The provision and continuation of the basic needs of affected communities, including water, food, and shelter remain the most important priorities in responding to disasters. In this regard, this study sought to investigate the management challenges of humanitarian hygiene items in recent disasters in Iran.

This qualitative study was conducted through a semi-structured interview. Nineteen participants with different experiences, roles, and responsibilities in the recent disaster of Iran and experiences of various events in the national and international arenas were included in the study. A thematic analysis was used, and an initial conceptual framework was defined based on the study aim. The relationship between the components was compared and interpreted in this framework and the main and subthemes were extracted accordingly.

Six main themes and 21 subthemes were extracted based on the results. The main challenges in recent disasters were the lack of protocols and standard guidelines, inappropriate selection of items in each hygiene kit, the lack of standard distribution of hygiene kits, and the lack of attention to the affected population’s culture.

Overall, it is necessary to define a system for preparation, supply, storage, and timely distribution of hygiene. Finally, it is suggested that an organization should be appointed for this purpose.

Cultural awareness is an important part of organizational success when interacting with multiple cultures. Research has shown a dearth of standardized cultural awareness training programs for non-governmental humanitarian organization staff.

This study aims to develop an expert-consensus set of cultural awareness competencies as the basis for development of humanitarian staff cultural awareness trainings.

A modified Delphi process was selected. The first round of surveys collected a list of cultural awareness competencies from experts in the fields of non-governmental organization (NGO) operations and cultural awareness education and research. This collated list of competencies was then used as the basis of a survey obtaining ratings by the group on a five-point Likert scale. Competencies which achieved an average rating of 4.0 or higher were considered to be “important” for inclusion in future training programs.

A total of 67.9% of contacted experts agreed to participate, with 84.2% of those completing all rounds of the survey. This group developed a list of ten competencies, including: Cultural Awareness/Sensitivity and Intercultural Communication; Cultural Intelligence; Unconscious Bias/Diversity Awareness; a Universal Declaration of Ethical Principles; Gender and Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual Identities (LGBTQ+) Issues and Safety; Analytical and Critical Thinking Skills; Negotiation; Program Mission; Power Dynamics; and Empathy.

This study defined a set of ten expert-consensus cultural awareness competencies which can be a basis for future NGO staff training. Future work can both use these competencies to create educational programs and further define and expand the set of competencies based on analyses of their implementation.

Cultural awareness can be defined as an understanding of the differences that exist between cultures. This understanding is a crucial first step towards the development of cultural sensitivity, a willingness to accept those differences as having equal merit, and becoming operationally effective when working within different cultures. The benefits of cultural awareness have become apparent in recent decades, including within governments, militaries, and corporations. Many organizations have developed cultural awareness training for their staffs to improve cross-cultural cooperation. However, there has not been a large movement toward cultural sensitivity training among non-governmental organizations (NGOs) who provide aid globally, across a number of countries and cultures. Cultural awareness can be a useful tool which enables an NGO to better serve the populations with which they engage.

The goal of this study was to evaluate the presence of cultural awareness training for employees and volunteers working within international NGOs.

Ten of the largest international NGOs were identified. Their websites were evaluated for any mention of training in cultural awareness available to their employees and volunteers. All ten were then contacted via their public email addresses to find out if they provide any form of cultural awareness training.

Of the ten NGOs identified, none had any publicly available cultural awareness training on their websites. One NGO dealt with cultural awareness by only hiring local staff, who were already a part of the prevalent culture of the area. None of the others who responded provided any cultural awareness training.

Cultural awareness is a vital tool when working internationally. Large NGOs, which operate in a wide-range of cultures, have an obligation to act in a culturally aware and accepting manner. Most large NGOs currently lack a systematic, robust cultural awareness training for their employees and volunteers.

In recent years, several high-profile attacks on hospitals providing medical aid in conflict settings have raised international concern. The International Humanitarian Law prohibits the deliberate targeting of health care settings. Violation of this law is considered a war crime and impacts both those delivering and receiving medical aid.

While it has been demonstrated that both aid workers and health care settings are increasingly being targeted, little is known about the trends and characteristics of security incidents involving aid workers in health care compared to non-health care settings.

