Introduction: As the years of displacement accumulate, the burden of secondary stressors (i.e., stressors not directly related to war) increase on the shoulders of millions of refugees, who do not have the option of either returning home due to war or having a sustainable livelihood in the host countries. This paper aims to shed light on the overlooked importance of secondary stressors among refugees of conflict in developing countries; it will do this by highlighting the experience of Syrian refugees in Jordan, and developing a typology of these stressors.

Methods: We approached this issue using two levels of exploration. In study 1, we used participant observation and 15 in-depth interviews in Irbid, Jordan. Data were analysed qualitatively using thematic analysis to explore the different types of stressors. In study 2, a questionnaire survey among Syrian refugees in Jordan (n = 305) was used to collect data about a wide range of stressors. Responses were subjected to factor analysis to examine the extent to which the stressors could be organized into different factors.

Results: The thematic analysis suggested three different types of secondary stressors: financial (money related), environmental (exile structures and feelings created by it), and social (directly related to social relations). The factor analysis of the survey data produced a similar typology, where secondary stressors were found to be grouped into four main factors (financial, services, safety, and relations with out-groups). The final result is a typology of 33 secondary stressors organised in three main themes.   

Discussion: Syrian refugees in Jordan suffer the most from financial stressors, due to loss of income and high living expenses. Environmental stressors arise from exile and are either circumstantial (e.g., services and legal requirements) or created by this environment (e.g., instability and lack of familiarity). Social stressors were observed among a considerable section of refugees, varying from stressors due to being targeted as a refugee by the locals (e.g., discrimination) to more traumatic stressors that came from both locals and other refugees (e.g., assault). The typology of secondary stressors suggested by the present analysis needs to be investigated in a larger sample of refugees of conflict in other countries in the Middle East, in order to determine its generality. We suggest that it is a basis for a framework for practitioners and academics working with refugees in the region.      

Key words: Armed conflict, Syrian, Jordan, refugees, forced displacement, exile, daily stressors, secondary stressors, trauma, typology.

Introduction: Studies show that natural disasters influence voters’ perception of incumbent politicians. To investigate whether voters are prone to punish politicians for events that are out of their control, this study was conducted in the previously unstudied context of Croatia, and by considering some of the methodological issues of previous studies. Method: Matching method technique was used, which ensures that affected and non-affected areas are matched on several control variables. The cases of natural disaster in the present study were floods that affected Croatia in 2014 and 2015. Results: Main results showed that, prior to matching, floods had an impact on voting behaviour in the 2014 and 2015 elections. Voters from flooded areas decreased their support for the incumbent government and president in the elections following the floods. However, once we accounted for differences in control variables between flooded and non-flooded areas, the flood effect disappeared. Furthermore, results showed that neither the presence nor the amount of the government’s relief spending had an impact on voting behaviour. Discussion: Presented results imply that floods did not have an impact on the election outcome. Results are interpreted in light of the retrospective voter model.

Introduction: Three jurisdictional earthquake resilience planning initiatives respectively conducted in California, Washington State, and Oregon are compared: SPUR Resilient City (SPUR), Resilient Washington State (RWS), and Oregon Resilience Plan (ORP). This paper presents an exploratory analysis that reveals divergent and convergent themes across the resilience planning initiatives, with the goal of informing similar initiatives in the future.

Methods: Data for this exploratory study comes primarily from the reports produced by the initiatives, but also initiative presentations, limited correspondence with initiative organizers for clarifications, and personal experience. Extensive computer-assisted text analysis was done to analyze, synthesize, and visualize the content of the SPUR, RWS, and ORP reports Results: The SPUR initiative was the inspiration for both RWS and ORP. As such, an evolution of ideas is evident from the first initiative (SPUR) to the most recent (ORP). While the SPUR initiative was a model for the RWS and ORP initiatives, the process and outcomes of the latter two initiatives were more similar than to the original SPUR initiative. Both the RWS and ORP initiatives were significantly smaller in scope. These two initiatives also made creation of recovery-based performance measurement frameworks–timetables of expected and desired recovery estimates–even more central to the process of identifying seismic resilience recommendations.

Discussion: The SPUR, RWS, and ORP initiatives have had demonstrated impact on jurisdictional pre-event planning, mitigation, and preparedness efforts. However, the impact of the specific innovations developed by the three earthquake resilience planning initiatives is not clear because of the limited degree that the resilience definition and performance measurement framework for each initiative were explicitly integrated to produce the respective recommendations. For example, Washington State’s Seismic Safety Committee made recommendations similar to their RWS recommendations as part of past initiatives that did not use a resilience lens or a recovery-based performance measurement framework.

