A Multi-Objective Decision-Making Model for Resources Allocation in Humanitarian Relief

This thesis addresses the critical resource allocation in the initial days of a disaster relief operation. One of the most important and essential components of relief operations is the allocation of scarce resources to accomplish the relief efforts. Every operation for disaster relief needs various critical resources whether they are personnel, equipment, supplies, or simply finances. Several research efforts for disaster relief have suggested methods to allocate scarce resources across a variety of competing objectives and programs in a disaster relief operation. Many of those efforts focused on optimizing a mathematical programming model subject to budget constraints. However, capturing the values of the decision-maker(s) in such a model is relatively under explored. The lack of clear organizational values contributes to the inconsistency in practice and hinders effective resources allocation across the disaster relief system. The purpose of this study is to develop a multi-objective decision-making (MODM) model to incorporate the decision-maker(s) value trade-offs in the disaster relief resources allocation problem. The notional model is based on a hurricane and flood scenario and the decision window for the resource allocation is the critical first 72 hours after the initial damage assessment has been made. The value focused thinking (VFT) process is used to capture the value trade-offs and the resulting value hierarchy is optimized via a mathematical programming model to solve the multi-objective resource allocation problem

Disasters and access to healthcare in the coastal region of Bangladesh: a gendered analysis

This research focuses on the gendered impacts of disasters on health and healthcare access. It aims to explore the gender-specific health impacts of cyclones, and the factors shaping accessibility to healthcare in disasters. It investigates current disaster plans and policies for pre-and post-disaster healthcare provision, and to what extent they account for gender. The study is situated in Barguna, Bangladesh, highly vulnerable to cyclones due to its remote coastal location, poor socio-economic conditions and transport, and insufficient healthcare provision. The qualitative research methodology included interviews with local inhabitants and officials from government and non-government organizations, focus groups discussions, participatory diagramming and observation. The findings reveal that disasters have very significant gendered impacts on health and healthcare access. Women are subject to an inverse care law, where those with more injuries receive less care. Advantages for some groups of women, in employment, educational status, position in the family, income and urban location, make a positive difference to the risks they face, but the research found that their status does not assure healthcare access after disasters. Thus gendered identity creates more homogeneity than difference among women in healthcare access after disasters, strongly influenced by cultural attitudes, behaviours and norms around gender within society. Prevailing disaster management plans consider 'women' without this context of gender relations, which raises serious questions about the successful implementation of disaster plans. The research also highlights the vital contributions of qualitative research in disaster and gender studies, in taking an approach that accessed a highly traditional society and collecting rich data from women on private experiences and perspectives. The thesis recommends consideration of deeply rooted social determinants, and gender-sensitive disaster management plans that focus on local culture, society and economic conditions. In this way, more effective implementation of disaster management plans may establish equality in healthcare access and reduce women’s vulnerability to future cyclones

Continuing oncologic care in the wake of an environmental disaster

BACKGROUND: Chronic, non-communicable diseases (NCD), such as cardiovascular disease and cancer, have overtaken communicable disease as the leading cause of morbidity and mortality worldwide. However, despite the substantial toll these diseases have on populations, patients suffering from these illnesses are often overlooked in the aftermath of an environmental disaster. Without proper disaster preparedness, these populations are often left vulnerable: without access to disease-modifying treatments or life-saving therapies. OBJECTIVE: This is a proposed disaster event health initiative for incorporating oncology care into disaster relief services worldwide. This study hypothesizes that with increased access to providers, resources, and cancer therapies during a disaster event, interruptions in patient oncology care will be minimized. METHODS: This disaster event health initiative consists of a detailed proposal for deploying a specialized oncology unit alongside traditional disaster response teams in an effort to decrease interruptions in patient oncology care. Depending on the severity of the disaster, available adjunct healthcare facilities, potential length of stay, most commonly used cancer therapies, and traditional patient: provider ratios, this proposal will inform the oncology unit assembly. Study measurables, such as how many patients seen, cancer diagnoses encountered, and most frequently used cancer therapies, will be collected using a standardized form. In addition, information regarding perceived patient satisfaction will be collected. System variable measures will be analyzed using frequency and average means whereas qualitative information will be coded for emerging themes. These measures of initiative efficacy will be used to revise and optimize future unit deployments. CONCLUSION: Worldwide morbidity and mortality from non-communicable diseases, such as cancer, are steadily increasing. When acute environmental disasters strike, access to essential healthcare resources is disrupted, leaving these vulnerable populations without life-saving therapies they desperately need. These interruptions in cancer treatment plans result in poorer, long-term patient outcomes, compounding the effects of the disaster situation. By deploying a specialized oncology unit with disaster response teams during the initial recovery process, interruptions in cancer care will be minimized, ultimately decreasing long-term morbidity and mortality outcomes in this vulnerable patient population

