] TJ ET
0.271 0.267 0.267 rg
BT 329.653 402.100 Td /F1 9.8 Tf  [( Based on those guidelines, the following is the )] TJ ET
BT 26.250 390.195 Td /F1 9.8 Tf  [(suggested scoring rubric for this parameter: The number of collected water samples depends on multiple factors including the )] TJ ET
BT 26.250 378.291 Td /F1 9.8 Tf  [(number of water sources, accessibility to water sources, time limitation, and resources available \(human and technical\). More )] TJ ET
BT 26.250 366.386 Td /F1 9.8 Tf  [(samples and better sampling techniques increase the accuracy of the water quality results. In 2009, a sample of 240 drinking )] TJ ET
BT 26.250 354.481 Td /F1 9.8 Tf  [(water sources in Nyala City in South Darfur, Sudan, found 45.2% of sources contaminated with fecal coliforms. This CHE would )] TJ ET
BT 26.250 342.576 Td /F1 9.8 Tf  [(get a score of 5 on this parameter.)] TJ ET
0.267 0.267 0.267 rg
BT 174.743 344.084 Td /F4 8.7 Tf  [(38)] TJ ET
q
26.250 318.959 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 321.706 Td /F1 9.8 Tf  [(Table 10. Water Quality)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 122.986 555.000 188.474 re f
0.965 0.965 0.965 rg
27.000 298.429 426.194 12.280 re f
0.267 0.267 0.267 rg
26.625 310.334 426.569 0.750 re f
26.625 298.054 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 301.185 Td /F4 9.8 Tf  [(Percentage of water samples with more than 10 fecal coliforms/100 ml)] TJ ET
0.965 0.965 0.965 rg
453.194 298.429 127.306 12.280 re f
0.267 0.267 0.267 rg
453.194 310.334 127.681 0.750 re f
580.125 298.054 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 457.694 301.185 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 298.054 426.944 0.750 re f
26.625 282.173 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 288.199 Td /F1 9.8 Tf  [(0%)] TJ ET
0.267 0.267 0.267 rg
452.819 298.054 128.056 0.750 re f
452.819 282.173 0.750 16.631 re f
580.125 282.173 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 288.199 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 282.173 426.944 0.750 re f
26.625 266.292 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 272.318 Td /F1 9.8 Tf  [(>0-9.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 282.173 128.056 0.750 re f
452.819 266.292 0.750 16.631 re f
580.125 266.292 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 272.318 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 266.292 426.944 0.750 re f
26.625 250.411 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 256.437 Td /F1 9.8 Tf  [(10-19.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 266.292 128.056 0.750 re f
452.819 250.411 0.750 16.631 re f
580.125 250.411 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 256.437 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 250.411 426.944 0.750 re f
26.625 234.529 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 240.556 Td /F1 9.8 Tf  [(20-29.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 250.411 128.056 0.750 re f
452.819 234.529 0.750 16.631 re f
580.125 234.529 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 240.556 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 234.529 426.944 0.750 re f
26.625 218.648 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 224.674 Td /F1 9.8 Tf  [(30-39.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 234.529 128.056 0.750 re f
452.819 218.648 0.750 16.631 re f
580.125 218.648 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 224.674 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 218.648 426.944 0.750 re f
26.625 202.767 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 208.793 Td /F1 9.8 Tf  [(40-49.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 218.648 128.056 0.750 re f
452.819 202.767 0.750 16.631 re f
580.125 202.767 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 208.793 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 202.767 426.944 0.750 re f
26.625 186.886 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 192.912 Td /F1 9.8 Tf  [(50-59.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 202.767 128.056 0.750 re f
452.819 186.886 0.750 16.631 re f
580.125 186.886 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 192.912 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 186.886 426.944 0.750 re f
26.625 171.004 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 177.031 Td /F1 9.8 Tf  [(60-69.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 186.886 128.056 0.750 re f
452.819 171.004 0.750 16.631 re f
580.125 171.004 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 177.031 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 171.004 426.944 0.750 re f
26.625 155.123 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 161.149 Td /F1 9.8 Tf  [(70-79.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 171.004 128.056 0.750 re f
452.819 155.123 0.750 16.631 re f
580.125 155.123 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 161.149 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 155.123 426.944 0.750 re f
26.625 139.242 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 145.268 Td /F1 9.8 Tf  [(80-89.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 155.123 128.056 0.750 re f
452.819 139.242 0.750 16.631 re f
580.125 139.242 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 145.268 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
26.625 139.242 426.944 0.750 re f
26.625 123.361 426.944 0.750 re f
26.625 123.361 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 129.387 Td /F1 9.8 Tf  [(>90%)] TJ ET
0.267 0.267 0.267 rg
452.819 139.242 128.056 0.750 re f
452.819 123.361 128.056 0.750 re f
452.819 123.361 0.750 16.631 re f
580.125 123.361 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 129.387 Td /F1 9.8 Tf  [(10)] TJ ET
BT 26.250 68.462 Td /F4 9.8 Tf  [(11. Level of Sanitation Facilities:)] TJ ET
BT 176.887 68.462 Td /F1 9.8 Tf  [( Sanitation is a concern to all communities impacted by complex emergencies. The )] TJ ET
BT 26.250 56.557 Td /F1 9.8 Tf  [(disruption and overcrowding of people accustomed to living in less crowded conditions in their own homes makes sanitation a )] TJ ET
BT 26.250 44.652 Td /F1 9.8 Tf  [(critical issue. The minimum standards for available sewage systems or temporary sanitation facilities are considered the basis )] TJ ET
Q
q
15.000 30.367 577.500 746.633 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(water demands immediate attention from the start of a CHE. According to The Sphere Project 2011, the total basic water need )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(is 7.5-15 liters per person per day \(l/p/d\).)] TJ ET
0.267 0.267 0.267 rg
BT 201.818 757.079 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 206.637 755.571 Td /F1 9.8 Tf  [( The minimum water quantity needed for survival is 2.5-3 l/p/d.)] TJ ET
0.267 0.267 0.267 rg
BT 475.405 757.079 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 480.224 755.571 Td /F1 9.8 Tf  [( Basic hygienic )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(practices require 2-6 l/p/d, and basic cooking needs are 3-6 l/p/d.)] TJ ET
0.267 0.267 0.267 rg
BT 306.426 745.174 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 311.245 743.667 Td /F1 9.8 Tf  [( Based on the above guidelines for water requirements, a )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(scoring rubric for water quantity is proposed in table 9. In 1994 in Rwanda, there were about 800,000 refugees, and the water )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(availability for the first few weeks was only 0.2 liters/person/day. This would get a score of 9 on this parameter.)] TJ ET
0.267 0.267 0.267 rg
BT 502.567 721.364 Td /F4 8.7 Tf  [(37)] TJ ET
q
26.250 696.240 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 698.987 Td /F1 9.8 Tf  [(Table 9. Water Quantity)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 516.148 555.000 172.592 re f
0.965 0.965 0.965 rg
27.000 675.710 376.137 12.280 re f
0.267 0.267 0.267 rg
26.625 687.615 376.512 0.750 re f
26.625 675.335 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 678.466 Td /F4 9.8 Tf  [(Water quantity \(liters/person/day\))] TJ ET
0.965 0.965 0.965 rg
403.137 675.710 177.363 12.280 re f
0.267 0.267 0.267 rg
403.137 687.615 177.738 0.750 re f
580.125 675.335 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 407.637 678.466 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 675.335 376.887 0.750 re f
26.625 659.454 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 665.480 Td /F1 9.8 Tf  [(>15)] TJ ET
0.267 0.267 0.267 rg
402.762 675.335 178.113 0.750 re f
402.762 659.454 0.750 16.631 re f
580.125 659.454 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 665.480 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 659.454 376.887 0.750 re f
26.625 643.573 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 649.599 Td /F1 9.8 Tf  [(12.5-15)] TJ ET
0.267 0.267 0.267 rg
402.762 659.454 178.113 0.750 re f
402.762 643.573 0.750 16.631 re f
580.125 643.573 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 649.599 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 643.573 376.887 0.750 re f
26.625 627.691 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 633.718 Td /F1 9.8 Tf  [(10-12.4)] TJ ET
0.267 0.267 0.267 rg
402.762 643.573 178.113 0.750 re f
402.762 627.691 0.750 16.631 re f
580.125 627.691 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 633.718 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 627.691 376.887 0.750 re f
26.625 611.810 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 617.836 Td /F1 9.8 Tf  [(7.5-9.9)] TJ ET
0.267 0.267 0.267 rg
402.762 627.691 178.113 0.750 re f
402.762 611.810 0.750 16.631 re f
580.125 611.810 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 617.836 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 611.810 376.887 0.750 re f
26.625 595.929 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 601.955 Td /F1 9.8 Tf  [(6.5-7.4)] TJ ET
0.267 0.267 0.267 rg
402.762 611.810 178.113 0.750 re f
402.762 595.929 0.750 16.631 re f
580.125 595.929 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 601.955 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 595.929 376.887 0.750 re f
26.625 580.048 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 586.074 Td /F1 9.8 Tf  [(5.5-6.4)] TJ ET
0.267 0.267 0.267 rg
402.762 595.929 178.113 0.750 re f
402.762 580.048 0.750 16.631 re f
580.125 580.048 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 586.074 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 580.048 376.887 0.750 re f
26.625 564.166 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 570.193 Td /F1 9.8 Tf  [(4.5-5.4)] TJ ET
0.267 0.267 0.267 rg
402.762 580.048 178.113 0.750 re f
402.762 564.166 0.750 16.631 re f
580.125 564.166 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 570.193 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 564.166 376.887 0.750 re f
26.625 548.285 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 554.311 Td /F1 9.8 Tf  [(3.5-4.4)] TJ ET
0.267 0.267 0.267 rg
402.762 564.166 178.113 0.750 re f
402.762 548.285 0.750 16.631 re f
580.125 548.285 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 554.311 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 548.285 376.887 0.750 re f
26.625 532.404 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 538.430 Td /F1 9.8 Tf  [(2.5-3.4)] TJ ET
0.267 0.267 0.267 rg
402.762 548.285 178.113 0.750 re f
402.762 532.404 0.750 16.631 re f
580.125 532.404 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 538.430 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 532.404 376.887 0.750 re f
26.625 516.523 376.887 0.750 re f
26.625 516.523 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 522.549 Td /F1 9.8 Tf  [(<2.5)] TJ ET
0.267 0.267 0.267 rg
402.762 532.404 178.113 0.750 re f
402.762 516.523 178.113 0.750 re f
402.762 516.523 0.750 16.631 re f
580.125 516.523 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 408.012 522.549 Td /F1 9.8 Tf  [(9)] TJ ET
BT 26.250 461.624 Td /F4 9.8 Tf  [(10. Water Quality:)] TJ ET
BT 108.608 461.624 Td /F1 9.8 Tf  [( Testing water quality in the field may not be an easy task. It depends on the resources available to the )] TJ ET
BT 26.250 449.719 Td /F1 9.8 Tf  [(assessment team. The most widely used tests detect and enumerate common fecal bacteria, such as fecal coliforms \(mostly )] TJ ET
BT 26.250 437.814 Td /F1 9.8 Tf  [(Escherichia coli\). The presence of fecal coliform bacteria indicates that the water has been contaminated by feces of humans or )] TJ ET
BT 26.250 425.910 Td /F1 9.8 Tf  [(other warm-blooded animals. Concentrations of fecal coliforms are usually expressed as the fecal coliform count per 100 )] TJ ET
BT 26.250 414.005 Td /F1 9.8 Tf  [(milliliters \(ml\) of water. The OFDA guidelines categorize the water fecal coliform counts as reasonable quality if the count is 1-10 )] TJ ET
BT 26.250 402.100 Td /F1 9.8 Tf  [(fecal coliforms/100 ml water, and polluted if more than 10 per 100 ml.)] TJ ET
0.267 0.267 0.267 rg
BT 324.834 403.607 Td /F4 8.7 Tf  [(4)] TJ ET
0.271 0.267 0.267 rg
BT 329.653 402.100 Td /F1 9.8 Tf  [( Based on those guidelines, the following is the )] TJ ET
BT 26.250 390.195 Td /F1 9.8 Tf  [(suggested scoring rubric for this parameter: The number of collected water samples depends on multiple factors including the )] TJ ET
BT 26.250 378.291 Td /F1 9.8 Tf  [(number of water sources, accessibility to water sources, time limitation, and resources available \(human and technical\). More )] TJ ET
BT 26.250 366.386 Td /F1 9.8 Tf  [(samples and better sampling techniques increase the accuracy of the water quality results. In 2009, a sample of 240 drinking )] TJ ET
BT 26.250 354.481 Td /F1 9.8 Tf  [(water sources in Nyala City in South Darfur, Sudan, found 45.2% of sources contaminated with fecal coliforms. This CHE would )] TJ ET
BT 26.250 342.576 Td /F1 9.8 Tf  [(get a score of 5 on this parameter.)] TJ ET
0.267 0.267 0.267 rg
BT 174.743 344.084 Td /F4 8.7 Tf  [(38)] TJ ET
q
26.250 318.959 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 321.706 Td /F1 9.8 Tf  [(Table 10. Water Quality)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 122.986 555.000 188.474 re f
0.965 0.965 0.965 rg
27.000 298.429 426.194 12.280 re f
0.267 0.267 0.267 rg
26.625 310.334 426.569 0.750 re f
26.625 298.054 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 301.185 Td /F4 9.8 Tf  [(Percentage of water samples with more than 10 fecal coliforms/100 ml)] TJ ET
0.965 0.965 0.965 rg
453.194 298.429 127.306 12.280 re f
0.267 0.267 0.267 rg
453.194 310.334 127.681 0.750 re f
580.125 298.054 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 457.694 301.185 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 298.054 426.944 0.750 re f
26.625 282.173 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 288.199 Td /F1 9.8 Tf  [(0%)] TJ ET
