Methodology

Frederick M. Burkle Jr. 7/2020. Robert Fox Interview with Frederick M. Burkle on Population-based Triage Management.Abstract
Interview: At first sight, Population-based Triage, PBT for short, isn't the most enticing social formula-but it may be the key to how the UK manages the next stages of the current Corona quagmire-and prepare for the next one, when and not if it happens. It could, and probably should, become standard operating procedure in public health population-based management decisions in the outbreak of widespread pestilence and disease. We need that new Public Health Strategy now. Under the PBT plan the population as a whole is treated to the triage technique familiar in accident and emergency, and battlefield medicine. Medical and rescue teams concentrate on treating the salvageable in preference to those most likely to die. "Traditional health care systems care systems care for patients individually, while public health is caring for an entire population," says Professor Frederick Burkle, Senior Scholar and Scientist of Public Health at Harvard. He published his plan for a population-based approach to pandemic in 2006. It was used in the major desk-top exercise by Public Health England for tackling a major influenza pandemic, Operation Cygnus, in 2016. The report partly adopted the professor's clear-eyed approach to running a major pandemic operation, but left many questions open. If they had been addressed in the present Covid crisis, thousands of lives might have bene saved. Much the same goes for Exercise Isis carried out by National Health Scotland in 2018, focused on a major outbreak of MERS (Middle East Respiratory Syndrome). The lessons of both exercises have been taken aboard, according to Matt Hancock, but as they say in Scots law, it looks like a case of not proven. Both the Cygnus and Isis reports of 2017 and 2018 cannot conceal the serious shortcomings in preparation against a major public health emergency. The Cygnus exercise, for instance concentrates on the role of the Local Resilience Forums in coordinating emergency services-yet the representatives of the eight LRFs were explicit about their lack of resources. The LRFs have proved vital since March, but they have no statutory powers and no funding. More ominously the Isis report for the Scottish Health flags up the lack of availability of protective equipment-PPE-for a nationwide viral outbreak. The problem of managing a workable Public Health Emergency strategy for this coronavirus crisis is brilliantly illustrated BBC1's drama documentary, The Salisbury Poisonings. It tells the real events of the attack by the nerve agent Novichok on the Skripals in Salisbury two years ago. The heroine is the Wiltshire Public Health Officer Tracy.
Krzysztof Goniewicz, Beata Osiak, Witold Pawłowski, Robert Czerski, Frederick M. Burkle Jr., Dorota Lasota, and Mariusz Goniewicz. 7/2020. “Bioterrorism Preparedness and Response in Poland: Prevention, Surveillance, and Mitigation Planning.” Disaster Medicine and Public Health Preparedness.Abstract

Objectives: Biological weapons are one of the oldest weapons of mass destruction used by man. Their use has not only determined the outcome of battles, but also influenced the fate of entire civilizations. Although the use of biological weapons agents in a terrorist attack is currently unlikely, all services responsible for the surveillance and removal of epidemiological threats must have clear guidelines and emergency response plans.

Methods: In the face of the numerous threats appearing in the world, it has become necessary to put the main emphasis on modernizing, securing, and maintaining structures in the field of medicine which are prepared for unforeseen crises and situations related to the use of biological agents.

Results: This article presents Poland’s current preparation to take action in the event of a bioterrorist threat. The study presents both the military aspect and procedures for dealing with contamination.

Conclusions: In Poland, as in other European Union countries fighting terrorism, preparations should be made to defend against biological attacks, improve the flow of information on the European security system, strengthen research centers, train staff, create observation units and vaccination centers, as well as prepare hospitals for the hospitalization of patients—potential victims of bioterrorist attacks.

Eric Weinstein, Luca Ragazzoni, Frederick M. Burkle Jr., Mea Allen, David Hogan, and Francesco Della Corte. 5/2020. “Delayed Primary and Specialty Care: The Coronavirus Disease-2019 Pandemic Second Wave.” Disaster Medicine and Public Health Preparedness.Abstract

Time is of the essence to continue the pandemic disaster cycle with a comprehensive post-COVID-19 health care delivery system RECOVERY analysis, plan and operation at the local, regional and state level. The second wave of COVID-19 pandemic response are not the ripples of acute COVID-19 patient clusters that will persist until a vaccine strategy is designed and implemented to effect herd immunity. The COVID-19 second wave are the patients that have had their primary and specialty care delayed. This exponential wave of patients requires prompt health care delivery system planning and response.

