Needs assessment following hurricane Georges--Dominican Republic, 1998.
Hurricane Georges struck the Carribean Islands in September 1998, causing numerous deaths and extensive damage throughout the region. The Dominican Republic was hardest hit, with approximately 300 deaths; extensive infrastructure damage; and severe agricultural losses, including staple crops of rice, plantain, and cassava. Two months after the hurricane, the American Red Cross (ARC) was asked to provide food to an estimated 170,000 families affected by the storm throughout the country. To assist in directing relief efforts, CDC performed a needs assessment to estimate the food and water availability, sanitation, and medical needs of the hurricane-affected population. This report summarizes the results of that assessment, which indicate that, 2 months after the disaster, 40% of selected families had insufficient food > or =5 days per and 28% of families reported someone in need of medical attention. (+info)
Cost-effectiveness analysis of humanitarian relief interventions: visceral leishmaniasis treatment in the Sudan.
Spending by aid agencies on emergencies has quadrupled over the last decade, to over US$6 billion. To date, cost-effectiveness has seldom been considered in the prioritization and evaluation of emergency interventions. The sheer volume of resources spent on humanitarian aid and the chronicity of many humanitarian interventions call for more attention to be paid to the issue of 'value for money'. In this paper we present data from a major humanitarian crisis, an epidemic of visceral leishmaniasis (VL) in war-torn Sudan. The special circumstances provided us, in retrospect, with unusually accurate data on excess mortality, costs of the intervention and its effects, thus allowing us to express cost-effectiveness as the cost per Disability Adjusted Life Year (DALY) averted. The cost-effectiveness ratio, of US$18.40 per DALY (uncertainty range between US$13.53 and US$27.63), places the treatment of VL in Sudan among health interventions considered 'very good value for money' (interventions of less than US$25 per DALY). We discuss the usefulness of this analysis to the internal management of the VL programme, the procurement of funds for the programme, and more generally, to priority setting in humanitarian relief interventions. We feel that in evaluations of emergency interventions attempts could be made more often to perform cost-effectiveness analyses, including the use of DALYs, provided that the outcomes of these analyses are seen in the broad context of the emergency situation and its consequences on the affected population. This paper provides a first contribution to what is hoped to become an international database of cost-effectiveness studies of health interventions during relief operations, which use a comparable measure of health outcome such as the DALY. (+info)
Public health and complex emergencies: new issues, new conditions.
Public health practice in complex emergencies has become increasingly sophisticated and well informed over the course of the past quarter century. Humanitarian relief organizations have learned many lessons in the areas of food, water and sanitation, shelter, and primary health. However, closer scrutiny from the media and funding agencies, together with changing conditions and an increasingly insecure environment, will require that changes be made. First and foremost, nongovernmental organizations must recognize that an increasing proportion of morbidity and mortality is the consequence of widespread human rights abuses. These organizations should become more familiar with international human rights and humanitarian law, and their personnel should receive clear guidance as to how to recognize and report violations. At the same time, nongovernmental organizations will have to work more closely with military forces that have a very different organizational culture. In addition, as emergencies become more complex, nongovernmental organizations should do more to attract and retain seasoned professionals. Finally, advances in both technical and operational areas will occur only through carefully designed and implemented research. (+info)
The impact of economic sanctions on health and human rights in Haiti, 1991-1994.
OBJECTIVES: This report examines the impact of an economic embargo from 1991 to 1994 on health, well-being, and human rights in Haiti. METHODS: Data from surveillance systems for nutrition, reportable diseases, and hospital diagnoses were combined with survey data and interviews with affected women, governmental representatives, diplomats, and staff of nongovernmental organizations. RESULTS: Changes included declining income, rising unemployment, poorer nutrition, declining infant mortality, rising mortality among 1- to 4-year-olds, decreased attention to children's well-being and education, and family breakdown. Survival strategies among poor Haitians included changed dietary habits, informal-sector economic activity, moving in with relatives, selling domestic goods, increased informal unions among couples, decreased school attendance, and indentured servitude among children. CONCLUSIONS: The implementation of economic sanctions in Haiti resulted in extensive violations of rights; the impact was greatest on the most disadvantaged Haitians. Many Haitian and international supporters of democracy were unaware of the extensive negative impact that sanctions could have. The impact continues now, 5 years after sanctions ended. Modified policies reduced some of the burden of sanctions, and international assistance prevented what otherwise might have become a humanitarian disaster during sanctions. (+info)
Pharmaceutical donations by the USA: an assessment of relevance and time-to-expiry.
