Vincenzo Bollettino, Tilly Alcayna, Krish Enriquez, and Patrick Vinck. 6/2018. Perceptions of Disaster Resilience and Preparedness in the Philippines.Abstract

The Philippines is one of the world’s most disaster-prone countries. Located along the boundary of major tectonic plates and at the center of a typhoon belt, its islands are regularly impacted by floods, typhoons, landslides, earthquakes, volcanoes, and droughts. The Philippines also ranks among the top three countries in the world for population exposure and vulnerability to hazards. The Philippine government has developed strong coping mechanisms over their long history of experience with disasters. Yet, significant gaps remain in disaster management capacities across different regions of the Philippines and surprisingly little data are available referencing local levels of disaster resilience and preparedness.

This research aims to address the gap in knowledge on both local disaster resilience and preparedness by providing a comprehensive overview of household measures of resilience and levels of disaster preparedness. This is the first nationwide household survey on measures of disaster resilience and disaster preparedness carried out in the Philippines. It comes at a time of critical importance as efforts are being made to ensure disaster management is based on evidence, especially at the local level and amid national discussions on centralizing disaster resilience efforts under a single national agency.

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6/2018. “An Innovative Global Diplomacy Public Health Student Program – Lessons from the Field in a Post-Conflict Medellin, Colombia”.Abstract

For over fifty years, Colombia has been embroiled in conflict, displacing nearly seven million people, second only to Syria for the highest number of internally displaced persons (IDPs) in the world. Most are displaced to urban environments into dense informal settlements with inadequate water, sanitation, shelter and power infrastructure. The city of Medellín, has become home to over 200,000 IDPs in informal agglomerations. Medellín’s transformation to a city of progress and innovation through the promotion of “social urbanism” is an example of how collaboration between city institutions and government sectors can address issues of poverty, violence, equality, engagement, and reintegration of displaced populations in Colombia.

The Post-Conflict Colombia Public Health Project is a collaborative academic exchange program aimed at bringing together public health students from the United States and Colombia for the purpose of understanding between the people of both countries. The project aims to educate students while also providing direct service and fostering long-term cross-cultural relationships and sustainable projects. Seminars, skill building workshops, cultural experiences, and community engagement are used to build professional competencies and inform policy recommendations for future projects. Despite the limited research on the educational impact of short-term global emersion programs, small scale evaluations point to an increase in learners’ cross-cultural adaptability. The believed benefit to students’ professional and personal development must be balanced with ethical considerations including preparedness of students, health and safety risks, cultural sensitivity, and issues of sustainability. In order to address these concerns, programs should be developed collaboratively through bi-directional participatory relationships, incorporating both education and direct service components, and promoting local capacity building and long-term sustainability.

Our course pairs 16 carefully selected graduate-level public health and medical students from Harvard and Universidad de Antioquia, who will serve as both student and citizen ambassadors, to come together and share about their culture, values, and experiences through the lens of diplomacy and dialogue to make a meaningful impact in the people and country of Colombia. The course examines the social development model of Medellín and its impact on advances in peace, social equity, and health. Beyond the theoretical concepts, students will learn to apply them to the Granizal community in order to create practical solutions that are sustainable, scalable, innovative, and measurable.

As other disciplines move away from curricula limited to rote learning and fact-based content, public health and policy education will also benefit from incorporating experiential and competency-based learning with an emphasis on skill building in leadership, management, policy-making, and research.5 The Institute of Medicine’s 2003 report, Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century, recommends eight content areas as essential to graduate level public health education programs: informatics, genomics, communication, cultural competence, community-based participatory research, global health, policy and law, and public health ethics.6 The report further acknowledges the importance of developing international relationships between academic institutions, community organizations, and health agencies for collaboration in interdisciplinary and community-based research, learning, and service. Health disparities, issues of social justice, and public health threats from infectious disease are less and less confined by political and geographic boundaries. The future generation of leaders in public health and policy must be able to bridge nations and cultures through diplomacy and be equipped to develop innovative strategies and partnerships across professional disciplines and on a global scale.

