While the world was facing difficulties in managing the coronavirus disease (COVID-19) pandemic, many cities and countries suffered from floods during this period. Reference Hiroki1 Flooding during the COVID-19 pandemic, as a multi-hazard, challenged the resilience of communities and health systems as well as intensified the severity of health consequences of COVID-19. Reference Quigley, Attanayake, King and Prideaux2 A multi-hazard is a combination of 2 or more hazards from different sources happening randomly and simultaneously with a destructive force. Reference Hariri-Ardebili and Lall3 Due to flooding, the COVID-19 pandemic management Reference Hiroki1 and the flood-affected communities’ efforts to reduce the spread of the pandemic faced several challenges. Reference Ishiwatari, Koike and Hiroki4 Cyclone Harold in the Pacific countries (in April 2020), the flood of Manitoba and Ottawa in Canada (in August 2020), and the flood of Bangladesh (during June and July 2020) occurring at the same time as the COVID-19 pandemic are examples of such cases. Reference Hariri-Ardebili and Lall3–Reference Ashraf5 Floods and tornadoes in Bangladesh (at the end of May 2020) doubled the number of COVID-19 instances to more than 110 000. In addition, Cyclone Amphan killed 26 people and displaced 2.4 million people from their homes in Bangladesh, significantly increasing the COVID-19 cases among the cyclone-affected communities. Reference Begum, Dutta, Naznin and Okura6
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging respiratory virus responsible for the pandemic of the ongoing COVID-19. Reference Chadha, Khullar and Mittal7 This syndrome can lead to severe respiratory complications, such as acute respiratory distress syndrome, acute respiratory injury, and severe pneumonia in patients. Reference Al-Quteimat and Amer8 On the other hand, floods, as the most common natural disasters in the world, Reference Salvati, Petrucci and Rossi9–Reference Ibrahim, Zardari and Shirazi12 lead to infectious diseases among flood survivors and refugees, Reference Ivers and Ryan13 as well as increase the risk of chronic respiratory diseases and the death of chronic respiratory patients. In addition, the aggravation of non-communicable diseases due to public health problems and the spread of other communicable diseases after the flood can be mentioned. Reference Ryan, Franklin and Burkle14 Lim et al. stated that one of the problems of the refugees in the camps was the spread of respiratory diseases due to floods and tsunamis. Reference Llewellyn15 Upper respiratory infections are the most common infectious disease after floods, along with flu-like symptoms, Reference Alderman, Turner and Tong16 and severe pneumonia. Reference Ivers and Ryan13 Moreover, studies showed that the number of visits and admissions of patients due to respiratory diseases increased after floods. Reference Ryan, Franklin and Burkle14
Effectively managing floods alongside the challenges posed by the COVID-19 pandemic is a formidable task. The actions taken to control 1 crisis may inadvertently exacerbate other issues. Reference Ashraf5 Mishandling flood responses during the pandemic have the potential to accelerate the spread of the COVID-19 virus, leading to heightened consequences. Consequently, there is a risk of increased human fatalities and amplified societal damages. Reference Ashraf5 Moreover, emergency flood responses, such as evacuations, may encounter complexities due to COVID-19 measures like social distancing and isolation, hindering their implementation. Indeed, stringent COVID-19 regulations might render flood risk management responses insufficient to mitigate the overall damage adequately. Reference Turay17
The combined effects of the flood and the COVID-19 pandemic led to an increased chance of disease transmission in vulnerable populations. Reference Begum, Dutta, Naznin and Okura6 There are various reasons for increasing the risk of transmission of infectious diseases, including respiratory diseases after floods, such as severe damage to vital infrastructure, displacement of populations, injury and damage to water supply sources, and pollution of facilities and drinking water sources. Reference Alderman, Turner and Tong16 In addition, flood victims may be exposed to polluted water, crowded living conditions, and severe traumatic injuries. Residential areas’ heating and ventilation systems are also damaged or submerged in floods, becoming a health hazard and a means of transmitting microorganisms and increasing respiratory and pulmonary complications after floods. Reference Llewellyn15
Floods and tornadoes in Bangladesh led to the complete or partial destruction of 200 000 houses and intensified the socioeconomic and health effects caused by the COVID-19 pandemic in Bangladesh. Reference Begum, Dutta, Naznin and Okura6 Inadequate response to floods during the COVID-19 pandemic also increased the spread of COVID-19. Further, the coincidence of the flood and COVID-19 increased the economic and social conditions of the communities under significant pressure, Reference Ishiwatari, Koike and Hiroki4 which led to the loss of human lives and financial losses in the future. Reference Ishiwatari, Koike and Hiroki4 Therefore, it is necessary to adopt new approaches to reduce the health consequences, damages, and casualties caused by the coexistence of COVID-19 and floods. Moreover, appropriate and effective response systems should be developed to strengthen health care services in the multi-hazards context. International policies in line with sustainable development to reduce environmental risks require research on multi-hazards as a part of disaster management programs in disaster-prone areas. Reference Pourghasemi, Gayen and Panahi18 Therefore, in line with the aforementioned policies, this study will attempt to identify the scientific and practical strategies for managing the simultaneous flood and COVID-19 by systematically reviewing and synthesizing the recent evidence.
