Harvard Humanitarian Initiative Research Articles

Enhancing trauma care in Ukraine amid conflict: A successful implementation of the modified advanced trauma life support course in an active war zone.

Following the 2022 Russian invasion, Ukraine's healthcare system suffered extensive damage, with over 1000 medical facilities destroyed, exacerbating the trauma care crisis. The absence of standardized trauma training left Ukrainian healthcare providers ill-equipped to manage the surge in trauma cases amid conflict. To bridge this gap, we implemented advanced trauma life support (ATLS) courses in Ukraine amid active warfare, aiming to enhance trauma care expertise among healthcare professionals. A consortium, including the International Medical Corps, Harvard Humanitarian Initiative, and others, responded to a request from the Ukrainian Ministry of Health. The ATLS curriculum, translated into Ukrainian, guided the training, with US-based instructors sent to Ukraine for teaching. Despite logistical challenges, such as missile attacks and curfews, the courses ran in multiple Ukrainian cities over 3months. Course effectiveness was evaluated through pre- and post-course knowledge tests, self-efficacy surveys, and satisfaction assessments. Ten ATLS courses trained 213 Ukrainian healthcare providers across five deployments. Significant improvements in knowledge scores (p<0.05) and enhanced self-reported confidence in trauma management were observed. Notably, no casualties were reported among instructors or students, highlighting program safety despite security challenges. Our study demonstrates successful ATLS course implementation in an active war zone, filling a critical gap in trauma education in Ukraine. Despite challenges, the program significantly enhanced participants' trauma care knowledge and confidence. Collaboration between international and local partners was pivotal. This model can serve as a valuable framework for trauma education globally, improving outcomes in conflict zones and resource-limited settings.

Risk perception on building construction safety

Building construction safety is a crucial factor ad rem to the construction industry. There are several safety measures adopted in industry towards safety. But, safety II methods, which adopts safety precautions improved based on work as done at site often surpass safety I measures which is based on work as imagined, based on previous studies. This is further confirmed in the present study. Based on incident reports and questionnaire a detailed study on risk perception on building construction safety is done. A web tool, kobo tool box, an online survey platform maintained by Harvard Humanitarian Initiative (HHI) is used for data collection. Data is collected from industrial experts, on three different tiers. Data obtained is analysed to obtain risk perception among the different levels of organization in the industry. A comparison on risk perception and safety measures obtained after study and those available in literature is done. The study developed by two types of study, one is the online questionnaire and another was direct questionnaire and direct observation done on selected organizations. There was a total of 31 respondents for online survey and 5 organizations for direct survey. The 5 organizations selected included those with crisil rating D to DA2 + as on July 2021 and developer rating super large developer. A statistical test was conducted to study if there is statistically significant difference in the dependent across the levels independent variables considered.