While several public health approaches have been documented in the literature, we describe a model for a multi-institutional and cross-cultural collaboration based on The Post-Conflict Colombia Public Health Project, a three-week intensive course developed in partnership between the Harvard Humanitarian Initiative, the Open Hands Initiative, and the University of Antioquia. While this model is a public health course focusing on Colombia, the concepts and educational strategies can be applied across academic disciplines and to other countries and communities.


Phuong Pham, Vandana Sharma, Rebecca Hémono, Jessica Jean-Francois, and Jennifer Scott. 5/2018. DEPP Evaluation Summative Phase Report.Abstract
This report provides the summative results from the three-year external impact evaluation of the Disasters and Emergencies Preparedness Programme (DEPP) conducted by a team at the Harvard Humanitarian Initiative (HHI). The DEPP was a £40 million programme funded by the Department for International Development (DFID) that aimed to strengthen skills and capacity and improve the quality and speed of humanitarian response in countries that are at risk of natural disasters or emergencies.
Phuong Pham, Vandana Sharma, Rebecca Hémono, Jessica Jean-Francois, and Jennifer Scott. 5/2018. DEPP Evaluation Summative Phase Report Annexes.Abstract

This report provides the summative results from the three-year external impact evaluation of the Disasters and Emergencies Preparedness Programme (DEPP) conducted by a team at the Harvard Humanitarian Initiative (HHI). The DEPP was a £40 million programme funded by the Department for International Development (DFID) that aimed to strengthen skills and capacity and improve the quality and speed of humanitarian response in countries that are at risk of natural disasters or emergencies.

This document provides the annexes of the report. 

Stuart R. Campo, Caitlin N. Howarth, Nathaniel A. Raymond, and Daniel P. Scarnecchia. 5/2018. Signal Code: Ethical Obligations for Humanitarian Information Activities.Abstract

Humanitarians today lack sufficient ethical guidance adapted to the realities of humanitarianism in the information age to responsibly navigate the challenges and realities of the digital age.

The Signal Code: Ethical Obligations for Humanitarian Information Activities translates and applies the foundational sources of ethical humanitarian practice to humanitarian information activities, such as mobile devices, WiFi provision, data collection, storage and analysis, and biometric registration tools. This document represents the first effort to provide humanitarian practitioners and researchers with comprehensive ethical guidance for this increasingly commonplace and critical area of humanitarian practice.

The Obligations builds upon the rights-based approach first articulated in the January 2017 publication of The Signal Code: A Human Rights Approach to Information during Crisis. The Code seeks to identify extant international humanitarian and human rights law and standards, as well as other relevant and accepted international instruments, that provide all people basic rights pertaining to the access to, and provision and treatment of, information during a crisis. The first volume of the Code is employed as an underlying framework for how the Obligations is structured and from where the obligations are, in part, derived.

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Jocelyn Kelly, Elizabeth Colantuoni, Courtland Robinson, and Michele R Decker. 4/2018. “From the battlefield to the bedroom: a multilevel analysis of the links between political conflict and intimate partner violence in Liberia.” BMJ Global Health, 3, 2. Read PublicationAbstract

Objectives Assess the link between levels of armed conflict and postconflict intimate partner violence (IPV) experienced by women in Liberia.

Methods Armed Conflict Location and Event Data Project data were used to measure conflict-related fatalities in districts in Liberia during the country’s civil war from 1999 to 2003. These data were linked to individual-level data from the 2007 Demographic and Health Survey, including past-year IPV. Multilevel logistic models accounting for the clustering of women within districts evaluated the relationship of conflict fatalities with postconflict past-year IPV. Additional conflict measures, including conflict events and cumulative years of conflict, were assessed.

Results After adjusting for individual-level characteristics correlated with IPV, residence in a conflict fatality-affected district was associated with a 50% increase in risk of IPV (adjusted OR (aOR): 1.55, 95% CI 1.26 to 1.92). Women living in a district that experienced 4–5 cumulative years of conflict were also more likely to experience IPV (aOR 1.88, 95% CI 1.29 to 2.75).

Conclusion Residing in a conflict-affected district even 5 years after conflict was associated with postconflict IPV.

Policy implications Recognising and preventing postconflict IPV violence is important to support long-term recovery in postconflict settings.

Harvard Humanitarian Initiative. 3/2018. HHI Annual Report 2017 .Abstract

The HHI 2017 Annual Report provides a look into the research and educational activities of the Harvard Humanitarian Initiative. 