0.267 0.267 0.267 rg
452.819 298.054 128.056 0.750 re f
452.819 282.173 0.750 16.631 re f
580.125 282.173 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 288.199 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 282.173 426.944 0.750 re f
26.625 266.292 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 272.318 Td /F1 9.8 Tf  [(>0-9.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 282.173 128.056 0.750 re f
452.819 266.292 0.750 16.631 re f
580.125 266.292 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 272.318 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 266.292 426.944 0.750 re f
26.625 250.411 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 256.437 Td /F1 9.8 Tf  [(10-19.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 266.292 128.056 0.750 re f
452.819 250.411 0.750 16.631 re f
580.125 250.411 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 256.437 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 250.411 426.944 0.750 re f
26.625 234.529 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 240.556 Td /F1 9.8 Tf  [(20-29.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 250.411 128.056 0.750 re f
452.819 234.529 0.750 16.631 re f
580.125 234.529 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 240.556 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 234.529 426.944 0.750 re f
26.625 218.648 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 224.674 Td /F1 9.8 Tf  [(30-39.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 234.529 128.056 0.750 re f
452.819 218.648 0.750 16.631 re f
580.125 218.648 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 224.674 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 218.648 426.944 0.750 re f
26.625 202.767 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 208.793 Td /F1 9.8 Tf  [(40-49.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 218.648 128.056 0.750 re f
452.819 202.767 0.750 16.631 re f
580.125 202.767 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 208.793 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 202.767 426.944 0.750 re f
26.625 186.886 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 192.912 Td /F1 9.8 Tf  [(50-59.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 202.767 128.056 0.750 re f
452.819 186.886 0.750 16.631 re f
580.125 186.886 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 192.912 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
26.625 186.886 426.944 0.750 re f
26.625 171.004 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 177.031 Td /F1 9.8 Tf  [(60-69.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 186.886 128.056 0.750 re f
452.819 171.004 0.750 16.631 re f
580.125 171.004 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 177.031 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
26.625 171.004 426.944 0.750 re f
26.625 155.123 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 161.149 Td /F1 9.8 Tf  [(70-79.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 171.004 128.056 0.750 re f
452.819 155.123 0.750 16.631 re f
580.125 155.123 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 161.149 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
26.625 155.123 426.944 0.750 re f
26.625 139.242 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 145.268 Td /F1 9.8 Tf  [(80-89.9%)] TJ ET
0.267 0.267 0.267 rg
452.819 155.123 128.056 0.750 re f
452.819 139.242 0.750 16.631 re f
580.125 139.242 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 145.268 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
26.625 139.242 426.944 0.750 re f
26.625 123.361 426.944 0.750 re f
26.625 123.361 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 129.387 Td /F1 9.8 Tf  [(>90%)] TJ ET
0.267 0.267 0.267 rg
452.819 139.242 128.056 0.750 re f
452.819 123.361 128.056 0.750 re f
452.819 123.361 0.750 16.631 re f
580.125 123.361 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 458.069 129.387 Td /F1 9.8 Tf  [(10)] TJ ET
BT 26.250 68.462 Td /F4 9.8 Tf  [(11. Level of Sanitation Facilities:)] TJ ET
BT 176.887 68.462 Td /F1 9.8 Tf  [( Sanitation is a concern to all communities impacted by complex emergencies. The )] TJ ET
BT 26.250 56.557 Td /F1 9.8 Tf  [(disruption and overcrowding of people accustomed to living in less crowded conditions in their own homes makes sanitation a )] TJ ET
BT 26.250 44.652 Td /F1 9.8 Tf  [(critical issue. The minimum standards for available sewage systems or temporary sanitation facilities are considered the basis )] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(9)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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0.271 0.267 0.267 rg
q
15.000 26.395 577.500 750.605 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(for the scoring rubric in this parameter, based on The Sphere Project guidelines.)] TJ ET
0.267 0.267 0.267 rg
BT 371.985 768.983 Td /F4 8.7 Tf  [(3)] TJ ET
q
26.250 743.859 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 746.606 Td /F1 9.8 Tf  [(Table 11. Levels of Sanitation Facilities)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 604.398 555.000 131.961 re f
0.965 0.965 0.965 rg
27.000 723.329 455.867 12.280 re f
0.267 0.267 0.267 rg
26.625 735.234 456.242 0.750 re f
26.625 722.954 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 726.085 Td /F4 9.8 Tf  [(Levels of sanitation facilities)] TJ ET
0.965 0.965 0.965 rg
482.867 723.329 97.633 12.280 re f
0.267 0.267 0.267 rg
482.867 735.234 98.008 0.750 re f
580.125 722.954 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 487.367 726.085 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 722.954 456.617 0.750 re f
26.625 707.073 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 713.099 Td /F1 9.8 Tf  [(Intact well developed sanitary system for disposal of excreta)] TJ ET
0.267 0.267 0.267 rg
482.492 722.954 98.383 0.750 re f
482.492 707.073 0.750 16.631 re f
580.125 707.073 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 487.742 713.099 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 707.073 456.617 0.750 re f
26.625 691.192 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 697.218 Td /F1 9.8 Tf  [(Minor disruption of a well developed sanitary system for disposal of excreta)] TJ ET
0.267 0.267 0.267 rg
482.492 707.073 98.383 0.750 re f
482.492 691.192 0.750 16.631 re f
580.125 691.192 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 487.742 697.218 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 691.192 456.617 0.750 re f
26.625 667.679 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 31.875 681.337 Td /F1 9.8 Tf  [(Two or more toilets \(or latrines\) per 20 people, or two or more family latrines per 4 families, or two or )] TJ ET
BT 31.875 673.705 Td /F1 9.8 Tf  [(more trench latrines per 100 people)] TJ ET
0.267 0.267 0.267 rg
482.492 691.192 98.383 0.750 re f
482.492 667.679 0.750 24.263 re f
580.125 667.679 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 487.742 681.337 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 667.679 456.617 0.750 re f
26.625 644.167 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 657.824 Td /F1 9.8 Tf  [(One toilet \(or latrine\) per 20 people, or one family latrine per 4 families, or one trench latrine per 100 )] TJ ET
BT 31.875 650.193 Td /F1 9.8 Tf  [(people)] TJ ET
0.267 0.267 0.267 rg
482.492 667.679 98.383 0.750 re f
482.492 644.167 0.750 24.262 re f
580.125 644.167 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 487.742 657.824 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 644.167 456.617 0.750 re f
26.625 620.654 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 634.312 Td /F1 9.8 Tf  [(Less than one toilet \(or latrine\) per 20 people, or one family latrine per 4 families, or one trench latrine )] TJ ET
BT 31.875 626.680 Td /F1 9.8 Tf  [(per 100 people)] TJ ET
0.267 0.267 0.267 rg
482.492 644.167 98.383 0.750 re f
482.492 620.654 0.750 24.262 re f
580.125 620.654 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 487.742 634.312 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 620.654 456.617 0.750 re f
26.625 604.773 456.617 0.750 re f
26.625 604.773 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 610.799 Td /F1 9.8 Tf  [(Complete absence of any system for disposal of excreta)] TJ ET
0.267 0.267 0.267 rg
482.492 620.654 98.383 0.750 re f
482.492 604.773 98.383 0.750 re f
482.492 604.773 0.750 16.631 re f
580.125 604.773 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 487.742 610.799 Td /F1 9.8 Tf  [(5)] TJ ET
BT 26.250 549.874 Td /F4 9.8 Tf  [(12. Gender-based violence:)] TJ ET
BT 153.049 549.874 Td /F1 9.8 Tf  [( Attacks against women are the most common type of gender-based violence and is particularly )] TJ ET
BT 26.250 537.969 Td /F1 9.8 Tf  [(disruptive to the movement of the population, the maintenance of agrarian sustenance farming, and security within the home. )] TJ ET
BT 26.250 526.065 Td /F1 9.8 Tf  [(The Convention on the Elimination of All Forms of Discrimination against Women \(CEDAW\), adopted in 1979 by the UN )] TJ ET
BT 26.250 514.160 Td /F1 9.8 Tf  [(General Assembly, is often described as an international bill of rights for women defining what constitutes discrimination against )] TJ ET
BT 26.250 502.255 Td /F1 9.8 Tf  [(women and proposing an agenda to end discrimination. In 1992, CEDAW defined gender-based violence as �violence that is )] TJ ET
BT 26.250 490.350 Td /F1 9.8 Tf  [(directed against a woman because she is a woman or that affects women disproportionately. It includes acts that inflict physical, )] TJ ET
BT 26.250 478.446 Td /F1 9.8 Tf  [(mental or sexual harm or suffering, threats of such acts, coercion and other deprivations of liberty.�)] TJ ET
0.267 0.267 0.267 rg
BT 451.096 479.953 Td /F4 8.7 Tf  [(39)] TJ ET
0.271 0.267 0.267 rg
BT 460.734 478.446 Td /F1 9.8 Tf  [( Below is a proposed )] TJ ET
BT 26.250 466.541 Td /F1 9.8 Tf  [(stochastic scoring rubric for this public health parameter in CHE, as proposed by the authors. Examples of systematic gender )] TJ ET
BT 26.250 454.636 Td /F1 9.8 Tf  [(based violence include former Yugoslavia where the European Community estimates 20,000-50,000 Bosnian women were )] TJ ET
BT 26.250 442.731 Td /F1 9.8 Tf  [(systematically raped as a means for ethnic displacement.)] TJ ET
0.267 0.267 0.267 rg
BT 273.344 444.239 Td /F4 8.7 Tf  [(40)] TJ ET
BT 282.982 444.239 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 292.619 442.731 Td /F1 9.8 Tf  [( This CHE would get the maximum score of 4 on this parameter, )] TJ ET
BT 26.250 430.827 Td /F1 9.8 Tf  [(taking the upper estimate, on the basis of sexual harm alone.)] TJ ET
q
26.250 407.209 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 409.957 Td /F1 9.8 Tf  [(Table 12. Gender-Based Violence)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 306.523 555.000 93.186 re f
0.965 0.965 0.965 rg
27.000 386.680 396.562 12.280 re f
0.267 0.267 0.267 rg
26.625 398.584 396.937 0.750 re f
26.625 386.305 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 389.436 Td /F4 9.8 Tf  [(Gender-based violence)] TJ ET
0.965 0.965 0.965 rg
423.562 386.680 156.938 12.280 re f
0.267 0.267 0.267 rg
423.562 398.584 157.313 0.750 re f
580.125 386.305 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 428.062 389.436 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 386.305 397.312 0.750 re f
26.625 370.423 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 376.450 Td /F1 9.8 Tf  [(None)] TJ ET
0.267 0.267 0.267 rg
423.187 386.305 157.688 0.750 re f
423.187 370.423 0.750 16.631 re f
580.125 370.423 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 428.437 376.450 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 370.423 397.312 0.750 re f
26.625 354.542 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 360.568 Td /F1 9.8 Tf  [(Isolated single events \(not daily\))] TJ ET
0.267 0.267 0.267 rg
423.187 370.423 157.688 0.750 re f
423.187 354.542 0.750 16.631 re f
580.125 354.542 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 428.437 360.568 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 354.542 397.312 0.750 re f
26.625 338.661 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 344.687 Td /F1 9.8 Tf  [(Average occurrences approximately one daily)] TJ ET
0.267 0.267 0.267 rg
423.187 354.542 157.688 0.750 re f
423.187 338.661 0.750 16.631 re f
580.125 338.661 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 428.437 344.687 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 338.661 397.312 0.750 re f
26.625 322.780 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 328.806 Td /F1 9.8 Tf  [(Average occurrences approximately multiple daily)] TJ ET
0.267 0.267 0.267 rg
423.187 338.661 157.688 0.750 re f
423.187 322.780 0.750 16.631 re f
580.125 322.780 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 428.437 328.806 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 322.780 397.312 0.750 re f
26.625 306.898 397.312 0.750 re f
26.625 306.898 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 312.925 Td /F1 9.8 Tf  [(Systematic gender-based violence)] TJ ET
0.267 0.267 0.267 rg
423.187 322.780 157.688 0.750 re f
423.187 306.898 157.688 0.750 re f
423.187 306.898 0.750 16.631 re f
580.125 306.898 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 428.437 312.925 Td /F1 9.8 Tf  [(4)] TJ ET
BT 26.250 234.802 Td /F4 12.0 Tf  [(Discussion)] TJ ET
BT 26.250 214.848 Td /F1 9.8 Tf  [(Assessment of public health impact in complex humanitarian emergencies is a daunting task of unparalleled importance.)] TJ ET
0.267 0.267 0.267 rg
BT 544.843 216.355 Td /F4 8.7 Tf  [(42)] TJ ET
BT 554.480 216.355 Td /F4 8.7 Tf  [(43)] TJ ET
BT 564.117 216.355 Td /F4 8.7 Tf  [(44)] TJ ET
BT 26.250 204.450 Td /F4 8.7 Tf  [(45)] TJ ET
BT 35.887 204.450 Td /F4 8.7 Tf  [(46)] TJ ET
0.271 0.267 0.267 rg
BT 45.525 202.943 Td /F1 9.8 Tf  [( It is the guiding compass for the type and scale of response undertaken by various stakeholders. The objectives of )] TJ ET
BT 26.250 191.038 Td /F1 9.8 Tf  [(assessment �especially in the acute phase- are to measure the magnitude of the complex emergency and population size )] TJ ET
BT 26.250 179.133 Td /F1 9.8 Tf  [(affected; identify the vulnerable population groups with high risk of death or disease; determine the present health priorities and )] TJ ET
BT 26.250 167.229 Td /F1 9.8 Tf  [(potential public health problems; and gather information on the availability of food, water and shelter, clinics and hospitals.)] TJ ET
0.267 0.267 0.267 rg
BT 551.375 168.736 Td /F4 8.7 Tf  [(47)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 155.324 Td /F1 9.8 Tf  [(Having background information about the affected population, such as demographics and baseline health indicators \(e.g. CMR\), )] TJ ET
