Author Profile

Shannon Doocy

Affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

Affiliation: Department of International Health, The Johns Hopkins Bloomberg School of Public Health

Recent Posts

Effectiveness of Interventions, Programs and Strategies for Gender-based Violence Prevention in Refugee Populations: An Integrative Review

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Background: Gender based violence (GBV) remains one of the most serious threats to the health and safety of women and girls worldwide. The problem is even more pronounced in refugee populations where women and girls are at increased risk of violence. In 2015, UNHCR reported the highest number of forcibly displaced people in recorded history. Despite growing need, there have been few rigorous evaluations of interventions aimed at primary GBV prevention and no systematic reviews of GBV prevention efforts specifically focused on refugee populations; reviews to date have primarily examined prevention of conflict related sexual violence, with very limited focus on other forms of GBV such as intimate partner violence

Methods: This study reviewed the scientific literature addressing strategies for primary prevention of GBV and their effectiveness among refugee populations over the past ten years (2006 to 2015). Narrative content analysis methods were used to extract findings related to prevention activities/programs recommended by the global humanitarian community, such as sociocultural norms change, rebuilding family and community support structures, improving accountability systems, designing effective services and facilities, working with formal and traditional legal systems, monitoring and documenting GBV, and/or engaging men and boys in GBV prevention and response.

Results: Study findings indicate that a range of GBV prevention activities recommended by the global humanitarian community are currently being applied in a variety of settings. However, there remains a limited body of evidence on the effectiveness of GBV prevention programs, interventions, and strategies, especially among refugee populations.

Conclusion: Commonly agreed upon standards or guidelines for evaluation of GBV prevention programming, and publication of evaluations conducted using these guidelines, could assist humanitarian stakeholders to build and disseminate an evidence base of effective GBV prevention interventions, programs and strategies. Evaluation of GBV prevention efforts, especially among refugee populations, must be given higher priority to justify continuation or revision of recommended GBV activities/programs being implemented in diverse humanitarian settings.

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

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

Preventing Malnutrition in Post-Conflict, Food Insecure Settings: A Case Study from South Sudan

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Background: Decades of civil conflict compound the challenges of food insecurity in South Sudan and contribute to persistent, high levels of child malnutrition. As efforts to prevent child malnutrition continue, there is a critical need for strategies that effectively supplement the diets of pregnant women and young children in transitional, highly food insecure settings like South Sudan.

Methods: This mixed-methods case study of four communities in South Sudan reports on the diets of children under 2 years of age and explores household-level factors including household size, intrahousehold food allocation practices, and responses to scarcity that may have significant impact on the effectiveness of strategies relying on household ration distribution to supplement the diets of pregnant women and children under 2 years of age.

Results: Participants reported experiencing increased scarcity as a result of prolonged drought and household sizes enlarged by the high volume of returning refugees. Although communities were receiving monthly household rations through a non-emergency food assistance program, most households had exhausted rations less than 30 days after receipt. Results showed that more than one half of children 12-17 months and one third of children 18-23 months consumed diets consisting of fewer than 4 food groups in the last week. Intrahousehold food allocation patterns give children first priority at meal times even in times of scarcity, yet adult women, including pregnant women, have last priority.

Discussion: These findings suggest that distribution of supplementary household rations will likely be insufficient to effectively supplement the diets of young children and pregnant women in particular. In light of the multiple contextual challenges experienced by households in transitional, food-insecure settings, these findings support recommendations to take a context-specific approach to food assistance programming, in which considerations of intrahousehold food allocation patterns and broader cultural and environmental factors inform program design. Incorporating assessments of intrahousehold food allocation patterns as part of needs assessments for food assistance and voucher or cash transfer programs may contribute to more effective, context specific programming.

The Human Impact of Tsunamis: a Historical Review of Events 1900-2009 and Systematic Literature Review

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Introduction.
Although rare, tsunamis have the potential to cause considerable loss of life and injury as well as widespread damage to the natural and built environments. The objectives of this review were to describe the impact of tsunamis on human populations in terms of mortality, injury, and displacement and, to the extent possible, identify risk factors associated with these outcomes. This is one of five reviews on the human impact of natural disasters.

