what really happens when disaster strikes? the truth about aid/file/alee... · the evidence gaps...

What Really Happens When Disaster Strikes? The Truth About Aid

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Dr Andrew Lee Senior Clinical University Tutor in Public Health The School of Health and Related Research

Outline

• Introduction

• What happens in disasters

• Overview of international humanitarian aid

• Issues & challenges

10/06/2014 © The University of Sheffield

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Afghanistan

2003/04

Sri Lanka 2004/05

Zimbabwe 2010

Philippines 2013

What is a disaster?

Disasters timeline • Earthquake in Egypt-Syria: 1.1 million deaths 1201

• Shaanzi earthquake (China): 830,000 deaths 1556

• Calcutta typhoon: 300,000 deaths 1737

• Tamboro eruption, Indonesia: 80,000 deaths 1815

• Influenza epidemic: 20 million deaths 1917

• Yangtze flood: 3 million deaths 1931

• Famine in Russia: 5 million deaths 1932

• Tangshan earthquake: 655,000 deaths 1976

• Indian Ocean tsunami: 228,000 deaths 2004

• Haiti earthquake: 316,000 deaths? 2010

Disaster trends

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What happens in a disaster?

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Source: E Fewster (2013)

Source: E Fewster (2013)

Welcome to the circus!

Battle of Solferino, 1859 Source: Wikimedia

Who responds to disasters and why?

Paspul, Badakhshan

Volunteers, bystanders, the curious, wannabee heroes…

Volunteer professionals, specialists…

The military and career professionals…

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Who?

Individuals

Local community

Govt

Military NGOs

UN agencies

Int’l Org.

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Who?

Individuals

Local community

Govt

Military NGOs

UN agencies

Int’l Org.

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MSF UK: £33.5m in 2013

In more than 60 countries

£228.4m in 2009

In 23 countries

McDonald’s

Where does the money come from?

Source: Global Humanitarian Assistance Report 2013

2.7 3.5 4.1 3.4 6.3 5.7 5.0

9.3 9.2

12.8 12.6

13.8 13.8 12.9

0.0

5.0

10.0

15.0

20.0

25.0

2006 2007 2008 2009 2010 2011 2012

US$

bill

ion

s

Global Humanitarian Assistance, 2006-2012

Private contributions Governments

Top donors of humanitarian aid, 2012

Donor Amount (US$m) Share of aid Aid per citizen

US 3805 29.4% $12

EU Institutions 1880 14.5% n/a

UK 1167 9.0% $18

Turkey 1039 8.0% $14

Sweden 784 6.1% $82

Germany 757 5.9% $9

Japan 606 4.7% $5

Canada 521 4.0% $15

Norway 509 3.9% $101

Australia 442 3.4% $19

2000 2001 2002 2003 2004 2012

Funds appealed for (US$billion)

1.9 2.6 4.4 5.2 3.4 3.3

Proportion of appeal not met

41% 45% 24% 24% 40% 37%

Image source: Microsoft clipart

Crisis Amount pledged

Amount delivered

Cambodian war rehabilitation

$880m by June 1992 $460m by 1995

Rwandan Genocide

$707m by Jan 1995 <$71m by July 1995

Hurricane Mitch $9bn in 1998 <$4.5bn by Dec 2004

Bam earthquake $1bn in Jan 2004 $116m by Dec 2004

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Image source: Microsoft clipart

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Aid: bane or boon?

Politicisation of aid?

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Unintended consequences

Unmet needs & expectations

Equity and transparency issues

Effect on pre-existing community tensions

Effect on war economy?

Issues

TEC Synthesis Report 2007

“communities felt that organisations were not accountable”

“inadequate consultation with intended beneficiaries”

“lack of contextual knowledge among agencies”

“obsession with ‘upward’ accountability to donors, the media and the public in donor countries”

“international response undermined local ownership”

Accountability deficit

Donor

NGO

Local people

Host country

He who pays the piper calls the tune

How can aid be more accountable?

“Dignity is a human need as much as food, shelter or clothing”

“Profound need to put people’s priorities at the heart of any

future disaster response”

Resilience vs.

Vulnerability

So aid is imperfect…

The evidence gaps for health emergency planning in the UK

“Patchy, Personality-driven & Impoverished”

Andrew CK Lee,1 Kirsty Challen,1,2 Paolo Gardois,1 Kevin Mackway-Jones,3

Simon Carley,3 Wendy Phillips,4 Andrew Booth,1 Darren Walter2 and Steve Goodacre1

1 School of Health and Related Research, University of Sheffield 2 Academic Department of Emergency Medicine and Planning, University Hospital of South Manchester. 3 Centre for Effective Emergency Care, Manchester Metropolitan University 4 South Yorkshire Health Protection Unit, Health Protection Agency.

KNOWLEDGE REVIEW

AND REVISION

Valuing knowledge

KNOWLEDGE DISTRIBUTION

Transfer and transaction

of knowledge

KNOWLEDGE ADOPTION

Translating and

retaining knowledge

KNOWLEDGE CREATION

Acquiring knowledge

“It’s very difficult…you can’t do a randomised control trial. You can’t compare because every

situation is very different.”

“Well a lot of (emergency planners and managers) don’t

see the relevance (of evidence) or how it can be done.”

(We need to) develop that mechanism for knowledge exchange … It’s getting the

knowledge out there about what happens, why it happens…

“… these settings are so far and few between and therefore lessons learnt are often forgotten until the next time ...”

• Social and behavioural science gaps

INDIVIDUAL & ORGANISATIONAL BEHAVIOUR

How will people react?

How are decisions made?

Issues of power & locus of control

Muddling through … relying on past experience and

intuition rather than the evidence base

Culture clashes

Key Gaps:

• Understanding public attitudes and expectations

We’ve molly coddled them into cotton wool … they don’t experience risk. We then move into this “risk averse” society that then makes everybody sort of suddenly become disassociated with helping themselves … We’ll never manage every incident effectively, we need people to contribute, … People suddenly become … “I’m a victim and I need to be looked after”. I think we’re storing up trouble for the future if we don’t get a grip of that.

The Knowledge Base

Individual and

Organisational

Behaviour

Health Care System

The Public

Build evidence base Manage knowledge

Understand & engage the public, build resilience

Identify best system, approach to and assessment of EP

Understand behaviour

We need to learn from disasters or we will end

up repeating the mistakes of the past

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10/06/2014 © The University of Sheffield