BT 26.250 143.419 Td /F1 9.8 Tf  [(is of prime importance to the overall assessment process. Coordination among various organizations and entities performing )] TJ ET
BT 26.250 131.514 Td /F1 9.8 Tf  [(assessment is also vital for both consistency and efficiency. The Johns Hopkins and Red Cross Red Crescent Public Health )] TJ ET
BT 26.250 119.610 Td /F1 9.8 Tf  [(Guide in Emergencies highlights some important considerations including, but not limited to, defining the terms of reference and )] TJ ET
BT 26.250 107.705 Td /F1 9.8 Tf  [(the objectives of the assessment, determining the priorities to be considered, and selecting how, in what order and what timeline )] TJ ET
BT 26.250 95.800 Td /F1 9.8 Tf  [(the information will be gathered.)] TJ ET
BT 164.437 99.688 Td /F1 8.7 Tf  [(49)] TJ ET
BT 174.074 95.800 Td /F1 9.8 Tf  [(The guide encourages the use of standardized checklists and measures, as proposed by the )] TJ ET
BT 26.250 83.895 Td /F1 9.8 Tf  [(PHISS model.)] TJ ET
BT 26.250 64.491 Td /F1 9.8 Tf  [(The proposed PHISS, illustrated above, constitute quantitative measures for the assessment of the public health impact of )] TJ ET
BT 26.250 52.586 Td /F1 9.8 Tf  [(Complex Humanitarian Emergencies. Conceptually, it may be used as a �big picture� multi-sectoral quantitative assessment )] TJ ET
BT 26.250 40.681 Td /F1 9.8 Tf  [(tool, by providing objective scores on specific parameters. It can potentially be used in entirety or partially, both cross-sectionally )] TJ ET
Q
q
15.000 26.395 577.500 750.605 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(for the scoring rubric in this parameter, based on The Sphere Project guidelines.)] TJ ET
0.267 0.267 0.267 rg
BT 371.985 768.983 Td /F4 8.7 Tf  [(3)] TJ ET
q
26.250 743.859 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 746.606 Td /F1 9.8 Tf  [(Table 11. Levels of Sanitation Facilities)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 604.398 555.000 131.961 re f
0.965 0.965 0.965 rg
27.000 723.329 455.867 12.280 re f
0.267 0.267 0.267 rg
26.625 735.234 456.242 0.750 re f
26.625 722.954 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 726.085 Td /F4 9.8 Tf  [(Levels of sanitation facilities)] TJ ET
0.965 0.965 0.965 rg
482.867 723.329 97.633 12.280 re f
0.267 0.267 0.267 rg
482.867 735.234 98.008 0.750 re f
580.125 722.954 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 487.367 726.085 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 722.954 456.617 0.750 re f
26.625 707.073 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 713.099 Td /F1 9.8 Tf  [(Intact well developed sanitary system for disposal of excreta)] TJ ET
0.267 0.267 0.267 rg
482.492 722.954 98.383 0.750 re f
482.492 707.073 0.750 16.631 re f
580.125 707.073 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 487.742 713.099 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 707.073 456.617 0.750 re f
26.625 691.192 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 697.218 Td /F1 9.8 Tf  [(Minor disruption of a well developed sanitary system for disposal of excreta)] TJ ET
0.267 0.267 0.267 rg
482.492 707.073 98.383 0.750 re f
482.492 691.192 0.750 16.631 re f
580.125 691.192 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 487.742 697.218 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 691.192 456.617 0.750 re f
26.625 667.679 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 31.875 681.337 Td /F1 9.8 Tf  [(Two or more toilets \(or latrines\) per 20 people, or two or more family latrines per 4 families, or two or )] TJ ET
BT 31.875 673.705 Td /F1 9.8 Tf  [(more trench latrines per 100 people)] TJ ET
0.267 0.267 0.267 rg
482.492 691.192 98.383 0.750 re f
482.492 667.679 0.750 24.263 re f
580.125 667.679 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 487.742 681.337 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 667.679 456.617 0.750 re f
26.625 644.167 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 657.824 Td /F1 9.8 Tf  [(One toilet \(or latrine\) per 20 people, or one family latrine per 4 families, or one trench latrine per 100 )] TJ ET
BT 31.875 650.193 Td /F1 9.8 Tf  [(people)] TJ ET
0.267 0.267 0.267 rg
482.492 667.679 98.383 0.750 re f
482.492 644.167 0.750 24.262 re f
580.125 644.167 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 487.742 657.824 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 644.167 456.617 0.750 re f
26.625 620.654 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 634.312 Td /F1 9.8 Tf  [(Less than one toilet \(or latrine\) per 20 people, or one family latrine per 4 families, or one trench latrine )] TJ ET
BT 31.875 626.680 Td /F1 9.8 Tf  [(per 100 people)] TJ ET
0.267 0.267 0.267 rg
482.492 644.167 98.383 0.750 re f
482.492 620.654 0.750 24.262 re f
580.125 620.654 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 487.742 634.312 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 620.654 456.617 0.750 re f
26.625 604.773 456.617 0.750 re f
26.625 604.773 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 610.799 Td /F1 9.8 Tf  [(Complete absence of any system for disposal of excreta)] TJ ET
0.267 0.267 0.267 rg
482.492 620.654 98.383 0.750 re f
482.492 604.773 98.383 0.750 re f
482.492 604.773 0.750 16.631 re f
580.125 604.773 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 487.742 610.799 Td /F1 9.8 Tf  [(5)] TJ ET
BT 26.250 549.874 Td /F4 9.8 Tf  [(12. Gender-based violence:)] TJ ET
BT 153.049 549.874 Td /F1 9.8 Tf  [( Attacks against women are the most common type of gender-based violence and is particularly )] TJ ET
BT 26.250 537.969 Td /F1 9.8 Tf  [(disruptive to the movement of the population, the maintenance of agrarian sustenance farming, and security within the home. )] TJ ET
BT 26.250 526.065 Td /F1 9.8 Tf  [(The Convention on the Elimination of All Forms of Discrimination against Women \(CEDAW\), adopted in 1979 by the UN )] TJ ET
BT 26.250 514.160 Td /F1 9.8 Tf  [(General Assembly, is often described as an international bill of rights for women defining what constitutes discrimination against )] TJ ET
BT 26.250 502.255 Td /F1 9.8 Tf  [(women and proposing an agenda to end discrimination. In 1992, CEDAW defined gender-based violence as �violence that is )] TJ ET
BT 26.250 490.350 Td /F1 9.8 Tf  [(directed against a woman because she is a woman or that affects women disproportionately. It includes acts that inflict physical, )] TJ ET
BT 26.250 478.446 Td /F1 9.8 Tf  [(mental or sexual harm or suffering, threats of such acts, coercion and other deprivations of liberty.�)] TJ ET
0.267 0.267 0.267 rg
BT 451.096 479.953 Td /F4 8.7 Tf  [(39)] TJ ET
0.271 0.267 0.267 rg
BT 460.734 478.446 Td /F1 9.8 Tf  [( Below is a proposed )] TJ ET
BT 26.250 466.541 Td /F1 9.8 Tf  [(stochastic scoring rubric for this public health parameter in CHE, as proposed by the authors. Examples of systematic gender )] TJ ET
BT 26.250 454.636 Td /F1 9.8 Tf  [(based violence include former Yugoslavia where the European Community estimates 20,000-50,000 Bosnian women were )] TJ ET
BT 26.250 442.731 Td /F1 9.8 Tf  [(systematically raped as a means for ethnic displacement.)] TJ ET
0.267 0.267 0.267 rg
BT 273.344 444.239 Td /F4 8.7 Tf  [(40)] TJ ET
BT 282.982 444.239 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 292.619 442.731 Td /F1 9.8 Tf  [( This CHE would get the maximum score of 4 on this parameter, )] TJ ET
BT 26.250 430.827 Td /F1 9.8 Tf  [(taking the upper estimate, on the basis of sexual harm alone.)] TJ ET
q
26.250 407.209 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 409.957 Td /F1 9.8 Tf  [(Table 12. Gender-Based Violence)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 306.523 555.000 93.186 re f
0.965 0.965 0.965 rg
27.000 386.680 396.562 12.280 re f
0.267 0.267 0.267 rg
26.625 398.584 396.937 0.750 re f
26.625 386.305 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 389.436 Td /F4 9.8 Tf  [(Gender-based violence)] TJ ET
0.965 0.965 0.965 rg
423.562 386.680 156.938 12.280 re f
0.267 0.267 0.267 rg
423.562 398.584 157.313 0.750 re f
580.125 386.305 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 428.062 389.436 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 386.305 397.312 0.750 re f
26.625 370.423 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 376.450 Td /F1 9.8 Tf  [(None)] TJ ET
0.267 0.267 0.267 rg
423.187 386.305 157.688 0.750 re f
423.187 370.423 0.750 16.631 re f
580.125 370.423 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 428.437 376.450 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 370.423 397.312 0.750 re f
26.625 354.542 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 360.568 Td /F1 9.8 Tf  [(Isolated single events \(not daily\))] TJ ET
0.267 0.267 0.267 rg
423.187 370.423 157.688 0.750 re f
423.187 354.542 0.750 16.631 re f
580.125 354.542 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 428.437 360.568 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 354.542 397.312 0.750 re f
26.625 338.661 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 344.687 Td /F1 9.8 Tf  [(Average occurrences approximately one daily)] TJ ET
0.267 0.267 0.267 rg
423.187 354.542 157.688 0.750 re f
423.187 338.661 0.750 16.631 re f
580.125 338.661 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 428.437 344.687 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 338.661 397.312 0.750 re f
26.625 322.780 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 328.806 Td /F1 9.8 Tf  [(Average occurrences approximately multiple daily)] TJ ET
0.267 0.267 0.267 rg
423.187 338.661 157.688 0.750 re f
423.187 322.780 0.750 16.631 re f
580.125 322.780 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 428.437 328.806 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 322.780 397.312 0.750 re f
26.625 306.898 397.312 0.750 re f
26.625 306.898 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 312.925 Td /F1 9.8 Tf  [(Systematic gender-based violence)] TJ ET
0.267 0.267 0.267 rg
423.187 322.780 157.688 0.750 re f
423.187 306.898 157.688 0.750 re f
423.187 306.898 0.750 16.631 re f
580.125 306.898 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 428.437 312.925 Td /F1 9.8 Tf  [(4)] TJ ET
BT 26.250 234.802 Td /F4 12.0 Tf  [(Discussion)] TJ ET
BT 26.250 214.848 Td /F1 9.8 Tf  [(Assessment of public health impact in complex humanitarian emergencies is a daunting task of unparalleled importance.)] TJ ET
0.267 0.267 0.267 rg
BT 544.843 216.355 Td /F4 8.7 Tf  [(42)] TJ ET
BT 554.480 216.355 Td /F4 8.7 Tf  [(43)] TJ ET
BT 564.117 216.355 Td /F4 8.7 Tf  [(44)] TJ ET
BT 26.250 204.450 Td /F4 8.7 Tf  [(45)] TJ ET
BT 35.887 204.450 Td /F4 8.7 Tf  [(46)] TJ ET
0.271 0.267 0.267 rg
BT 45.525 202.943 Td /F1 9.8 Tf  [( It is the guiding compass for the type and scale of response undertaken by various stakeholders. The objectives of )] TJ ET
BT 26.250 191.038 Td /F1 9.8 Tf  [(assessment �especially in the acute phase- are to measure the magnitude of the complex emergency and population size )] TJ ET
BT 26.250 179.133 Td /F1 9.8 Tf  [(affected; identify the vulnerable population groups with high risk of death or disease; determine the present health priorities and )] TJ ET
BT 26.250 167.229 Td /F1 9.8 Tf  [(potential public health problems; and gather information on the availability of food, water and shelter, clinics and hospitals.)] TJ ET
0.267 0.267 0.267 rg
BT 551.375 168.736 Td /F4 8.7 Tf  [(47)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 155.324 Td /F1 9.8 Tf  [(Having background information about the affected population, such as demographics and baseline health indicators \(e.g. CMR\), )] TJ ET
BT 26.250 143.419 Td /F1 9.8 Tf  [(is of prime importance to the overall assessment process. Coordination among various organizations and entities performing )] TJ ET
BT 26.250 131.514 Td /F1 9.8 Tf  [(assessment is also vital for both consistency and efficiency. The Johns Hopkins and Red Cross Red Crescent Public Health )] TJ ET
BT 26.250 119.610 Td /F1 9.8 Tf  [(Guide in Emergencies highlights some important considerations including, but not limited to, defining the terms of reference and )] TJ ET
BT 26.250 107.705 Td /F1 9.8 Tf  [(the objectives of the assessment, determining the priorities to be considered, and selecting how, in what order and what timeline )] TJ ET
BT 26.250 95.800 Td /F1 9.8 Tf  [(the information will be gathered.)] TJ ET
BT 164.437 99.688 Td /F1 8.7 Tf  [(49)] TJ ET
BT 174.074 95.800 Td /F1 9.8 Tf  [(The guide encourages the use of standardized checklists and measures, as proposed by the )] TJ ET
BT 26.250 83.895 Td /F1 9.8 Tf  [(PHISS model.)] TJ ET
BT 26.250 64.491 Td /F1 9.8 Tf  [(The proposed PHISS, illustrated above, constitute quantitative measures for the assessment of the public health impact of )] TJ ET
BT 26.250 52.586 Td /F1 9.8 Tf  [(Complex Humanitarian Emergencies. Conceptually, it may be used as a �big picture� multi-sectoral quantitative assessment )] TJ ET
BT 26.250 40.681 Td /F1 9.8 Tf  [(tool, by providing objective scores on specific parameters. It can potentially be used in entirety or partially, both cross-sectionally )] TJ ET
Q
q
15.000 26.395 577.500 750.605 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(for the scoring rubric in this parameter, based on The Sphere Project guidelines.)] TJ ET
0.267 0.267 0.267 rg
BT 371.985 768.983 Td /F4 8.7 Tf  [(3)] TJ ET
q
26.250 743.859 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 746.606 Td /F1 9.8 Tf  [(Table 11. Levels of Sanitation Facilities)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 604.398 555.000 131.961 re f
0.965 0.965 0.965 rg
27.000 723.329 455.867 12.280 re f
0.267 0.267 0.267 rg
26.625 735.234 456.242 0.750 re f
26.625 722.954 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 726.085 Td /F4 9.8 Tf  [(Levels of sanitation facilities)] TJ ET
0.965 0.965 0.965 rg
482.867 723.329 97.633 12.280 re f
0.267 0.267 0.267 rg
482.867 735.234 98.008 0.750 re f
580.125 722.954 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 487.367 726.085 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 722.954 456.617 0.750 re f
26.625 707.073 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 713.099 Td /F1 9.8 Tf  [(Intact well developed sanitary system for disposal of excreta)] TJ ET
0.267 0.267 0.267 rg
482.492 722.954 98.383 0.750 re f
482.492 707.073 0.750 16.631 re f
580.125 707.073 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 487.742 713.099 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 707.073 456.617 0.750 re f
26.625 691.192 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 697.218 Td /F1 9.8 Tf  [(Minor disruption of a well developed sanitary system for disposal of excreta)] TJ ET
0.267 0.267 0.267 rg
482.492 707.073 98.383 0.750 re f
482.492 691.192 0.750 16.631 re f
580.125 691.192 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 487.742 697.218 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 691.192 456.617 0.750 re f