Research Objectives and Questions
This study aimed to investigate and categorize strategies for managing the health consequences of the simultaneous flood and COVID-19, and other emerging diseases, in order to provide a basis for managing and reducing the health consequences of multi-hazards. The review will try to answer the following questions:
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What are the strategies for managing the health consequences of multi-hazard, such as simultaneous floods and COVID-19?
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How has the management of health consequences been conducted of simultaneous disasters in communities affected by floods and COVID-19?
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What is the role of the health sector in different phases of multi-hazard management, such as flood and COVID-19, including prevention, preparedness, response, and recovery?
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What is the role of other responsible organizations and the affected community in different phases of multi-hazard management, such as flood and COVID-19, including prevention, preparedness, response, and recovery?
Materials and Methods
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines Reference Page, McKenzie and Bossuyt19 for the study and used the Mixed Method Appraisal Tool (MMAT) to assess the methodological quality of the eligible articles. Reference Hong, Pluye and Fàbregues20
Inclusion and Exclusion Criteria
The included studies and documents were articles and reports for managing health consequences caused by the coexistence of flood risk and COVID-19 or the coexistence of flood and other emerging diseases that were within the scope of the research question of this study. We reviewed the articles and documents published from January 1980. Studies that did not investigate these types of strategies and investigated other outcomes were excluded. Documents whose full text was unavailable and were published in non-academic publications were also excluded. In addition, studies published in other languages, except in English, were excluded from the study.
Databases and Search Strategies
This systematic review focused on the publications and documents related to strategies for managing the health consequences of simultaneous floods and COVID-19, and other emerging diseases worldwide. Several government, non-government, and academic electronic sources as well as several electronic databases, including Scopus, Web of Science, and PubMed, were searched for the relevant literature from January 1980 to June 11, 2021. Google Scholar articles were also searched manually. We also used the articles’ reference lists and the snowball method to find relevant studies.
We developed the search term using Medline indexing, Embase, and Medical Subject Headings (MESH) to identify as many articles as possible. The search syntax was written using keywords and synonyms that were searched in the title, abstract, or keyword sections of the databases. The keywords selected were the same as those used when searching websites and databases. The summarized form of the search strategy was as follows:
(*Flood*) AND (Health OR Disease) AND (COVID-19 OR Pandem* OR Emerging epidemics)
Study Selection
One researcher (AY) screened the titles and abstracts of the found articles to find related articles using end-note software. Then, 2 independent researchers (AY and MSB) reviewed the full text of the selected articles. In disagreements between the 2 researchers, the third researcher (MEM) resolved the issues and helped them make the best choices. Figure 1 shows the process of reviewing and selecting articles.
Figure 1. Flow diagram of the search and selection of papers.