Data from the publicly available Aid Worker Security Database (AWSD) containing security incidents involving humanitarian aid workers world-wide were used in this study. The security incidents occurring from January 1, 1997 through December 31, 2016 were classified by two independent reviewers as having occurred in health care and non-health care settings, and those in health care settings were further classified into five categories (hospital, health clinic, mobile clinic, ambulance, and vaccination visit) for the analysis. A stratified descriptive analysis, χ2 Goodness of Fit test, and Cochran-Armitage test for trend were used to examine and compare security incidents occurring in health care and non-health care settings.

Among the 2,139 security incidents involving 4,112 aid workers listed in the AWSD during the study period, 74 and 2,065 incidents were in health care settings and non-health care settings, respectively. There was a nine-fold increase from five to 45 incidents in health care settings (χ2 = 56.27; P < .001), and a five-fold increase from 159 to 852 incidents in non-health care settings (χ2 = 591.55; P < .001), from Period 1 (1997-2001) to Period 4 (2012-2016). Of the 74 incidents in health care settings, 23 (31.1%) occurred in ambulances, 15 (20.3%) in hospitals, 13 (17.6%) in health clinics, 13 (17.6%) during vaccination visits, and six (8.1%) in mobile clinics. Bombings were the most common means of attack in hospitals (N = 9; 60.0%), followed by gun attacks (N = 3; 20.0%). In health care settings, 184 (95.3%) were national staff and nine (4.7%) were international staff.

Security threats are a growing occupational health hazard for aid workers, especially those working in health care settings. There is a need for high-quality data from the field to better monitor the rapidly changing security situation and improve counter-strategies so aid workers can serve those in need without having to sacrifice their lives.

While the concept of community resilience is gaining traction, the role of spontaneous volunteers during the initial response to disasters remains controversial. In an attempt to resolve some of the debate, investigators examined the activities of a spontaneous volunteer group called Nafeer after the Sudan floods around the city of Khartoum in August of 2013.

Can spontaneous volunteers successfully initiate, coordinate, and deliver sustained assistance immediately after a disaster?

This retrospective, descriptive case study involved: (1) interviews with Nafeer members that participated in the disaster response to the Khartoum floods; (2) examination of documents generated during the event; and (3) subsequent benchmarking of their efforts with the Sphere Handbook. Members who agreed to participate were requested to provide all documents in their possession relating to Nafeer. The response by Nafeer was then benchmarked to the Sphere Handbook’s six core standards, as well as the 11 minimum standards in essential health services.

A total of 11 individuals were interviewed (six from leadership and five from active members). Nafeer’s activities included: food provision; delivery of basic health care; environmental sanitation campaigns; efforts to raise awareness; and construction and strengthening of flood barricades. Its use of electronic platforms and social media to collect data and coordinate the organization’s response was effective. Nafeer adopted a flat-management structure, dividing itself into 14 committees. A Coordination Committee was in charge of liaising between all committees. The Health and Sanitation Committee supervised two health days which included mobile medical and dentistry clinics supported by a mobile laboratory and pharmacy. The Engineering Committee managed to construct and maintain flood barricades. Nafeer used crowd-sourcing to fund its activities, receiving donations locally and internationally using supporters outside Sudan. Nafeer completely fulfilled three of Sphere’s core standards and partially fulfilled the other three, but none of the essential health services standards were fulfilled. Even though the Sphere Handbook was chosen as the best available “gold standard” to benchmark Nafeer’s efforts, it showed significant limitations in effectively measuring this group.

It appears that independent spontaneous volunteer initiatives, like Nafeer, potentially can improve community resilience and play a significant role in the humanitarian response. Such organizations should be the subject of increased research activity. Relevant bodies should consider issuing separate guidelines supporting spontaneous volunteer organizations.

AlbahariA, SchultzCH. A Qualitative Analysis of the Spontaneous Volunteer Response to the 2013 Sudan Floods: Changing the Paradigm. Prehosp Disaster Med. 2017;32(3):240–248.