Frederick M. Burkle Jr. and Asha V. Devereaux. 5/2020. “50 States or 50 Countries: What Did We Miss and What Do We Do Now?” Prehospital and Disaster Medicine.Abstract

There have been multiple inconsistencies in the manner the COVID-19 pandemic has been investigated and managed by countries. Population-based management (PBM) has been inconsistent, yet serves as a necessary first step in managing public health crises. Unfortunately, these have dominated the landscape within the United States and continue as of this writing. Political and economic influences have greatly influenced major public health management and control decisions. Responsibility for global public health crises and modeling for management are the responsibility of the World Health Organization (WHO) and the International Health Regulations Treaty (IHR). This review calls upon both to reassess their roles and responsibilities that must be markedly improved and better replicated world-wide in order to optimize the global public health protections and its PBM. 

Krzysztof Goniewicz, Maciej Magiera, Dorota Rucińska, Witold Pawłowski, Frederick M. Burkle Jr., Attila J. Hertelendy, and Mariusz Goniewicz. 5/2020. “Geographic Information System Technology: Review of the Challenges for Its Establishment as a Major Asset for Disaster and Emergency Management in Poland.” Disaster Medicine and Public Health Preparedness.Abstract

Technical and technological progress in the 21st century, especially emerging geographic information system (GIS) technology, offers new and unprecedented opportunities to counteract the impact of crisis situations and emergencies. Computerization and development of GIS enabled the digital visualization of space for interactive analysis of multiple data in the form of models or simulations. Additionally, computerization, which gives rise to a new quality of database management, requires continuous modernization of computer hardware and software. This study examines selected examples of the implications and impact of the GIS commonly used in Poland.

Frederick M. Burkle Jr. 3/2020. “Opportunities Lost: Political Interference in the Systematic Collection of Population Health Data During and After the 2003 War in Iraq.” Disaster Medicine and Public Health Preparedness.Abstract

The review of the article, “Developing a Public Health Monitoring System in a War-torn Region: A Field Report from Iraqi Kurdistan,” prompted the writing of this commentary. Decisions to implement health data systems within Iraq require exploration of many otherwise undisclosed or unknown historical facts that led to the politicization of and ultimate demise of the pre-2003 Iraq war systematic health data monitoring system designed to mitigate both direct and indirect mortality and morbidity. Absent from the field report’s otherwise accurate history leading up to and following the war is the politically led process by which the original surveillance system planned for the war and its aftermath was destroyed. The successful politicization of the otherwise extensively planned for public health monitoring in 2003 and its legacy harmed any future attempts to implement similar monitoring systems in succeeding wars and conflicts. Warring factions only collect military casualty data. The field report outlines current attempts to begin again in building a systematic health monitoring system emphasizing it is the “only way to manage the complex post-war events that continue to lead to disproportionate preventable mortality and morbidity.”

Amir Khorram-Manesh, Phatthranit Phattharapornjaroen, Luc J Mortelmans, and Frederick M. Burkle Jr. 2/2021. “Current Perspectives and Concerns Facing Hospital Evacuation: The Results of a Pilot Study and Literature Review.” Disaster Medicine and Public Health Preparedness. Read PublicationAbstract

Objective: To analyze the evacuation preparedness of hospitals within the European Union (EU).

Method: This study consisted of 2 steps. In the first step, a systematic review of the subject matter, according to the PRISMA flow diagram, was performed. Using Scopus (Elsevier, Amsterdam, Netherlands), PubMed (National Library of Medicine, Bethesda, MD), and Gothenburg University´s search engine, 11 questions were extracted from the review and were sent to representatives from 15 European Union (EU)- and non-EU countries.

Results: The findings indicate that there is neither a full preparedness nor a standard guideline for evacuation within the EU or other non-EU countries in this study. A major shortcoming revealed by this study is the lack of awareness of the untoward consequences of medical decision-making during an evacuation. Some countries did not respond to the questions due to the lack of relevant guidelines, instructions, or time.

Conclusion: Hospitals are exposed to internal and external incidents and require an adequate evacuation plan. Despite many publications, reports, and conclusions on successful and unsuccessful evacuation, there is still no common guide for evacuation, and many hospitals lack the proper preparedness. There is a need for a multinational collaboration, specifically within the EU, to establish such an evacuation planning or guideline to be used mutually within the union and the international community.

