Introduction: In August 2016, the United Nations (U.N.) Secretary General acknowledged the U.N.’s role in the cholera epidemic that has beset Haiti since 2010. Two months later, the Secretary General issued a historic apology to the Haitian people before the U.N. General Assembly, for the organization’s insufficient response to the cholera outbreak. These steps are part of the U.N.’s “new approach” to cholera in Haiti, which also includes launching a material assistance package for those most affected by cholera.

Methods: This paper draws on the authors’ experience and findings from consultations with more than 60,000 victims and communities affected by disasters and violence in a dozen countries. We reviewed the literature on best practices for consultation with and outreach to communities affected by development and transitional justice programming, and reviewed our own findings from previous studies with a view to identifying recommendations for ensuring that the assistance package reflects the views of people affected by cholera.

Results: The assistance package program is an opportunity to rebuild the relationship between the victims and the United Nations. This can only be achieved if victims are informed and engaged in the process. This consultation effort is also an opportunity to answer a set of key questions related to the nature, structure, and implementation of the victims’ assistance program, but also how the program may be designed to contribute to rebuilding Haitians’ confidence in the U.N. as an institution that promotes peace, human rights, and development.

Discussion: We recommend that the consultations must be accompanied by an outreach effort that provides clear, accurate information on the assistance program, so that it begins to establish a dialogue between the U.N. and cholera victims. Finally, we conclude by offering a number of concrete next steps that the U.N. can take to kick start the consultation process.

Crisis-affected populations and humanitarian aid providers are both becoming increasingly reliant on information and communications technology (ICTs) for finding and provisioning aid. This is exposing critical, unaddressed gaps in the legal and ethical frameworks that traditionally defined and governed the professional conduct of humanitarian action. The most acute of these gaps is a lack of clarity about what human rights people have regarding information in disaster, and the corresponding obligations incumbent upon governments and aid providers.  This need is lent urgency by emerging evidence demonstrating that the use of these technologies in crisis response may be, in some cases, causing harm to the very populations they intend to serve.  Preventing and mitigating these harms, while also working to responsibly ensure access to the benefits of information during crises, requires a rights-based framework to guide humanitarian operations. In this brief report, we provide a commentary that accompanies our report, the Signal Code: A Human Rights Approach to Information During Crisis, where we have identified five rights pertaining to the use of information and data during crisis which are grounded in current international human rights and customary law. It is our belief that the continued relevance of the humanitarian project, as it grows increasingly dependent on the use of data and ICTs, urgently requires a discussion of these rights and corresponding obligations.

Introduction: The Veterans Health Administration (VHA), the largest integrated healthcare delivery system in the United States, is charged with ensuring timely access to high-quality care for veterans during disasters, and supporting national, state, local, and tribal emergency management and homeland security efforts. In 2008, the VHA Office of Public Health (OPH) sponsored the first VHA Emergency Management Research Agenda-setting conference to develop research priorities that address the needs of veterans and to position VHA as a national leader in emergency management by having VHA serve as a “laboratory” for the development of evidence-based emergency management practices.

Methods: We focused on four steps: #1: Appraising the emergency management research portfolio of VHA-based researchers; #2: Obtaining systematic information on VHA’s role in emergency management and the healthcare needs of veterans during disasters; #3: Based upon gaps between the current research portfolio and the existing evidence base, identifying strategic priorities using a research agenda-setting conference; and #4: Laying the groundwork to foster the conduct of emergency management research within VHA.

Results: Identified research priorities included how to prevent and treat behavioral health problems related to a disaster, the efficacy of training programs, crisis communication strategies, workforce resilience, and evacuating veterans from health care facilities.

Conclusion: VHA is uniquely situated to answer research questions that cannot be readily addressed in other settings. VHA should partner with other governmental and private entities to build on existing work and establish shared research priorities.

Introduction: Typhoon Haiyan was the strongest storm recorded in Philippine history. Surveillance in Post Extreme Emergencies and Disasters (SPEED) was activated during the typhoon response. This study analyzes the health impact of different diseases during different timeframes post-disaster during Typhoon Haiyan in 2013 using a syndromic surveillance database.

Methods: SPEED reports medical consultations based on 21 syndromes covering a range of conditions from three syndrome groups: communicable diseases, injuries, and non-communicable diseases (NCDs). We analyzed consultation rates for 150 days post-disaster by syndrome, syndrome group, time period, and health facility type for adults as well as for children under the age of five.