United States foreign policy is tied extensively to health initiatives, many related to the use of military assets. Despite substantial resource investment by the US Department of Defense (DoD) in hospital ship humanitarian assistance and disaster response missions, the impact of this investment is unclear.

A systematic literature review of both peer-reviewed and grey literature using eight databases representing the international community and multiple sectors was conducted. Data on the characteristics of missions directly related to US Navy hospital ship humanitarian assistance and disaster response from 2004-2012 were extracted and documented.

Of the 1445 sources reviewed, a total of 43 publications met criteria for review. Six (13.9%) met empirical documentation criteria and 37 (86.0%) were considered nonempirical expert opinions and anecdotal accounts that were primarily descriptive in nature. Overall, disaster response accounted for 67.4% (29/43) and humanitarian assistance 25.6% (11/43). Public and private sector participants produced 79.0% (34/43) and 20.9% (9/43) of the publications respectively. Of private sector publications, 88.9% (8/9) focused on disaster response compared to 61.8% (21/34) from the public sector. Of all publications meeting inclusion criteria, 81.4% (35/43) focused on medical care, 9.3% (4/43) discussed partnerships, 4.7% (2/43) training, and 4.7% (2/43) medical ethics and strategic utilization. No primary author publications from the diplomatic, development, or participating host nations were identified. One (2.3%) of the 43 publications was from a partner nation participant.

Without rigorous research methods yielding valid and reliable data-based information pertaining to Navy hospital ship mission impact, policy makers are left with anecdotal reports to influence their decision-making processes. This is inadequate considering the frequency of hospital ship deployments used as a foreign policy tool and the considerable funding that is involved in each mission. Future research efforts should study empirically the short- and long-term impacts of hospital ship missions in building regional and civil-military partnerships while meeting the humanitarian and disaster response needs of host nation populations.

LicinaD. Hospital Ships Adrift? Part 1: A Systematic Literature Review Characterizing US Navy Hospital Ship Humanitarian and Disaster Response, 2004-2012. Prehosp Disaster Med.2013;28(3):1–10..

Increasing attention is being focused on the needs of vulnerable populations during humanitarian emergency response. Vulnerable populations are those groups with increased susceptibility to poor health outcomes rendering them disproportionately affected by the event. This discussion focuses on women's health needs during the disaster relief effort after the 2010 earthquake in Haiti.

The Emergency Department (ED) of the temporary mobile encampment in L'Hôpital de l'Université d'Etat d'Haïti (HUEH) was the site of the team's disaster relief mission. In February 2010, most of the hospital was staffed by foreign physicians and nurses, with a high turnover rate. Although integration with local Haitian staff was encouraged, implementation of this practice was variable. Common presentations in the ED included infectious diseases, traumatic injuries, chronic disease exacerbations, and follow-up care of post-earthquake injuries and infections. Women-specific complaints included vaginal infections, breast pain or masses, and pregnancy-related concerns or complications. Women were also targets of gender-based violence.

Recent disasters in Haiti, Pakistan, and elsewhere have challenged the international health community to provide gender-balanced health care in suboptimal environments. Much room for improvement remains. Although the assessment team was gender-balanced, improved incorporation of Haitian personnel may have enhanced patient trust, and improved cultural sensitivity and communication. Camp geography should foster both patient privacy and security during sensitive examinations. This could have been improved upon by geographically separating men's and women's treatment areas and using a barrier screen to generate a more private examination environment. Women's health supplies must include an appropriate exam table, emergency obstetrical and midwifery supplies, urine dipsticks, and sanitary and reproductive health supplies. A referral system must be established for patients requiring a higher level of care. Lastly, improved inter-organization communication and promotion of resource pooling may improve treatment access and quality for select gender-based interventions.

Simple, inexpensive modifications to disaster relief health care settings can dramatically reduce barriers to care for vulnerable populations.

BloemCM, MillerAC. Disasters and Women's Health: Reflections from the 2010 Earthquake in Haiti. Prehosp Disaster Med.2013;28(2):1-5.

Expatriate healthcare professionals frequently participate in international relief operations that are initiated in response to disasters due to natural hazards or humanitarian emergencies in low resource settings. This practice environment is significantly different from the healthcare delivery environment in the home countries of expatriate healthcare professionals. Human rights, public health, medicine, and ethics intersect in distinct ways as healthcare professionals provide care and services in communities affected by crisis.