Conclusion: More systematic research into the innovative elements of the SPUR, RWS, and ORP initiatives, such as development of the recovery-based performance measurement frameworks, is warranted given the initiatives’ popularity and influence on the National Institute of Standards and Technology’s Community Resilience Planning Guide.

Background: Emergency preparedness at all levels (individuals and communities) is the corner stone of effective response to the increasing trends of global disasters due to man-made and natural hazards. It is determined by different factors, including (among others) past direct and indirect exposures to hazards. This study was carried out in Dire Dawa town, Ethiopia, which in the past experienced frequent flooding events, yet dearth of information exists about preparedness in the area.  The aim of the study was to assess the levels of emergency preparedness for flood hazards at households and communities levels.

Methods: The study was conducted in a qualitative approach and was conducted in Dire Dawa town, which has been divided into nine administrative-units called Kebeles. Two focus group discussions were held in two of these units (Kebele-05 and 06), each focus group comprising twelve people (all above 18 years of age), and in total 24 people (13 females and 11 males) took part in the study. Open ended questions were used that could guide the discussions, and the discussions were audio-taped and transcribed. The results were translated from local language to English and qualitatively presented. 

Results: The findings of focus group discussions showed that the local government in collaboration with the federal government built the flood protection dams in areas where flood hazards have been thought to be repeatedly wreaking havoc, specifically after the flood disaster of the year 2006. In addition, in Kebele-05, where one Non-Governmental Organization (NGO) was operating on flood hazards prevention and mitigation program, some non-structural emergency preparedness measures were undertaken by the communities. These non-structural measures (the major ones) entailed: establishment of committees recruited from residents and training them to raise awareness among communities on emergency preparedness; some residents made changes to their own houses (retrofitted) and put sandbags around their houses to temporarily protect the flooding; establishment of communication channels between communities to alarm each other in the event of flood disaster; and reforestation of the already deforested mountainous areas surrounding the town. However, concerns were raised by study participants about strengths of the constructed flood protection dams. Furthermore, the non-structural emergency preparedness measures identified by this study were not comprehensive; for example, residents were not trained in first aid, first aid kits were not provided, there was no linkage being established between communities and health facilities so as to provide emergency medical care to victims in the event of flood disaster. 

Discussion: The findings of this study concur with some of the previous quantitative studies’ results in that the past direct and indirect disaster experiences invoke preparedness intention and actual preparedness for flood hazards at individuals, communities and organizations levels. The only one quantitative and behavioral based study conducted thus far in Dire Dawa town reported the strong association of past flood disaster experience with household emergency preparedness. Among the residents there was a tendency to rely on the dams to be constructed with “good quality” and “higher strength” than making preparedness efforts on their own at their households. Structural measures such as building of dams, dikes, levees, and channel improvements could be means of mitigation measures; however, solely relying on these measures could have far reaching consequences.

Conclusions: To mitigate flood hazards, dams were built and in addition, in Kebele-05 where an NGO was operating, some non-structural emergency preparedness measures were undertaken. In the course of construction of flood protection dams, ensuring communities’ involvement is needed; and at the same time undertaking comprehensive non-structural emergency preparedness measures in all Kebeles is highly recommended.

Key words: Emergency, Preparedness, Flood, Dire Dawa, Ethiopia.

Introduction: In Northern Ghana, a combination of torrential rains coupled with the spilling of the Bagre dam in neighboring Burkina Faso in the past few years has resulted in perennial flooding of communities. This has often led to the National Disaster Management Organization (NADMAO) the main disaster responder agency in Ghana, being called upon to act. However affected communities have never had the opportunity to evaluate the activities of the agency. The aim of this study is therefore to assess the performance of the main responder agency by affected community members to improve on future disaster management.

Methods: A mixed qualitative design employing a modified form of the community score card methodology and focus group discussions was conducted in the 4 most affected communities during the last floods of 2012 in the Kasena-Nankana West district of the Upper East Region of Northern Ghana. Community members comprising of chiefs, elders, assembly members, women groups, physically challenged persons, farmers, traders and youth groups formed a group in each of the four communities. Generation and scoring of evaluative indicators was subsequently performed by each group through the facilitation of trained research assistants. Four Focus group discussions (FGDs) were also conducted with the group members in each community to get an in-depth understanding of how the responder agency performed in handling disasters.

Results: A total of four community score cards and four focus group discussions were conducted involving 48 community representatives. All four communities identified NADMO as the main responder agency during the last disaster. Indicators such as education/awareness, selection process of beneficiaries, networking/collaboration, timing, quantity of relief items, appropriateness, mode of distribution of relief items, investigation and overall performance of NADMO were generated and scored. The timing of response, quantity and appropriateness of relief items were evaluated as being poor whereas the overall performance of the responder agency was above average.