26.625 667.679 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 31.875 681.337 Td /F1 9.8 Tf  [(Two or more toilets \(or latrines\) per 20 people, or two or more family latrines per 4 families, or two or )] TJ ET
BT 31.875 673.705 Td /F1 9.8 Tf  [(more trench latrines per 100 people)] TJ ET
0.267 0.267 0.267 rg
482.492 691.192 98.383 0.750 re f
482.492 667.679 0.750 24.263 re f
580.125 667.679 0.750 24.263 re f
0.271 0.267 0.267 rg
BT 487.742 681.337 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 667.679 456.617 0.750 re f
26.625 644.167 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 657.824 Td /F1 9.8 Tf  [(One toilet \(or latrine\) per 20 people, or one family latrine per 4 families, or one trench latrine per 100 )] TJ ET
BT 31.875 650.193 Td /F1 9.8 Tf  [(people)] TJ ET
0.267 0.267 0.267 rg
482.492 667.679 98.383 0.750 re f
482.492 644.167 0.750 24.262 re f
580.125 644.167 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 487.742 657.824 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 644.167 456.617 0.750 re f
26.625 620.654 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 634.312 Td /F1 9.8 Tf  [(Less than one toilet \(or latrine\) per 20 people, or one family latrine per 4 families, or one trench latrine )] TJ ET
BT 31.875 626.680 Td /F1 9.8 Tf  [(per 100 people)] TJ ET
0.267 0.267 0.267 rg
482.492 644.167 98.383 0.750 re f
482.492 620.654 0.750 24.262 re f
580.125 620.654 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 487.742 634.312 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 620.654 456.617 0.750 re f
26.625 604.773 456.617 0.750 re f
26.625 604.773 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 610.799 Td /F1 9.8 Tf  [(Complete absence of any system for disposal of excreta)] TJ ET
0.267 0.267 0.267 rg
482.492 620.654 98.383 0.750 re f
482.492 604.773 98.383 0.750 re f
482.492 604.773 0.750 16.631 re f
580.125 604.773 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 487.742 610.799 Td /F1 9.8 Tf  [(5)] TJ ET
BT 26.250 549.874 Td /F4 9.8 Tf  [(12. Gender-based violence:)] TJ ET
BT 153.049 549.874 Td /F1 9.8 Tf  [( Attacks against women are the most common type of gender-based violence and is particularly )] TJ ET
BT 26.250 537.969 Td /F1 9.8 Tf  [(disruptive to the movement of the population, the maintenance of agrarian sustenance farming, and security within the home. )] TJ ET
BT 26.250 526.065 Td /F1 9.8 Tf  [(The Convention on the Elimination of All Forms of Discrimination against Women \(CEDAW\), adopted in 1979 by the UN )] TJ ET
BT 26.250 514.160 Td /F1 9.8 Tf  [(General Assembly, is often described as an international bill of rights for women defining what constitutes discrimination against )] TJ ET
BT 26.250 502.255 Td /F1 9.8 Tf  [(women and proposing an agenda to end discrimination. In 1992, CEDAW defined gender-based violence as �violence that is )] TJ ET
BT 26.250 490.350 Td /F1 9.8 Tf  [(directed against a woman because she is a woman or that affects women disproportionately. It includes acts that inflict physical, )] TJ ET
BT 26.250 478.446 Td /F1 9.8 Tf  [(mental or sexual harm or suffering, threats of such acts, coercion and other deprivations of liberty.�)] TJ ET
0.267 0.267 0.267 rg
BT 451.096 479.953 Td /F4 8.7 Tf  [(39)] TJ ET
0.271 0.267 0.267 rg
BT 460.734 478.446 Td /F1 9.8 Tf  [( Below is a proposed )] TJ ET
BT 26.250 466.541 Td /F1 9.8 Tf  [(stochastic scoring rubric for this public health parameter in CHE, as proposed by the authors. Examples of systematic gender )] TJ ET
BT 26.250 454.636 Td /F1 9.8 Tf  [(based violence include former Yugoslavia where the European Community estimates 20,000-50,000 Bosnian women were )] TJ ET
BT 26.250 442.731 Td /F1 9.8 Tf  [(systematically raped as a means for ethnic displacement.)] TJ ET
0.267 0.267 0.267 rg
BT 273.344 444.239 Td /F4 8.7 Tf  [(40)] TJ ET
BT 282.982 444.239 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 292.619 442.731 Td /F1 9.8 Tf  [( This CHE would get the maximum score of 4 on this parameter, )] TJ ET
BT 26.250 430.827 Td /F1 9.8 Tf  [(taking the upper estimate, on the basis of sexual harm alone.)] TJ ET
q
26.250 407.209 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 409.957 Td /F1 9.8 Tf  [(Table 12. Gender-Based Violence)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 306.523 555.000 93.186 re f
0.965 0.965 0.965 rg
27.000 386.680 396.562 12.280 re f
0.267 0.267 0.267 rg
26.625 398.584 396.937 0.750 re f
26.625 386.305 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 389.436 Td /F4 9.8 Tf  [(Gender-based violence)] TJ ET
0.965 0.965 0.965 rg
423.562 386.680 156.938 12.280 re f
0.267 0.267 0.267 rg
423.562 398.584 157.313 0.750 re f
580.125 386.305 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 428.062 389.436 Td /F4 9.8 Tf  [(Severity score)] TJ ET
0.267 0.267 0.267 rg
26.625 386.305 397.312 0.750 re f
26.625 370.423 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 376.450 Td /F1 9.8 Tf  [(None)] TJ ET
0.267 0.267 0.267 rg
423.187 386.305 157.688 0.750 re f
423.187 370.423 0.750 16.631 re f
580.125 370.423 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 428.437 376.450 Td /F1 9.8 Tf  [(0)] TJ ET
0.267 0.267 0.267 rg
26.625 370.423 397.312 0.750 re f
26.625 354.542 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 360.568 Td /F1 9.8 Tf  [(Isolated single events \(not daily\))] TJ ET
0.267 0.267 0.267 rg
423.187 370.423 157.688 0.750 re f
423.187 354.542 0.750 16.631 re f
580.125 354.542 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 428.437 360.568 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 354.542 397.312 0.750 re f
26.625 338.661 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 344.687 Td /F1 9.8 Tf  [(Average occurrences approximately one daily)] TJ ET
0.267 0.267 0.267 rg
423.187 354.542 157.688 0.750 re f
423.187 338.661 0.750 16.631 re f
580.125 338.661 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 428.437 344.687 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 338.661 397.312 0.750 re f
26.625 322.780 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 328.806 Td /F1 9.8 Tf  [(Average occurrences approximately multiple daily)] TJ ET
0.267 0.267 0.267 rg
423.187 338.661 157.688 0.750 re f
423.187 322.780 0.750 16.631 re f
580.125 322.780 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 428.437 328.806 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 322.780 397.312 0.750 re f
26.625 306.898 397.312 0.750 re f
26.625 306.898 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 312.925 Td /F1 9.8 Tf  [(Systematic gender-based violence)] TJ ET
0.267 0.267 0.267 rg
423.187 322.780 157.688 0.750 re f
423.187 306.898 157.688 0.750 re f
423.187 306.898 0.750 16.631 re f
580.125 306.898 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 428.437 312.925 Td /F1 9.8 Tf  [(4)] TJ ET
BT 26.250 234.802 Td /F4 12.0 Tf  [(Discussion)] TJ ET
BT 26.250 214.848 Td /F1 9.8 Tf  [(Assessment of public health impact in complex humanitarian emergencies is a daunting task of unparalleled importance.)] TJ ET
0.267 0.267 0.267 rg
BT 544.843 216.355 Td /F4 8.7 Tf  [(42)] TJ ET
BT 554.480 216.355 Td /F4 8.7 Tf  [(43)] TJ ET
BT 564.117 216.355 Td /F4 8.7 Tf  [(44)] TJ ET
BT 26.250 204.450 Td /F4 8.7 Tf  [(45)] TJ ET
BT 35.887 204.450 Td /F4 8.7 Tf  [(46)] TJ ET
0.271 0.267 0.267 rg
BT 45.525 202.943 Td /F1 9.8 Tf  [( It is the guiding compass for the type and scale of response undertaken by various stakeholders. The objectives of )] TJ ET
BT 26.250 191.038 Td /F1 9.8 Tf  [(assessment �especially in the acute phase- are to measure the magnitude of the complex emergency and population size )] TJ ET
BT 26.250 179.133 Td /F1 9.8 Tf  [(affected; identify the vulnerable population groups with high risk of death or disease; determine the present health priorities and )] TJ ET
BT 26.250 167.229 Td /F1 9.8 Tf  [(potential public health problems; and gather information on the availability of food, water and shelter, clinics and hospitals.)] TJ ET
0.267 0.267 0.267 rg
BT 551.375 168.736 Td /F4 8.7 Tf  [(47)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 155.324 Td /F1 9.8 Tf  [(Having background information about the affected population, such as demographics and baseline health indicators \(e.g. CMR\), )] TJ ET
BT 26.250 143.419 Td /F1 9.8 Tf  [(is of prime importance to the overall assessment process. Coordination among various organizations and entities performing )] TJ ET
BT 26.250 131.514 Td /F1 9.8 Tf  [(assessment is also vital for both consistency and efficiency. The Johns Hopkins and Red Cross Red Crescent Public Health )] TJ ET
BT 26.250 119.610 Td /F1 9.8 Tf  [(Guide in Emergencies highlights some important considerations including, but not limited to, defining the terms of reference and )] TJ ET
BT 26.250 107.705 Td /F1 9.8 Tf  [(the objectives of the assessment, determining the priorities to be considered, and selecting how, in what order and what timeline )] TJ ET
BT 26.250 95.800 Td /F1 9.8 Tf  [(the information will be gathered.)] TJ ET
BT 164.437 99.688 Td /F1 8.7 Tf  [(49)] TJ ET
BT 174.074 95.800 Td /F1 9.8 Tf  [(The guide encourages the use of standardized checklists and measures, as proposed by the )] TJ ET
BT 26.250 83.895 Td /F1 9.8 Tf  [(PHISS model.)] TJ ET
BT 26.250 64.491 Td /F1 9.8 Tf  [(The proposed PHISS, illustrated above, constitute quantitative measures for the assessment of the public health impact of )] TJ ET
BT 26.250 52.586 Td /F1 9.8 Tf  [(Complex Humanitarian Emergencies. Conceptually, it may be used as a �big picture� multi-sectoral quantitative assessment )] TJ ET
BT 26.250 40.681 Td /F1 9.8 Tf  [(tool, by providing objective scores on specific parameters. It can potentially be used in entirety or partially, both cross-sectionally )] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(10)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 26.250 767.476 Td /F1 9.8 Tf  [(or longitudinally across time. The cumulative PHISS score ranges from a minimum of 0 to a maximum of 100. It uses absolute )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(numbers instead of percentages \(e.g. excess mortality instead of mortality rates\), in order to depict the actual scale of the )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(impact that would be applicable to affected populations of various sizes. Whenever possible, existing scoring rubric criteria were )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(utilized for the parameters. This scale does not undermine the value of descriptive methods, nor is it meant to replace existing )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(guidelines and tools, but rather to build upon and augment them. Adopting and applying such a quantitative scale in CHE )] TJ ET
BT 26.250 707.952 Td /F1 9.8 Tf  [(maybe useful for guiding response efforts, longitudinal assessment within each CHE, and comparative studies between various )] TJ ET
BT 26.250 696.048 Td /F1 9.8 Tf  [(CHE. Such methodology would compliment current descriptive assessment tools. This approach may streamline the post-CHE )] TJ ET
BT 26.250 684.143 Td /F1 9.8 Tf  [(assessment phase by providing an overall quantitative objective measure, and provide the opportunity of pooling comparable )] TJ ET
BT 26.250 672.238 Td /F1 9.8 Tf  [(data from various sources and organizations. The opportunity to aggregate data from various agencies and organizations )] TJ ET
BT 26.250 660.333 Td /F1 9.8 Tf  [(increases the precision of assessment data, and optimizes the speed and accuracy of resource allocation in CHE. In )] TJ ET
BT 26.250 648.429 Td /F1 9.8 Tf  [(longitudinal assessments, comparable periods of time need to be taken into consideration. A uniform quantitative assessment )] TJ ET
BT 26.250 636.524 Td /F1 9.8 Tf  [(method would help facilitate inter-agency communication and reduce subjective variations and errors in assessment. The scale )] TJ ET
BT 26.250 624.619 Td /F1 9.8 Tf  [(may allow the standardization of the various approaches currently in use across health organizations, which would reduce )] TJ ET
BT 26.250 612.714 Td /F1 9.8 Tf  [(redundancy of assessment efforts. Moreover, applying an overall quantitative score to different events allows for historical )] TJ ET
BT 26.250 600.810 Td /F1 9.8 Tf  [(comparisons between disparate CHE. Of note, the reason PHISS has not been applied to one single historical CHE, is that data )] TJ ET
BT 26.250 588.905 Td /F1 9.8 Tf  [(on the 12 proposed parameters are not readily available and do not reside in one or multitude of data sources.)] TJ ET
BT 26.250 569.500 Td /F1 9.8 Tf  [(It is of prime importance to note that sound and standardized sampling methodology, in addition to uniformity of measurement )] TJ ET
BT 26.250 557.595 Td /F1 9.8 Tf  [(techniques, are key to the accuracy of the PHISS results. Technical issues regarding cluster sampling and data aggregation for )] TJ ET
BT 26.250 545.691 Td /F1 9.8 Tf  [(various parameters require thorough evaluation and further recommendation.)] TJ ET
BT 26.250 509.088 Td /F4 12.0 Tf  [(Limitations and Strengths)] TJ ET
BT 26.250 489.134 Td /F1 9.8 Tf  [(There are several limitations and challenges to our proposed scale; most are related to the availability of baseline population )] TJ ET
BT 26.250 477.229 Td /F1 9.8 Tf  [(figures, and to the accuracy and standardized methodology of measuring the 12 proposed parameters. First, some of those )] TJ ET
BT 26.250 465.324 Td /F1 9.8 Tf  [(parameters \(e.g. excess mortality\) require baseline population figures which may be lacking in CHE. This potential problem is )] TJ ET
BT 26.250 453.420 Td /F1 9.8 Tf  [(not unique to this proposed tool, and may be remedied by estimation methods. Second, there would still be some variation in )] TJ ET
BT 26.250 441.515 Td /F1 9.8 Tf  [(the data collected by various assessors. A training program for potential assessment teams can minimize this variation. Third, )] TJ ET
BT 26.250 429.610 Td /F1 9.8 Tf  [(PHISS is not meant to be an exhaustive tool, and some parameters might be suggested to be added to the scale \(e.g. food )] TJ ET
BT 26.250 417.705 Td /F1 9.8 Tf  [(availability by calories\). Other CHEs might have special characteristics that are not included. Yet, the parameters included in )] TJ ET
BT 26.250 405.801 Td /F1 9.8 Tf  [(PHISS constitute the major public health categories in the acute phase of CHE, as identified by many benchmark guidelines )] TJ ET
BT 26.250 393.896 Td /F1 9.8 Tf  [(including The Sphere Project. Fourth, there is an inherent element of stochasticity -though chosen by consensus- when )] TJ ET
BT 26.250 381.991 Td /F1 9.8 Tf  [(assigning scoring rubrics for some of the parameters. In addition, the maximum score for few parameters varies, giving more )] TJ ET
BT 26.250 370.086 Td /F1 9.8 Tf  [(weight to some more than others. These restrictions were due to the absence of standardized reference ranges in the literature. )] TJ ET
