Publications

2018
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.
2017
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. 

gbi_addis_report_new_final.pdf
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. 

gbi_multi-city_report_new_final.pdf
Jocelyn Kelly, Katherine Albutt, Justin Kabanga, Kimberley Anderson, and Michael VanRooyen. 12/2017. “Rejection, acceptance and the spectrum between: understanding male attitudes and experiences towards conflict-related sexual violence in eastern Democratic Republic of Congo.” BMC Women's Health, 17. Read PublicationAbstract
Female survivors of sexual violence in conflict experience not only physical and psychological sequelae from the event itself, but often many negative social outcomes, such as rejection and ostracisation from their families and community. Male relatives – whether husbands, fathers, brothers – play a key role in determining how the family and community respond to a survivor of sexual violence. Understanding these perspectives could help improve services for survivors of sexual violence, as well as their families and communities.
Ronak B. Patel and Kelsey Gleason. 10/2017. “The association between social cohesion and community resilience in two urban slums of Port au Prince, Haiti.” International Journal of Disaster Risk Reduction. Read PublicationAbstract
Multiple recent global agendas have advanced the case for resilience to underpin humanitarian action and disaster risk reduction. These agendas have been incorporated into multiple efforts but evidence to guide action has lagged behind. This study examines a specific link, often cited through qualitative research, between social cohesion and community resilience in two urban slums of Port au Prince, Haiti. Scales to measure social cohesion and resilience are applied to these communities to develop a quantitative measure of these two characteristics. These two characteristics are then analyzed with various other demographic variables of community members to quantitatively explore associations among them. The results show that a higher social cohesion score is statistically associated with a higher resilience score and among the variables tested, social cohesion had the greatest impact on the community resilience as measured by these scales. and shows a statistical association between the two. The findings add to the growing but nascent literature on empirical evidence for resilience characteristics. Further examinations are drawn out of the findings and future investigations should tackle the inductively derived characteristics of resilience to further guide programs and policy.
10/2017. “Crisis Code: Humanitarian Protection in the Digital Age”. Watch VideoAbstract
Crisis Code: Humanitarian Protection in the Digital Age. Panel 1: Humanitarian Threats in the Age of Cyberwar, part of our #SwissTouch events at swissnex San Francisco.
Ronak B. Patel, Jami King, Laura Phelps, and David Sanderson. 10/2017. “Discussion Informed by Recurrent Lessons from a Systematic Review on Targeting Practices in Urban Humanitarian Crises.” PLOS Currents: Disasters. Read PublicationAbstract

Introduction: Urbanization has challenged many humanitarian practices given the complexity of cities. Urban humanitarian crises have similarly made identifying vulnerable populations difficult. As humanitarians respond to cities with chronic deficiencies in basic needs stressed by a crisis, identifying and prioritizing the most in need populations with finite resources is critical.

Methods: The full systematic review applied standard systematic review methodology that was described in detail, peer-reviewed, and published before the research was conducted.

Results: While the science of humanitarian practice is still developing, a systematic review of targeting vulnerable populations in urban humanitarian crises shed some light on the evidence base to guide policy and practice. This systematic review, referenced and available online, led to further findings that did not meet the pre-defined inclusion and exclusion criteria for evidence set out in the full review but that the authors, in their expert opinion, believe provide valuable insight nonetheless given their recurrence.

Vincenzo Bollettino, Patrick Vinck, Tilly Alcayna, and Philip Dy. 9/2017. “Introduction to Socio-Ecological Resilience.” Oxford Research Encyclopedia of Natural Hazard Science. Read PublicationAbstract

In recent years, the notion of resilience has grown into an important concept for both scholars and practitioners working on disasters. This evolution reflects a growing interest from diverse disciplines in a holistic understanding of complex systems, including how societies interact with their environment. This new lens offers an opportunity to focus on communities’ ability to prepare for and adapt to the challenges posed by natural hazards, and the mechanism they have developed to cope and adapt to threats. This is important because repeated stresses and shocks still cause serious damages to communities across the world, despite efforts to better prepare for disasters.

Scholars from a variety of disciplines have developed resilience frameworks both to guide macro-level policy decisions about where to invest in preparedness and to measure which systems perform best in limiting losses from disasters and ensuring rapid recovery. Yet there are competing conceptions of what resilience encompasses and how best to measure it. While there is a significant amount of scholarship produced on resilience, the lack of a shared understanding of its conceptual boundaries and means of measurement make it difficult to demonstrate the results or impact of resilience programs.