WiFi Use and Mental Health in a Refugee Camp in Italy

Background: Migrants often rely on digital connectivity enabled by WiFi hotspots accessed via technologies such as mobile phones. However, there is a lack of evidence of the relationship between WiFi use and mental health during displacement. We assessed the relationship between symptoms of depressive disorder and digital connectivity, as well as potential mediating mental health outcomes of perceived social support and self-efficacy. Methods: This study included a cross-sectional, census survey of displaced individuals in a transit camp in Italy. The survey consisted of a structured questionnaire: connectivity was operationalized as WiFi use in the past week and mobile phone ownership. Mental health status was evaluated by interviewer-administered screening tools for depressive disorder (8-item Patient Health Questionnaire), perceived social support (Duke-UNC Functional Social Support Questionnaire), and self-efficacy (General Self-Efficacy Scale). Results: In total, 104 migrants were included (97% men). The median age was 26 years (interquartile range 22-30). Nearly two-thirds (72%) of participants accessed WiFi daily in the past week, and 60% owned a mobile phone. Over 86% of participants had symptoms consistent with moderate/major depressive disorder. There is a trend between daily access to WiFi in the past week and increased social support and perceived self-efficacy (OR: 1.28, 95% CI: 0.52 – 3.13 and OR: 1.41, 95% CI 0.57 – 3.48, respectively), and lower odds of depressive symptoms (OR: 0.84, 95% CI 0.16 – 4.44). Interpretation: This data provides evidence of the role of WiFi access in the mental health of displaced persons in a refugee camp setting. Funding Statement: This research was conducted in a partnership between Technology for Development (T4D) of Mercy Corps and the Signal Program on Human Security and Technology at the Harvard Humanitarian Initiative (HHI) and was funded by a subaward from the CiscoMercy Corps Technology for Impact partnership. Declaration of Interests: None to declare. Ethics Approval Statement: This study was under ethics review, oversight, and governance both in Italy and in the United States by the Ethics Committee of the Unita di Bioetica, Istituto Superiore di Sanita and the Institutional Review Board of the Harvard T.H. Chan School of Public Health (Protocol IRB19-0692), respectively. Informed consent was obtained orally from all participants to avoid the potential risks of collecting participant names.

Ukraine - Conflict in the Donbas: Civilians Hostage to Adversarial Geopolitics

Since 2014, the war in the Donbas, fueled and sustained by local and regional political priorities, has inflicted a heavy burden of civilian death, injury, displacement, destruction, and lasting trauma. As the conflict continues, the people of Donbas are more isolated than ever from the rest of their country, subjected to discrimination and stigmatization by both the Ukrainian authorities and separatist leaders. Today, a confluence of factors continues to drive conflict in Eastern Ukraine. Triggered by the 2013 Euromaidan protests in Kyiv, the rupture between the post-Maidan Ukrainian government and local elites in the Donbas over aspirations of independence and self-determination highlighted the growing schism between those with Russian-oriented ambitions and those supporting the new Ukrainian regime. As clans, warlords, and oligarchs within Ukraine fight for political influence and financial gain, Russian influence continues to destabilize the Westward-leaning Ukrainian authorities in Kyiv, reinvigorating the enduring geopolitical rivalry between Russia and the West. Humanitarian operations in Eastern Ukraine are also under significant pressure by the separatist authorities. Agencies struggle to bridge the gap between critical needs and their response capacity, while being forced to rely almost exclusively on local organizations. In the process of humanitarian and access negotiations, agencies must guard against the instrumentalization of aid, the blurring of lines between political, military, and relief operations, and an ever-shrinking humanitarian space. What drives this protracted conflict? How have global politics and local agendas contributed to sustaining a “frozen” conflict at the expense of communities and in the interest of asserting nationalist independence at all costs? How have the hopes of local communities in the Donbas withered over time, as they navigate the dissonance in geopolitical rhetoric and their lived reality? What avenues exist for reconciliation and unity amidst this violent divisiveness? This report explores these questions and offers reflections based on more than 250 interviews undertaken during two field visits to Ukraine, in both government and separatist-controlled areas, and one visit to Russia, between November 2019 and January 2020. It also draws on an extensive desk analysis of relevant literature to complement the findings of these interviews and consultations. The Ukrainian, Russian, French, and German translations of the Key Messages, Executive Summary, and Recommendations can be found on the web-page of the Harvard Humanitarian Initiative at http://hhi.harvard.edu/.

Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey

The current outbreak of Ebola in eastern DR Congo, beginning in 2018, emerged in a complex and violent political and security environment. Community-level prevention and outbreak control measures appear to be dependent on public trust in relevant authorities and information, but little scholarship has explored these issues. We aimed to investigate the role of trust and misinformation on individual preventive behaviours during an outbreak of Ebola virus disease (EVD). We surveyed 961 adults between Sept 1 and Sept 16, 2018. We used a multistage sampling design in Beni and Butembo in North Kivu, DR Congo. Of 412 avenues and cells (the lowest administrative structures; 99 in Beni and 313 in Butembo), we randomly selected 30 in each city. In each avenue or cell, 16 households were selected using the WHO Expanded Programme on Immunization's random walk approach. In each household, one adult (aged ≥18 years) was randomly selected for interview. Standardised questionnaires were administered by experienced interviewers. We used multivariate models to examine the intermediate variables of interest, including institutional trust and belief in selected misinformation, with outcomes of interest related to EVD prevention behaviours. Among 961 respondents, 349 (31·9%, 95% CI 27·4-36·9) trusted that local authorities represent their interest. Belief in misinformation was widespread, with 230 (25·5%, 21·7-29·6) respondents believing that the Ebola outbreak was not real. Low institutional trust and belief in misinformation were associated with a decreased likelihood of adopting preventive behaviours, including acceptance of Ebola vaccines (odds ratio 0·22, 95% CI 0·21-0·22, and 1·40, 1·39-1·42) and seeking formal health care (0·06, 0·05-0·06, and 1·16, 1·15-1·17). The findings underscore the practical implications of mistrust and misinformation for outbreak control. These factors are associated with low compliance with messages of social and behavioural change and refusal to seek formal medical care or accept vaccines, which in turn increases the risk of spread of EVD. The Harvard Humanitarian Initiative Innovation Fund.

Evaluating Progress in the Global Surgical Crisis: Contrasting Access to Emergency and Essential Surgery and Safe Anesthesia Around the World.

Since 2007, observations reveal that low- and middle-income countries (LICs and LMICs) experience similar surgical access and safety issues, though the etiology of these challenges varies by country. The collective voice of surveys completed to date has pushed the agenda for the inclusion of safe surgery and anesthesia within global health discussions. Comparison of four countries across the world shows similar basic progress as well as ongoing surgical and anesthesia needs in resource-challenged countries. By studying these common needs, a comprehensive plan to provide infrastructure and personnel support can work in multiple austere settings. A standardized survey tool published, designed, and developed initially by the Harvard Humanitarian Initiative and modified at Vanderbilt University was completed in Guatemala, Guyana, Laos, and Mozambique. The survey assessed eight key areas of essential surgical care: access to and availability of surgical services, access to human resources, essential infrastructure (including access to water, electricity, sanitation, blood products, and essential medicines including supplemental oxygen), surgical outcomes, operating room information and procedures, equipment, International Organization, and Non-Government Organization provision of surgical care. These results were compared and contrasted to evaluate resource challenges and assets in each country. A total of 49 hospitals were surveyed in this comparison cohort. The results reveal common needs for emergency and essential surgery in each country, but some differences in human and capital resources exist. While minimal resources exist, all surgical sites provided running water, electricity, and oxygen-assets not seen in previous surveys as recent as 2011. The most basic needs to provide essential surgery are now present in LICs and LMICs. Many more resources are needed to ensure access to safe surgery and anesthesia. The next steps to provide essential surgery must include common solutions for access to surgery and anesthesia, and an evaluation of patient safety in these endeavors through the perioperative mortality rate.

GRID: A Methodology Integrating Witness Testimony and Satellite Imagery Analysis for Documenting Alleged Mass Atrocities

Aim: This article documents the development and initial use case of the GRID (Ground Reporting through Imagery Delivery) methodology by the Harvard Humanitarian Initiative (HHI). GRID was created to support corroboration of witness testimony of mass atrocity related-events using satellite imagery analysis. A repeating analytic limitation of employing imagery for this purpose is that differences in the geographic knowledge of a witness and an imagery analyst can limit or impede corroboration. Methods: The primary method used in this article is a case study of HHI’s development and use of GRID. The GRID methodology was designed during HHI’s work with the Satellite Sentinel Project. It was deployed to corroborate reports that mass graves were being created in Sudan in the summer of 2011. Results: The results of this specific case study are examined, step-by-step guidelines for using GRID are provided, and possible areas for further research are discussed. This case demonstrates that the GRID methodology facilitates corroboration when differences exist between the local geographic knowledge of a witness and the more cursory geographic knowledge of an analyst. Conclusions: The initial use of GRID warrants further research into potential applications in other regional and operational contexts. Future use cases will help advance GRID as a standardized methodology for use by different types of groups that utilize satellite imagery. Distinct research should also focus on operational, cultural, psychological, and ethical impacts of this methodology due to its involvement of the witness in the imagery analysis process.