The purpose of this study was to explore the moral experience of Canadian healthcare professionals during humanitarian relief work.

This is a qualitative study with 18 semi-structured individual interviews based on Interpretive Description methodology. There are two groups of participants: (1) 15 healthcare professionals (nine doctors, five nurses, and one midwife) with more than three months experience in humanitarian work; and (2) three individuals who have experience as human resource or field coordination officers for humanitarian, non-governmental organizations. Participants were recruited by contacting non-governmental organizations, advertisement at the global health interest group of a national medical society, word of mouth, and a snowball sampling approach in which participants identified healthcare professionals with experience practicing in humanitarian settings who might be interested in the research.

Five central themes were identified during the analysis: (1) examination of motivations and expectations; (2) the relational nature of humanitarian work; (3) attending to steep power imbalances; (4) acknowledging and confronting the limits of what is possible in a particular setting; and (5) recognition of how organizational forms and structures shape everyday moral experience.

Humanitarian relief work is a morally complex activity. Healthcare professionals who participate in humanitarian relief activities, or who are contemplating embarking on a humanitarian project, will benefit from carefully considering the moral dimensions of this work. Humanitarian organizations should address the moral experiences of healthcare professionals in staff recruitment, as they implement training prior to departure, and in supporting healthcare professionals in the field.

While the number of humanitarian health workers has grown considerably along with the emphasis on evidence-based humanitarian practice over the last 15 years, no organization exists to ensure ongoing professionalization of this area of expertise.

To determine whether and to what degree the community of humanitarian health workers self-identify as a professional group; whether a need for a professional society exists to support such a group; and if so, what fundamental elements and activities should it encompass and provide.

A humanitarian, listserv-based survey was undertaken to evaluate humanitarian professional self-identification, needs for and interest in professional support functions, and priorities toward developing a professional organization to provide needed services.

The resulting respondent population represented a broad distribution of age and experience with education and experience being equally important factors in defining humanitarian health professionals. Respondents viewed themselves as humanitarian professionals nearly to the extent they viewed themselves as health-specific technical experts who happen to work in humanitarian assistance; they expressed a strong desire to establish a professional society reflecting that self-identification; and that body should focus on activities of education and training, networking and dialogue, and developing and refining core competencies to support best practices.

Humanitarian health workers self-identify as professionals in humanitarian assistance and as technical experts. A professional organization with specific support functions would be of interest to many humanitarian health professionals.

Humanitarian agencies in North Korea operate within a complex sociopolitical environment historically characterized by a baseline of mistrust. As a result of operating within such a heated environment, health sector collaborations between such agencies and the North Korean government have followed unpredictable courses.

The factors that have contributed to successful programmatic collaborations, as perceived by United States non-governmental organizations (NGOs) and North Korean officials were investigated.

A qualitative, multi-case, comparative, research design using semistructured interviews was used. Expert North Korean informants were interviewed to generate a list of factors contributing to programmatic success, defined as fulfilling mutually established objectives through collaboration. The North Korean informants were asked to identify US NGOs that fulfill these criteria (“mission-compatible NGOs”). Representatives from all of the missioncompatible NGOs were interviewed. All informants provided their perspectives on the factors that contributed to successful programmatic collaborations. The interviews were recorded, transcribed, and analyzed for thematic content.

North Korean informants identified six mission-compatible US NGOs. The North Korean and US NGO informants provided a number of factors that contributed to successful programs.These factors were grouped into the following themes: (1) responsiveness to North Korean requests; (2) resident status; (3) program monitoring; (4) sincerity (apolitical objectives); (5) information gathering; and (6) interagency collaboration.

Some US NGOs have devised innovative measures to work within a unique set of parameters in North Korea. Both US NGOs and North Korean authorities have made significant concessions to maintain their programmatic partnerships. In this manner, seasoned collaborators have employed creative strategies and a form of health diplomacy to facilitate programmatic success in North Korea by building trust within a complex sociopolitical space.