Methods.
Data on the impact of tsunamis were compiled using two methods, a historical review from 1900 to mid 2009 of tsunami events from multiple databases and a systematic literature review to October 2012 of publications. Analysis included descriptive statistics and bivariate tests for associations between tsunami mortality and characteristics using STATA 11.

Findings.
There were 255,195 deaths (range 252,619-275,784) and 48,462 injuries (range 45,466-51,457) as a result of tsunamis from 1900 to 2009. The majority of deaths (89%) and injuries reported during this time period were attributed to a single event –the 2004 Indian Ocean tsunami. Findings from the systematic literature review indicate that the primary cause of tsunami-related mortality is drowning, and that females, children and the elderly are at increased mortality risk. The few studies that reported on tsunami-related injury suggest that males and young adults are at increased injury-risk.

Conclusions.
Early warning systems may help mitigate tsunami-related loss of life.

The Human Impact of Volcanoes: a Historical Review of Events 1900-2009 and Systematic Literature Review

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Introduction.
More than 500 million people live within the potential exposure range of a volcano. The risk of catastrophic losses in future eruptions is significant given population growth, proximities of major cities to volcanoes, and the possibility of larger eruptions. The objectives of this review are to describe the impact of volcanoes on the human population, in terms of mortality, injury, and displacement and, to the extent possible, identify risk factors associated with these outcomes. This is one of five reviews on the human impact of natural disasters.

Methods.
Data on the impact of volcanoes were compiled using two methods, a historical review of volcano events from 1900 to 2009 from multiple databases and a systematic literature review of publications ending in October 2012. Analysis included descriptive statistics and bivariate tests for associations between volcano mortality and characteristics using STATA 11.

Findings.
There were a total of 91,789 deaths (range: 81,703-102,372), 14,068 injuries (range 11,541-17,922), and 4.72 million people affected by volcanic events between 1900 and 2008. Inconsistent reporting suggests this is an underestimate, particularly in terms of numbers injured and affected. The primary causes of mortality in recent volcanic eruptions were ash asphyxiation, thermal injuries from pyroclastic flow, and trauma. Mortality was concentrated with the ten deadliest eruptions accounting for more than 80% of deaths; 84% of fatalities occurred in four locations (the Island of Martinique (France), Colombia, Indonesia, and Guatemala).

Conclusions.
Changes in land use practices and population growth provide a background for increasing risk; in conjunction with increasing urbanization in at risk areas, this poses a challenge for future volcano preparedness and mitigation efforts.

The Human Impact of Floods: a Historical Review of Events 1980-2009 and Systematic Literature Review

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Background.
Floods are the most common natural disaster and the leading cause of natural disaster fatalities worldwide. Risk of catastrophic losses due to flooding is significant given deforestation and the increasing proximity of large populations to coastal areas, river basins and lakeshores. The objectives of this review were to describe the impact of flood events on human populations in terms of mortality, injury, and displacement and, to the extent possible, identify risk factors associated with these outcomes. This is one of five reviews on the human impact of natural disasters

Methods.
Data on the impact of floods were compiled using two methods, a historical review of flood events from 1980 to 2009 from multiple databases and a systematic literature review of publications ending in October 2012. Analysis included descriptive statistics, bivariate tests for associations and multinomial logistic regression of flood characteristics and mortality using Stata 11.0.

Findings.
There were 539,811 deaths (range: 510,941 to 568,680), 361,974 injuries and 2,821,895,005 people affected by floods between 1980 and 2009. Inconsistent reporting suggests this is an underestimate, particularly in terms of the injured and affected populations. The primary cause of flood-related mortality is drowning; in developed countries being in a motor-vehicle and male gender are associated with increased mortality, whereas female gender may be linked to higher mortality in low-income countries.

Conclusions.
Expanded monitoring of floods, improved mitigation measures, and effective communication with civil authorities and vulnerable populations has the potential to reduce loss of life in future flood events.

The Human Impact of Earthquakes: a Historical Review of Events 1980-2009 and Systematic Literature Review

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Introduction.
Population growth and increasing urbanization in earthquake-prone areas suggest that earthquake impacts on human populations will increase in the coming decades. Recent large earthquakes affecting large populations in Japan, Haiti, Chile and New Zealand are evidence of this trend and also illustrate significant variations in outcomes such damage and mortality levels. The objectives of this review were to describe the impact of earthquakes on human populations in terms of mortality, injury and displacement and, to the extent possible, identify risk factors associated with these outcomes. This is one of five reviews on the human impact of natural disasters.