Conclusion: NADMO was identified as the main responder agency during the last disasters with community members identifying education/awareness, selection process of beneficiaries, networking/collaboration, timing of response, quantity of relief items, appropriateness of relief items, mode of distribution of relief items, investigation and overall performance as the main evaluative indicators. The overall performance of NADMO was rated to be satisfactory.

Key words: Kasena-Nankana West district, NADMO, community score card, Rural Northern Ghana

Introduction: Humanitarian emergencies and the number of people who are adversely affected are increasing. In such emergencies, the vulnerability of women and girls to gender-based violence increases signifi­cantly and they often experience high levels of intimate partner violence (IPV). There are a limited number of interventions to reduce gender-based violence (GBV) and IPV in the contexts of humanitarian emergencies, and there is uncertainty about the effectiveness of these preventive interventions. This is the protocol for a systematic review that will synthesize the evidence on interventions for primary or secondary prevention of IPV in humanitarian settings, and assess the effect of existing types of IPV-related interventions in these settings.

Methods and Design: The PRISMA-P 2015 statement has been used to prepare this report. Studies published from January 2000 to January 2017 will be reviewed with no language limits. Any experimental, quasi-experimental, or controlled trials will be included. A combination of four key concepts, including “IPV” AND “population” AND “humanitarian setting” AND “intervention” will be used in the search and a variety of information sources will be used: (1) bibliographic databases; (2) special databases and grey literature; (3) and the reference lists of eligible studies. Two reviewers will independently screen articles, extract relevant data and assess study quality. Discrepancies will be resolved through consensus. Risk of bias will be assessed using the Cochrane Risk of Bias tool and the quality of evidence will be assessed using the CONSORT checklist. A narrative synthesis will be provided. If a sufficient number of studies are found, their results will be pooled using a random-effects meta-analysis. For dichotomous outcomes, summaries of intervention effects for each study will be provided by calculating risk ratios with 95% confidence interval. Standardized mean differences will be used for continuous outcomes.

Discussion: The review will be useful for IPV management policy and related planning. It will help researchers, policymakers and guideline developers with an interest in reducing violence against women among refugees, internally displaced persons (IDPs), and conflict-affected population.

Introduction: It is estimated that five thousand people die on Lake Victoria every year by drowning which is triggered by severe weather hazards like lightning.

Objectives:  In order to improve predictability of severe weather conditions on Lake Victoria, there is need to deliver timely and effective Severe Weather Early Warning Systems (SWEWS) to those at risk. On Lake Victoria, previous SWEW service trials ceased with the end of the funding grants. This study therefore assessed the possibility of sustaining the SWEW service by assessing willingness to pay.  

Methods: An assessment was conducted between March and May 2015 to determine the SWEW service improvements desired by the population. A convenience sample of respondents was gathered and interviewed during impromptu visits to landing sites on Lake Victoria. The respondents were also among community members that had earlier participated in a pilot assessing the feasibility of mobile phones is delivering SWEW alerts.  Semi-structured questionnaires were administered to fishermen and fisher folks at the landing site to gather suggestions/strategies for (i) better design and implementation of SWEW service, (ii) use of smart phones, and (iii) their ability and willingness to pay for a SWEW service. Results were presented as frequencies.

Results: Two hundred fifteen respondents from fourteen landing sites (communities) were interviewed. Over 50% of the respondents (113/215) were aware about at least one community member who had been injured due to lightening on the lake in the past year. Ninety two percent (198/215) of the respondents reported using mobile phones as their main tool of communication but only 4% had smart phones that could receive early warning weather alerts through internet connectivity. Seventy five percent of respondents said they would welcome a system that could deliver commercial weather alerts and 65% were willing to pay for such a service.  

Conclusions: A SWEW service is feasible in this community but must be accompanied with public education on risk, a design that can fit the basic phone functionality and a system that the community majority will be willing to pay for on a continuing basis as a sustainability plan/strategy for an early warning system. This will enable timely dissemination of severe weather alerts and reduce risk of drowning on lakes among fishing communities. 

Introduction: The twin earthquakes of eastern Azerbaijan induced considerable devastations of many villages and cities. About 70% of all victims were women and children. The present case report was aimed at describing the lessons learnt from both capabilities and challenges of girls and women after the twin earthquakes of eastern Azerbaijan.