A Multi-Attribute decision support system for allocation of humanitarian cluster resources , based on decision makers’ perspective

The rush of the humanitarian suppliers into the disaster area proved to be counter-productive. To reduce this proliferation problem, the present research is designed to provide a technique for supplier ranking/selection in disaster response using the principles of utility theory. A resource allocation problem is solved using optimisation based on decision maker’s preferences. Due to the lack of real-time data in the first 72 h after the disaster strike, a Decision Support System (DSS) framework called EDIS is introduced to employ secondary historical data from disaster response in four humanitarian clusters (WASH: Water, Sanitation and Hygiene, Nutrition, Health, and Shelter) to estimate the demand of the affected population. A methodology based on multi-attribute decision-making (MADM), Analytical Hierarchy processing (AHP) and Multi-attribute utility theory (MAUT) provides the following results. First a need estimation technique is put forward to estimate minimum standard requirements for disaster response. Second, a method for optimization of the humanitarian partners selection is provided based on the resources they have available during the response phase. Third, an estimate of resource allocation is provided based on the preferences of the decision makers. This method does not require real-time data from the aftermath of the disasters and provides the need estimation, partner selection and resource allocation based on historical data before the MIRA report is released

Migrants in countries in crisis. Thailand case study: migration and natural disasters – the impact on migrants of the 2011 floods in Thailand

This case study examines the immediate and longer-term consequences of the 2011 floods in Thailand on migrants from Myanmar, Cambodia, Lao PDR and Vietnam. It was conducted as part of the EU-funded project Migrants in Countries in Crisis: Supporting an Evidence-Based Approach for Effective and Cooperative State Action. Under this project, six case studies were prepared. The current report represents one of these. Due to the nature of the 2011 flood disaster in Thailand and the relatively fast rebound of the Thai economy, most of the migrants affected by the crisis were still in Thailand at the time this research was done. For many of them, the longer-term effects of the disaster stemmed mainly from their experiences during the crisis, the choices they made to cope and other events in the aftermath of the floods, particularly changes in Thailand’s migrant registration system

The Role of Transportation in Campus Emergency Planning, MTI Report 08-06

In 2005, Hurricane Katrina created the greatest natural disaster in American history. The states of Louisiana, Mississippi and Alabama sustained significant damage, including 31 colleges and universities. Other institutions of higher education, most notably Louisiana State University (LSU), became resources to the disaster area. This is just one of the many examples of disaster impacts on institutions of higher education. The Federal Department of Homeland Security, under Homeland Security Presidential Directive–5, requires all public agencies that want to receive federal preparedness assistance to comply with the National Incident Management System (NIMS), which includes the creation of an Emergency Operations Plan (EOP). Universities, which may be victims or resources during disasters, must write NIMS–compliant emergency plans. While most university emergency plans address public safety and logistics management, few adequately address the transportation aspects of disaster response and recovery. This MTI report describes the value of integrating transportation infrastructure into the campus emergency plan, including planning for helicopter operations. It offers a list of materials that can be used to educate and inform campus leadership on campus emergency impacts, including books about the Katrina response by LSU and Tulane Hospital, contained in the report´s bibliography. It provides a complete set of Emergency Operations Plan checklists and organization charts updated to acknowledge lessons learned from Katrina, 9/11 and other wide–scale emergencies. Campus emergency planners can quickly update their existing emergency management documents by integrating selected annexes and elements, or create new NIMS–compliant plans by adapting the complete set of annexes to their university´s structures

Assessing the impact of humanitarian assistance in the health sector

There have been significant improvements in the design and management of humanitarian aid responses in the last decade. In particular, a significant body of knowledge has been accumulated about public health interventions in emergencies, following calls for developing the evidence base of humanitarian health interventions. Several factors have prompted this, such as the increased volume of humanitarian assistance with subsequent higher levels of scrutiny on aid spending, and greater pressure for improving humanitarian aid quality and performance. However, documentation of the ability of humanitarian interventions to alleviate suffering and curb mortality remains limited. This paper argues that epidemiological studies can potentially be a useful tool for measuring the impact of health interventions in humanitarian crises. Survey methods or surveillance systems are mainly used for early warning or needs assessment and their potential for assessing the impact of aid programmes is underutilised

PREdictive model for DISaster response configuration (PREDIS decision platform)

