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