BT 26.250 358.182 Td /F1 9.8 Tf  [(However, every attempt was made to use available data and references when applicable. Fifth, the sum of all the parameters� )] TJ ET
BT 26.250 346.277 Td /F1 9.8 Tf  [(scores might not always reflect the complexity of the CHE. Sixth, we comparing different CHE, the period of time need to be )] TJ ET
BT 26.250 334.372 Td /F1 9.8 Tf  [(standardized for parameters one and tow \(excess deaths and under-5 excess deaths\). Finally, one parameter, namely water )] TJ ET
BT 26.250 322.467 Td /F1 9.8 Tf  [(quality, requires some basic technological capacity. Simple commercial kits are readily available on the market, can be used to )] TJ ET
BT 26.250 310.563 Td /F1 9.8 Tf  [(collect the water quality data. Of note, pooling data from existing tools may readily provide quantitative scores on certain PHISS )] TJ ET
BT 26.250 298.658 Td /F1 9.8 Tf  [(parameters \(e.g. estimated number of excess deaths\). Since testing the validity and feasibility of PHISS was not the objective of )] TJ ET
BT 26.250 286.753 Td /F1 9.8 Tf  [(this proposed study, the authors hope that the introduction of this quantitative scale would invigorate scientific discussion and )] TJ ET
BT 26.250 274.848 Td /F1 9.8 Tf  [(prompt organizations and agencies with sufficient resources to apply PHISS prospectively in future CHE.)] TJ ET
BT 26.250 238.246 Td /F4 12.0 Tf  [(Conclusion)] TJ ET
BT 26.250 218.292 Td /F1 9.8 Tf  [(Measuring the public health impact of complex humanitarian emergencies is germane to objectively and accurately identify the )] TJ ET
BT 26.250 206.387 Td /F1 9.8 Tf  [(scope and scale of the critical needs and relief priorities for affected populations. A new quantitative assessment tool \(PHISS\) )] TJ ET
BT 26.250 194.482 Td /F1 9.8 Tf  [(has been proposed, based on The Sphere Project �minimum standards�, in order to streamline and standardize the post-CHE )] TJ ET
BT 26.250 182.577 Td /F1 9.8 Tf  [(assessment phase. PHISS is a conceptual disaster metric that has not yet been validated, and studies are needed with )] TJ ET
BT 26.250 170.673 Td /F1 9.8 Tf  [(prospective data collection to test its validity, feasibility and reliability.)] TJ ET
BT 26.250 134.070 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 114.116 Td /F1 9.8 Tf  [(The authors would like to acknowledge Dr. Nawar Abdul Latif, Mr. Ahmad Bayram, and Mrs. Jomana Musmar-Bayram for their )] TJ ET
BT 26.250 102.211 Td /F1 9.8 Tf  [(valuable assistance in this study.)] TJ ET
BT 26.250 73.109 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 45.654 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 45.654 Td /F1 9.8 Tf  [(Inter-Agency Standing Committee Secretariat. Working paper on the definition of complex emergency. December 9, 1994. )] TJ ET
Q
q
15.000 31.369 577.500 745.631 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(or longitudinally across time. The cumulative PHISS score ranges from a minimum of 0 to a maximum of 100. It uses absolute )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(numbers instead of percentages \(e.g. excess mortality instead of mortality rates\), in order to depict the actual scale of the )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(impact that would be applicable to affected populations of various sizes. Whenever possible, existing scoring rubric criteria were )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(utilized for the parameters. This scale does not undermine the value of descriptive methods, nor is it meant to replace existing )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(guidelines and tools, but rather to build upon and augment them. Adopting and applying such a quantitative scale in CHE )] TJ ET
BT 26.250 707.952 Td /F1 9.8 Tf  [(maybe useful for guiding response efforts, longitudinal assessment within each CHE, and comparative studies between various )] TJ ET
BT 26.250 696.048 Td /F1 9.8 Tf  [(CHE. Such methodology would compliment current descriptive assessment tools. This approach may streamline the post-CHE )] TJ ET
BT 26.250 684.143 Td /F1 9.8 Tf  [(assessment phase by providing an overall quantitative objective measure, and provide the opportunity of pooling comparable )] TJ ET
BT 26.250 672.238 Td /F1 9.8 Tf  [(data from various sources and organizations. The opportunity to aggregate data from various agencies and organizations )] TJ ET
BT 26.250 660.333 Td /F1 9.8 Tf  [(increases the precision of assessment data, and optimizes the speed and accuracy of resource allocation in CHE. In )] TJ ET
BT 26.250 648.429 Td /F1 9.8 Tf  [(longitudinal assessments, comparable periods of time need to be taken into consideration. A uniform quantitative assessment )] TJ ET
BT 26.250 636.524 Td /F1 9.8 Tf  [(method would help facilitate inter-agency communication and reduce subjective variations and errors in assessment. The scale )] TJ ET
BT 26.250 624.619 Td /F1 9.8 Tf  [(may allow the standardization of the various approaches currently in use across health organizations, which would reduce )] TJ ET
BT 26.250 612.714 Td /F1 9.8 Tf  [(redundancy of assessment efforts. Moreover, applying an overall quantitative score to different events allows for historical )] TJ ET
BT 26.250 600.810 Td /F1 9.8 Tf  [(comparisons between disparate CHE. Of note, the reason PHISS has not been applied to one single historical CHE, is that data )] TJ ET
BT 26.250 588.905 Td /F1 9.8 Tf  [(on the 12 proposed parameters are not readily available and do not reside in one or multitude of data sources.)] TJ ET
BT 26.250 569.500 Td /F1 9.8 Tf  [(It is of prime importance to note that sound and standardized sampling methodology, in addition to uniformity of measurement )] TJ ET
BT 26.250 557.595 Td /F1 9.8 Tf  [(techniques, are key to the accuracy of the PHISS results. Technical issues regarding cluster sampling and data aggregation for )] TJ ET
BT 26.250 545.691 Td /F1 9.8 Tf  [(various parameters require thorough evaluation and further recommendation.)] TJ ET
BT 26.250 509.088 Td /F4 12.0 Tf  [(Limitations and Strengths)] TJ ET
BT 26.250 489.134 Td /F1 9.8 Tf  [(There are several limitations and challenges to our proposed scale; most are related to the availability of baseline population )] TJ ET
BT 26.250 477.229 Td /F1 9.8 Tf  [(figures, and to the accuracy and standardized methodology of measuring the 12 proposed parameters. First, some of those )] TJ ET
BT 26.250 465.324 Td /F1 9.8 Tf  [(parameters \(e.g. excess mortality\) require baseline population figures which may be lacking in CHE. This potential problem is )] TJ ET
BT 26.250 453.420 Td /F1 9.8 Tf  [(not unique to this proposed tool, and may be remedied by estimation methods. Second, there would still be some variation in )] TJ ET
BT 26.250 441.515 Td /F1 9.8 Tf  [(the data collected by various assessors. A training program for potential assessment teams can minimize this variation. Third, )] TJ ET
BT 26.250 429.610 Td /F1 9.8 Tf  [(PHISS is not meant to be an exhaustive tool, and some parameters might be suggested to be added to the scale \(e.g. food )] TJ ET
BT 26.250 417.705 Td /F1 9.8 Tf  [(availability by calories\). Other CHEs might have special characteristics that are not included. Yet, the parameters included in )] TJ ET
BT 26.250 405.801 Td /F1 9.8 Tf  [(PHISS constitute the major public health categories in the acute phase of CHE, as identified by many benchmark guidelines )] TJ ET
BT 26.250 393.896 Td /F1 9.8 Tf  [(including The Sphere Project. Fourth, there is an inherent element of stochasticity -though chosen by consensus- when )] TJ ET
BT 26.250 381.991 Td /F1 9.8 Tf  [(assigning scoring rubrics for some of the parameters. In addition, the maximum score for few parameters varies, giving more )] TJ ET
BT 26.250 370.086 Td /F1 9.8 Tf  [(weight to some more than others. These restrictions were due to the absence of standardized reference ranges in the literature. )] TJ ET
BT 26.250 358.182 Td /F1 9.8 Tf  [(However, every attempt was made to use available data and references when applicable. Fifth, the sum of all the parameters� )] TJ ET
BT 26.250 346.277 Td /F1 9.8 Tf  [(scores might not always reflect the complexity of the CHE. Sixth, we comparing different CHE, the period of time need to be )] TJ ET
BT 26.250 334.372 Td /F1 9.8 Tf  [(standardized for parameters one and tow \(excess deaths and under-5 excess deaths\). Finally, one parameter, namely water )] TJ ET
BT 26.250 322.467 Td /F1 9.8 Tf  [(quality, requires some basic technological capacity. Simple commercial kits are readily available on the market, can be used to )] TJ ET
BT 26.250 310.563 Td /F1 9.8 Tf  [(collect the water quality data. Of note, pooling data from existing tools may readily provide quantitative scores on certain PHISS )] TJ ET
BT 26.250 298.658 Td /F1 9.8 Tf  [(parameters \(e.g. estimated number of excess deaths\). Since testing the validity and feasibility of PHISS was not the objective of )] TJ ET
BT 26.250 286.753 Td /F1 9.8 Tf  [(this proposed study, the authors hope that the introduction of this quantitative scale would invigorate scientific discussion and )] TJ ET
BT 26.250 274.848 Td /F1 9.8 Tf  [(prompt organizations and agencies with sufficient resources to apply PHISS prospectively in future CHE.)] TJ ET
BT 26.250 238.246 Td /F4 12.0 Tf  [(Conclusion)] TJ ET
BT 26.250 218.292 Td /F1 9.8 Tf  [(Measuring the public health impact of complex humanitarian emergencies is germane to objectively and accurately identify the )] TJ ET
BT 26.250 206.387 Td /F1 9.8 Tf  [(scope and scale of the critical needs and relief priorities for affected populations. A new quantitative assessment tool \(PHISS\) )] TJ ET
BT 26.250 194.482 Td /F1 9.8 Tf  [(has been proposed, based on The Sphere Project �minimum standards�, in order to streamline and standardize the post-CHE )] TJ ET
BT 26.250 182.577 Td /F1 9.8 Tf  [(assessment phase. PHISS is a conceptual disaster metric that has not yet been validated, and studies are needed with )] TJ ET
BT 26.250 170.673 Td /F1 9.8 Tf  [(prospective data collection to test its validity, feasibility and reliability.)] TJ ET
BT 26.250 134.070 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 114.116 Td /F1 9.8 Tf  [(The authors would like to acknowledge Dr. Nawar Abdul Latif, Mr. Ahmad Bayram, and Mrs. Jomana Musmar-Bayram for their )] TJ ET
BT 26.250 102.211 Td /F1 9.8 Tf  [(valuable assistance in this study.)] TJ ET
BT 26.250 73.109 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 45.654 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 45.654 Td /F1 9.8 Tf  [(Inter-Agency Standing Committee Secretariat. Working paper on the definition of complex emergency. December 9, 1994. )] TJ ET
Q
q
15.000 31.369 577.500 745.631 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(or longitudinally across time. The cumulative PHISS score ranges from a minimum of 0 to a maximum of 100. It uses absolute )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(numbers instead of percentages \(e.g. excess mortality instead of mortality rates\), in order to depict the actual scale of the )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(impact that would be applicable to affected populations of various sizes. Whenever possible, existing scoring rubric criteria were )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(utilized for the parameters. This scale does not undermine the value of descriptive methods, nor is it meant to replace existing )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(guidelines and tools, but rather to build upon and augment them. Adopting and applying such a quantitative scale in CHE )] TJ ET
BT 26.250 707.952 Td /F1 9.8 Tf  [(maybe useful for guiding response efforts, longitudinal assessment within each CHE, and comparative studies between various )] TJ ET
BT 26.250 696.048 Td /F1 9.8 Tf  [(CHE. Such methodology would compliment current descriptive assessment tools. This approach may streamline the post-CHE )] TJ ET
BT 26.250 684.143 Td /F1 9.8 Tf  [(assessment phase by providing an overall quantitative objective measure, and provide the opportunity of pooling comparable )] TJ ET
BT 26.250 672.238 Td /F1 9.8 Tf  [(data from various sources and organizations. The opportunity to aggregate data from various agencies and organizations )] TJ ET
BT 26.250 660.333 Td /F1 9.8 Tf  [(increases the precision of assessment data, and optimizes the speed and accuracy of resource allocation in CHE. In )] TJ ET
BT 26.250 648.429 Td /F1 9.8 Tf  [(longitudinal assessments, comparable periods of time need to be taken into consideration. A uniform quantitative assessment )] TJ ET
BT 26.250 636.524 Td /F1 9.8 Tf  [(method would help facilitate inter-agency communication and reduce subjective variations and errors in assessment. The scale )] TJ ET
BT 26.250 624.619 Td /F1 9.8 Tf  [(may allow the standardization of the various approaches currently in use across health organizations, which would reduce )] TJ ET
BT 26.250 612.714 Td /F1 9.8 Tf  [(redundancy of assessment efforts. Moreover, applying an overall quantitative score to different events allows for historical )] TJ ET
BT 26.250 600.810 Td /F1 9.8 Tf  [(comparisons between disparate CHE. Of note, the reason PHISS has not been applied to one single historical CHE, is that data )] TJ ET
BT 26.250 588.905 Td /F1 9.8 Tf  [(on the 12 proposed parameters are not readily available and do not reside in one or multitude of data sources.)] TJ ET
BT 26.250 569.500 Td /F1 9.8 Tf  [(It is of prime importance to note that sound and standardized sampling methodology, in addition to uniformity of measurement )] TJ ET
BT 26.250 557.595 Td /F1 9.8 Tf  [(techniques, are key to the accuracy of the PHISS results. Technical issues regarding cluster sampling and data aggregation for )] TJ ET
BT 26.250 545.691 Td /F1 9.8 Tf  [(various parameters require thorough evaluation and further recommendation.)] TJ ET
BT 26.250 509.088 Td /F4 12.0 Tf  [(Limitations and Strengths)] TJ ET
BT 26.250 489.134 Td /F1 9.8 Tf  [(There are several limitations and challenges to our proposed scale; most are related to the availability of baseline population )] TJ ET
BT 26.250 477.229 Td /F1 9.8 Tf  [(figures, and to the accuracy and standardized methodology of measuring the 12 proposed parameters. First, some of those )] TJ ET
BT 26.250 465.324 Td /F1 9.8 Tf  [(parameters \(e.g. excess mortality\) require baseline population figures which may be lacking in CHE. This potential problem is )] TJ ET
BT 26.250 453.420 Td /F1 9.8 Tf  [(not unique to this proposed tool, and may be remedied by estimation methods. Second, there would still be some variation in )] TJ ET
BT 26.250 441.515 Td /F1 9.8 Tf  [(the data collected by various assessors. A training program for potential assessment teams can minimize this variation. Third, )] TJ ET
BT 26.250 429.610 Td /F1 9.8 Tf  [(PHISS is not meant to be an exhaustive tool, and some parameters might be suggested to be added to the scale \(e.g. food )] TJ ET