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonThe extraordinary conditions of a disaster, require the mobilisation of all available resources, inducing the rush of humanitarian partners into the affected area. This phenomenon called the proliferation of actors, causes serious problems during the disaster response phase including the oversupply, duplicated efforts, lack of planning. The aim of this research is to provide a solution to reduce the partner proliferation problem. To that end the main research question is put forward as “How to reduce the proliferation of partners in a disaster response”? Panel analysis of the historic record of 4,252 natural onset disasters between 1980 to 2013 via regression analysis, MA and AHP gives rise to the formation of a predictive decision-making platform called PREDIS. It is capable of predicting the human impact of the disaster (fatality, injured, homeless) of up to 3% of errors and enables the decision makers to estimate the required needs for each disaster and prioritises them based on the disaster type and socio-economics of the affected country. It further renders it possible to rank and optimise the desired partners based on the decision maker’s preferences. Verification of the PREDIS through a simulation game design using a sample group of decision makers, show that this technique enables the user to decide within one hour after the disaster strike using the widely available data at the time of the disaster. It also enables non-experts to decide almost identically to experts in terms of the similarity of the choices and the speed of the decision.The lack of an extensive database for the potential humanitarian partners from which to choose, is the limitation of this research in addition to the lack of standardised set of minimum requirements for the suitable partners.The model is also as strong as its data feed which is inconsistent in various humanitarian sources

Homelessness and Public Health in Los Angeles

Los Angeles faces a housing crisis of unprecedented scale. After years of underinvestment, in 2016/2017 LA County voters approved Measures H and HHH, which provided an infusion of resources for homeless services, permanent housing, and integrated outreach through the LA County Homeless Initiative (HI). An estimated 58,936 individuals in LA County remain homeless as of January 2019, 75% of them unsheltered and living on streets, in tents, or encampments. Our best estimates suggest that the homeless population has grown since 2017.HI takes a Housing First approach to homelessness, with the largest amount of total funds allocated to housing solutions. However, rehousing is often subject to delays in construction and case management. These delays, combined with persistent market forces driving new homelessness, have left the county well short of its targets. While no forecasts were issued, the initial gap analysis for HI had assumed a 34% reduction in the total homeless count from 2016 to 2019. The count has in fact increased by 26% over that period, meaning 28,000 more homeless clients than anticipated on any night. Whereas cities with comparable homeless crises such as New York have focused on increasing the availability of emergency shelters and safe havens in addition to permanent housing, LA County’s relatively low investment in transitional options has resulted in persistent levels of unsheltered homelessness.Research has shown that homelessness has severe health consequences. Homeless individuals have a high risk of mortality, with a recent LA County Medical Examiner report finding an average age of death of 48 for women and 51 for men. Homeless individuals have much higher risks of mental illness, substance abuse, infectious disease, chronic illness, violence, and reproductive health risks than the general population. Much less is known about the health burdens associated with being unsheltered, but most evidence points to substantially greater health risks given the more intense exposures to violence, weather, pollution, poor sanitation, and behavioral risk. Research is just beginning to quantify the burdens of living on the streets.Our analysis of the LA County homelessness response drew on expert interviews, data analysis, and document review. Beyond the growing numerical gap between HI’s targets and actual trends, we identified five critical service gaps that require immediate attention: Taking a person-centered approach that recognizes both the diversity of client needs and the limitations of existing resources, yet honors the principle that everyone deserves housing; Improving access to emergency shelters by reducing legal and political barriers to construction and adopting “low barrier shelters” that facilitate entry; Delivering comprehensive street medicine and other services to unsheltered homeless populations using evidence-based models that support the path to housing and recovery Adopting more extensive outreach models that engage citizens, empower homeless clients and leverage mobile technology so that case workers can focus on clients most in need; Strengthening data collection and research methods to understand the consequences of unsheltered homelessness, pilot new service models, and evaluate rehousing efforts

Public Health Humanitarian Responses to Natural Disasters

The pressure of climate change, environmental degradation, and urbanisation, as well as the widening of socio- economic disparities have rendered the global population increasingly vulnerable to the impact of natural disasters. With a primary focus on medical and public health humanitarian response to disasters, Public Health Humanitarian Responses to Natural Disasters provides a timely critical analysis of public health responses to natural disasters. Using a number of case studies and examples of innovative disaster response measures developed by international agencies and stakeholders, this book illustrates how theoretical understanding of public health issues can be practically applied in the context of humanitarian relief response. Starting with an introduction to public health principles within the context of medical and public health disaster and humanitarian response, the book goes on to explore key trends, threats and challenges in contemporary disaster medical response. This book provides a comprehensive overview of an emergent discipline and offers a unique multidisciplinary perspective across a range of relevant topics including the concepts of disaster preparedness and resilience, and key challenges in human health needs for the twenty-first century. This book will be of interest to students of public health, disaster and emergency medicine and development studies, as well as to development and medical practitioners working within NGOs, development agencies, health authorities and public administration