Quality Appraisal
The quality of the finally included articles was evaluated using the Mixed Methods Appraisal Tool (MMAT), and the articles were classified into 3 groups: low, medium, and high. Reference Hong, Pluye and Fàbregues20 The articles in the low group were excluded from the study. The MMAT is reliable for appraising the methodological quality of quantitative, qualitative, and mixed-methods studies, including randomized controlled trials, nonrandomized trials, and descriptive quantitative studies. Reference Hong, Fàbregues and Bartlett21
Data Extraction and Analysis
The extracted data were recorded in 2 separate forms. The first form included the general characteristics of the article, such as the article’s authors, study location, study objectives, publication date, methodology, and type of article (Table 1). The second form was related to extracting categories and subcategories for classifying strategies and managing the health consequences of the simultaneous flood and COVID-19, as well as other emerging diseases in the world (Table 2). Then, descriptive and thematic analyses were performed for selected articles and texts. Thematic analysis is used as a systematic method for data analysis to identify, understand, analyze, and report topics in a set of related data. Reference Yari, Ostadtaghizadeh and Ardalan10 After extracting descriptive data, the authors coded the strategies for managing the health consequences of the simultaneous flood and COVID-19, and other emerging diseases worldwide. Then, similar codes were grouped, and the grouped findings were analyzed to categorize these solutions. The accuracy and completeness of the data extracted by the research team were discussed in a group.
Table 1. Descriptive analysis of included papers in the systematic review of health consequences management of multi-hazard, including flood and COVID-19
Table 2. Reviewed categories and subcategories of multi-hazard health management strategies and approaches
a Union Disaster Management Committee (UDMC).
Results
In total, 4271 articles and documents were identified through the initial literature search. After removing 631 duplicate articles, the remaining 3640 article titles and abstracts were screened. Then, the full text of 35 articles was reviewed after removing 3605 articles based on the inclusion and exclusion criteria. Finally,10 eligible studies were included in the research and analyzed. Figure 1 provides a quick overview of how the data were collected. The eligible articles were evaluated using the MMAT tool and classified as low, medium, and high methodological quality. Any study with serious methodological concerns and low quality was excluded (see Table 1).
Descriptive Analysis
Most of the included articles (9 out of 10) were related to areas that experienced flooding during the COVID-19 pandemic. Among them, 1.5 were related to the Asian continent, and 30% were related to the American continent. In addition, Indonesia had the highest number of studies (20%). Most studies (40%) examined the simultaneity of floods and COVID-19 and the measures taken by reviewing scientific literature. About 30% of the included studies were a report or a case report, which analyzed the actions taken and described the simultaneous events of the flood and COVID-19. A study also qualitatively analyzed the vulnerability and preparedness of society during the accompanying flood and COVID-19. The specifications of the included articles are shown in Table 1.
Thematic Analysis
In total, 9 categories, 25 subcategories, and 199 solutions were extracted from the 10 articles. Many solutions or strategies were mentioned commonly in all studies, such as planning, training, information, evaluation, quick evacuation, quick warning system, and coordination. For example, the planning solution and different types of programs were mentioned 26 times in the planning category, and the evacuation solution was mentioned 24 times as the most repeated solution in the reviewed articles. Some studies specifically mentioned the management and attraction of humanitarian and international aid. Reference Ivers and Ryan13 The flood insurance solution was mentioned only once in the reviewed studies. Reference Simonovic, Kundzewicz and Wright22 In addition, most solutions were related to the response operation category, with 51 consisting of 4 essential subcategories: warning, management and command, rescue and relief, and health response. The logistics category was in second place with 28 solutions and 5 subcategories. In the subcategory level, health sector management had the most solutions (19).
Discussion
To the best of the authors’ knowledge, this is the first systemic review that summarizes and classifies the strategies for managing the health consequences caused by the coexistence of flood and COVID-19. We found a comprehensive list of strategies by reviewing studies and the experiences of countries affected by flood and COVID-19, and other emerging diseases (Figure 2). Our study findings can be beneficial in designing response protocols and managing health consequences caused by multi-hazard risks, especially for floods and emerging diseases. In addition, the classification of solutions can be very effective in policy making and decision making, coordination, risk communication, and organizing the activities of communities affected by the simultaneous flood and pandemic. Moreover, we found several categorical strategies, such as the roles of the health department, other responsible organizations and bodies, and the affected society in different phases of crisis management, including the prevention, preparation, relief, and response phases, which are also valuable. All these strategies aimed to reduce the health consequences of the co-occurring or simultaneous flood and COVID-19 with other emerging diseases.
Figure 2. Multi-hazards health management conceptual framework.