BT 26.250 417.705 Td /F1 9.8 Tf  [(availability by calories\). Other CHEs might have special characteristics that are not included. Yet, the parameters included in )] TJ ET
BT 26.250 405.801 Td /F1 9.8 Tf  [(PHISS constitute the major public health categories in the acute phase of CHE, as identified by many benchmark guidelines )] TJ ET
BT 26.250 393.896 Td /F1 9.8 Tf  [(including The Sphere Project. Fourth, there is an inherent element of stochasticity -though chosen by consensus- when )] TJ ET
BT 26.250 381.991 Td /F1 9.8 Tf  [(assigning scoring rubrics for some of the parameters. In addition, the maximum score for few parameters varies, giving more )] TJ ET
BT 26.250 370.086 Td /F1 9.8 Tf  [(weight to some more than others. These restrictions were due to the absence of standardized reference ranges in the literature. )] TJ ET
BT 26.250 358.182 Td /F1 9.8 Tf  [(However, every attempt was made to use available data and references when applicable. Fifth, the sum of all the parameters� )] TJ ET
BT 26.250 346.277 Td /F1 9.8 Tf  [(scores might not always reflect the complexity of the CHE. Sixth, we comparing different CHE, the period of time need to be )] TJ ET
BT 26.250 334.372 Td /F1 9.8 Tf  [(standardized for parameters one and tow \(excess deaths and under-5 excess deaths\). Finally, one parameter, namely water )] TJ ET
BT 26.250 322.467 Td /F1 9.8 Tf  [(quality, requires some basic technological capacity. Simple commercial kits are readily available on the market, can be used to )] TJ ET
BT 26.250 310.563 Td /F1 9.8 Tf  [(collect the water quality data. Of note, pooling data from existing tools may readily provide quantitative scores on certain PHISS )] TJ ET
BT 26.250 298.658 Td /F1 9.8 Tf  [(parameters \(e.g. estimated number of excess deaths\). Since testing the validity and feasibility of PHISS was not the objective of )] TJ ET
BT 26.250 286.753 Td /F1 9.8 Tf  [(this proposed study, the authors hope that the introduction of this quantitative scale would invigorate scientific discussion and )] TJ ET
BT 26.250 274.848 Td /F1 9.8 Tf  [(prompt organizations and agencies with sufficient resources to apply PHISS prospectively in future CHE.)] TJ ET
BT 26.250 238.246 Td /F4 12.0 Tf  [(Conclusion)] TJ ET
BT 26.250 218.292 Td /F1 9.8 Tf  [(Measuring the public health impact of complex humanitarian emergencies is germane to objectively and accurately identify the )] TJ ET
BT 26.250 206.387 Td /F1 9.8 Tf  [(scope and scale of the critical needs and relief priorities for affected populations. A new quantitative assessment tool \(PHISS\) )] TJ ET
BT 26.250 194.482 Td /F1 9.8 Tf  [(has been proposed, based on The Sphere Project �minimum standards�, in order to streamline and standardize the post-CHE )] TJ ET
BT 26.250 182.577 Td /F1 9.8 Tf  [(assessment phase. PHISS is a conceptual disaster metric that has not yet been validated, and studies are needed with )] TJ ET
BT 26.250 170.673 Td /F1 9.8 Tf  [(prospective data collection to test its validity, feasibility and reliability.)] TJ ET
BT 26.250 134.070 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 114.116 Td /F1 9.8 Tf  [(The authors would like to acknowledge Dr. Nawar Abdul Latif, Mr. Ahmad Bayram, and Mrs. Jomana Musmar-Bayram for their )] TJ ET
BT 26.250 102.211 Td /F1 9.8 Tf  [(valuable assistance in this study.)] TJ ET
BT 26.250 73.109 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 45.654 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 45.654 Td /F1 9.8 Tf  [(Inter-Agency Standing Committee Secretariat. Working paper on the definition of complex emergency. December 9, 1994. )] TJ ET
Q
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0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(11)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 26.250 767.476 Td /F1 9.8 Tf  [(Geneva, Switzerland.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 748.071 Td /F1 9.8 Tf  [(Burkle FM Jr. Lessons learnt and future expectations of complex emergencies. BMJ. 1999;319:422.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 728.667 Td /F1 9.8 Tf  [(The Sphere Project- Humanitarian Charter and Minimum Standards in Disaster Response, third edition 2011. Available at )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(https://www.sphereproject.org/component/option,com_docman/task,cat_view/gid,17/Itemid,203/lang,english/. Accessed on )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(March 21, 2012.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 38.132 685.452 Td /F1 9.8 Tf  [(Field epidemiology \(Epicentre\)- M�decins Sans Fronti�res. Available on-line @ https://epicentre.msf.org/field-)] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(epidemiology/field-epidemiology#A. Accessed on March 11, 2012.)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 654.143 Td /F1 9.8 Tf  [(U.S. Agency for International Development- Bureau for Humanitarian Response Office of Foreign Disaster Assistance. Field )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(Operations Guide for Disaster Assessment and Response. Available on-line @ https://www.usaid.gov/policy/ads/200/fog_v3.pdf. )] TJ ET
BT 26.250 630.333 Td /F1 9.8 Tf  [(Accessed on March 21, 2012.)] TJ ET
BT 26.250 610.929 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 38.132 610.929 Td /F1 9.8 Tf  [(Initial Rapid Assessment \(IRA\) Tool. Inter-Agency Standing Committee \(IASC\). Available at )] TJ ET
BT 26.250 599.024 Td /F1 9.8 Tf  [(https://www.who.int/hac/network/global_health_cluster/ira_form_v2_7_eng.pdf. Accessed on March 21, 2012.)] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(7.)] TJ ET
BT 38.132 579.619 Td /F1 9.8 Tf  [(Initial Rapid Assessment \(IRA\) Guidance Notes. Inter-Agency Standing Committee \(IASC\), June 2009. Available at )] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(https://www.who.int/hac/network/global_health_cluster/ira_guidance_note_june2009.pdf. Accessed on March 21, 2012.)] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(8.)] TJ ET
BT 38.132 548.310 Td /F1 9.8 Tf  [(United Nations Office for Coordination of Humanitarian Affairs \(OCHA\). Haiti Earthquake: Key Findings from the Multi-Cluster )] TJ ET
BT 26.250 536.405 Td /F1 9.8 Tf  [(Rapid Initial Situational Assessment for Haiti \(January 23 to February 6, 2010\). Summary available @ )] TJ ET
BT 26.250 524.500 Td /F1 9.8 Tf  [(https://oneresponse.info/Disasters/Haiti/Coordination/publicdocuments/Rapid%20Initial%20Needs%20Assessment%20Haiti%20English.pdf. )] TJ ET
BT 26.250 512.595 Td /F1 9.8 Tf  [(Accessed on March 11, 2012.)] TJ ET
BT 26.250 493.191 Td /F1 9.8 Tf  [(9.)] TJ ET
BT 38.132 493.191 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention. CDC Summary of Initial Rapid Assessment \(IRA\) Conducted by UN OCHA in )] TJ ET
BT 26.250 481.286 Td /F1 9.8 Tf  [(Haiti, February 2010. Available @ )] TJ ET
BT 26.250 469.381 Td /F1 9.8 Tf  [(https://oneresponse.info/Disasters/Haiti/Coordination/publicdocuments/Summary_Report_v_3_5_19_Feb_2010.pdf. Accessed )] TJ ET
BT 26.250 457.476 Td /F1 9.8 Tf  [(on March 11, 2012.)] TJ ET
BT 26.250 438.072 Td /F1 9.8 Tf  [(10.)] TJ ET
BT 43.553 438.072 Td /F1 9.8 Tf  [(Checchi F, Roberts L. Interpreting and using mortality data in emergencies: A primer for non-epidemiologists. Humanitarian )] TJ ET
BT 26.250 426.167 Td /F1 9.8 Tf  [(Practice Network. Available @ https://www.odihpn.org/documents/networkpaper052.pdf. Accessed on March 11, 2012.)] TJ ET
BT 26.250 406.762 Td /F1 9.8 Tf  [(11.)] TJ ET
BT 43.553 406.762 Td /F1 9.8 Tf  [(United Nations High Commission for Refugees. Handbook of emergencies. 1999. Geneva, Switzerland. Available @ )] TJ ET
BT 26.250 394.857 Td /F1 9.8 Tf  [(https://www.unhcr.org/publ/PUBL/3bb2fa26b.pdf. Accessed on March 21, 2012.)] TJ ET
BT 26.250 375.453 Td /F1 9.8 Tf  [(12.)] TJ ET
BT 43.553 375.453 Td /F1 9.8 Tf  [(Skinnider M, L Blok. Manual for the Assessment of Health and Humanitarian Emergencies. M�decins Sans Fronti�res, )] TJ ET
BT 26.250 363.548 Td /F1 9.8 Tf  [(Amsterdam, 2002. Available @ https://www.scribd.com/doc/6702027/Msfh-Assessment-Manual. Accessed on March 11, 2012.)] TJ ET
BT 26.250 344.143 Td /F1 9.8 Tf  [(13.)] TJ ET
BT 43.553 344.143 Td /F1 9.8 Tf  [(The International Disaster Database \(EM-DAT\). Centre for Research on the Epidemiology of Disasters \(CRED\). Available )] TJ ET
BT 26.250 332.238 Td /F1 9.8 Tf  [(@ https://www.emdat.be/criteria-and-definition. Accessed on March 11, 2012.)] TJ ET
BT 26.250 312.834 Td /F1 9.8 Tf  [(14.)] TJ ET
BT 43.553 312.834 Td /F1 9.8 Tf  [(Ascherio A, Chase R, Cote T, et al. Effect of the Gulf War on Infant and Child Mortality in Iraq. N Engl J Med. )] TJ ET
BT 26.250 300.929 Td /F1 9.8 Tf  [(1992;327\(13\):931-936.)] TJ ET
BT 26.250 281.524 Td /F1 9.8 Tf  [(15.)] TJ ET
BT 43.553 281.524 Td /F1 9.8 Tf  [(Howard MJ, Brillman JC, Burkle Jr. FM. Infectious disease emergencies in disasters. Emergency Medicine Clinics of North )] TJ ET
BT 26.250 269.619 Td /F1 9.8 Tf  [(America. 1996: 14\(2\):413-421.)] TJ ET
BT 26.250 250.215 Td /F1 9.8 Tf  [(16.)] TJ ET
BT 43.553 250.215 Td /F1 9.8 Tf  [(Waring SC, Brown BJ. The threat of communicable diseases following natural disasters: a public health response. Disaster )] TJ ET
BT 26.250 238.310 Td /F1 9.8 Tf  [(Manag Response. 2005;3:41�47.)] TJ ET
BT 26.250 218.905 Td /F1 9.8 Tf  [(17.)] TJ ET
BT 43.553 218.905 Td /F1 9.8 Tf  [(World Health Organization. Global Alert and Response \(GAR\). Cholera in Haiti. Available @ )] TJ ET
BT 26.250 207.000 Td /F1 9.8 Tf  [(https://www.who.int/csr/don/2010_10_26/en/index.html. Accessed on March 11, 2012.)] TJ ET
BT 26.250 187.596 Td /F1 9.8 Tf  [(18.)] TJ ET
BT 43.553 187.596 Td /F1 9.8 Tf  [(Connolly MA, Gayer M, Ryan MJ. Et al. Communicable diseases in complex emergencies: impact and challenges. Lancet. )] TJ ET
BT 26.250 175.691 Td /F1 9.8 Tf  [(2004;364 \(9449\): 1974-1983.)] TJ ET
BT 26.250 156.286 Td /F1 9.8 Tf  [(19.)] TJ ET
BT 43.553 156.286 Td /F1 9.8 Tf  [(United Nations Office for Coordination of Humanitarian Affairs \(OCHA\). Haiti Earthquake Situation Report #18, 5 February )] TJ ET
BT 26.250 144.381 Td /F1 9.8 Tf  [(2010. Available @ https://www.reliefweb.int/rw /RWFiles2010.nsf/FilesByRWDocUnidFilename/MUMA-82E896-)] TJ ET
BT 26.250 132.477 Td /F1 9.8 Tf  [(full_report.pdf/$File/full_report.pdf. Accessed on March 11, 2012.)] TJ ET
BT 26.250 113.072 Td /F1 9.8 Tf  [(20.)] TJ ET
BT 43.553 113.072 Td /F1 9.8 Tf  [(United States Geological Survey�s \(USGS\). Earthquake Hazards Program. Magnitude 8.8 - OFFSHORE MAULE, CHILE. )] TJ ET
BT 26.250 101.167 Td /F1 9.8 Tf  [(Available @ https://earthquake.usgs.gov/earthquakes/eqinthenews/2010/us2010tfan/#summary. Accessed on March 11, 2012.)] TJ ET
BT 26.250 81.762 Td /F1 9.8 Tf  [(21.)] TJ ET
BT 43.553 81.762 Td /F1 9.8 Tf  [(Fasanoff S. The Bhopal Disaster and the Right to Know. Sot. Ser. Med. 1988;27\(10\):1113-1123.)] TJ ET
BT 26.250 62.358 Td /F1 9.8 Tf  [(22.)] TJ ET
BT 43.553 62.358 Td /F1 9.8 Tf  [(The SPHERE Project�Humanitarian Charter and Minimum Standards in Disaster Response \(The Handbook Manual 2004 )] TJ ET
BT 26.250 50.453 Td /F1 9.8 Tf  [(Revised Edition\). Available at https://www.sphereproject.org/content/view/27/84. Accessed March 22, 2012.)] TJ ET
Q
q
15.000 40.572 577.500 736.428 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(Geneva, Switzerland.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 748.071 Td /F1 9.8 Tf  [(Burkle FM Jr. Lessons learnt and future expectations of complex emergencies. BMJ. 1999;319:422.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 728.667 Td /F1 9.8 Tf  [(The Sphere Project- Humanitarian Charter and Minimum Standards in Disaster Response, third edition 2011. Available at )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(https://www.sphereproject.org/component/option,com_docman/task,cat_view/gid,17/Itemid,203/lang,english/. Accessed on )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(March 21, 2012.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 38.132 685.452 Td /F1 9.8 Tf  [(Field epidemiology \(Epicentre\)- M�decins Sans Fronti�res. Available on-line @ https://epicentre.msf.org/field-)] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(epidemiology/field-epidemiology#A. Accessed on March 11, 2012.)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 654.143 Td /F1 9.8 Tf  [(U.S. Agency for International Development- Bureau for Humanitarian Response Office of Foreign Disaster Assistance. Field )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(Operations Guide for Disaster Assessment and Response. Available on-line @ https://www.usaid.gov/policy/ads/200/fog_v3.pdf. )] TJ ET
BT 26.250 630.333 Td /F1 9.8 Tf  [(Accessed on March 21, 2012.)] TJ ET
BT 26.250 610.929 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 38.132 610.929 Td /F1 9.8 Tf  [(Initial Rapid Assessment \(IRA\) Tool. Inter-Agency Standing Committee \(IASC\). Available at )] TJ ET
BT 26.250 599.024 Td /F1 9.8 Tf  [(https://www.who.int/hac/network/global_health_cluster/ira_form_v2_7_eng.pdf. Accessed on March 21, 2012.)] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(7.)] TJ ET
BT 38.132 579.619 Td /F1 9.8 Tf  [(Initial Rapid Assessment \(IRA\) Guidance Notes. Inter-Agency Standing Committee \(IASC\), June 2009. Available at )] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(https://www.who.int/hac/network/global_health_cluster/ira_guidance_note_june2009.pdf. Accessed on March 21, 2012.)] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(8.)] TJ ET
BT 38.132 548.310 Td /F1 9.8 Tf  [(United Nations Office for Coordination of Humanitarian Affairs \(OCHA\). Haiti Earthquake: Key Findings from the Multi-Cluster )] TJ ET
BT 26.250 536.405 Td /F1 9.8 Tf  [(Rapid Initial Situational Assessment for Haiti \(January 23 to February 6, 2010\). Summary available @ )] TJ ET
BT 26.250 524.500 Td /F1 9.8 Tf  [(https://oneresponse.info/Disasters/Haiti/Coordination/publicdocuments/Rapid%20Initial%20Needs%20Assessment%20Haiti%20English.pdf. )] TJ ET
BT 26.250 512.595 Td /F1 9.8 Tf  [(Accessed on March 11, 2012.)] TJ ET
BT 26.250 493.191 Td /F1 9.8 Tf  [(9.)] TJ ET
BT 38.132 493.191 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention. CDC Summary of Initial Rapid Assessment \(IRA\) Conducted by UN OCHA in )] TJ ET
BT 26.250 481.286 Td /F1 9.8 Tf  [(Haiti, February 2010. Available @ )] TJ ET
BT 26.250 469.381 Td /F1 9.8 Tf  [(https://oneresponse.info/Disasters/Haiti/Coordination/publicdocuments/Summary_Report_v_3_5_19_Feb_2010.pdf. Accessed )] TJ ET
BT 26.250 457.476 Td /F1 9.8 Tf  [(on March 11, 2012.)] TJ ET
BT 26.250 438.072 Td /F1 9.8 Tf  [(10.)] TJ ET
BT 43.553 438.072 Td /F1 9.8 Tf  [(Checchi F, Roberts L. Interpreting and using mortality data in emergencies: A primer for non-epidemiologists. Humanitarian )] TJ ET
BT 26.250 426.167 Td /F1 9.8 Tf  [(Practice Network. Available @ https://www.odihpn.org/documents/networkpaper052.pdf. Accessed on March 11, 2012.)] TJ ET