Frederick M. Burkle Jr., David A. Bradt, Joseph Green, and Benjamin J. Ryan. 10/2020. “Global Public Health Database Support to Population-Based Management of Pandemics and Global Public Health Crises, Part II: The Database.” Prehospital and Disaster Medicine. Read PublicationAbstract

This two-part article examines the global public health (GPH) information system deficits emerging in the coronavirus disease 2019 (COVID-19) pandemic. It surveys past, missed opportunities for public health (PH) information system and operational improvements, examines current megatrend changes to information management, and describes a new multi-disciplinary model for population-based management (PBM) supported by a GPH Database applicable to pandemics and GPH crises.

HPCR. 9/2003. Roundtable Report on Human Rights and Rule of Law: Constitutional and Legal Reform.Abstract

The opportunities for engaging the Afghan public in the process of constitution building and legal reform are quickly disappearing. Decades of war have left the legal system, and its legal culture, in ruins. The project of constitutional and legal reform will be central to the success of reconstruction efforts. For the first time, Afghan legal professionals, civil society leaders, and other groups have the chance to engage in the rebuilding of their country’s legal foundations: both to stabilize a still-insecure country, and to transform their society in more long-lasting ways. However, as the Constitutional Loya Jirga approaches, many key questions regarding the nature of the new Afghan legal order remain, and many Afghans are beginning to feel that they have been left out of the process. The Afghan Independent Human Rights Commission (AIHRC) is in an ideal position to engage civil society groups and legal professionals in wider debate about the protection and integration of human rights standards in the new legal system. Its mandate includes the harmonization of international human rights standards with national law, and perhaps more importantly, the Commission enjoys access to a nation-wide constituency of individuals and groups who support the central government and the modernization of Afghan law. This roundtable report, which presents topics and analysis from a roundtable co-hosted by AIHRC and the Program on Humanitarian Policy and Conflict Research (HPCR) at Harvard University and entitled Human Rights and Rule of Law: Constitutional and Legal Reform, attempts to capture the outcomes of one such effort at engagement and discussion. This Roundtable was one of the first such meetings in Kabul to engage a broad representation of civil society leaders, legal professionals, and Loya Jirga delegates from provinces outside Kabul. In total, there were about forty participants, with half of the group from Kabul and half from other cities and towns. The Roundtable was led by members of the AIHRC, with attendance and participation by members of the Judicial Reform Commission. A series of background papers in Dari was drafted by HPCR (in close consultation with members of the AIHRC) prior to the Roundtable, and made available to the participants along with a copy of President Hamid Karzai’s most recent decree on the Constitutional Loya Jirga and a paper on legal reform in Afghanistan.

International Humanitarian Law Research Initiative. 5/2004. Rules of IHL Applicable to the Conduct of Military Operations in Urban Areas.Abstract

Urban warfare constitutes one of the most serious threats to the security and integrity of civilians in times of war. It represents, consequently, one of the most challenging areas of International Humanitarian Law (IHL) in practice. This note reviews the rules of IHL applicable to the conduct of hostilities in urban environments, and identifies key legal provisions desgned to enhance the protection of civilians in these areas.

HPCR. 5/2002. Securing Communities for Reconstruction in Afghanistan: Final Report of the Conflict Prevention Initiative E-Conference.Abstract

For two weeks in April and May 2002, the Conflict Prevention Initiative (CPI) of the Harvard Program on Humanitarian Policy and Conflict Research (HPCR) hosted the first ever international e-conference on “Securing Communities for Reconstruction in Afghanistan,” attracting over 90 participants. The majority of the participants were Afghan NGO and civil society leaders working in Pakistan and Afghanistan. Others included representatives of various inter-governmental organizations, INGOs, academic institutions and donor governments. This report summarizes the principal themes of the discussion and concludes with a series of recommendations for various actors involved in the process of reconstruction in Afghanistan. These recommendations include both those specifically formulated by participants as well as those drawn more generally from the conference discussion. In addition, actual quotes from the participants are interspersed throughout the report in shaded boxes to suggest the richness and depth of the discussion. The e-conference was preceded by conversations with NGO leaders in Kabul, as well as roundtables with Afghan civil society leaders in Peshawar, Pakistan and Mashad and Zahedan, Iran. The roundtables were designed both to produce substantive inputs for the e-conference as well as to gather perspectives from those who may not have regular internet access. In this way, both the roundtables and the e-conference were designed to engage participants from their separate localities and yet still connect them with broader discussions and analysis. 