Scarcity of protective items against HIV and other bloodborne infections in 13 low- and middle-income countries.

To assess protection of surgical healthcare workers against HIV and other bloodborne infections in low- and middle-income countries (LMICs). Literature review based on recent studies assessing baseline surgical capacity in LMICs using the WHO Situational Analysis of Access to Emergency and Essential Surgical Care, the Surgeons OverSeas (SOS) Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) survey and the Harvard Humanitarian Initiative survey tools. The availability of protective eyewear, sterile gloves and sterilisers was assessed. Thirteen individual country studies with relevant data were identified documenting items from 399 hospitals. The countries included Afghanistan, Bolivia, Gambia, Ghana, Liberia, Mongolia, Nigeria, Sierra Leone, Solomon Islands, Somalia, Sri Lanka, Tanzania and Zambia. Overall, only 29% (79/270) of hospitals always had eye protection. Sterilisers were only available at 64% (244/383) of facilities. Sterile gloves were the most available item, available at 75% of facilities (256/340). Surgical healthcare worker protection for bloodborne infections continues to be deficient in LMICs. Improved documentation of these items should be incorporated into future surgical capacity studies. Policy makers and clinicians should work together to secure resources and interventions that will protect this vital workforce.

Burmese Refugee Experience Accessing Health Care in New Delhi: A Qualitative Study

Provision of health services to urban refugees is challenging given wide dispersal and tenuous legal status, particularly in regions where host population urban residents also face limited access to health care. This study aims to understand Burmese refugee and asylum-seeker experiences accessing health care in New Delhi, India. During March 2012, investigators from the Harvard Humanitarian Initiative in collaboration with the Chin Human Rights Organization conducted focus group discussions and key informant interviews in New Delhi. Qualitative analysis identified the following three overlapping categories with regard to health care access: discrimination, poor quality health services, and financial barriers to obtaining health care. Of these, discrimination is the most prominent. Efforts to provide health services to urban refugees in New Delhi must address discrimination, in addition to advocating for access to national health systems and reduction of financial barriers, in order to be acceptable to the urban refugee community.

Hospitals Safety from Disasters in I.R.Iran: The Results from Assessment of 224 Hospitals

Background and objective: Iran’s hospitals have been considerably affected by disasters during last decade. To address this, health system of I.R.Iran has taken an initiative to assess disaster safety of the hospitals using an adopted version of Hospital Safety Index (HSI). This article presents the results of disaster safety assessment in 224 Iran’s hospitals. Methods: A self-assessment approach was applied to assess the disaster safety in 145 items categorized in 3 components including structural, non-structural and functional capacity. For each item, safety level was categorized to 3 levels: not safe (0), average safe (1) and high safe (2). A raw score was tallied for each safety component and its elements by a simple sum of all the corresponding scores. All scores were normalized on a 100 point scale. Hospitals were classified to three safety classes according to their normalized total score: low (≤34.0), average (34.01-66.0) and high (>66.0). Results: The average score of all safety components were 32.4 out of 100 (± 12.7 SD). 122 hospitals (54.5%) were classified as low safe and 102 hospitals (45.5%) were classified as average safe. No hospital was placed in the high safe category. Average safety scores out of 100 were 27.3 (±14.2 SD) for functional capacity, 36.0 (±13.9 SD) for non-structural component and 36.0 (±19.0 SD) for structural component. Neither the safety classes nor the scores of safety components were significantly associated with types of hospitals in terms of affiliation, function and size (P>0.05). Conclusions: To enhance the hospitals safety for disaster in Iran, we recommend: 1) establishment of a national committee for hospital safety in disasters; 2) supervision on implementation of the safety standards in construction of new hospitals; 3) enhancement of functional readiness and safety of non-structural components while structural retrofitting of the existing hospitals is being taken into consideration, whenever is cost-effective; 4) considering the disaster safety status as the criteria for licensing and accreditation of the hospitals. Key words: Hospital, safety, disaster, emergency, Iran Correspondence to: Ali Ardalan MD, PhD. Tehran University of Medical Sciences, Harvard Humanitarian Initiative, Email: aardalan@tums.ac.ir, ardalan@hsph.harvard.edu