Methods: A qualitative approach using in-depth unstructured interviews was used for this study. A total of 13 participants (two men and 11 women), affected by the quakes, were interviewed applying the purposeful sampling method. A manifest content analysis was performed for analyzing the transcribed interviews

Case presentation: Two categories of women’s capabilities and challenges and four subcategories of women’s participation in community reconstruction, livelihood efforts, aggravated poverty and violence were extracted from the data which were gathered in the destroyed fields of eastern Azerbaijan.

Lessons learnt: Women can play an important role in post-disaster recovery. Consequently, ignoring the challenges and capabilities of women may impede post-disaster development processes, which would adversely affect the whole community.

Introduction: This study examines how changes in emotional closeness and exchanges of support among family members after Hurricane Sandy affected residents’ psychological outcomes both positively and negatively.

Methods: The working sample included 130 family ties reported by 85 respondents recruited from community and shelter residents on Staten Island after it was seriously damaged by the 2012 Hurricane Sandy. Regression with robust standard errors was used to examine how changes in emotional closeness and exchanges of support with adult family members affected respondents’ posttraumatic psychological distress and posttraumatic growth.

Results: Results showed psychological distress was significantly increased with higher levels of instrumental support received from family members; whereas posttraumatic growth was significantly increased with greater improved emotional closeness with family members. In addition, having higher levels of education was associated with lower levels of psychological distress and respondents from shelters showed higher levels of posttraumatic growth than those who were from the community.

Discussion: It is suggested that after a significant disaster, although a family may be the best to take care of its members’ emotional needs, it should not be expected to satisfy the instrumental needs of its members. In addition, posttraumatic psychological distress and growth are not necessarily opposite to each other; the psychological well- being of residents after a disaster needs to be carefully examined from both perspectives.

Objectives: This review sought to identify, describe and assess the effectiveness of teacher-mediated interventions that aim to support child and adolescent recovery after a natural or man-made disaster. We also aimed to assess intervention applicability to rural and remote Australian school settings.

Method: A systematic search of the academic literature was undertaken utilising six electronic databases (EBSCO, Medline, PsycINFO, Embase, ERIC and CINAHL) using terms that relate to: teacher-mediated and school-based interventions; children and adolescents; mental health and wellbeing; natural disasters and man-made disasters. This was supplemented by a grey literature search.

Results: A total of 20 articles reporting on 18 separate interventions were identified. Nine separate interventions had been evaluated using methodologically adequate research designs, with findings suggesting at least short-term improvement in student wellbeing outcomes and academic performance.

Conclusions: Although none of the identified studies reported on Australian-based interventions, international interventions could be adapted to the Australian rural and remote context using existing psychosocial programs and resources available online to Australian schools. Future research should investigate the acceptability, feasibility and effectiveness of implementing interventions modelled on the identified studies in Australian schools settings.

Recent years have demonstrated the devastating health consequences of complex emergencies and natural disasters and thereby highlighted the importance of comprehensive and collaborative approaches to humanitarian responses and risk reduction. Simultaneously, noncommunicable diseases are now recognised as a real and growing threat to population health and development; a threat that is magnified by and during emergencies.

Noncommunicable diseases, however, continue to receive little attention from humanitarian organisations in the acute phase of disaster and emergency response.

This paper calls on all sectors to recognise and address the specific health challenges posed by noncommunicable diseases in emergencies and disaster situations. This publication aims to highlight the need for:

• Increased research on morbidity and mortality patterns due to noncommunicable diseases during and following emergencies;
• Raised awareness through greater advocacy for the issue and challenges of noncommunicable diseases during and following emergencies;
• Incorporation of noncommunicable diseases into existing emergency-related policies, standards, and resources;
• Development of technical guidelines on the clinical management of noncommunicable diseases in emergencies;
• Greater integration and coordination in health service provision during and following emergencies;
• Integrating noncommunicable diseases into practical and academic training of emergency workers and emergency-response coordinators.

In July 2010, Pakistan suffered nationwide floods after unprecedented monsoon rains overwhelmed the Indus basin. The ensuing floods claimed 1985 lives, injured 2946 people and affected over 20.2 million people. Seventy-eight out of 121 districts were affected and at one stage one-fifth of the country’s land was inundated with water. Indiscriminate damage was caused to housing, educational and health facilities, communication networks, power plants and grids, irrigation channels, agricultural land and livestock. Over 37 million medical consultations were reported within one year of the floods with acute respiratory infection, skin diseases, acute diarrhoea and suspected malaria forming the most common presentations. Rescue and relief operations were organised through the National Disaster Management Authority and a UN Cluster Approach was adopted for providing humanitarian assistance. The Office for the Coordination of Humanitarian Affairs (OCHA) played a pivotal role in coordinating relief efforts between cluster groups and providing communication platforms for identifying gaps and sharing information. This paper attempts to collate information available in the public domain into a summary report based on key principles described by Kulling et al. (2010) on health crisis reporting.

