Wednesday, January 13, 2010

Haiti & Disaster Aid

As we learn more about the massive earthquake in Port-au-Prince yesterday, it gives us the opportunity to look at the science behind a lot of the disaster aid that is going to happen over the next few days, weeks, and years. [The International Federation of Red Cross and Red Crescent Societies have the most on-the-ground experience, and are probably the best place for you to send money. And please, don't send t-shirts and old blankets.] Contrary to popular belief, there is a method behind all of the madness, and operations will be scaled up in a (hopefully) thoughtful and organized fashion, based on years of experience and publications. Unfortunately, we don't have the scientific rigor that other fields have, with their randomized trials and the like, but for a literature that, by its very nature, has to be spontaneous, the disaster response academic community is robust. A lot of it comes from the Katrina experience, and while things will be drastically different in Port-au-Prince because of the underlying infrastructure, there are definitely lessons to be applied.

The Sphere Project has been the guiding light for this formalization of a previously informal community, setting standards and codes for any humanitarian or disaster response. The seminal paper in the literature is from the CDC, published in the Lancet in 2002, where, retrospectively, and across various camps, they found exactly what you would expect. That refugee camps located close to the conflict or disruption, further from hospitals, or where there was less water, had higher mortality rates.

Nutrition is obviously crucial, and there are many review papers looking at the best way to feed a displaced, post-emergency population. The most thorough is this one, once again from the Lancet in 2004.

The dictum of epidemiologists (the ones that I know, anyway) is "don't just do something, stand there (and measure something)". No disaster response is effective without mapping out what you're responding to, and our modern satellite technology has changed how this is done. We all remember how Google Earth was used during the Katrina response, and the GIS (geographic information systems) technology has exponentially grown since then.

Lastly, shelter creation is one of the most important facets of disaster response. Here's a link to the USAID site on shelters and settlements, and some of the innovative things happening globally with creating that perfect new shelter, which must be cheap, weather-proof, easy to deploy and transport, culturally appropriate, and therefore, almost impossible to create.

SPIEGEL, P., SHEIK, M., GOTWAYCRAWFORD, C., & SALAMA, P. (2002). Health programmes and policies associated with decreased mortality in displaced people in postemergency phase camps: a retrospective study The Lancet, 360 (9349), 1927-1934 DOI: 10.1016/S0140-6736(02)11915-5

YOUNG, H., BORREL, A., HOLLAND, D., & SALAMA, P. (2004). Public nutrition in complex emergencies The Lancet, 364 (9448), 1899-1909 DOI: 10.1016/S0140-6736(04)17447-3

Nourbakhsh, I., Sargent, R., Wright, A., Cramer, K., McClendon, B., & Jones, M. (2006). Mapping disaster zones Nature, 439 (7078), 787-788 DOI: 10.1038/439787a

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