If resilience is to emerge as a concept capable of aiding decision-makers in identifying socio-geographical areas of vulnerability and improving preparedness, then scholars and practitioners need to adopt a common lexicon on the different elements of the concept and harmonize understandings of the relationships amongst them and means of measuring them. This article reviews the origins and evolution of resilience as an interdisciplinary, conceptual umbrella term for efforts by different disciplines to tackle complex problems arising from more frequent natural disasters. It concludes that resilience is a useful concept for bridging different academic disciplines focused on this complex problem set, while acknowledging that specific measures of resilience will differ as different units and levels of analysis are employed to measure disparate research questions.

Caitlin Howarth. 9/2017. “A Rights-based Approach to Information in Humanitarian Assistance.” PLOS Currents: Disasters. Read PublicationAbstract
Crisis-affected populations and humanitarian aid providers are both becoming increasingly reliant on information and communications technology (ICTs) for finding and provisioning aid. This is exposing critical, unaddressed gaps in the legal and ethical frameworks that traditionally defined and governed the professional conduct of humanitarian action. The most acute of these gaps is a lack of clarity about what human rights people have regarding information in disaster, and the corresponding obligations incumbent upon governments and aid providers.  This need is lent urgency by emerging evidence demonstrating that the use of these technologies in crisis response may be, in some cases, causing harm to the very populations they intend to serve.  Preventing and mitigating these harms, while also working to responsibly ensure access to the benefits of information during crises, requires a rights-based framework to guide humanitarian operations. In this brief report, we provide a commentary that accompanies our report, the Signal Code: A Human Rights Approach to Information During Crisis, where we have identified five rights pertaining to the use of information and data during crisis which are grounded in current international human rights and customary law. It is our belief that the continued relevance of the humanitarian project, as it grows increasingly dependent on the use of data and ICTs, urgently requires a discussion of these rights and corresponding obligations.
Summer Marion and Michael R. Snyder. 8/2017. “Book Review: The Power Behind Global Health .” International Peace Institute Global Observatory. Read PublicationAbstract
Doctoral student Summer Marion recently published “The Power Behind Global Health,” a review of Chelsea Clinton and Devi Sridhar’s recent book, Governing Global Health: Who Runs the World, and Why? The review was co-authored with Michael R. Snyder, a research analyst at Johns Hopkins Bloomberg School of Public Health, and published by the International Peace Institute’s Global Observatory. In their book, Clinton and Sridhar profile the inner workings of four of the biggest players in global heath, including two traditional institutions -- the World Health Organization (WHO) and the World Bank – and their younger cousins, known as public-private partnerships (PPPs) – the Global Fund to Fight Aids, Tuberculosis, and Malaria; and Gavi, the Vaccine Alliance. Marion and Snyder analyze the book’s empirical contributions to the field of global health governance, examining disruption and innovation brought about by the rise of PPPs. Additionally, the review highlights the close relationships among PPPs, global health reform, and recent shifts toward earmarked and philanthropic funding. Finally, the book review evaluates Clinton and Sridhar’s contributions to principal-agent theory, a commonly used framework in studies of multilateral aid, and potential for elaboration in future research.
Kristin Bergtora Sandvik and Nathaniel A. Raymond. 5/2017. “Beyond the Protective Effect: Towards a Theory of Harm for Information Communication Technologies in Mass Atrocity Response.” Genocide Studies and Prevention: An International Journal, 11, 1, Pp. 9-24. Read PublicationAbstract
Information Communication Technologies (ICTs) are now being employed as a standard part of mass atrocity response, evidence collection, and research by non-governmental organizations, governments, and the private sector. Deployment of these tools and techniques occur for a variety of stated reasons, most notably the ostensible goal of “protecting” vulnerable populations. However, these often experimental applications of ICTs and digital data are occurring in the absence of agreed normative frameworks and accepted theory to guide their ethical and responsible use. This article surveys the current state-of-the-art of ICT use in mass atrocity response and research to identify harms and hazards inherent in the use of ICT-centric approaches in mass atrocity producing environments. The article proposes an initial theory of harm for evaluating the potential risks and impacts of these applications as a critical component of developing ethical standards for the responsible use of ICTs in the mass atrocity response context.
Katherine Albutt, Jocelyn Kelly, Justin Kabanga, and Michael VanRooyen. 4/2017. “Stigmatisation and rejection of survivors of sexual violence in eastern Democratic Republic of the Congo.” Disasters, 41, 2, Pp. 211-227. Read PublicationAbstract
Studies report that between 6 per cent and 29 per cent of survivors of sexual violence in eastern Democratic Republic of the Congo (DRC) are rejected by their families and communities. This research project was designed to provide insights into survivors' experiences of stigmatisation and rejection. Surveys were conducted with 310 women as they sought psychosocial services in eastern DRC. In total, 44.3 per cent of women reported suffering rejection after sexual violence. The majority of women felt that their status in the household (58.0 per cent) and community (54.9 per cent) diminished after rape. The odds of rejection were greater among women reporting ongoing displacement, pregnancy owing to sexual violence, worsening family relations, and diminished community status. This work highlights the extremely high levels of loss associated with the war in eastern DRC, particularly among survivors of sexual violence. The rejection of a survivor of rape has concrete and devastating psychosocial consequences.
Faine Greenwood, Caitlin Howarth, Danielle Escudero Poole, Nathaniel A. Raymond, and Daniel P. Scarnecchia. 1/2017. The Signal Code: A Human Rights Approach to Information During Crisis.Abstract

