While health impacts from heat include dehydration and heat stroke, increasing infectious disease transmission, and respiratory stress, other social impacts include loss of working hours and productivity, sleep disruption, and instability of basic infrastructure like power and water.

Often the most adversely affected communities from extreme heat waves are those already living in tropical areas, which are disproportionately poor and contribute little or nothing to greenhouse gas emissions. However, many historically colder areas of the world, from the Pacific Northwest in North America to the United Kingdom and Ireland, parts of Scandinavia, Switzerland, and Austria, are also experiencing their own crises of adaptation, often based on the pervasiveness of infrastructure that was originally developed for much lower average and minimum temperatures and which now often fails to offset increasing heat.

The combination of high El Nino marine temperatures in the Pacific and long-term climate patterns as the world nears the +1.5C threshold set by the Intergovernmental Panel on Climate Change (IPCC) for “safe” levels of global warming appear to be principally driving the recent spikes in temperature. What does the future hold for these types of trends, if climate forecasts worsen beyond 1.5C, as many scientists expect will happen within only a few more years, both for areas already experiencing extreme heat and for those facing relative adaptation crises?

New modeling from researchers at Oxford University, published this week in the journal Nature Sustainability, makes a case that we can expect drastic changes in heat exposure in both absolute and relative terms, throughout the world. Moreover, those changes imply very different scenarios and policy implications, depending on whether the increases are occurring absolutely or relatively, in areas already acclimated to heat or more historically temperate.

Using the standard metric of the “cooling degree day,” or CDD, which measures heating above a temperate standard of 18C (65F), the researchers conclude that large parts of the tropics will see massive increases in exposure to elevated heat, requiring improved access to cooling. Countries like the Central African Republic, South Sudan, Chad, and Uganda will see increases in CDDs of more than 220 annually, dramatically worsening anticipated health impacts and loss of livelihoods based on pre-existing lack of access to affordable cooling. Meanwhile, countries like Switzerland, the UK, Sweden, and Denmark will see proportional changes in annual CDDs of more than 24%, placing enormous strains on public and private budgets to equitably shift their infrastructures towards increasing cooling capacity over the short- and medium-term.

Direct Relief’s global humanitarian distribution network already serves a large proportion of people in areas experiencing high degrees of heat stress, with many of them likely, according to this new research, to face even greater impacts as the world moves further towards a 2C warming scenario. Based on the Oxford team’s calculations, on average, Direct Relief’s recipient network is expected to see an additional 132 cooling degree days under the 2C scenario. Additionally, the 579 organizations in Direct Relief’s network at the upper end of the absolute warming increases beyond 1 standard deviation from the mean, are expected to see average increases of 209 CDDs, a 37% increase over the network average.

In terms of relative increases, the Direct Relief network is expected to see an average increase in CDDs of 12.9%. Organizations seeing changes at 1 standard deviation above the mean are anticipated to experience increases in CDDs ranging from 19% to 108% under the 2C scenario. Organizations in the Direct Relief network expected to see these large relative changes tend to be located in California, the U.S. Midwest and Northeast.

The post Extreme Heat Poses Serious Immediate and Long-Term Health and Adaptation Challenges appeared first on Direct Relief.

As of March 20, the official civilian casualty totals from the United Nations included 902 deaths and 1,459 injuries. As usual, these numbers are a significant undercount, based upon the difficulty of receiving confirmed information from areas with active ongoing combat. Civilian casualties have been almost entirely confirmed according to the results of combat, and do not reflect elevated mortality because of losses to health care or other systems disruptions. According to UNHCR, “Most of the civilian casualties recorded were caused by the use of explosive weapons with a wide impact area, including shelling from heavy artillery and multiple-launch rocket systems, and missile and air strikes.”

Remote sensing of the most damaged areas of Ukraine is starting to tell a compelling picture of the scale of destruction to residential neighborhoods, critical infrastructure including health care, transportation corridors, schools, shopping areas, and recreational buildings including theaters. Satellite image analysis from UNOSAT, the United Nations satellite mapping agency, highlights the extraordinary impact of missile attacks and shelling on the city of Mariupol, where roughly 80% of residential infrastructure has been damaged to some degree. Mariupol has been the scene of some of the most highly visible recent attacks, including the missile attack on a maternity hospital and another on a theater where civilians including children were sheltering.