BT 26.250 406.762 Td /F1 9.8 Tf  [(11.)] TJ ET
BT 43.553 406.762 Td /F1 9.8 Tf  [(United Nations High Commission for Refugees. Handbook of emergencies. 1999. Geneva, Switzerland. Available @ )] TJ ET
BT 26.250 394.857 Td /F1 9.8 Tf  [(https://www.unhcr.org/publ/PUBL/3bb2fa26b.pdf. Accessed on March 21, 2012.)] TJ ET
BT 26.250 375.453 Td /F1 9.8 Tf  [(12.)] TJ ET
BT 43.553 375.453 Td /F1 9.8 Tf  [(Skinnider M, L Blok. Manual for the Assessment of Health and Humanitarian Emergencies. M�decins Sans Fronti�res, )] TJ ET
BT 26.250 363.548 Td /F1 9.8 Tf  [(Amsterdam, 2002. Available @ https://www.scribd.com/doc/6702027/Msfh-Assessment-Manual. Accessed on March 11, 2012.)] TJ ET
BT 26.250 344.143 Td /F1 9.8 Tf  [(13.)] TJ ET
BT 43.553 344.143 Td /F1 9.8 Tf  [(The International Disaster Database \(EM-DAT\). Centre for Research on the Epidemiology of Disasters \(CRED\). Available )] TJ ET
BT 26.250 332.238 Td /F1 9.8 Tf  [(@ https://www.emdat.be/criteria-and-definition. Accessed on March 11, 2012.)] TJ ET
BT 26.250 312.834 Td /F1 9.8 Tf  [(14.)] TJ ET
BT 43.553 312.834 Td /F1 9.8 Tf  [(Ascherio A, Chase R, Cote T, et al. Effect of the Gulf War on Infant and Child Mortality in Iraq. N Engl J Med. )] TJ ET
BT 26.250 300.929 Td /F1 9.8 Tf  [(1992;327\(13\):931-936.)] TJ ET
BT 26.250 281.524 Td /F1 9.8 Tf  [(15.)] TJ ET
BT 43.553 281.524 Td /F1 9.8 Tf  [(Howard MJ, Brillman JC, Burkle Jr. FM. Infectious disease emergencies in disasters. Emergency Medicine Clinics of North )] TJ ET
BT 26.250 269.619 Td /F1 9.8 Tf  [(America. 1996: 14\(2\):413-421.)] TJ ET
BT 26.250 250.215 Td /F1 9.8 Tf  [(16.)] TJ ET
BT 43.553 250.215 Td /F1 9.8 Tf  [(Waring SC, Brown BJ. The threat of communicable diseases following natural disasters: a public health response. Disaster )] TJ ET
BT 26.250 238.310 Td /F1 9.8 Tf  [(Manag Response. 2005;3:41�47.)] TJ ET
BT 26.250 218.905 Td /F1 9.8 Tf  [(17.)] TJ ET
BT 43.553 218.905 Td /F1 9.8 Tf  [(World Health Organization. Global Alert and Response \(GAR\). Cholera in Haiti. Available @ )] TJ ET
BT 26.250 207.000 Td /F1 9.8 Tf  [(https://www.who.int/csr/don/2010_10_26/en/index.html. Accessed on March 11, 2012.)] TJ ET
BT 26.250 187.596 Td /F1 9.8 Tf  [(18.)] TJ ET
BT 43.553 187.596 Td /F1 9.8 Tf  [(Connolly MA, Gayer M, Ryan MJ. Et al. Communicable diseases in complex emergencies: impact and challenges. Lancet. )] TJ ET
BT 26.250 175.691 Td /F1 9.8 Tf  [(2004;364 \(9449\): 1974-1983.)] TJ ET
BT 26.250 156.286 Td /F1 9.8 Tf  [(19.)] TJ ET
BT 43.553 156.286 Td /F1 9.8 Tf  [(United Nations Office for Coordination of Humanitarian Affairs \(OCHA\). Haiti Earthquake Situation Report #18, 5 February )] TJ ET
BT 26.250 144.381 Td /F1 9.8 Tf  [(2010. Available @ https://www.reliefweb.int/rw /RWFiles2010.nsf/FilesByRWDocUnidFilename/MUMA-82E896-)] TJ ET
BT 26.250 132.477 Td /F1 9.8 Tf  [(full_report.pdf/$File/full_report.pdf. Accessed on March 11, 2012.)] TJ ET
BT 26.250 113.072 Td /F1 9.8 Tf  [(20.)] TJ ET
BT 43.553 113.072 Td /F1 9.8 Tf  [(United States Geological Survey�s \(USGS\). Earthquake Hazards Program. Magnitude 8.8 - OFFSHORE MAULE, CHILE. )] TJ ET
BT 26.250 101.167 Td /F1 9.8 Tf  [(Available @ https://earthquake.usgs.gov/earthquakes/eqinthenews/2010/us2010tfan/#summary. Accessed on March 11, 2012.)] TJ ET
BT 26.250 81.762 Td /F1 9.8 Tf  [(21.)] TJ ET
BT 43.553 81.762 Td /F1 9.8 Tf  [(Fasanoff S. The Bhopal Disaster and the Right to Know. Sot. Ser. Med. 1988;27\(10\):1113-1123.)] TJ ET
BT 26.250 62.358 Td /F1 9.8 Tf  [(22.)] TJ ET
BT 43.553 62.358 Td /F1 9.8 Tf  [(The SPHERE Project�Humanitarian Charter and Minimum Standards in Disaster Response \(The Handbook Manual 2004 )] TJ ET
BT 26.250 50.453 Td /F1 9.8 Tf  [(Revised Edition\). Available at https://www.sphereproject.org/content/view/27/84. Accessed March 22, 2012.)] TJ ET
Q
q
15.000 40.572 577.500 736.428 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(Geneva, Switzerland.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 748.071 Td /F1 9.8 Tf  [(Burkle FM Jr. Lessons learnt and future expectations of complex emergencies. BMJ. 1999;319:422.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 728.667 Td /F1 9.8 Tf  [(The Sphere Project- Humanitarian Charter and Minimum Standards in Disaster Response, third edition 2011. Available at )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(https://www.sphereproject.org/component/option,com_docman/task,cat_view/gid,17/Itemid,203/lang,english/. Accessed on )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(March 21, 2012.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 38.132 685.452 Td /F1 9.8 Tf  [(Field epidemiology \(Epicentre\)- M�decins Sans Fronti�res. Available on-line @ https://epicentre.msf.org/field-)] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(epidemiology/field-epidemiology#A. Accessed on March 11, 2012.)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 654.143 Td /F1 9.8 Tf  [(U.S. Agency for International Development- Bureau for Humanitarian Response Office of Foreign Disaster Assistance. Field )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(Operations Guide for Disaster Assessment and Response. Available on-line @ https://www.usaid.gov/policy/ads/200/fog_v3.pdf. )] TJ ET
BT 26.250 630.333 Td /F1 9.8 Tf  [(Accessed on March 21, 2012.)] TJ ET
BT 26.250 610.929 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 38.132 610.929 Td /F1 9.8 Tf  [(Initial Rapid Assessment \(IRA\) Tool. Inter-Agency Standing Committee \(IASC\). Available at )] TJ ET
BT 26.250 599.024 Td /F1 9.8 Tf  [(https://www.who.int/hac/network/global_health_cluster/ira_form_v2_7_eng.pdf. Accessed on March 21, 2012.)] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(7.)] TJ ET
BT 38.132 579.619 Td /F1 9.8 Tf  [(Initial Rapid Assessment \(IRA\) Guidance Notes. Inter-Agency Standing Committee \(IASC\), June 2009. Available at )] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(https://www.who.int/hac/network/global_health_cluster/ira_guidance_note_june2009.pdf. Accessed on March 21, 2012.)] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(8.)] TJ ET
BT 38.132 548.310 Td /F1 9.8 Tf  [(United Nations Office for Coordination of Humanitarian Affairs \(OCHA\). Haiti Earthquake: Key Findings from the Multi-Cluster )] TJ ET
BT 26.250 536.405 Td /F1 9.8 Tf  [(Rapid Initial Situational Assessment for Haiti \(January 23 to February 6, 2010\). Summary available @ )] TJ ET
BT 26.250 524.500 Td /F1 9.8 Tf  [(https://oneresponse.info/Disasters/Haiti/Coordination/publicdocuments/Rapid%20Initial%20Needs%20Assessment%20Haiti%20English.pdf. )] TJ ET
BT 26.250 512.595 Td /F1 9.8 Tf  [(Accessed on March 11, 2012.)] TJ ET
BT 26.250 493.191 Td /F1 9.8 Tf  [(9.)] TJ ET
BT 38.132 493.191 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention. CDC Summary of Initial Rapid Assessment \(IRA\) Conducted by UN OCHA in )] TJ ET
BT 26.250 481.286 Td /F1 9.8 Tf  [(Haiti, February 2010. Available @ )] TJ ET
BT 26.250 469.381 Td /F1 9.8 Tf  [(https://oneresponse.info/Disasters/Haiti/Coordination/publicdocuments/Summary_Report_v_3_5_19_Feb_2010.pdf. Accessed )] TJ ET
BT 26.250 457.476 Td /F1 9.8 Tf  [(on March 11, 2012.)] TJ ET
BT 26.250 438.072 Td /F1 9.8 Tf  [(10.)] TJ ET
BT 43.553 438.072 Td /F1 9.8 Tf  [(Checchi F, Roberts L. Interpreting and using mortality data in emergencies: A primer for non-epidemiologists. Humanitarian )] TJ ET
BT 26.250 426.167 Td /F1 9.8 Tf  [(Practice Network. Available @ https://www.odihpn.org/documents/networkpaper052.pdf. Accessed on March 11, 2012.)] TJ ET
BT 26.250 406.762 Td /F1 9.8 Tf  [(11.)] TJ ET
BT 43.553 406.762 Td /F1 9.8 Tf  [(United Nations High Commission for Refugees. Handbook of emergencies. 1999. Geneva, Switzerland. Available @ )] TJ ET
BT 26.250 394.857 Td /F1 9.8 Tf  [(https://www.unhcr.org/publ/PUBL/3bb2fa26b.pdf. Accessed on March 21, 2012.)] TJ ET
BT 26.250 375.453 Td /F1 9.8 Tf  [(12.)] TJ ET
BT 43.553 375.453 Td /F1 9.8 Tf  [(Skinnider M, L Blok. Manual for the Assessment of Health and Humanitarian Emergencies. M�decins Sans Fronti�res, )] TJ ET
BT 26.250 363.548 Td /F1 9.8 Tf  [(Amsterdam, 2002. Available @ https://www.scribd.com/doc/6702027/Msfh-Assessment-Manual. Accessed on March 11, 2012.)] TJ ET
BT 26.250 344.143 Td /F1 9.8 Tf  [(13.)] TJ ET
BT 43.553 344.143 Td /F1 9.8 Tf  [(The International Disaster Database \(EM-DAT\). Centre for Research on the Epidemiology of Disasters \(CRED\). Available )] TJ ET
BT 26.250 332.238 Td /F1 9.8 Tf  [(@ https://www.emdat.be/criteria-and-definition. Accessed on March 11, 2012.)] TJ ET
BT 26.250 312.834 Td /F1 9.8 Tf  [(14.)] TJ ET
BT 43.553 312.834 Td /F1 9.8 Tf  [(Ascherio A, Chase R, Cote T, et al. Effect of the Gulf War on Infant and Child Mortality in Iraq. N Engl J Med. )] TJ ET
BT 26.250 300.929 Td /F1 9.8 Tf  [(1992;327\(13\):931-936.)] TJ ET
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BT 43.553 281.524 Td /F1 9.8 Tf  [(Howard MJ, Brillman JC, Burkle Jr. FM. Infectious disease emergencies in disasters. Emergency Medicine Clinics of North )] TJ ET
BT 26.250 269.619 Td /F1 9.8 Tf  [(America. 1996: 14\(2\):413-421.)] TJ ET
BT 26.250 250.215 Td /F1 9.8 Tf  [(16.)] TJ ET
BT 43.553 250.215 Td /F1 9.8 Tf  [(Waring SC, Brown BJ. The threat of communicable diseases following natural disasters: a public health response. Disaster )] TJ ET
BT 26.250 238.310 Td /F1 9.8 Tf  [(Manag Response. 2005;3:41�47.)] TJ ET
BT 26.250 218.905 Td /F1 9.8 Tf  [(17.)] TJ ET
BT 43.553 218.905 Td /F1 9.8 Tf  [(World Health Organization. Global Alert and Response \(GAR\). Cholera in Haiti. Available @ )] TJ ET
BT 26.250 207.000 Td /F1 9.8 Tf  [(https://www.who.int/csr/don/2010_10_26/en/index.html. Accessed on March 11, 2012.)] TJ ET
BT 26.250 187.596 Td /F1 9.8 Tf  [(18.)] TJ ET
BT 43.553 187.596 Td /F1 9.8 Tf  [(Connolly MA, Gayer M, Ryan MJ. Et al. Communicable diseases in complex emergencies: impact and challenges. Lancet. )] TJ ET
BT 26.250 175.691 Td /F1 9.8 Tf  [(2004;364 \(9449\): 1974-1983.)] TJ ET
BT 26.250 156.286 Td /F1 9.8 Tf  [(19.)] TJ ET
BT 43.553 156.286 Td /F1 9.8 Tf  [(United Nations Office for Coordination of Humanitarian Affairs \(OCHA\). Haiti Earthquake Situation Report #18, 5 February )] TJ ET
BT 26.250 144.381 Td /F1 9.8 Tf  [(2010. Available @ https://www.reliefweb.int/rw /RWFiles2010.nsf/FilesByRWDocUnidFilename/MUMA-82E896-)] TJ ET
BT 26.250 132.477 Td /F1 9.8 Tf  [(full_report.pdf/$File/full_report.pdf. Accessed on March 11, 2012.)] TJ ET
BT 26.250 113.072 Td /F1 9.8 Tf  [(20.)] TJ ET
BT 43.553 113.072 Td /F1 9.8 Tf  [(United States Geological Survey�s \(USGS\). Earthquake Hazards Program. Magnitude 8.8 - OFFSHORE MAULE, CHILE. )] TJ ET
BT 26.250 101.167 Td /F1 9.8 Tf  [(Available @ https://earthquake.usgs.gov/earthquakes/eqinthenews/2010/us2010tfan/#summary. Accessed on March 11, 2012.)] TJ ET
BT 26.250 81.762 Td /F1 9.8 Tf  [(21.)] TJ ET
BT 43.553 81.762 Td /F1 9.8 Tf  [(Fasanoff S. The Bhopal Disaster and the Right to Know. Sot. Ser. Med. 1988;27\(10\):1113-1123.)] TJ ET
BT 26.250 62.358 Td /F1 9.8 Tf  [(22.)] TJ ET
BT 43.553 62.358 Td /F1 9.8 Tf  [(The SPHERE Project�Humanitarian Charter and Minimum Standards in Disaster Response \(The Handbook Manual 2004 )] TJ ET
BT 26.250 50.453 Td /F1 9.8 Tf  [(Revised Edition\). Available at https://www.sphereproject.org/content/view/27/84. Accessed March 22, 2012.)] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(12)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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15.000 44.977 577.500 732.023 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(23.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(Pelletier D, Frongillo EA, Habicht JP. Epidemiologic evidence for a potentiating effect of malnutrition on child mortality. Am J )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(Public Health. 1993;83\(8\):1130-1133.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(24.)] TJ ET
BT 43.553 728.667 Td /F1 9.8 Tf  [(Pelletier DL, Frongillo EA, Schroeder DJ, et al. The effects of malnutrition on child mortality in developing countries. Bulletin )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(of the World Health Organization. 1995;73\(4\):443-448.)] TJ ET
BT 26.250 697.357 Td /F1 9.8 Tf  [(25.)] TJ ET
BT 43.553 697.357 Td /F1 9.8 Tf  [(World Health Organization-Regional Office for the Eastern Mediterranean. Field Guide on Rapid Nutritional Assessment in )] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(Emergencies, 1995. Available @ https://whqlibdoc.who.int/emro/1994-99/9290211989.pdf. Accessed on March 11, 2012.)] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(26.)] TJ ET
BT 43.553 666.048 Td /F1 9.8 Tf  [(World Health Organization. The Management of Nutrition in Major Emergencies, 2000. WHO Geneva: Switzerland. )] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(Available @ https://whqlibdoc.who.int/publications/2000/9241545208.pdf. Accessed on March 11, 2012.)] TJ ET
BT 26.250 634.738 Td /F1 9.8 Tf  [(27.)] TJ ET
BT 43.553 634.738 Td /F1 9.8 Tf  [(UNHCR/UNICEF/WFP/WHO. Food and Nutrition Needs in Emergencies, 2002. WHO Geneva, Switzerland. Available @ )] TJ ET
BT 26.250 622.833 Td /F1 9.8 Tf  [(https://whqlibdoc.who.int/hq/2004/a83743.pdf. Accessed on March 11, 2012.)] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(28.)] TJ ET
BT 43.553 603.429 Td /F1 9.8 Tf  [(World Food Program \(WFP\). Food and Nutrition Handbook, 2000. WFP Rome, Italy. Available @ )] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(https://foodquality.wfp.org/FoodNutritionalQuality/WFPNutritionPolicy/tabid/362/Default.aspx?PageContentID=537. Accessed on )] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(March 11, 2012.)] TJ ET
BT 26.250 560.214 Td /F1 9.8 Tf  [(29.)] TJ ET
BT 43.553 560.214 Td /F1 9.8 Tf  [(Prudhon C. Assessment and Treatment of Malnutrition in Emergency Situations: Manual of Therapeutic Care and Planning )] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(for a Nutritional Programme. Action Contre la Faim, 2002. Paris, France.)] TJ ET
BT 26.250 528.905 Td /F1 9.8 Tf  [(30.)] TJ ET
BT 43.553 528.905 Td /F1 9.8 Tf  [(Young H, Borrel A, Holland D, et al. Public nutrition in complex emergencies. Lancet. 2004;364\(9448\):1899-1909.)] TJ ET
BT 26.250 509.500 Td /F1 9.8 Tf  [(31.)] TJ ET
BT 43.553 509.500 Td /F1 9.8 Tf  [(M�decins Sans Fronti�res \(MSF\). Acute Malnutrition: A highly prevalent, frequently fatal, imminently treatable, neglected )] TJ ET
BT 26.250 497.595 Td /F1 9.8 Tf  [(disease. International Activity Report. MSF, 2006. Available @ )] TJ ET
BT 26.250 485.691 Td /F1 9.8 Tf  [(https://www.doctorswithoutborders.org/publications/ar/report_print.cfm?id=3228. Accessed on March 11, 2012.)] TJ ET
BT 26.250 466.286 Td /F1 9.8 Tf  [(32.)] TJ ET
BT 43.553 466.286 Td /F1 9.8 Tf  [(M�decins Sans Fronti�res \(MSF\). Niger: What to do next? MSF, February 2006. Available @ )] TJ ET