 

The Signal Code is the result of a six month study by the Signal Program on Human Security and Technology at the Harvard Humanitarian Initiative (HHI) at the Harvard T.H. Chan School of Public Health to identify what human rights people have to information during disasters. The Signal Code identifies five rights from multiple sources of international human rights and humanitarian law and standards that already exist and apply to humanitarian information activities (HIAs). 

These five rights are the following: 1. The Right to Information; 2. The Right to Protection; 3. The Right to Privacy and Security; 4. The Right to Data Agency; and 5. The Right to Rectification and Redress. The goal of the Signal Code is to provide a foundation for the future development of ethical obligations for humanitarian actors and minimum technical standards for the safe, ethical, and responsible conduct of HIAs before, during, and after disasters strike.

Visit the Signal Code Minisite

 

signalcode_final.pdf
Ronak B. Patel, Jami King, Laura Phelps, and David Sanderson. 1/2017. What Practices Are Used to Identify and Prioritize Vulnerable Populations Affected by Urban Humanitarian Emergencies?. Humanitarian Evidence Programme. Read PublicationAbstract

Individuals and organizations responding to humanitarian crises recognize the need to improve urban emergency response and preparedness – including the need to devise better methods for assessing vulnerability within urban populations. 

This systematic review represents the first ever attempt to systematically search, sort and synthesize the existing evidence in order to consolidate findings on the tools, methods and metrics used to identify and prioritize vulnerable people, households and communities, including those displaced within and to urban areas. It is accompanied by a stand-alone executive summary and evidence brief. It forms part of a series of humanitarian evidence syntheses and systematic reviews commissioned by the Humanitarian Evidence Programme

Ronak B. Patel and Leah Nosal. 1/2017. Defining the Resilient City. United Nations University Centre for Policy Research. Read PublicationAbstract
This background note is part of the United Nations University project on Resilience and the Fragile City and is meant to complement the paper ‘Conceptualizing City Fragility and Resilience’ (de Boer, Muggah, Patel 2016) which formally presents the fragile and resilient cities assessment framework. As resilience has become a more prominent and pervasive concept, this paper explores its application for urban environments in contexts of fragility (i.e. urban zones characterized by complex crises that often involve high levels of violence, extreme poverty, and disaster simultaneously) (see de Boer 2015). The paper reviews dozens of resilience frameworks and highlights a number of important findings: 1) the majority of existing resilience frameworks are useful for assessing resilience to natural disasters, yet few are effective in understanding resilience in contexts of fragility; and (2) many existing frameworks have yet to be empirically tested and largely rest on a Theory of Change. This means that very few indicators have been independently derived based on empirical data of what works. To fill these gaps, the paper concludes by proposing an approach to assessing resilience in contexts of urban fragility, which is then fully developed in the framework paper mentioned above.
Timothy B Erickson and Navneet Cheema. 2017. “Arthropod Envenomation in North America.” Emerg Med Clin North Am, 35, 2, Pp. 355-375.Abstract
Arthropods (phylum Arthopoda) account for a higher percentage of morbidity and mortality to humans than do mammalian bites, snake bites, or marine envenomation. They are ubiquitous in domestic dwellings, caves, and campsites and in wilderness settings such as deserts, forests, and lakes. Although arthropods are most intrusive during warmer months, many are active throughout the winter, particularly indoors. Arthropods are also nocturnal and often bite unsuspecting victims while they are sleeping. Encounters with humans are generally defensive, accidental, or reactive. An individual stung by an insect or bitten by an arachnid may experience pain and local swelling, an anaphylactic reaction, or life-threatening toxicity. This review discusses the clinical presentation and latest treatment recommendations for bites and stings from spiders, scorpions, bees, ants, ticks and centipedes of North America.
Frederick M Burkle, Timothy B Erickson, Johan von Schreeb, Anthony D Redmond, Stephanie Kayden, and Michael VanRooyen. 2017. “A declaration to the UN on wars in the Middle East.” Lancet, 389, 10070, Pp. 699-700.

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