Results: Communicable diseases had the highest consultation rates followed by similar rates for both injuries and NCDs. While communicable diseases were the predominant syndrome group for children, wounds and hypertension were common syndromes observed in adults. Village health centers had the most consultations amongst health facilities, but also showed the highest variability.

Discussion: Children were more vulnerable to communicable diseases compared to adults. Community health centers showing consistently high consultation rates point out a need for their prioritization. The predominance of primary care conditions requires disaster managers to focus on basic health care and public health measures in community health centers that target the young, elderly and impoverished appropriate to the time period.

The wars in the Middle East have led to unprecedented threats and attacks on patients, healthcare workers, and purposeful targeting of hospitals and medical facilities. It is crucial that every healthcare provider, both civilian and military, on either side of the conflict become aware of the unique and inherent protections afforded to them under International Humanitarian Law. However, these protections come with obligations. Whereas Governments must guarantee these protections, when violated, medical providers have equal duty and obligations under the Law to ensure that they will neither commit nor assist in these violations nor take part in any act of hostility. Healthcare providers must not allow any inhuman or degrading treatment of which they are aware and must report such actions to the appropriate authorities. Failure to do so leads to risks of moral, ethical and legal consequences as well as penalties for their actions and inactions. There must be immediate recognition by all parties of the neutrality of health care workers and their rights and responsibilities to care for any sick and injured patient, regardless of their nationality, race, religion, or political point of view.

Introduction: On April 6th 2009 an earthquake of Mw=6.3 hit the historical downtown of L’Aquila and its hinterland causing more than 300 fatalities and severe damage to private and public buildings. At the time, the University of L’Aquila represented a major source of employment and income for the city. The earthquake impacted both the facilities and the administrative, financial and patrimonial activities of the university, bringing into the open the tendency – widespread in Italy – to rely on adaptive tactics rather than on strategic pre-disaster plans. This paper investigates the university’s emergency preparedness and response capability and  the strategies adopted to restore the education activities as well as avoid students migration to other universities. In addition, emphasis is placed on the role played by Student Associations in pre and post-disaster phases, and how students perceived the activities performed by these associations.

Methods: To achieve this goal, it was undertaken: i) qualitative evaluation to assess the impact of earthquake on services and facilities of the university, the emergency preparedness and the measures adopted to face the emergency, ii) survey on the role played by Student Associations, both in emergency preparedness and response, according to students’ perception; iii) quantitative analysis to measure changes in the enrollment trend after the earthquake, and how university policies could curb students’ migration.

Results: The policies adopted by the University allowed to diminish students’ migration; however, the measures taken by the university were based on an ad hoc plan as no emergency and continuity plans were prepared in advance. Similarly Student Associations got involved more in restoration activities than in emergency preparedness and risk awareness promotion.

Discussion: Greater awareness and involvement are essential at each level (administrators, faculties, students) to plan in advance for an adverse scenario and to make important steps forward in understanding and embracing a culture of safety. The present paper is starting point for future research to deepen the emergency preparedness of Universities and the role that Student Associations may play to support and spread such a culture of safety.

Introduction: On November 8, 2013, Super Typhoon Haiyan struck the Philippines, causing a humanitarian emergency. According to the World Health Organization, non-communicable diseases (NCDs), also known as chronic diseases, are the leading cause of death and disability around the world. NCDs kill 38 million people each year.  Sixteen million NCD deaths occur before the age of 70; 82% of which occurred in low- and middle-income countries.  NCDs are further exacerbated during a crisis, and addressing them should be a concern of any medical disaster response.

Methods: We conducted a retrospective observational study to determine the prevalence of hypertension among patients seeking medical care at mobile medical clinics after Typhoon Haiyan in the Philippines.

Results: A total of 3,730 adults were evaluated at the mobile medical clinics. Analysis of the medical records revealed that the overall prevalence of hypertension among adult patients was 47%. Approximately 24% of adult females and 27% of adult males were classified with stage 2 Hypertension.

Conclusions: Evidence-based guidelines on the management of hypertension and other NCDs (diabetes mellitus, cardiovascular disease, chronic lung disease and mental health) during humanitarian emergencies are limited. Clinical care of victims of humanitarian emergencies suffering with NCDs should be a critical part of disaster relief and recovery efforts.  We therefore recommend the development of best practices and evidence based management guidelines of hypertension and other NCDs in post-disaster settings.