BT 26.250 454.381 Td /F1 9.8 Tf  [(https://www.doctorswithoutborders.org/publications/article.cfm?id=1744. Accessed on April 11, 2012.)] TJ ET
BT 26.250 434.976 Td /F1 9.8 Tf  [(33.)] TJ ET
BT 43.553 434.976 Td /F1 9.8 Tf  [(Office of the United Nations High Commissioner for Human Rights. Convention relating to the Status of Refugees, April )] TJ ET
BT 26.250 423.072 Td /F1 9.8 Tf  [(1954. Available @ https://www2.ohchr.org/english/law/refugees.htm. Accessed on April 11, 2012.)] TJ ET
BT 26.250 403.667 Td /F1 9.8 Tf  [(34.)] TJ ET
BT 43.553 403.667 Td /F1 9.8 Tf  [(Internal Displacement Monitoring Centre. The definition of an internally displaced person \(IDP\). Available @ )] TJ ET
BT 26.250 391.762 Td /F1 9.8 Tf  [(https://www.internal-)] TJ ET
BT 26.250 379.857 Td /F1 9.8 Tf  [(displacement.org/8025708F004D404D/\(httpPages\)/CC32D8C34EF93C88802570F800517610?OpenDocument. Accessed on )] TJ ET
BT 26.250 367.953 Td /F1 9.8 Tf  [(April 11, 2012.)] TJ ET
BT 26.250 348.548 Td /F1 9.8 Tf  [(35.)] TJ ET
BT 43.553 348.548 Td /F1 9.8 Tf  [(United Nations Children�s Fund \(UNICEF\). UNICEF responds as floods affect over 3 million in north-western Pakistan, )] TJ ET
BT 26.250 336.643 Td /F1 9.8 Tf  [(August 2010. Available @ https://www.unicef.org/infobycountry/pakistan_55400.html. Accessed on April 11, 2012.)] TJ ET
BT 26.250 317.238 Td /F1 9.8 Tf  [(36.)] TJ ET
BT 43.553 317.238 Td /F1 9.8 Tf  [(From Horror to Hopelessness Kenya�s Forgotten Somali Refugee Crisis. Human Rights Watch, 2009. Available at )] TJ ET
BT 26.250 305.334 Td /F1 9.8 Tf  [(https://www.hrw.org/sites/default/files/reports/kenya0309webwcover_1.pdf. Accessed on April 12, 2012.)] TJ ET
BT 26.250 285.929 Td /F1 9.8 Tf  [(37.)] TJ ET
BT 43.553 285.929 Td /F1 9.8 Tf  [(Fewtrell L, Kaufmann R, Kay D, et al. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed )] TJ ET
BT 26.250 274.024 Td /F1 9.8 Tf  [(countries: a systematic review and meta-analysis. Lancet Infect Dis. 2005;5:42-52.)] TJ ET
BT 26.250 254.619 Td /F1 9.8 Tf  [(38.)] TJ ET
BT 43.553 254.619 Td /F1 9.8 Tf  [(Abdelrahman AA, Eltahir YM. Bacteriological quality of drinking water in Nyala, South Darfur, Sudan. Environ Monit Assess. )] TJ ET
BT 26.250 242.715 Td /F1 9.8 Tf  [(2011;175\(1-4\):37-43. Epub 2010 May 18.)] TJ ET
BT 26.250 223.310 Td /F1 9.8 Tf  [(39.)] TJ ET
BT 43.553 223.310 Td /F1 9.8 Tf  [(United Nations Division for the Advancement of Women- Department of Economic and Social Affairs. Convention on the )] TJ ET
BT 26.250 211.405 Td /F1 9.8 Tf  [(Elimination of All Forms of Discrimination against Women \(CEDAW\). Available @ )] TJ ET
BT 26.250 199.500 Td /F1 9.8 Tf  [(https://www.un.org/womenwatch/daw/cedaw/recommendations/recomm.htm. Accessed on April 11, 2012.)] TJ ET
BT 26.250 180.096 Td /F1 9.8 Tf  [(40.)] TJ ET
BT 43.553 180.096 Td /F1 9.8 Tf  [(PeaceWomen. A Special 1325 Anniversary Issue, 2002. Available @ )] TJ ET
BT 26.250 168.191 Td /F1 9.8 Tf  [(https://www.peacewomen.org/publications_enews_issue.php?id=126. Accessed on April 11, 2012.)] TJ ET
BT 26.250 148.786 Td /F1 9.8 Tf  [(41.)] TJ ET
BT 43.553 148.786 Td /F1 9.8 Tf  [(de Brouwer AM. Supranational Criminal Prosecution of Sexual Violence: The ICC and the Practice of the ICTY and the )] TJ ET
BT 26.250 136.881 Td /F1 9.8 Tf  [(ICTR. INTERSENTIA, Tilburg, the Hague-Netherlands 2005.)] TJ ET
BT 26.250 117.477 Td /F1 9.8 Tf  [(42.)] TJ ET
BT 43.553 117.477 Td /F1 9.8 Tf  [(Redmond AD. ABC of conflict and disaster: Needs assessment of humanitarian crises. BMJ. 2005;330:1320.)] TJ ET
BT 26.250 98.072 Td /F1 9.8 Tf  [(43.)] TJ ET
BT 43.553 98.072 Td /F1 9.8 Tf  [(Burkle FM Jr. Complex humanitarian emergencies: A review of epidemiological and response models. J Postgrad Med. )] TJ ET
BT 26.250 86.167 Td /F1 9.8 Tf  [(2006;52\(2\):110-115)] TJ ET
BT 26.250 66.762 Td /F1 9.8 Tf  [(44.)] TJ ET
BT 43.553 66.762 Td /F1 9.8 Tf  [(Salama P, Spiegel P, Talley L, et al. Lessons learned from complex emergencies over past decade. Lancet. )] TJ ET
BT 26.250 54.858 Td /F1 9.8 Tf  [(2004;364:1801�1813.)] TJ ET
Q
q
15.000 44.977 577.500 732.023 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(23.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(Pelletier D, Frongillo EA, Habicht JP. Epidemiologic evidence for a potentiating effect of malnutrition on child mortality. Am J )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(Public Health. 1993;83\(8\):1130-1133.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(24.)] TJ ET
BT 43.553 728.667 Td /F1 9.8 Tf  [(Pelletier DL, Frongillo EA, Schroeder DJ, et al. The effects of malnutrition on child mortality in developing countries. Bulletin )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(of the World Health Organization. 1995;73\(4\):443-448.)] TJ ET
BT 26.250 697.357 Td /F1 9.8 Tf  [(25.)] TJ ET
BT 43.553 697.357 Td /F1 9.8 Tf  [(World Health Organization-Regional Office for the Eastern Mediterranean. Field Guide on Rapid Nutritional Assessment in )] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(Emergencies, 1995. Available @ https://whqlibdoc.who.int/emro/1994-99/9290211989.pdf. Accessed on March 11, 2012.)] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(26.)] TJ ET
BT 43.553 666.048 Td /F1 9.8 Tf  [(World Health Organization. The Management of Nutrition in Major Emergencies, 2000. WHO Geneva: Switzerland. )] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(Available @ https://whqlibdoc.who.int/publications/2000/9241545208.pdf. Accessed on March 11, 2012.)] TJ ET
BT 26.250 634.738 Td /F1 9.8 Tf  [(27.)] TJ ET
BT 43.553 634.738 Td /F1 9.8 Tf  [(UNHCR/UNICEF/WFP/WHO. Food and Nutrition Needs in Emergencies, 2002. WHO Geneva, Switzerland. Available @ )] TJ ET
BT 26.250 622.833 Td /F1 9.8 Tf  [(https://whqlibdoc.who.int/hq/2004/a83743.pdf. Accessed on March 11, 2012.)] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(28.)] TJ ET
BT 43.553 603.429 Td /F1 9.8 Tf  [(World Food Program \(WFP\). Food and Nutrition Handbook, 2000. WFP Rome, Italy. Available @ )] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(https://foodquality.wfp.org/FoodNutritionalQuality/WFPNutritionPolicy/tabid/362/Default.aspx?PageContentID=537. Accessed on )] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(March 11, 2012.)] TJ ET
BT 26.250 560.214 Td /F1 9.8 Tf  [(29.)] TJ ET
BT 43.553 560.214 Td /F1 9.8 Tf  [(Prudhon C. Assessment and Treatment of Malnutrition in Emergency Situations: Manual of Therapeutic Care and Planning )] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(for a Nutritional Programme. Action Contre la Faim, 2002. Paris, France.)] TJ ET
BT 26.250 528.905 Td /F1 9.8 Tf  [(30.)] TJ ET
BT 43.553 528.905 Td /F1 9.8 Tf  [(Young H, Borrel A, Holland D, et al. Public nutrition in complex emergencies. Lancet. 2004;364\(9448\):1899-1909.)] TJ ET
BT 26.250 509.500 Td /F1 9.8 Tf  [(31.)] TJ ET
BT 43.553 509.500 Td /F1 9.8 Tf  [(M�decins Sans Fronti�res \(MSF\). Acute Malnutrition: A highly prevalent, frequently fatal, imminently treatable, neglected )] TJ ET
BT 26.250 497.595 Td /F1 9.8 Tf  [(disease. International Activity Report. MSF, 2006. Available @ )] TJ ET
BT 26.250 485.691 Td /F1 9.8 Tf  [(https://www.doctorswithoutborders.org/publications/ar/report_print.cfm?id=3228. Accessed on March 11, 2012.)] TJ ET
BT 26.250 466.286 Td /F1 9.8 Tf  [(32.)] TJ ET
BT 43.553 466.286 Td /F1 9.8 Tf  [(M�decins Sans Fronti�res \(MSF\). Niger: What to do next? MSF, February 2006. Available @ )] TJ ET
BT 26.250 454.381 Td /F1 9.8 Tf  [(https://www.doctorswithoutborders.org/publications/article.cfm?id=1744. Accessed on April 11, 2012.)] TJ ET
BT 26.250 434.976 Td /F1 9.8 Tf  [(33.)] TJ ET
BT 43.553 434.976 Td /F1 9.8 Tf  [(Office of the United Nations High Commissioner for Human Rights. Convention relating to the Status of Refugees, April )] TJ ET
BT 26.250 423.072 Td /F1 9.8 Tf  [(1954. Available @ https://www2.ohchr.org/english/law/refugees.htm. Accessed on April 11, 2012.)] TJ ET
BT 26.250 403.667 Td /F1 9.8 Tf  [(34.)] TJ ET
BT 43.553 403.667 Td /F1 9.8 Tf  [(Internal Displacement Monitoring Centre. The definition of an internally displaced person \(IDP\). Available @ )] TJ ET
BT 26.250 391.762 Td /F1 9.8 Tf  [(https://www.internal-)] TJ ET
BT 26.250 379.857 Td /F1 9.8 Tf  [(displacement.org/8025708F004D404D/\(httpPages\)/CC32D8C34EF93C88802570F800517610?OpenDocument. Accessed on )] TJ ET
BT 26.250 367.953 Td /F1 9.8 Tf  [(April 11, 2012.)] TJ ET
BT 26.250 348.548 Td /F1 9.8 Tf  [(35.)] TJ ET
BT 43.553 348.548 Td /F1 9.8 Tf  [(United Nations Children�s Fund \(UNICEF\). UNICEF responds as floods affect over 3 million in north-western Pakistan, )] TJ ET
BT 26.250 336.643 Td /F1 9.8 Tf  [(August 2010. Available @ https://www.unicef.org/infobycountry/pakistan_55400.html. Accessed on April 11, 2012.)] TJ ET
BT 26.250 317.238 Td /F1 9.8 Tf  [(36.)] TJ ET
BT 43.553 317.238 Td /F1 9.8 Tf  [(From Horror to Hopelessness Kenya�s Forgotten Somali Refugee Crisis. Human Rights Watch, 2009. Available at )] TJ ET
BT 26.250 305.334 Td /F1 9.8 Tf  [(https://www.hrw.org/sites/default/files/reports/kenya0309webwcover_1.pdf. Accessed on April 12, 2012.)] TJ ET
BT 26.250 285.929 Td /F1 9.8 Tf  [(37.)] TJ ET
BT 43.553 285.929 Td /F1 9.8 Tf  [(Fewtrell L, Kaufmann R, Kay D, et al. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed )] TJ ET
BT 26.250 274.024 Td /F1 9.8 Tf  [(countries: a systematic review and meta-analysis. Lancet Infect Dis. 2005;5:42-52.)] TJ ET
BT 26.250 254.619 Td /F1 9.8 Tf  [(38.)] TJ ET
BT 43.553 254.619 Td /F1 9.8 Tf  [(Abdelrahman AA, Eltahir YM. Bacteriological quality of drinking water in Nyala, South Darfur, Sudan. Environ Monit Assess. )] TJ ET
BT 26.250 242.715 Td /F1 9.8 Tf  [(2011;175\(1-4\):37-43. Epub 2010 May 18.)] TJ ET
BT 26.250 223.310 Td /F1 9.8 Tf  [(39.)] TJ ET
BT 43.553 223.310 Td /F1 9.8 Tf  [(United Nations Division for the Advancement of Women- Department of Economic and Social Affairs. Convention on the )] TJ ET
BT 26.250 211.405 Td /F1 9.8 Tf  [(Elimination of All Forms of Discrimination against Women \(CEDAW\). Available @ )] TJ ET
BT 26.250 199.500 Td /F1 9.8 Tf  [(https://www.un.org/womenwatch/daw/cedaw/recommendations/recomm.htm. Accessed on April 11, 2012.)] TJ ET
BT 26.250 180.096 Td /F1 9.8 Tf  [(40.)] TJ ET
BT 43.553 180.096 Td /F1 9.8 Tf  [(PeaceWomen. A Special 1325 Anniversary Issue, 2002. Available @ )] TJ ET
BT 26.250 168.191 Td /F1 9.8 Tf  [(https://www.peacewomen.org/publications_enews_issue.php?id=126. Accessed on April 11, 2012.)] TJ ET
BT 26.250 148.786 Td /F1 9.8 Tf  [(41.)] TJ ET
BT 43.553 148.786 Td /F1 9.8 Tf  [(de Brouwer AM. Supranational Criminal Prosecution of Sexual Violence: The ICC and the Practice of the ICTY and the )] TJ ET
BT 26.250 136.881 Td /F1 9.8 Tf  [(ICTR. INTERSENTIA, Tilburg, the Hague-Netherlands 2005.)] TJ ET
BT 26.250 117.477 Td /F1 9.8 Tf  [(42.)] TJ ET
BT 43.553 117.477 Td /F1 9.8 Tf  [(Redmond AD. ABC of conflict and disaster: Needs assessment of humanitarian crises. BMJ. 2005;330:1320.)] TJ ET
BT 26.250 98.072 Td /F1 9.8 Tf  [(43.)] TJ ET
BT 43.553 98.072 Td /F1 9.8 Tf  [(Burkle FM Jr. Complex humanitarian emergencies: A review of epidemiological and response models. J Postgrad Med. )] TJ ET
BT 26.250 86.167 Td /F1 9.8 Tf  [(2006;52\(2\):110-115)] TJ ET
BT 26.250 66.762 Td /F1 9.8 Tf  [(44.)] TJ ET
BT 43.553 66.762 Td /F1 9.8 Tf  [(Salama P, Spiegel P, Talley L, et al. Lessons learned from complex emergencies over past decade. Lancet. )] TJ ET
BT 26.250 54.858 Td /F1 9.8 Tf  [(2004;364:1801�1813.)] TJ ET
Q
q
15.000 44.977 577.500 732.023 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(23.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(Pelletier D, Frongillo EA, Habicht JP. Epidemiologic evidence for a potentiating effect of malnutrition on child mortality. Am J )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(Public Health. 1993;83\(8\):1130-1133.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(24.)] TJ ET
BT 43.553 728.667 Td /F1 9.8 Tf  [(Pelletier DL, Frongillo EA, Schroeder DJ, et al. The effects of malnutrition on child mortality in developing countries. Bulletin )] TJ ET
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BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 26.250 759.976 Td /F1 9.8 Tf  [(45.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(Noji EK. Disaster epidemiology: Challenges for public health action. J Public Health Policy. 1992;13\(3\):332-340.)] TJ ET
BT 26.250 740.571 Td /F1 9.8 Tf  [(46.)] TJ ET
BT 43.553 740.571 Td /F1 9.8 Tf  [(Spiegel PB, Burkle FM Jr., Dey CC, et al. Developing Public Health Indicators in Complex Emergency Response. Prehosp )] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(Disaster Med. 2001;16\(4\):281-285.)] TJ ET
BT 26.250 709.262 Td /F1 9.8 Tf  [(47.)] TJ ET
BT 43.553 709.262 Td /F1 9.8 Tf  [(The Johns Hopkins and Red Cross Red Crescent. Public health guide in emergencies, 2008. Available @ )] TJ ET
BT 26.250 697.357 Td /F1 9.8 Tf  [(https://www.ifrc.org/Docs/pubs/health/public_health_guide_in_emergencies.pdf. Accessed on April 11, 2012.)] TJ ET
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BT 26.250 759.976 Td /F1 9.8 Tf  [(45.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(Noji EK. Disaster epidemiology: Challenges for public health action. J Public Health Policy. 1992;13\(3\):332-340.)] TJ ET
BT 26.250 740.571 Td /F1 9.8 Tf  [(46.)] TJ ET
BT 43.553 740.571 Td /F1 9.8 Tf  [(Spiegel PB, Burkle FM Jr., Dey CC, et al. Developing Public Health Indicators in Complex Emergency Response. Prehosp )] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(Disaster Med. 2001;16\(4\):281-285.)] TJ ET
BT 26.250 709.262 Td /F1 9.8 Tf  [(47.)] TJ ET
BT 43.553 709.262 Td /F1 9.8 Tf  [(The Johns Hopkins and Red Cross Red Crescent. Public health guide in emergencies, 2008. Available @ )] TJ ET
BT 26.250 697.357 Td /F1 9.8 Tf  [(https://www.ifrc.org/Docs/pubs/health/public_health_guide_in_emergencies.pdf. Accessed on April 11, 2012.)] TJ ET
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BT 26.250 759.976 Td /F1 9.8 Tf  [(45.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(Noji EK. Disaster epidemiology: Challenges for public health action. J Public Health Policy. 1992;13\(3\):332-340.)] TJ ET
BT 26.250 740.571 Td /F1 9.8 Tf  [(46.)] TJ ET
BT 43.553 740.571 Td /F1 9.8 Tf  [(Spiegel PB, Burkle FM Jr., Dey CC, et al. Developing Public Health Indicators in Complex Emergency Response. Prehosp )] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(Disaster Med. 2001;16\(4\):281-285.)] TJ ET
BT 26.250 709.262 Td /F1 9.8 Tf  [(47.)] TJ ET
BT 43.553 709.262 Td /F1 9.8 Tf  [(The Johns Hopkins and Red Cross Red Crescent. Public health guide in emergencies, 2008. Available @ )] TJ ET
BT 26.250 697.357 Td /F1 9.8 Tf  [(https://www.ifrc.org/Docs/pubs/health/public_health_guide_in_emergencies.pdf. Accessed on April 11, 2012.)] TJ ET
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