This paper assesses the relevance and time-to-expiry of pharmaceutical donations by the USA by means of a convenience sample of two private voluntary organizations. Data were collected on 16,566 donations shipped between 1994 and 1997 for the two organizations to a total of 129 countries. For three field study countries (Armenia, Haiti, and the United Republic of Tanzania), between 37% and 65% of donated unique drug products were on the recipient countries' essential drugs lists, and between 50% and 80% were either on these lists or were permissible therapeutic alternatives. Between 10% and 42% were not listed on either the national essential drugs lists or the WHO Model List of Essential Drugs, nor were they permissible therapeutic alternatives. For the worldwide data set, the median times to expiry when shipment by the organizations took place were 599 and 550 days; about 30% of shipment items had a year or less of shelf-life, and about 6% had less than 100 days of shelf-life. Although a majority of the donations fulfilled the criteria of relevance and time-to-expiry, a substantial proportion failed to do so. Actions are proposed with a view to improving the relevance and time-to-expiry of USA pharmaceutical donations. (+info)
Intervention of the Renal Disaster Relief Task Force in the 1999 Marmara, Turkey earthquake.
BACKGROUND: Major earthquakes are followed by a substantial number of crush syndromes and pigment-induced acute renal failures (ARFs). The natural evolution of this problem rapidly leads to death. Today's possibilities of dialysis therapy enable saving numerous lives that otherwise would be lost. Currently, the primary problem is organizational, if huge catastrophes occur and complex therapeutic options need to be offered to a large number of victims. METHODS: Following the 1988 Spitak earthquake in Armenia, the International Society of Nephrology (ISN) established the Renal Disaster Relief Task Force (RDRTF) in order to anticipate organizational problems related to renal care in the aftermath of large natural and human-made catastrophes. The proposed concept was one of a dialysis advance team, which would assess the needs and possibilities of dialysis treatment, to be followed by supportive manpower and supplies. This article describes the organizational aspects of a rescue action that was undertaken following the Marmara earthquake, which occurred on August 17th, 1999, in northwestern Turkey. In conjunction with Medecins Sans Frontieres, a team landed at Istanbul Airport less than 22 hours after the disaster, and logistic and material support as well as manpower were provided over a period of approximately one month. Specific attention was paid to the choice of the renal replacement therapy, the transport of victims and materials, the implementation of preventive rehydration, and the problem of chronic renal failure patients dialyzed in the damaged area. CONCLUSIONS: We demonstrate how previously anticipated international support may offer moral, financial, as well as logistical help to local nephrological communities confronted with serious disasters. (+info)
Medical relief operation in rural northern Ethiopia: addressing an ongoing disaster.
BACKGROUND: Following the recent drought in Ethiopia, the Jewish Agency, aided by the Israel Ministry of Foreign Affairs, launched a medical relief mission to a rural district in Ethiopia in May-August 2000. OBJECTIVES: To present the current medical needs and deficiencies in this representative region of Central Africa, to describe the mission's mode of operation, and to propose alternative operative modes. METHODS: We critically evaluate the current local needs and existing medical system, retrospectively analyze the mission's work and the patients' characteristics, and summarize a panel discussion of all participants and organizers regarding potential alternative operative modes. RESULTS: An ongoing medical disaster exists in Ethiopia, resulting from the burden of morbidity, an inadequate health budget, and insufficient medical personnel, facilities and supplies. The mission operated a mobile outreach clinic for 3 months, providing primary care to 2,500 patients at an estimated cost of $48 per patient. Frequent clinical diagnoses included gastrointestinal and respiratory tract infections, skin and ocular diseases (particularly trachoma), sexually transmitted diseases, AIDS, tuberculosis, intestinal parasitosis, malnutrition and malaria. CONCLUSIONS: This type of operation is feasible but its overall impact is marginal and temporary. Potential alternative models of providing medical support under such circumstances are outlined. (+info)
The World Trade Center attack. The paramedic response: an insider's view.
The World Trade Center attack and collapse is the first time an aircraft has been used as a weapon of mass effect. The scale and magnitude of this manmade disaster can only be compared with a natural catastrophe such as the Armenian earthquake of December 1988. The importance of an incident command system and the Simple Triage and Rapid Treatment, and the need for fixed Casualty Collection Points, is explained. (+info)