Needs assessments for international humanitarian health assistance in disasters

Abstract: Background: Natural and man-made disasters overwhelmingly affect people in low and middle-income countries. In that socio-economic context both the immediate and long-term needs of those affected often exceed national resources. Therefore some form of needs assessments are required to guide the volume and composition of international humanitarian assistance. How such needs assessments serve their purpose has rarely been researched. Objective: To explore contextual and conceptual aspects of needs assessments and how their results may influence the international humanitarian health assistance response in disaster situations. Methods and Results: The five sub-studies used mixtures of secondary literature review (I-V), direct observations (II-IV), semi-structured interviews (II-IV), focus group discussions (I-II) and a quantitative interview survey (V). Study I assessed the extent to which Sida had access to and used needs assessment information when deciding to fund health related humanitarian projects in 2003. Data on the size of the target population was only available in 37% of the applications and reference to any quantified health needs was made in less than 20% of the decisions. Study II assessed the health needs of the Palestinian population in the occupied territories during the low-intense conflict in 2002. Restriction of movement was the main health threat, while health facilities had sufficient staff and equipment. Study III assessed the need for international medical assistance following the terrorist attack in the Beslan School. The medical care provided by 500 local medical doctors and the other local and national resources was adequate to care for emergency medical trauma needs. International health assistance was not required. Study IV explored if assistance by Foreign Field Hospitals (FFH) in four recent Sudden Impact Disasters were appropriate. None of 43 FFH were operational within the 48h limit to save lives of acute trauma cases. Study V explored the feasibility of interviewing a selection of visitors to health facilities regarding needs of their households following the earthquake in Kashmir. The results from the sample were geographically representative and compared well with those of a later house-to-house survey. Conclusions: There is a clear discrepancy between the donor policy of funding humanitarian health projects based on needs assessment results and donor practice, which may be due to an insufficiently defined policy rather than bad practice (I). Needs assessment results cannot be correctly interpreted without information on the socioeconomic context in the affected area and country (II, III). There exists considerable capacities in middle-income countries to handle disaster situations that must be accounted for when designing international humanitarian health assistance (II, III, IV). No Foreign Field Hospital deployed in four recent Sudden Impact Disasters arrived in time to provide lifesaving trauma care (IV). It is feasible to quickly get geographically representative information from the affected population using a Clinic Entrance Interview survey in a post earthquake context (V).