The 2010 Haitian earthquake and consequent Cholera epidemic taxed the already fragile health system. A large number of humanitarian organizations participated in the disaster response and the health communication response was analysed. Health Cluster updates from both periods were analysed for contents with a World Health Organization draft check list for monitoring and evaluating the quality of epidemiological data contained in WHO and Health Cluster emergency reports. The Pan-American Health Organization Emergency Operations Centre reports from the Earthquake had the lowest score with an average score of 2.54/17 and the Health Cluster – Cholera reports had the highest average score of 11/17. There is a wide variety and quality of information published in terms of epidemiological information in emergency reports with a distinct difference found between the earthquake reporting and the cholera event. A comprehensive and modifiable template for emergency reporting could alleviate these differences and allow for improved reporting.

Citation: Dhillon P, Annunziata G. The Haitian Health Cluster Experience: A comparative evaluation of the professional communication response to the 2010 earthquake and the subsequent cholera outbreak. PLOS Currents Disasters. 2012 Sep 5. doi: 10.1371/5014b1b407653.

Background: Complex Humanitarian Emergencies (CHE) result in rapid degradation of population health and quickly overwhelm indigenous health resources. Numerous governmental, non-governmental, national and international organizations and agencies are involved in the assessment of post-CHE affected populations. To date, there is no entirely quantitative assessment tool conceptualized to measure the public health impact of CHE.

Methods: Essential public health parameters in CHE were identified based on the Sphere Project “Minimum Standards”, and scoring rubrics were proposed based on the prevailing evidence when applicable.

Results: 12 quantitative parameters were identified, representing the four categories of “Minimum Standards for Disaster Response” according to the Sphere Project; health, shelter, food and nutrition, in addition to water and sanitation. The cumulative tool constitutes a quantitative scale, referred to as the Public Health Impact Severity Scale (PHISS), and the score on this scale ranges from a minimum of 0 to a maximum of 100.

Conclusion: Quantitative measurement of the public health impact of CHE is germane to accurate assessment, in order to identify the scale and scope of the critical response required for the relief efforts of the affected populations. PHISS is a new conceptual metric tool, proposed to add an objective quantitative dimension to the post-CHE assessment arsenal. PHISS has not yet been validated, and studies are needed with prospective data collection to test its validity, feasibility and reliability.

Citation: Bayram JD, Kysia R, Kirsch TD. Disaster Metrics: A Proposed Quantitative Assessment Tool in Complex Humanitarian Emergencies – The Public Health Impact Severity Scale (PHISS). PLOS Currents Disasters. 2012 Aug 21. doi: 10.1371/4f7b4bab0d1a3.

Introduction
Reviews of mass gathering events have traditionally concentrated on crowd variables that affect the level and type of medical care needed. Weather and environmental hazards at mass gathering events have not been fully researched. This review examines these events and aims to provide future suggestions for event organisers, medical resource planners, and emergency services, including local hospital emergency departments.

Methods
A review was conducted using computerised data bases: MEDLINE, The Cochrane Library, HMIC and EMBASE, with Google used to widen the search beyond peer-reviewed publications, to identify grey literature. All peer-review literature articles found containing information pertaining to lessons identified from mass gathering disasters due to weather or environmental hazards leading to participant death, injury or illness were analysed and reviewed. Disasters occurring due to crowd variables were not included. These articles were read, analysed, abstracted and summarised.

Results
20 articles from literature search were found detailing mass gathering disasters relating directly to weather or environmental hazards from 1988 – 2011, with only 17 cases found within peer-review literature. Two events grey literature from 2011 are due to undergo further inquiry while one article reviews an event originally occurring in 1922. Analysis of cases were categorised in to heat and cold-related events, lightning and storms and disease outbreak.

Conclusions
Mass gathering events have an enormous potential to place a severe strain on the local health care system, Prior health resource and environmental planning for heat & cold-related illness, lightning & storms, and disease outbreak can advance emergency preparedness and response to potential disasters.

Citation: Soomaroo L, Murray V. Weather and Environmental Hazards at Mass Gatherings. PLoS Currents Disasters. 2012 Jul 31

Keywords: Mass Gatherings, Disasters, Sporting Events, Festivals, Concerts, Storm, Lightning, Cyclone, Hot-weather illness, Cold-weather illness, Disease, Public Health, Syndromic Surveillance

Abbreviations: ALS – Advance Life support; BLS – Basic Life support; ED – Emergency Department;
EMS – Emergency Medical Services; PPR – Patient Presentation Rate