At a time of deepening challenges nationally, globally, and especially in the humanitarian sector, the Harvard Humanitarian Initiative (HHI) is uniquely positioned to shape the future of humanitarian response, research, and education. The crises of the past year - including protracted conflicts, refugee displacement, and worsening natural disasters - have further underscored the importance of our work, and deepened our commitment to advancing the science and practice of humanitarian response. Our growing team of leading researchers, practitioners, and educators is working with local organizations and international institutions to build the evidence-base within the field, exchange knowledge with tens of thousands of current and future practitioners around the globe, and shape the development of policy at the forefront of humanitarian action.

Mark Latonero, Danielle Poole, and Jos Berens. 3/2018. Refugee Connectivity: A Survey of Mobile Phones, Mental Health, and Privacy at a Syrian Refugee Camp in Greece.Abstract
The report, Refugee Connectivity: A Survey of Mobile Phones, Mental Health, and Privacy at a Syrian Refugee Camp in Greece, is the result of 2017 field research by Data & Society, the Harvard Humanitarian Initiative’s (HHI) Signal Program on Human Security and Technology, and Centre for Innovation at Leiden University. Lead authors of the report are Mark Latonero, Ph.D. of Data & Society, Danielle Poole of HHI/Signal and the Harvard School of Public Health, and Jos Berens, formerly of Leiden University. 
International Committee Red of the Cross and Harvard Humanitarian Initiative. 2/2018. Engaging with People Affected by Armed Conflicts and Other Situations of Violence: Recommendations for Humanitarian Organizations and Donors in the Digital Era.Abstract

ICRC & the Harvard Humanitarian Initiative (HHI) launch a joint discussion paper that provides recommendations for humanitarian organisations and donors in today's digital era.

Based on a review of the relevant literature and interviews with representatives of the humanitarian sector, donors, and community-based organizations, the paper offers an overview of how the humanitarian community currently engages with people affected by armed conflict and violence; a review of the opportunities and challenges for meaningful engagement; and a series of recommendations for both humanitarian organizations and donors.

Phuong Pham and Patrick Vinck. 2/2018. “Human Rights and Mixed Methods.” Chance, 31, 1, Pp. 29-37. Read PublicationAbstract
Research in the field of human rights can have many goals. Among others, it serves to uncover and document evidence of crimes, seeks to tell the stories of victims and survivors, and strives to inform and influence policies and strategies to deal with human rights violations. Most commonly, it is defines as seeking to uncover "the truth" - what happened, to whom, by whom, where, when, how, and how many were effected. 
Susan Andrea Bartels, Saja Michael, Sophie Roupetz, Stephanie Garbern, Lama Kilzar, Harveen Bergquist, Nour Bakhache, Colleen Davison, and Annie Bunting. 1/2018. “Making sense of child, early and forced marriage among Syrian refugee girls: a mixed methods study in Lebanon.” BMJ Global Health, 3, 1. Read PublicationAbstract

The Syrian conflict has resulted in over 2.3 million child refugees in the Middle East and the prevalence of early marriage has reportedly increased among displaced Syrian families. This study explores the underlying factors contributing to child marriage among Syrian refugees in Lebanon with the goal of informing community-based strategies to address the issue.

In July–August 2016, trained interviewers collected self-interpreted stories in Lebanon using Cognitive Edge’s SenseMaker, a mixed-method data collection tool. Participants included married and unmarried Syrian girls, Syrian parents as well as married and unmarried men. Each participant shared a story about the experiences of Syrian girls and then interpreted the story by plotting their perspectives on a variety of questions. Patterns in the responses were analysed in SPSS and the accompanying qualitative narratives were reviewed to facilitate interpretation of the quantitative results.