Methods.
Data on the impact of earthquakes were compiled using two methods, a historical review from 1980 to mid 2009 of earthquake events from multiple databases and a systematic literature review of publications, ending in October 2012. Analysis included descriptive statistics and bivariate tests for associations between earthquake mortality and characteristics using STATA 11.

Findings.
From 1980 through 2009, there were a total of 372,634 deaths (range 314,634-412,599), 995,219 injuries (range: 845,345-1,145,093), and more than 61 million people affected by earthquakes, and mortality was greatest in Asia. Inconsistent reporting across data sources suggests that the numbers injured and affected are likely underestimates. Findings from a systematic review of the literature indicate that the primary cause of earthquake-related death was trauma due to building collapse and, the very young and the elderly were at increased mortality risk, while gender was not consistently associated with mortality risk.

Conclusions.
Strategies to mitigate the impact of future earthquakes should include improvements to the built environment and a focus on populations most vulnerable to mortality and injury.

The Human Impact of Tropical Cyclones: a Historical Review of Events 1980-2009 and Systematic Literature Review

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Background.
Cyclones have significantly affected populations in Southeast Asia, the Western Pacific, and the Americas over the past quarter of a century. Future vulnerability to cyclones will increase due to factors including population growth, urbanization, increasing coastal settlement, and global warming. The objectives of this review were to describe the impact of cyclones on human populations in terms of mortality, injury, and displacement and, to the extent possible, identify risk factors associated with these outcomes. This is one of five reviews on the human impact of natural disasters.

Methods.
Data on the impact of cyclones were compiled using two methods, a historical review from 1980 to 2009 of cyclone events from multiple databases and a systematic literature review of publications ending in October 2012. Analysis included descriptive statistics and bivariate tests for associations between cyclone characteristics and mortality using Stata 11.0.

Findings.
There were 412,644 deaths, 290,654 injured, and 466.1 million people affected by cyclones between 1980 and 2009, and the mortality and injury burden was concentrated in less developed nations of Southeast Asia and the Western Pacific. Inconsistent reporting suggests this is an underestimate, particularly in terms of the injured and affected populations. The primary cause of cyclone-related mortality is drowning; in developed countries male gender was associated with increased mortality risk, whereas females experienced higher mortality in less developed countries.

Conclusions.
Additional attention to preparedness and early warning, particularly in Asia, can lessen the impact of future cyclones.

Impact of the 2010 Pakistan Floods on Rural and Urban Populations at Six Months

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The 2010 Pakistan flood affected 20 million people. The impact of the event and recovery is measured at 6 months.
Methods: Cross-sectional cluster survey of 1769 households conducted six months post-flood in 29 most-affected districts. The outcome measures were physical damage, flood-related death and illness and changes in income, access to electricity, clean water and sanitation facilities.
Results: Households were headed by males, large and poor. The flood destroyed 54.8% of homes and caused 86.8% households to move, with 46.9% living in an IDP camp. Lack of electricity increased from 18.8% to 32.9% (p = 0.000), lack of toilet facilities from 29.0% to 40.4% (p=0.000). Access to protected water remained unchanged (96.8%); however, the sources changed (p=0.000). 88.0% reported loss of income (90.0% rural, 75.0% urban, p=0.000) with rural households loosing significantly more and less likely to recovered. Immediate deaths and injuries were uncommon but 77.0% reported flood-related illnesses. Significant differences were noted between urban and rural as well as gender and education of the head of houshold.
Discussion: After 6 months, much of the population had not recovered their prior standard of living or access to services. Rural households were more commonly impacted and slower to recover. Targeting relief to high-risk populations including rural, female-headed and those with lower education is needed.

Citation: Kirsch TD, Wadhwani C, Sauer L, Doocy S, Catlett C. Impact of the 2010 Pakistan Floods on Rural and Urban Populations at Six Months. PLOS Currents Disasters. 2012 Aug 22. doi: 10.1371/4fdfb212d2432.