Policy Making and Decision Making
Response and management policies for natural hazards and a pandemic are different. A pandemic requires implementing several management measures outside the routine activities of the crisis management cycle for other natural crises. Reference Ishiwatari, Koike and Hiroki4 Flood management during a pandemic, as a multi-hazard phenomenon, requires the application of new policies and approaches, Reference Laksmi, Rudiarto and Luqman23 including integrated policy Reference Hariri-Ardebili and Lall3 and multiple risk approach. Reference Simonovic, Kundzewicz and Wright22 The correlation between integrated disaster management and sustainable development will lead to a new development model, reducing the consequences of disasters and strengthening resilience. Reference Simonovic, Kundzewicz and Wright22 Moreover, maintaining human security by improving people’s capabilities and participation in crisis management and involving scientists in the fields of health, water, and disaster management in policy-making and decision-making processes will be very helpful. Reference Ishiwatari, Koike and Hiroki4 Therefore, it is recommended that approaches should be changed from reducing vulnerability to promoting resilience against disasters. Reference Simonovic, Kundzewicz and Wright22 Increasing leaders’ awareness of disaster risk reduction (DRR) measures during a pandemic, Reference Hariri-Ardebili and Lall3 using interdisciplinary knowledge and all related sciences to ensure social justice and equal access, Reference Hariri-Ardebili and Lall3 strengthening coordination mechanisms, Reference Fatemi and Moslehi24 global solidarity and cooperation between countries, Reference Hariri-Ardebili and Lall3 transparent hierarchical decision making, Reference Frausto-Martínez, Aguilar-Becerra and Colín-Olivares25 and correct prioritization Reference Ishiwatari, Koike and Hiroki4 should be considered in policy making to respond to these crises.
Coordination
Coordination is one of the key factors in health systems’ response to flood or multi-hazard. Reference Louw, Olanrewaju, Olanrewaju and Chitakira26 Successful crisis management requires coordination among local leaders, NGOs, politicians, and all related organizations, including health, to plan and manage the coexistence of disasters with COVID-19. Local communities and stakeholders should also be well-coordinated Reference Laksmi, Rudiarto and Luqman23 to increase access to health services to reduce the health consequences of this multi-hazard, which also requires coordination with local government and health facilities. Reference Begum, Dutta, Naznin and Okura6 These types of coordination are effective when coordination mechanisms, networks, and operating procedures are established before the crisis, Reference Begum, Dutta, Naznin and Okura6 services are coordinated, and people’s roles are evident during the problem. Reference Louw, Olanrewaju, Olanrewaju and Chitakira26
Risk Communication
Disaster risk assessment is one of the foundations of development and investment in societies. Further, preparing a disaster risk map of areas at risk is one of the main components of risk assessment during a pandemic. Reference Aji, Hayati and Benardi27 In this multi-hazard, a rapid health assessment, Reference Shortus, Musto and Bugoro28 and then establishing or activating the disease care system, Reference Louw, Olanrewaju, Olanrewaju and Chitakira26–Reference Shortus, Musto and Bugoro28 and collecting data from the care system Reference Shortus, Musto and Bugoro28 help reduce the resulting health consequences. Thus, it is essential to consider food security indicators, livelihood needs, and how COVID-19 affects them in community assessment, in addition to health assessments. Reference Begum, Dutta, Naznin and Okura6
Management and response to multi-hazard floods and COVID-19 require risk communication with scientific knowledge due to the limited knowledge about pandemics in societies. Reference Hariri-Ardebili and Lall3,Reference Ishiwatari, Koike and Hiroki4 Effective and transparent information sharing can prevent rumors and the spread of wrong information. Reference Ishiwatari, Koike and Hiroki4 Risk communication systems should have features that can save human lives, reduce consequences, and improve the level of preparedness when facing threats caused by disasters in multi-hazard situations. Providing quick and timely warnings to the whole society, using clear messages and understandable information, and conveying the message through authorized and famous institutions or media can be mentioned in this regard. Reference Aji, Hayati and Benardi27