HPCR. 2/2004. The Separation Barrier and International Humanitarian Law.Abstract

This briefing note discusses the legal implications under international humanitarian law (IHL) of erecting and maintaining a separation barrier in the Occupied Palestinian Territory (OPT). The main objective of this note is to review the applicable IHL rules and present the various legal perspectives of the parties involved in the debate on the legality of the separation barrier, particularly in the context of the advisory proceedings before the International Court of Justice in the Hague. This briefing note will be updated as arguments of the various parties are presented to the courts, and as the courts’ rulings are made public.

HPCR. 2/2001. Setting Priorities for Preventive Action in Nepal: Final Report of the Web Conference.Abstract

The Conflict Prevention Initiative of the Harvard Program on Humanitarian Policy and Conflict Research convened an online conference on setting the priorities for preventive action in Nepal from 25 January to 1 February 2001. Eighty respected scholars, NGO activists and officials were selected from Nepal and around the world to join this important forum. The participants were carefully chosen to represent a wide variety of different perspectives on the sources of the current insecurity. The objective of the conference was to provide a closed forum for the exchange of information and analysis on the sources of social, political and economic insecurity in Nepal as well as to deliberate on the most effective strategies for conflict prevention in the region. This conference was the first to develop the use of online conferencing to facilitate exchange between scholars and practitioners from around the world on conflict prevention strategies. This provided an opportunity to bring together a diverse group of individuals, many of whom would be unable to meet in a more traditional forum. This report presents a succinct summary of the main issues and findings of the online discussion, including recommended policies for organizations involved in the promotion of human security in Nepal. It summarizes over 140 contributions by over 80 participants, many of them from Nepal. The contributions were not censored and represent a vast array of political opinions regarding the sources of instability in Nepal. The role of the Program was to present the various perspectives and distill innovative recommendations from the discussion, and not to determine the value of these observations or to judge their appropriateness. Consequently, the report reflects the views of the participants and not necessarily those of the Harvard Program. The report is divided into three sections. The first section outlines the historical background of the unrest. The second provides a discussion of the most significant factors contributing to the current instability. An analysis of a wide range of measures that may contribute to increased stability in Nepal forms the final section. 

Mohammad-Mahmoud Ould Mohamedou. 3/2005. The Pitfalls of Lawlessness: Disorder, Emergencies, and Conflict.Abstract

This paper examines the issues of disorder, emergency, and conflict and their management in a rule of law-based framework, with illustration from the aftermath of the September 11, 2001 attacks on the United States and the war in Iraq. Noting that the promotion of the rule of law by state institutions has decreased in recent years, the paper postulates that the manifestation of violence as a result of sociopolitical unrest and armed conflict, whether domestic or international, is an indicator of a defective functioning of institutions, and that the maintenance and strengthening of the rule of law at all times are key to an effective enjoyment of human rights and to the practice of democracy. The paper notes that there exist a number of distinct corpora of rules in international and domestic law that are applicable to an orderly, efficient, and rights-respecting management of disorder. In particular, it calls for a symbiotic application of international humanitarian law and international human rights law. Whereas the latter is a general law which is implemented at all times, the former is a special branch of law that to be only enacted during conflicts. Yet, though clearly different, the two bodies overlap, particularly in times of emergency as both seek to protect human dignity and reduce human suffering. Clarifying the core connections and establishing an explicit recognition of the international human rights normative framework and humanitarian values to democracy is particularly called for in times of emergency. The typical state response to internal disorder is to enforce stricter interpretations of security laws, assert the power of the state government, and enact emergency legislation meant to facilitate investigation and prevention of violent emergencies. In that respect, the paper places emphasis on the existence of legal limits to emergency powers noting the extent to which derogation is codified formally. Similarly, the paper argues that legitimacy of the power to compel is a fundamental component of the rule of law, particularly in situations where institutions are failing. The practical result, during emergencies, is that no room is provided (or no longer available) for the articulation of citizens’ aspirations as no structural accountability derivative of democratic dynamics is present. In times of crisis and social disorder, dangers to the effective enjoyment of rights can originate (i) in the context of the implementation of derogation to rights, (ii) in the process of the administration of justice, or (iii) in the course of the enforcement of security laws. Limiting the effect of emergency powers and delineating clearly permissible derogations, so that the state of emergency is regarded as a temporary situation and not a norm, is a central aspect of the regulation of societal disorder processes. During emergencies, particular attention should also be paid to the administration of justice, which can come to suffer from degraded or weakened institutions. The modus operandi is the perpetuation of effective and justiciable remedies under the umbrella of a constitution incorporating the principles of international human rights and freedoms. 

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