Background:Lower extremity trauma during earthquakes accounts for the largest burden of geophysical disaster-related injuries. Insufficient pain management is common in disaster settings, and regional anesthesia (RA) has the potential to reduce pain in injured patients beyond current standards. To date, no prospective research has evaluated the use of RA in a disaster setting. This cross-sectional study assesses knowledge translation and skill acquisition outcomes for lower extremity RA performed with and without ultrasound guidance among a cohort of Médecins Sans Frontières (MSF) volunteers who will function as proceduralists in a planned randomized controlled trial evaluating the efficacy of RA for pain management in an earthquake setting.

Methods:Generalist humanitarian healthcare responders, including both physicians and nurses, were trained in ultrasound guided femoral nerve block (USGFNB) and landmark guided fascia iliaca compartment block (LGFICB) techniques using didactic sessions and interactive simulations during a one-day focused course. Outcome measures evaluated interval knowledge attainment and technical proficiency in performing the RA procedures. Knowledge attainment was assessed via pre- and post-test evaluations and procedural proficiency was evaluated through monitored simulations, with performance of critical actions graded by two independent observers.

Results:Twelve humanitarian response providers were enrolled and completed the trainings and assessments. Knowledge scores significantly increased from a mean pre-test score of 79% to post-test score of 88% (p<0.001). In practical evaluation of the LGFICB, participants correctly performed a median of 15.0 (Interquartile Range (IQR) 14.0-16.0) out of 16 critical actions. For the USGFNB, the median score was also 15.0 (IQR 14.0-16.0) out of 16 critical actions. Inter-rater reliability for completion of critical actions was excellent, with inter-rater agreement of 83.3% and 91.7% for the LGFICB and USGFNB evaluations, respectively.

Discussion:Prior to conducting a trial of RA in a disaster setting, providers need to gain understanding and skills necessary to perform the interventions. This evaluation demonstrated attainment of high knowledge and technical skill scores in both physicians and nurses after a brief training in regional anesthesia techniques. This study demonstrates the feasibility of rapidly training generalist humanitarian responders to provide both LGFICB and USGFNB during humanitarian emergencies.

On 9 April 2013 at 11:52 UTC (16:22 local time), a Mw 6.2 earthquake occurred at the depth of 20 Km in Dashti district in south-west Iran’s Bushehr province. The macroseismic epicenter was located nearby the city of Shonbeh. During one month after the earthquake, a total of 282 aftershocks hit the epicentral region, mostly at the east and north sides. They ranged from 2.5 to 5.7 on the Richter scale. Seventy aftershocks (24.9%) were M4.0-4.9 and eight (2.8%) were M5.0-5.7. Aftershocks are potentially able to do additional damage. In Bushehr earthquake, a M5.4 aftershock on 10 April in Chahgah village caused at least four injuries and destruction of several buildings that had been already damaged by the main shock. Knowledge about the aftershock induced damages provides opportunities for timely risk communication with the affected people and for long term community education. This will hopefully increase the community awareness and minimize the risk of further loss of lives.

Brief Incident Report On 15 April 2012 at around 13:00 local time, following a heavy rainfall in Tehran, a break in the channel wall of Kan River caused a flash flood in the Tehran metro tunnels. Consequently, line 4 of the metro went out of operation for about two weeks 1 . The flood was […]

On 9 April 2013, an earthquake of 6.1 magnitude hit southwestern Iran near the city of Khvormuj and the towns of Kaki and Shonbeh in Bushehr province. The official disaster mitigation committee took immediate actions to coordinate rescue teams equipped with 24-hour medical air assistance. Overall, 160 victims were transferred to and treated in the Khvormuj hospital, while 139 survivors were transferred to the hospitals in Bushehr for specialized care. The survivors have been settled in temporary shelters with adequate primary supplies. Considering the hot climate of the area, immediate measures should be taken in order to avoid any further casualties particularly heatstroke, dehydration, diarrheal and vector-borne diseases.

Brief Incident Report Within eleven minutes on 11 August 2012, twin earthquakes measured 6.3 and 6.4 on the Richter scale jolted Ahar and Varzaqan in northwestern Iran, claiming 300 lives and leaving thousands of injured in rural villages.12 The magnitude of the earthquakes was so immense that more than a hundred villages were 70-90% destroyed, […]