In addition, preparing people for floods and promoting health awareness and prevention methods of disease transmission and pandemic growth significantly reduce the health consequences caused by the coexistence of floods and COVID-19. Reference Ishiwatari, Koike and Hiroki4 Getting help from local leaders for training, ensuring people have timely access to information, understanding the necessary measures for prevention, Reference Begum, Dutta, Naznin and Okura6 and making it possible for people to contact in emergencies are also recommended. Reference Laksmi, Rudiarto and Luqman23
Logistics
Ensuring logistics is crucial in a multiple-hazard situation, such as the supply of food and medical equipment. In some countries, a flood and COVID-19 multi-hazard led to the creation of obstacles and problems, such as reduced access and humanitarian aid due to supply chain interruption, food insecurity, lack of shelters, social distancing, and limited and unequal distribution. Reference Frausto-Martínez, Aguilar-Becerra and Colín-Olivares25 In addition, floods and storms during the pandemic had potential effects on the aggravation of the pandemic and the increase in disease cases. During simultaneous disasters, infrastructural and logistic preparation Reference Frausto-Martínez, Aguilar-Becerra and Colín-Olivares25 reduce health consequences caused by (1) providing equipment and technology to predict, diagnose and reduce disasters, and create the required human capacity Reference Louw, Olanrewaju, Olanrewaju and Chitakira26 ; (2) preparing quick warning and evacuation systems in the prevention phase Reference Frausto-Martínez, Aguilar-Becerra and Colín-Olivares25,Reference Aji, Hayati and Benardi27 ; (3) facilitating access to warning and messaging systems, such as using free meteorological warning applications with the ability to install on mobile phones Reference Laksmi, Rudiarto and Luqman23 ; (4) considering evacuation sites and emergency accommodation centers and camps based on risk assessment Reference Ishiwatari, Koike and Hiroki4 ; (5) applying health protocols in emergency accommodation sites Reference Ishiwatari, Koike and Hiroki4,Reference Frausto-Martínez, Aguilar-Becerra and Colín-Olivares25 ; and (6) providing medical equipment, pharmaceuticals, and sanitary items needed for the affected population. Reference Hariri-Ardebili and Lall3,Reference Fatemi and Moslehi24
A pandemic like COVID-19 increases communities’ needs in various aspects of health, such as medical, pharmaceutical, health equipment, livelihood, and financial markets. Reference Kaye, Okeagu and Pham29 When a pandemic coincides with a natural disaster such as a flood, the needs’ intensity affects the communities’ health. Reference Ishiwatari, Koike and Hiroki4 Thus, the correct distribution of resources based on prioritization Reference Ishiwatari, Koike and Hiroki4,Reference Louw, Olanrewaju, Olanrewaju and Chitakira26 potentially reduces the health consequences caused by a multi-generational disease. Furthermore, measures for preparing communities for natural hazards, such as flood insurance, disaster risk reduction (DRR) measures, Reference Frausto-Martínez, Aguilar-Becerra and Colín-Olivares25 disaster financial management, and meeting the financial needs of affected communities, Reference Hariri-Ardebili and Lall3,Reference Begum, Dutta, Naznin and Okura6,Reference Frausto-Martínez, Aguilar-Becerra and Colín-Olivares25,Reference Louw, Olanrewaju, Olanrewaju and Chitakira26 can reduce the economic consequences of those impacts.
Planning
The 2030 Agenda for Sustainable Development emphasizes planning for disaster risk reduction and recommends that disaster management planning processes be integrated into development planning. Therefore, a disaster management plan should include all phases of a disaster, including pre-disaster, disaster response, and post-disaster. Integrating disaster risk management (DRM) into planning processes, such as national development plans, may pose significant challenges for governments. Reference Bello, Bustamante and Pizarro30 On the other hand, COVID-19 has created new challenges because it differs from previous disasters in several ways. Global phenomena require global cooperation, and international organizations play an essential role in laying the groundwork for this cooperation. Reference Bello, Bustamante and Pizarro30 Therefore, planning is one of the basic steps in flood management. Raising public awareness; establishing communication, information, and warning systems; and creating evacuation infrastructure, equipment, and rescue facilities are some actions in flood preparedness plans. Reference Rehman, Sohaib, Asif and Pradhan31