Prioritizing essential surgery and safe anesthesia for the Post-2015 Development Agenda: Operative capacities of 78 district hospitals in 7 low- and middle-income countries

Surgery has been neglected in low- and middle-income countries for decades. It is vital that the Post-2015 Development Agenda reflect that surgery is an important part of a comprehensive global health care delivery model. We compare the operative capacities of multiple low- and middle-income countries and identify critical gaps in surgical infrastructure. The Harvard Humanitarian Initiative survey tool was used to assess the operative capacities of 78 government district hospitals in Bangladesh (n = 7), Bolivia (n = 11), Ethiopia (n = 6), Liberia (n = 11), Nicaragua (n = 10), Rwanda (n = 21), and Uganda (n = 12) from 2011 to 2012. Key outcome measures included infrastructure, equipment availability, physician and nonphysician surgical providers, operative volume, and pharmaceutical capacity. Seventy of 78 district hospitals performed operations. There was fewer than one surgeon or anesthesiologist per 100,000 catchment population in all countries except Bolivia. There were no physician anesthesiologists in any surveyed hospitals in Rwanda, Liberia, Uganda, or in the majority of hospitals in Ethiopia. Mean annual operations per hospital ranged from 374 in Nicaragua to 3,215 in Bangladesh. Emergency operations and obstetric operations constituted 57.5% and 40% of all operations performed, respectively. Availability of pulse oximetry, essential medicines, and key infrastructure (water, electricity, oxygen) varied widely between and within countries. The need for operative procedures is not being met by the limited operative capacity in numerous low- and middle-income countries. It is of paramount importance that this gap be addressed by prioritizing essential surgery and safe anesthesia in the Post-2015 Development Agenda.

Academic Affiliated Training Centers in Humanitarian Health, Part I: Program Characteristics and Professionalization Preferences of Centers in North America

The collaborative London based non-governmental organization network ELRHA (Enhancing Learning and Research for Humanitarian Assistance) supports partnerships between higher education institutions and humanitarian organizations worldwide with the objective to enhance the professionalization of the humanitarian sector. While coordination and control of the humanitarian sector has plagued the response to every major crisis, concerns highlighted by the 2010 Haitian earthquake response further catalyzed and accelerated the need to ensure competency-based professionalization of the humanitarian health care work force. The Harvard Humanitarian Initiative sponsored an independent survey of established academically affiliated training centers in North America that train humanitarian health care workers to determine their individual training center characteristics and preferences in the potential professionalization process. The survey revealed that a common thread of profession-specific skills and core humanitarian competencies were being offered in both residential and online programs with additional programs offering opportunities for field simulation experiences and more advanced degree programs. This study supports the potential for the development of like-minded academic affiliated and competency-based humanitarian health programs to organize themselves under ELRHA's regional "consultation hubs" worldwide that can assist and advocate for improved education and training opportunities in less served developing countries.