Elan R Small, Sarah R Burbank, Jeanette M Lorme, Karl Carlson, Timothy B Erickson, and David S Young. 2018. “Apostle Islands National Lakeshore: A Review of Search and Rescue and Emergency Medical Services Operations, 2006-2015.” Wilderness Environ Med, 29, 4, Pp. 463-470.Abstract
INTRODUCTION: Apostle Islands National Lakeshore (APIS) lies at the northern tip of Wisconsin and is home to a network of 21 islands along Lake Superior. The goal of this report is to investigate search and rescue (SAR) and emergency medical services (EMS) trends at APIS in an effort to improve visitor safety and resource allocation. METHODS: This study is a retrospective analysis reviewing APIS SAR reports and annual EMS summary reports from January 1, 2006, to December 31, 2015. Information related to incident type, incident date, individual demographic characteristics and activities, injury/illness type, cost, and contributing factors were recorded and analyzed in frequency tables. RESULTS: From 2006 to 2015, APIS SAR conducted 133 total missions assisting 261 individuals-200 not injured/ill, 57 injured/ill, and 4 fatalities. Median cost per SAR incident involving aircraft totaled $21,695 (range: $2,993-141,849), whereas incidents not involving aircraft had a median cost of $363 (range: $35-8,830). Nonmotorized boating was the most common activity resulting in SAR incidents. All 4 fatalities were attributed to drowning while kayaking or swimming. Cold-related injury/illness accounted for nearly half of all injuries/illnesses (45%) with the most commonly reported contributing factor being high winds. EMS responded to a total of 134 incidents. Trauma and first aid accounted for 43% and 34% of EMS workload, respectively. CONCLUSIONS: Overall, this study highlights the hazards associated with the frigid and rough conditions of Lake Superior. The reported results aim to help APIS personnel more saliently convey risks to visitors and plan appropriately in an effort to decrease the need for future rescues.
Joshua N Goldstein, David M Dudzinski, Timothy B Erickson, and Grace Linder. 2018. “Case 12-2018: A 30-Year-Old Woman with Cardiac Arrest.” N Engl J Med, 378, 16, Pp. 1538-1549.
Robert K Needleman, Isabelle P Neylan, and Timothy B Erickson. 2018. “Environmental and Ecological Effects of Climate Change on Venomous Marine and Amphibious Species in the Wilderness.” Wilderness Environ Med, 29, 3, Pp. 343-356.Abstract
INTRODUCTION: Recent analyses of data show a warming trend in global average air and sea surface ocean temperatures. The atmosphere and ocean have warmed, the amounts of snow and ice have diminished, the sea level has risen, and the concentrations of greenhouse gases have increased. This article will focus on climate change and projected effects on venomous marine and amphibious creatures with the potential impact on human health. METHODS: Retrospective analysis of environmental, ecological, and medical literature with a focus on climate change, toxinology, and future modeling specific to venomous aquatic and amphibious creatures. Species included venomous jellyfish, poisonous fish, crown-of-thorns starfish, sea snakes, and toxic frogs. RESULTS: In several projected scenarios, rising temperatures, weather extremes, and shifts in seasons will increase poisonous population numbers, particularly with certain marine creatures like jellyfish and crown-of-thorns starfish. Habitat expansions by lionfish and sea snakes are projected to occur. These phenomena, along with increases in human populations and coastal development will likely increase human-animal encounters. Other species, particularly amphibious toxic frogs, are declining rapidly due to their sensitivity to any temperature change or subtle alterations in the stability of their environment. If temperatures continue to rise to record levels over the next decades, it is predicted that the populations of these once plentiful and critically important animals to the aquatic ecosystem will decline and their geographic distributions will shrink. CONCLUSION: Review of the literature investigating the effect and forecasts of climate change on venomous marine and amphibious creatures has demonstrated that temperature extremes and changes to climatic norms will likely have a dramatic effect on these toxicological organisms. The effects of climate change on these species through temperature alteration and rising coastal waters will influence each species differently and in turn potentially affect commercial industries, travel, tourism, and human health.
Aruna Ramesh, Kenneth A LaBresh, Rhea Begeman, Bentley Bobrow, Teri Campbell, Nayanjeet Chaudhury, Marcia Edison, Timothy B Erickson, John D Manning, Bellur S Prabhakar, Pavitra Kotini-Shah, Naresh Shetty, Pamela A Williams, and Terry Vanden Hoek. 2018. “Implementing a STEMI system of care in urban Bangalore: Rationale and Study Design for heart rescue India.” Contemp Clin Trials Commun, 10, Pp. 105-110.Abstract
Background: A system of care designed to measure and improve process measures such as symptom recognition, emergency response, and hospital care has the potential to reduce mortality and improve quality of life for patients with ST-elevation myocardial infarction (STEMI). Objective: To document the methodology and rationale for the implementation and impact measurement of the Heart Rescue India project on STEMI morbidity and mortality in Bangalore, India. Study Design: A hub and spoke STEMI system of care comprised of two interventional, hub hospitals and five spoke hospitals will build and deploy a dedicated emergency response and transport system covering a 10 Km. radius area of Bangalore, India. High risk patients will receive a dedicated emergency response number to call for symptoms of heart attack. A dedicated operations center will use geo-tracking strategies to optimize response times including first responder motor scooter transport, equipped with ECG machines to transmit ECG's for immediate interpretation and optimal triage. At the same time, a dedicated ambulance will be deployed for transport of appropriate STEMI patients to a hub hospital while non-STEMI patients will be transported to spoke hospitals. To enhance patient recognition and initiation of therapy, school children will be trained in basic CPR and signs and symptom of chest pain. Hub hospitals will refine their emergency department and cardiac catheterization laboratory protocols using continuous quality improvement techniques to minimize treatment delays. Prior to hospital discharge, secondary prevention measures will be initiated to enhance long-term patient outcomes.