In our systematic review, all measures to improve preparedness before the multi-hazard event were included in the category of preparedness programs. Developing a multi-hazard emergency management plan in the preparation phase with the following features can have a significant impact on multi-hazard management: (1) compilation of the national level plan as necessary, based on (2) the scenario of possible future events and consequences with a high probability of occurrence, with the possibility of (3) a quantitative assessment of resilience, equipped with (4) predictive scenarios for possible future consequences, and (5) ability to predict, check, and supply requirements. Reference Simonovic, Kundzewicz and Wright22 This plan should have different features, such as the response Reference Louw, Olanrewaju, Olanrewaju and Chitakira26 and operational strategy, especially in emergencies and the command structure, Reference Simonovic, Kundzewicz and Wright22 roles for all departments and organizations that are clear and specific, Reference Louw, Olanrewaju, Olanrewaju and Chitakira26 and participation and cooperation of all stakeholders. Reference Rehman, Sohaib, Asif and Pradhan31 Flexibility is one of the essential features of preparedness programs, given the complexity of multi-hazard situations. Reference Simonovic, Kundzewicz and Wright22,Reference Louw, Olanrewaju, Olanrewaju and Chitakira26
Health consequences, including deaths caused by natural disasters, are not due to the disaster’s direct and immediate impact but the disaster’s continuous and indirect effects, such as delays in medical care, health, and access. Moreover, the experiences of natural disasters and epidemics show the inadequate preparation and response of the health system. The frequency and severity of natural disasters are expected to increase in the coming years. Therefore, the health system should consider the response plan to strengthen preparedness and the appropriate response. Reference Balsari, Kiang and Buckee32 A comprehensive plan to respond to multi-hazard floods and pandemics should consider all aspects of multi-hazard response. A comprehensive response program to multi-hazards includes the following programs and sectors: (1) disaster response during the pandemic, Reference Laksmi, Rudiarto and Luqman23,Reference Aji, Hayati and Benardi27 (2) epidemic evacuation program and primary health care program in flood, Reference Louw, Olanrewaju, Olanrewaju and Chitakira26 (3) livelihood programs to integrate disaster and COVID-19 resilience, Reference Begum, Dutta, Naznin and Okura6 (4) disaster risk assessment program, Reference Aji, Hayati and Benardi27 and (5) operational and response protocols. Reference Frausto-Martínez, Aguilar-Becerra and Colín-Olivares25
The development of the multi-hazard flood and epidemic plan should also pay attention to other risk management measures, and the steps needed for additional risk management should be taken into account simultaneously. For example, there should be detailed guidelines for managing COVID-19 in the planning of disaster management like floods, Reference Begum, Dutta, Naznin and Okura6 or a guide for the prevention, preparation, and management of emergencies, such as floods should be developed in the response plan to COVID-19. Reference Frausto-Martínez, Aguilar-Becerra and Colín-Olivares25
Preparedness Measures
Improving the disaster preparedness of societies is one of the practical tools to deal with the risks and consequences of disasters. Reference Ma, Guo, Deng and Xu33 Preparedness is also essential to respond to multi-hazard floods and pandemics, and people should be ready through the development of operational plans and command structures, in addition to effective response and defense to disasters. Reference Simonovic, Kundzewicz and Wright22 Several measures should be taken to prepare communities for the combined risks of COVID-19 and floods, such as (1) building additional evacuation centers, (2) informing communities about how to prevent the transmission of COVID-19, (3) providing essential items such as hand soap, water, and hygiene kits at evacuation sites, Reference Begum, Dutta, Naznin and Okura6 (4) stocking essential drugs, Reference Laksmi, Rudiarto and Luqman23 and (5) conducting evacuation and rescue drills. Reference Hariri-Ardebili and Lall3 Additionally, multi-hazard management can benefit significantly from organizational preparation in responsible and accountable organizations. Thus, a list of experienced people and organizations should be available to call them if needed. Reference Laksmi, Rudiarto and Luqman23
Response Operation
Most of the articles and studies were devoted to investigating response activities. Generally, the activities of the response phase can be divided into 3 stages: (1) early warning and warning, (2) response and management of disasters, and (3) rescue and relief activities. Reference Ajay34 Therefore, a proper warning system is necessary to respond to floods or other natural disasters during a pandemic. Reference Aji, Hayati and Benardi27 An early warning system is effective when it can give organizations and communities enough time to prepare for a disaster. Reference Ajay34