Impacts of Natural Hazards on Primary Health Care Facilities of Iran: A 10-Year Retrospective Survey

Public health facilities in Iran are exposed to a wide range of natural hazards. This article presents the first survey of the impacts of such natural hazards on primary health care (PHC) centers in Iran from 2001 to 2011. A retrospective survey was conducted in 25 out of 30 provinces of Iran. Archival reports at provincial public health departments were cross-referenced with key informant interviews. During a 10-year period, 119 natural hazard events were recorded that led to physical damage and/or functional failure in 1,401 health centers, 127 deaths and injury or illness in 644 health staff. Earthquakes accounted for the most physical damage and all health-worker deaths. However, there was an increasing trend of impacts due to hydro-meteorological hazards. Iran’s health system needs to establish a registry to track the impact of natural hazards on health facilities, conduct regular hazard and vulnerability assessments and increase mitigation and preparedness measures. Keywords: Disaster, primary health care, facility, Iran, natural hazard Corresponding author: Ali Ardalan MD, PhD. Iran’s National Institute of Health Research, Tehran University of Medical Sciences. Harvard Humanitarian Initiative. Email: aardalan@tums.ac.ir

Four Key Challenges in Disaster Response

This paper summarizes a project to explore challenges associated with information sharing in disaster response and identify innovative solutions. Challenges associate with domestic disaster response such as volunteer organizations are well-documented (Harvard Humanitarian Initiative, 2011; Militello, Patterson, Bowman, Wears, 2007). To obtain a deeper understanding of these problems, we conducted several site visits to experience the environment in which these decisions are made. We identified four key challenges across these domains that must be addressed in order to improve training and operations: coordination among groups involved in the response, communication among these groups, timely information exchange, and effective information technology support for emergency responders in the field. As a potential solution, we conceptualized an integrated software package that combines the flexible capabilities of mobile applications for personnel with desktop software to be used in static planning to allow individuals to gather and distribute information, as well as query for specific information when needed. The envisioned tool would allow the State Emergency Operations Center to gather data from multiple sources. The software would organize information according to functional needs, providing easy access on demand for use by responders in a range of roles and settings.

Survey of Surgery and Anesthesia Infrastructure in Ethiopia

Information regarding surgical capacity in the developing world is limited by the paucity of available data regarding surgical care, infrastructure, and human resources in the literature. The purpose of this study was to assess surgical and anesthesia infrastructure and human resources in Ethiopia as part of a larger study by the Harvard Humanitarian Initiative examining surgical and anesthesia capacity in ten low-income countries in Africa. A comprehensive survey tool developed by the Harvard Humanitarian Initiative was used to assess surgical capacity of hospitals in Ethiopia. A total of 20 hospitals were surveyed through convenience sampling. Eight areas of surgical and anesthesia care were examined, including access and availability, access to human resources, infrastructure, outcomes, operating room information and procedures, equipment, nongovernmental organization delivery of surgical services, and pharmaceuticals. Results were obtained over a 1-month period during October 2011. There is wide variation in accessibility, with hospital-to-population ratios ranging from 1:99,010 to 1:1,082,761. The overall physician to population ratio ranges from 1:4715 to 1:107,602. The average hospital has one to two operating rooms, 4.2 surgeons, one gynecologist, and 4.5 anesthesia providers-although in all but three hospitals anesthesiology was provided by nonphysician personnel only (i.e., a nurse anesthetist). Access to continuous electricity, running water, essential medications, and monitoring systems is very limited in all hospitals surveyed, although such access did vary across regions. This survey of Ethiopia's hospital resources attempts to identify specific areas of need where resources, education, and development can be targeted. Because the major surgical mortality comes from late presentations, increasing accessibility through infrastructure development would likely provide a major improvement in surgical morbidity and mortality rates. Infrastructure limitations of electricity, water, oxygen, and blood banking do not prove to be significant barriers to surgical care. The increasing number of physicians is promising, although efforts should be directed specifically toward increasing the number of anesthesiologists and surgeons in the country.