Peter R Chai, Bryan D Hayes, Timothy B Erickson, and Edward W Boyer. 2018. “Novichok agents: a historical, current, and toxicological perspective.” Toxicol Commun, 2, 1, Pp. 45-48.Abstract
The , or "newcomer" class of nerve agents are lesser characterized, weaponized organophosphate agents. The use of known agents in warfare is banned under the Chemical Weapons Convention of 1997. agents are considered more potent than VX gas and can be applied in unitary and binary forms. Like other nerve agents, agents irreversibly bind acetylcholinesterase and produce a cholinergic toxidrome. Uniquely, these agents are thought to also target neurons in the peripheral nervous system. Delayed treatment or massive exposure may therefore cause a debilitating neuropathy. The recent 2018 assassination attempt of Russian dissident Sergei Skripal and his daughter Yulia in the United Kingdom highlights the importance of recognizing the potential lethal effects of these nerve agents. Treatment of agent poisoning is similar to management of other nerve agents. Given increasing worldwide incidents attributed to chemical weapons such as agents, clinicians should know how to rapidly recognize symptoms of acute poisoning and administer life-saving antidotal therapy, when indicated.
Robert K Needleman, Isabelle P Neylan, and Timothy Erickson. 2018. “Potential Environmental and Ecological Effects of Global Climate Change on Venomous Terrestrial Species in the Wilderness.” Wilderness Environ Med, 29, 2, Pp. 226-238.Abstract
INTRODUCTION: Climate change has been scientifically documented, and its effects on wildlife have been prognosticated. We sought to predict the overall impact of climate change on venomous terrestrial species. We hypothesize that given the close relationship between terrestrial venomous species and climate, a changing global environment may result in increased species migration, geographical redistribution, and longer seasons for envenomation, which would have repercussions on human health. METHODS: A retrospective analysis of environmental, ecological, and medical literature was performed with a focus on climate change, toxinology, and future modeling specific to venomous terrestrial creatures. Species included venomous reptiles, snakes, arthropods, spiders, and Hymenoptera (ants and bees). Animals that are vectors of hemorrhagic infectious disease (eg, mosquitos, ticks) were excluded. RESULTS: Our review of the literature indicates that changes to climatic norms will have a potentially dramatic effect on terrestrial venomous creatures. Empirical evidence demonstrates that geographic distributions of many species have already shifted due to changing climatic conditions. Given that most terrestrial venomous species are ectotherms closely tied to ambient temperature, and that climate change is shifting temperature zones away from the equator, further significant distribution and population changes should be anticipated. For those species able to migrate to match the changing temperatures, new geographical locations may open. For those species with limited distribution capabilities, the rate of climate change may accelerate faster than species can adapt, causing population declines. Specifically, poisonous snakes and spiders will likely maintain their population numbers but will shift their geographic distribution to traditionally temperate zones more often inhabited by humans. Fire ants and Africanized honey bees are expected to have an expanded range distribution due to predicted warming trends. Human encounters with these types of creatures are likely to increase, resulting in potential human morbidity and mortality. CONCLUSIONS: Temperature extremes and changes to climatic norms may have a dramatic effect on venomous terrestrial species. As climate change affects the distribution, populations, and life histories of these organisms, the chance of encounters could be altered, thus affecting human health and the survivability of these creatures.
Julia Brooks, Timothy B Erickson, Stephanie Kayden, Raul Ruiz, Stephen Wilkinson, and Frederick M Burkle. 2018. “Responding to chemical weapons violations in Syria: legal, health, and humanitarian recommendations.” Confl Health, 12, Pp. 12.Abstract
Background: The repeated use of prohibited chemical weapons in the Syrian conflict poses serious health, humanitarian, and security threats to civilians, healthcare personnel, and first responders. Moreover, the use of chemical weapons constitutes a clear and egregious violation of international law-likely amounting to a war crime-for which continued impunity is setting a dangerous precedent in relation to current and future conflicts. This debate article calls upon concerned states, organizations, and individuals to respond urgently and unequivocally to this serious breach of international legal and humanitarian norms. Main Body: Based on health, humanitarian, and legal findings, this article calls for concrete action to: 1) reduce the risk of chemical weapons being used in current and future conflicts; 2) review and support the preparedness equipment and antidote supplies of first responders, humanitarian organizations, and military forces operating in Syria; 3) support international mechanisms for monitoring and enforcing the prohibition on chemical weapons, including through criminal accountability; 4) support civilian victims of chemical weapons attacks, including refugees; and 5) re-commit to the complete elimination of chemical weapons in compliance with the (1993), a comprehensive treaty that bans chemical weapons and requires their complete destruction. Conclusion: All involved states and organizations should take urgent steps to ensure the protection of the most vulnerable victims of conflict, including victims of chemical weapons attacks in Syria, and to reinforce international law in the face of such serious violations.
Beth J. Maclin, Hannah Wild, Nirma D. Bustamante, and Ronak B. Patel. 12/2017. Investigating Gender Based Insecurity & Mobility: Addis Ababa Country Report.Abstract