Effective management of a multi-hazard requires the timely implementation of emergency measures and several strategic interventions. Reference Shortus, Musto and Bugoro28 Implementation of preventive strategies and measures to protect areas affected by water-related disasters should prevent them from becoming new epidemic foci. Reference Hariri-Ardebili and Lall3 Outbreaks and new epidemics should be identified and controlled in a timely manner. Reference Louw, Olanrewaju, Olanrewaju and Chitakira26 In addition, the following issues should be considered in this phase to ensure proper multi-hazard management: (1) damages caused by calamities, Reference Louw, Olanrewaju, Olanrewaju and Chitakira26 (2) geographical location and affected area, Reference Hariri-Ardebili and Lall3 (3) deploying forces, including scientists Reference Ishiwatari, Koike and Hiroki4 and all stakeholders, Reference Louw, Olanrewaju, Olanrewaju and Chitakira26 (4) necessary equipment, Reference Louw, Olanrewaju, Olanrewaju and Chitakira26 (5) evacuation centers Reference Ishiwatari, Koike and Hiroki4 and disaster management staff, Reference Hariri-Ardebili and Lall3 (6) availability and quality of the services, Reference Louw, Olanrewaju, Olanrewaju and Chitakira26 and (7) effectiveness of the operations. Reference Shortus, Musto and Bugoro28
Relief and rescue operation is one of the main stages of the disaster response phase, Reference Ciottone, Biddinger and Darling35 whose task is to quickly investigate and search the area affected by disasters and rescue victims. Reference Becker, Blatt and Szczerbicka36 To carry out rescue operations, access to areas affected by disasters is necessary. Reference Louw, Olanrewaju, Olanrewaju and Chitakira26 In a multi-hazard context, dealing with flood-affected people with a team is also required to defend and adequately respond to floods and prevent the spread of the pandemic. Reference Ishiwatari, Koike and Hiroki4 Thus, the following are suggested to protect human lives at this stage: protecting evacuees or people housed in evacuation centers against the threat of COVID-19, Reference Hariri-Ardebili and Lall3 saving patients with COVID-19 against the threat of flood, Reference Ishiwatari, Koike and Hiroki4 preserving rescue workers during defense against flooding principles, and observing the principles of protection against the pandemic and COVID-19 restrictions, such as social distance. Reference Ishiwatari, Koike and Hiroki4,Reference Laksmi, Rudiarto and Luqman23
The health department’s response is also critical in the case of multiple hazards. Timely health measures, compliance with the correct health protocols, Reference Frausto-Martínez, Aguilar-Becerra and Colín-Olivares25 and raising health awareness in the affected area Reference Ishiwatari, Koike and Hiroki4 can prevent the spread of the pandemic in the flood-affected areas and reduce multi-hazard health consequences. Some of these measures that health teams should take are: activating community health brigades, Reference Frausto-Martínez, Aguilar-Becerra and Colín-Olivares25 monitoring the health of the community Reference Hariri-Ardebili and Lall3 when declaring an emergency, providing health and wellness services, especially in rural areas, Reference Louw, Olanrewaju, Olanrewaju and Chitakira26 increasing flood disaster management measures in health care facilities where people are sick or infected with COVID-19, Reference Ishiwatari, Koike and Hiroki4 using properly designed toilets to prevent contamination of underground water sources, controlling critical points for managing waste infected with the COVID-19 virus in medical centers or field hospitals, early diagnosing COVID-19 patients in the displaced population, isolating sick people by establishing a care system in emergency camps and temporary accommodations, Reference Fatemi and Moslehi24 providing clean water Reference Hariri-Ardebili and Lall3 and sanitary items, Reference Frausto-Martínez, Aguilar-Becerra and Colín-Olivares25 individual health and social health sustainably during and after the flood disaster, Reference Hariri-Ardebili and Lall3 preparing health system service providers such as nurses and knowledgeable doctors, Reference Frausto-Martínez, Aguilar-Becerra and Colín-Olivares25 and providing counseling and psychological support to flood victims, especially families who have lost members to COVID-19. Reference Fatemi and Moslehi24
Additionally, the flood victims should cooperate with the health management teams to prevent the spread of pandemics and reduce the health consequences of the flood Reference Laksmi, Rudiarto and Luqman23 and maintain the following activities: maintaining social distance Reference Laksmi, Rudiarto and Luqman23 during the process of evacuation from areas at risk and in temporary residences, Reference Frausto-Martínez, Aguilar-Becerra and Colín-Olivares25 avoiding crowding in evacuation centers and staying at home, if possible, Reference Ishiwatari, Koike and Hiroki4 wearing a mask, Reference Hariri-Ardebili and Lall3,Reference Fatemi and Moslehi24 especially during evacuation or in evacuation centers, Reference Laksmi, Rudiarto and Luqman23 cleaning and implementing disinfection protocols, Reference Hariri-Ardebili and Lall3,Reference Laksmi, Rudiarto and Luqman23 decontaminating surfaces with water and detergents, Reference Fatemi and Moslehi24 and not using the food contaminated with floods, even canned food. Reference Laksmi, Rudiarto and Luqman23