(P1-45) Harvard Humanitarian Initiative (HHI) and Federal University of Paraiba (UFP) Joint Emergency Medicine and Disaster Preparedness Training Center A Model for Academic and Clinical Exchange of Expertise

IntroductionEvolving health systems frequently seek guidance with emergency medicine related topics. This has lead to countless international collaboration between organizations attempting to meet this need.BackgroundParaiba, a state of 3.6 million, ranks near the bottom in Brazil for per capita income. The medical establishment has private, public and military systems without emergency medicine training and no disaster plans. HHI and Harvard International Emergency Medicine Fellowship are academic research and service oriented organizations with an emergency medicine and disaster preparedness focus. In 2009 a request for technical assistance was made to HHI from Paraiba, concerning disaster preparedness, clinical emergency medicine and pre-hospital training.MethodsExchange of correspondence surrounding needs and expectations of the partner organizations was conducted until the August 2010. During August a series of meetings was conducted among the civilian, military and federal representatives and a collaborating body was formed under the guidance of UFP consisting of SAMU (prehospital care), the medical school and the five main hospitals of the city. In September HHI staff conducted a series of meetings and assessments in Paraiba. Plan Evaluation, educational and programmatic steps were decided on to be conducted over the several year project. Space and resources for the training center at the UFP was allocated. Establishment of 8–12 teaching modules for practicing physicians and nurses, built and taught by local staff with HHI support will be implemented and become a requirement to work in emergency areas. An assessment of disaster risks and emergency metrics will be conducted concomitantly. Exchange of staff between Brazil and USA will occur throughout the project.ConclusionNo standard model of collaboration exists regarding international emergency medicine and disaster planning but ours demonstrates that exchange of information can evolve to match the abilities and expectations of both parties.

Post-Conflict Health System Recovery: The Case of Kosovo

Senior Scholar, TWoodrow WilsonInternational Center for Scholars,Washington, DC USA; Senior Fellow,Harvard Humanitarian Initiative, HarvardUniversity, Cambridge, Massachusetts USA;Professor, Department of CommunityEmergency Health & Paramedic Practice,Monash University Medical School,Melbourne, AustraliaKeywords: academic humanitarian programs;health system and infrastructure recovery;humanitarian assistance and development;Kosovo; post-conflict; primary healthcarerecovery Correspondence:E-mail: skipmd77@aol.comWeb publication: c23 February 2010

Anesthesia and the Global Burden of Surgical Disease

*Valley Anesthesiology Consultants, Ltd Phoenix, AZ †Harvard Humanitarian Initiative Cambridge, MA Reprints: K. A. Kelly McQueen, MD, MPH, Anesthesiologist, Valley Anesthesiology Consultants, Ltd. 4134 N 49th Place, Phoenix, AZ 85018, E-mail: [email protected]

Burden of Surgical Disease: Strategies to Manage an Existing Public Health Emergency

The World Health Organization estimates that the burden of surgical disease due to war, self-inflicted injuries, and road traffic incidents will rise dramatically by 2020. During the 2009 Harvard Humanitarian Initiative's Humanitarian Action Summit (HHI/HAS),members of the Burden of Surgical Disease Working Group met to review the state of surgical epidemiology, the unmet global surgical need, and the role international organizations play in filling the surgical gap during humanitarian crises, conflict, and war. An outline of the group's findings and recommendations is provided.

Coming together to document mortality in conflict situations: proceedings of a symposium.

The use of epidemiology in documenting the mortality experience in complex emergencies has become pervasive in humanitarian practice. Recent assessments in Iraq and Darfur have provoked much discussion on the assessment of mortality in scientific and policy spheres. In this context, the Centre for Research on the Epidemiology of Disasters and the Harvard Humanitarian Initiative held an inter-disciplinary symposium to examine the topic among epidemiologists, demographers, forensic scientists and legal and human rights investigators.We aimed to strengthen the scientific understanding of mortality estimation by reviewing progress across fields and building inter-disciplinary bridges. We report on the presentations and discussions here.