This study of gender based insecurity in Addis Ababa found that women and girls are vulnerable in public and private spaces at any time to assault and harassment, though they are at greater risk for physical violence, including rape, at night. They sacrifice time, money, education, socializing, and their mental health to mitigate the risks they face moving around their community and the city.
Overall, men commit almost all of the violence described by participants. Much of the insecurity is blamed on unemployed young men that abuse drugs and alcohol. Some also linked unemployment with massive migration from other areas of the country to Addis Ababa. Two cultural factors seem to inform violence against women. First, society normalizes men and boys touching and saying inappropriate things to women and girls, which then leads to increasingly violent forms of abuse. Additionally, limited police response to gender-based violence creates a culture of impunity, which furthers a cultural acceptance of violence against women. Several strategies that draw from participant coping strategies and an analysis of the sources of insecurity can be explored and are detailed at the end of this report.

This formative research seeks to determine the experiences, sources and effects of GBV and GBI among the urban extreme poor of Dhaka, Bangladesh; Port-au-Prince, Haiti; and Addis Ababa, Ethiopia, with the goal of informing the development of a pilot survey instrument to measure the prevalence and impact of GBI in selected urban slums of the same three cities. 

Ronak B. Patel, Beth J. Maclin, Nirma D. Bustamante, and Hannah Wild. 12/2017. Investigating Gender Based Insecurity & Mobility: Multi-City Report.Abstract

Rapid urbanization is the most significant demographic shift taking place. By the year 2050, it is predicted that 70% of the world population will be urban. The urban poor live in a state of chronic crisis and reside in extremely dense informal settlements without basic infrastructure or services. High levels of insecurity are of particular concern. Due to their unofficial status, density, high concentrations of poverty and, often, high turnover, urban informal settlements are either extremely difficult to police or effectively remain un-policed and ungoverned. While all residents of urban informal settlements face significant insecurity and susceptibility to violent crimes, women are especially vulnerable. 

This formative research seeks to determine the experiences, sources and effects of GBV and GBI among the urban extreme poor of Dhaka, Bangladesh; Port-au-Prince, Haiti; and Addis Ababa, Ethiopia, with the goal of informing the development of a pilot survey instrument to measure the prevalence and impact of GBI in selected urban informal settlements of the same three cities.