Social and Humanitarian Support
Despite travel and movement restrictions during the pandemic, multi-hazard management requires humanitarian assistance and international support even in the worst-case scenario. Reference Ishiwatari, Koike and Hiroki4 Therefore, restrictions on shipments of international aid should be minimized. In addition, to prevent the spread of the COVID-19 pandemic, the disinfection of shipments should be considered. Reference Laksmi, Rudiarto and Luqman23 Moreover, vulnerable groups, that is, older adults and informal immigrants with limited access to health services and WASH facilities, including waste management, should be given special attention Reference Ishiwatari, Koike and Hiroki4 by providing them with food and monetary support, Reference Begum, Dutta, Naznin and Okura6 arranging special places for the older adults and those with a disability, and protecting human rights. Reference Laksmi, Rudiarto and Luqman23
Local Communities and NGOs
Since, during the COVID-19 pandemic, floods occurred in many countries, timely foreign support cannot be expected as it was in the pre-COVID-19 period. Therefore, local organizations’ and communities’ capacity and participation should be increased to manage multi-hazard situations. Reference Ishiwatari, Koike and Hiroki4 The roles of volunteers in helping COVID-19 patients, Reference Aji, Hayati and Benardi27 supplying clean water, and rebuilding houses affected by floods Reference Ishiwatari, Koike and Hiroki4,Reference Laksmi, Rudiarto and Luqman23 can be very effective in multi-hazard management. Financial and personnel support of local communities and union disaster management committees (UDMCs) is necessary to strengthen and increase the capacity of local communities. Reference Begum, Dutta, Naznin and Okura6
Conclusion
This systematic study examined strategies for managing the health consequences of co-occurring flood and COVID-19, as well as other emerging diseases. Managing a multi-hazard and reducing the health consequences require a wide range of actions, including policy and decision making, coordination, risk communication, logistics, planning, preparedness, response, and social and humanitarian support. Activities should not aggravate the consequences of health and life caused by COVID-19 and should prevent the further spread of COVID-19 in flooded areas while managing the flood disaster and protecting the affected people’s health and livelihoods.
Based on the findings of this study, no study has examined the views and attitudes of the health system people involved in managing and responding to this multi-hazard. In addition, no protocol or program has been designed for this purpose. Therefore, fundamental studies are needed to evaluate the viewpoint of officials and experts in health systems, designing protocols, and methods of responding to multi-hazards. In addition, attention should be paid to the health recovery of communities affected by floods during the COVID-19 pandemic.
Supplementary material
To view supplementary material for this article, please visit https://doi.org/10.1017/dmp.2024.46
Acknowledgments
The authors appreciate the executive and financial support of the Kurdistan University of Medical Sciences and Disaster Risk Management Office in the Ministry of Health, respectively.
Author contributions
AY and HYK developed the idea and design for this protocol. AY wrote the first draft of the manuscript and developed the search strategy and methodology. MKH, MSB, and MEM critically revised this manuscript. All the authors critically revised the methodology and approved the final version of the manuscript. AY and MSB performed the study selection and data extraction. MEM and MKH supervised the study. All authors have read and agreed to the published version of the manuscript.
Funding statement
This study was funded by the Disaster Risk Management Office in the Ministry of Health, Iran.
Competing interests
The authors declare that they have no competing interests.
Ethical standards
This study has obtained the approval of Kurdistan University of Medical Sciences’ Institutional Review Board (IRB). The IRB follows the stipulated clauses of the Helsinki Declaration. The Ethics Committee of Kurdistan University of Medical Sciences approved this study, and the Ethical Approval Number “IR.MUK.REC.1399.204” was obtained. This committee follows the required principles of the Helsinki Declaration.
