Urbanization And Emergencies


The world is rapidly urbanizing with the majority of the world’s population now living in urban areas. In many rapidly urbanizing states, the slum population now makes up over 60% of the urban populace. This demographic transition is creating complex urban landscapes with disproportionately large slums that concentrate hazards and vulnerabilities to natural and man-made disasters. As a result, humanitarian emergencies will increasingly affect urban populations. Governments will need to proactively create development and planning policies for their urban areas and preparedness plans based on evidence. Humanitarian actors must learn to respond to the unique challenges of urban contexts while exploiting the advantages. HHI is taking the lead on these complex topics by determining how to appropriately prepare for and respond to urban humanitarian emergencies and the chronic crisis facing urban slum populations. Through the Urbanization and Humanitarian Emergencies Program, we advance knowledge on the chronic and acute needs of urban populations, address these challenges and investigate program and policy solutions. We partner with local actors, government authorities, international agencies and non-government organizations that have the ability to scale up our work and have an immediate impact.

For a document with a brief summary of this program, click here.


Through a combination of organizational partnerships, research initiatives, and mapping projects, HHI is sparking analysis into the humanitarian approaches best suited for urban environments. These projects include:

Mapping Vulnerabilities and Health: Policy makers, officials and service providers need accurate maps that display data where the most vulnerable populations in their city are located and how to measure their risk for potential crisis to adequately prepare for and mitigate the effects of emergencies on these communities. In collaboration with Concern Worldwide and the WHO, we aim to develop a prototype map of Nairobi city with a specific focus on identifying the most vulnerable populations for various types of emergencies as well as identifying resources. We hope to develop standardized methods to measure and map these vulnerabilities and promote this map as a tool for use by cities and organizations across the globe. We also aim to adapt the WHO Urban HEART tool into a map that allows city governments to use the data in a visual format exploiting satellite and other technology to collect more granular data that allows better analysis and tracking of performance on various health-related indicators.

Through a combination of organizational partnerships, research initiatives, and mapping projects, HHI is sparking analysis into the humanitarian approaches best suited for urban environments in the following ways:

  • Investigating the burden of illness and determinants of health in complex urban environments with a focus on urban slums and problems common to humanitarian crises
  • Operational research on interventions to improve health outcomes, mitigate vulnerability and guide urban planning and policy
  • Convening aid organizations, researchers, international agencies and policy-makers to consolidate the knowledgebase on urbanization and humanitarian emergencies while identifying the gaps to address.
  • Developing tools for city planners, community based organizations, policy-makers and aid organizations to plan for and respond to urban humanitarian emergencies.
  • Collaborating with the Harvard-wide community to leverage expertise from the various schools, faculty and programs to develop the multidisciplinary solutions needed to address rapid urbanization

In partnership with the African Population Health Research Center (APHRC), we are comparing the current standard of living in the Nairobi Slums with the Sphere minimum standards used during humanitarian emergencies. Other projects will measure the burden of gender-based violence and mental illness in urban slums.

With the Self Employed Women’s Association (SEWA) in Ahmedabad, India we have investigated the health impact of a public private partnership using microfinance for slum-upgrading. We are currently working with SEWA to investigate the burden and sources of mental illness in urban slums and testing an intervention.

  • A project in Mumbai, India with Partners for Urban Knowledge Action and Research (PUKAR) will analyze the burden of water-borne illness in terms of financial cost to households and episodes of illness with a cost-benefit analysis of various water-sanitation interventions.
  • With the Society for the Promotion of Area Resource Centers (SPARC) and Slum Dwellers International (SDI) we are investigating the health and financial impact of sanitation interventions in Mumbai, India including mortality and GDP loss.

Urbanization and Climate Change Vulnerabilities:The current pattern of urbanization places communities directly in the most vulnerable areas for environmental emergencies such as floodplains with poorly built and crowded settlements lacking very basic city infrastructure. Additionally, cities are outpacing available resources and land degrading their very protections from environmental emergencies with deforestation, land erosion, and clogging of natural water runoff paths. This recipe for disaster is now playing out across the world. The current knowledge base on the interplay between the environment and urbanization is very small. The patterns of this process and the consequences of these effects remain largely unknown. We aim to develop a research agenda around this topic and consolidate the state of the art while identifying the key gaps in knowledge to bring together collaborators to address these challenges.

Urban Humanitarian Emergencies Working Group: Through the working group, HHI is building relationships among stakeholders (including aid organizations, UN agencies, the WHO and representatives from the Sphere Project) to pool global experience and expertise and develop new guidelines for urban humanitarian emergencies.
  • Adapting the current Sphere Guidelines for response in humanitarian emergencies to urban settings.
  • Developing the indicators for preparedness for urban humanitarian emergencies for use by the WHO in its Urban HEART tool.

As the universally recognized authority on minimum standards during emergencies, the Sphere Project will amplify HHI’s work into a well established resource for humanitarian aid response. The second objective, in partnership with the WHO Centre for Health Development, will develop the indicators used by cities to measure and improve their preparedness for humanitarian emergencies for the Urban HEART tool and scale up its adoption by city governments across the globe. Finally, this working group will also identify the current gaps in knowledge to help guide HHI’s future research projects in urban humanitarian emergencies.

Human Security and Resilience in Complex Urban Landscapes: Rapid urbanization in the global south creates complex urban landscapes that are especially vulnerable to natural and man-made hazards. These vulnerabilities are exacerbated in conflict and transitional contexts, where urban violence, psychosocial health and gender-based violence may be especially acute. Given the complexity of these environments, a human security research approach allows for a comprehensive examination of the requirements for minimum levels of survival (public health, personal safety, livelihoods and shelter), as well as basic psychosocial conditions (identity, recognition, participation, and autonomy). In order to further human security and mitigate risks, it is essential to identify and develop policies for strengthening resilience mechanisms utilized by marginalized communities.

The first phase of the study is an examination of human security and resilience in Distrito de Aguablanca (Cali, Colombia), a complex urban landscape with over 500,000 residents, a history of sociopolitical volatility, and a large population of internally displaced persons. It is being supported by the Feinstein International Center, the Leir Foundation at the Fletcher School, and the Institute for Global Leadership (Tufts University).



Below are the most recently published reports from the Urbanization and Humanitarian Emergencies Program. For the full list of the program's publications, go here.


Rapid Urbanization and the Growing Threat of Violence and Conflict: A 21stCentury Crisis

By Ronak B. Patel and Fredrick M. Burkle


Urbanization and Humanitarian Access Working Group: Toward Guidelines for Humanitarian Standards and Operations in Urban Settings

By Laura M. Janneck, MD, MPH; Ronak Patel, MD, MPH; Shada A. Rouhani, MD; Frederick M. Burkle, Jr, MD, MPH, DTM




Urbanization and Humanitarian Access Working Group: A Blueprint for the Development of Prevention and Preparedness Indicators for Urban Humanitarian Crises

By Shada A. Rouhani, Ronak B. Patel, Laura M. Janneck, Amit Prasad, Jostacio Lapitan and Frederick M. Burkle Jr




Ronak B. Patel, MD, MPH
Director of the Urbanization and Humanitarian Emergencies Program

Michael VanRooyen, MD, MPH, FACEP 
Director, Harvard Humanitarian Initiative

Gregg Greenough, MD, MPH 
Director of Research

Jocelyn Kelly, MS 
Director of the Women and War Program

Vincenzo Bollettino, PhD 
Executive Director