Tehran University of Medical Sciences Institute of Public Health Research Health in Emergency & Disaster Department (HE&DD) Rapid Assessment in Disaster Ali Ardalan MD, MPH, PhD Assistant Professor

Learning Objectives: By the end of the session, participants will be able to: Explain the characteristics of data & information after disasters Explain the importance & main applications of rapid assessments following disasters Develop a rapid assessment form To criticize a rapid assessment report

Lack of information as the strongest indicator of a crisis Lack of information is not = to lack of data Disaster impact on information

Routine information systems collapse Population movements lack of reliable denominators Collection & analysis of data clash with other priority activities Disaster impact on information

No information is available, or what is available is flawed to such a degree to be useless. Therefore: Postpone any decision until new data become available: Paralysis by analysis OR Given gravity of crisis, there is not time to gather reliable data; Proceed quickly with field activities Main Myth of Health Information in Crises

The opportunity cost of information in emergencies

Non-routine data collection methods in emergencies

The 10 Priorities in Emergency 1.Rapid assessment of health status 2.Mass immunization against measles! 3.Environmental hygiene and water availability 4.Food availability 5.Shelter 6.Case management, therapeutic protocols 7.Prevention and control of epidemic prone diseases 8.Health information system (public health) 9.Human resources 10.Coordination of interventions source : Refugee Health, MSF

Rapid Assessment Rapid Health Assessment Rapid Public Health Assessment Rapid Epidemiological Assessment Rapid …………….?

Purpose of Rapid Health Assessment (RHA) The purpose of a rapid assessment is to: Confirm the emergency Describe the type, impact and possible evolution of the emergency Measure its present and potential health impact Assess the adequacy of existing response capacity & immediate additional needs Recommend priority action for immediate response Disseminate findings widely

RA: Main issues Area of information? Source of information? Which instrument? Team composition? Report format?

RA: Area of Information MAIN ISSUE Nature of the emergency: Main causative hazard Additional hazards Projected evolution Affected area Administrative division Access to area: Main routes and conditions Distance from the closest town outside the affected area Closest operational airport, port or navigable river Affected population: Characteristics (e.g residents, refugees, IDPs) Number/estimates Sex/age breakdown Patterns of settlement/movement Source of information & method of data collection

RA: Area of Information HEALTH IMPACT Direct impact: reasons for alert Main causes of morbidity and mortality CMR Under-5 Mortality Rate Malnutrition status Reports/rumours of outbreak Other reasons for concern: e.g. traumas/injures due to landmines, etc Indirect health impact e.g. damage to water plants, other vital infrastructures or lifelines Pre-emergency baseline morbidity and mortality data Projected evolution of the health situation: Main causes of concern in the coming months

RA: Area of Information VITAL NEEDS: THE CURRENT SITUATION Water Excreta disposal Food Shelter and environment on site Soap and buckets Fuel and cooking utensils Clothing and blankets

RA: Area of Information CRITICAL CONSTRAINTS Security Transport and logistics Social/political and geographical constraints

RA: Area of Information RESPONSE CAPACITY Activities already underway Measles coverage National contingency plans, procedures, guidelines and special expertise Operational support Location of field forward control post Health system: Closest functioning health unit and referral system External assistance: Closest organization and relevant resources Capacity for reprogramming the resources above State of communications Storage capacity close to affected area and supply lines

RA: Area of Information RESPONSE CAPACITY Operational coordination: Lead agency Mechanisms Flows of information Strategic coordination Relations between government and UN country team National institutions for emergency management Standing agreements with neighbouring areas Relations between government and international community at large

RA: Source of information Visual inspection Analysis of records Interview of key informants Rapid surveys

RA: Instrument Minimal Essential Data Set (MEDS) Evaluation Criteria

RA Instrument: International Source 1.WHO: Rapid Health Assessment Protocol for Emergencies 2.UNICEF: Handbook for Emergencies 3.IFRC: Handbook for Delegates 4.Sphere: Humanitarian Charter & Minimum Standards in Disaster Response 5.MSF: Refugee Health 6.OFDA: Field Operation Guide 7.CDC: Famine-Affected, Refugee, and displaced populations: Recommendations for Public Health Issues

RA Instrument: Evaluation Criteria 1.Disaster specificity (Specific / Non-specific) 2.Assessment focus: (Site-targeted / System targeted) 3.Metadata (Captured / Not captured) 4.Information priorities (Critical / Non-critical) 5.Performance indicators (SMART / not SMART) 6.Benchmarks (Present / Absent) 7.Data structure (Checklist / Template) 8.Portability (High / Intermediate / Low) 9.Time needed (Stated / Unstated) 10.Field utility (High / Low)

RA: Team Composition Public health professional Epidemiologist Environmental health expert …

RA: Report Format

RA: Information User Wide spectrum: UN Agencies NNGOs & INGOs MOH departments Health sector partners Media …

RA: Common Problems Poorly coordinated; each organization doing different assessment Findings not disseminated Findings ignored Ongoing information system not established

Contact info: Office/FAx: Mobile: Ali Ardalan MD MPH PhD Assistant Professor Health Emergency & Disaster Department (HE&DD) Institute of Public Health Research Tehran University of Medical Sciences