INTRODUCTION

The ways that individuals and communities are affected by humanitarian crises are the result of a matrix of determinants including various forms of inequality (O'Keefe 1976). These features create gradients of vulnerability – unequal susceptibility for incurring additional wrongs (Hurst 2008) – both within and between populations. Pre-existing inequalities are exacerbated in the context of catastrophes; disasters do not affect people equally and those that are already marginalised or disadvantaged (because of gender, ethnic, religious or socio-economic divides), in poor health or in precarious social situations, are likely to experience greater deprivation and harm. That vulnerability to catastrophe is determined by social, cultural and economic factors, and that catastrophes widen existing inequalities, is clear. It is less clear how these understandings should map on to programming and prioritisation for humanitarian medical assistance, and how questions of justice should be addressed by non-governmental organisations (NGOs) involved in the medical response to natural disasters in low resource settings.

In this paper, we argue that health vulnerabilities that exist in disaster-affected populations are, in part, the results of structural injustices pertaining to social and economic interactions as well as power relations between agents (both individual and collective) that can be observed at the domestic and international levels. These structural injustices are part of the context in which disaster response is carried out and contribute to how individuals and communities are affected by disaster.