The team at REACH has concluded an initial analysis of nighttime lights imagery in order to understand the change in urban settlements which remain illuminated at night and therefore demonstrate some reasonable level of continuous occupancy and activity. Power outages are a constant problem in Ukraine at the moment, so some of this analysis may reflect evacuations, displacement, and damage, while some reflects higher rates of power outage even if buildings may be occupied. The nighttime lights analysis shows drastic reductions in luminosity throughout the outskirts of Kyiv, almost total darkness at night throughout most of Kharkiv and Kherson, and significant changes even in the relatively less affected western Ukrainian city of Lviv.

The other crucial ongoing issue related to civilian infrastructure involves the ongoing drumbeat of attacks on health facilities. The World Health Organization currently estimates that there are roughly two missile or shelling attacks on health facilities every day in Ukraine. Their official count now includes 62 attacks on hospitals or other health facilities including ambulances since the war began, which have resulted in 52 casualties including the deaths of 15 health workers. These numbers are drastically lower than the government of Ukraine’s own tally given the WHO’s rigorous verification process. Deliberate targeting of civilian health infrastructure is considered a war crime under the Geneva Conventions.

Refugees and Internally Displaced Persons

The refugee and internal displacement crisis from and within Ukraine has moved with unprecedented speed and scale. Although the war is less than one month old the fighting has already produced a total of roughly 10 million displaced persons, which is nearly one-quarter of the entire population of Ukraine. As of March 20. UNHCR estimates there are nearly 3.5 million total Ukrainian refugees. The rate of border crossings continues to decline daily, however, with a steady reduction in the numbers entering neighboring countries ever since the peak daily crossing of 209,000 people on March 6.

Refugee services are being established throughout the surrounding countries in the region. New data from UNHCR highlights the locations and type of refugee reception and accommodation centers now established across eastern Europe. The disproportionate share of facilities have been established on the borders between different countries, with Romania as the most extreme example perhaps, without any recorded refugee facilities in the interior.

While Poland continues to house most Ukrainian refugees, there is now clear evidence from a variety of sources that diffusion of refugee populations is occurring throughout most of the European Union. A recent draft report from Meta (Facebook) which looks at the dispersion of people with an origin point in Ukraine found that Germany and the Czech Republic have seen the second and third most arrivals in total, with significant flows also occurring to countries such as Italy, France, and Turkey. Note that the numbers in the data from Meta may vary from the official counts and should be understood in conjunction with official numbers to add context and perspective.

Recent work from the International Organization for Migration (IOM) on internal displacement within Ukraine has drastically revised upward the numbers of displaced to more than 6.5 million people.

While most internally displaced persons (about 40%) are in the western region of the country, there is no part of Ukraine that does not currently contain a significant number of displaced persons. While current estimates show almost 2.6 million displaced in the west, each of the north, central, east, and south regions contain over 1 million displaced persons. Key health issues for displaced persons include lack of adequate food, water, and sanitation, exposure to extremely cold temperatures, disconnection from medical services, lack of access to medications, as well as high levels of stress, anxiety, and mental trauma.

Non-Communicable and Infectious Diseases: Focus on Tuberculosis

Ukraine has one of the most severe problems with tuberculosis and multi-drug resistance tuberculosis of any country. Roughly 32,000 new cases of active TB infection occur in Ukraine annually. According to a recent article in the journal Nature, there is already considerable concern among health professionals that many TB patients have been forced to flee with a limited supply of medications and limited or no ability to re-supply their medications or to comply with basic directly observed therapy (DOTS) protocols. As quoted in the Nature article:

“Any interruption of treatment will lead to drug-resistant TB, including MDR TB,” Ditiu says. “After 5 years without treatment, 50% of people with pulmonary TB can die. Meanwhile, you infect many others around you.” And if you interrupt treatment for MDR TB, she says, “it is possible to develop extremely drug-resistant TB, where there are few drugs that work”.

Prior to the war there was already significant evidence of artificially low rates of tuberculosis diagnosis in Ukraine, largely attributed to the confounding effect of Covid-19 which also showed up as severe respiratory infection. The combination of under-diagnosis, displacement due to the conflict, disruption of access to replenished drug supplies, and the lack of capacity to follow standard treatment protocols is dramatically raising risks that active TB patients will develop more severe forms of the infection, leading towards serious health complications and even death, while becoming increasingly infectious to those around them.

Maternal, Newborn, Sexual and Reproductive Health

According to the World Health Organization, as of March 18 there have been 4,300 births in Ukraine since the start of the war, which averages out to roughly 1,400 births per week. As increasing pressure mounts through the combination of the destruction of civilian infrastructure, attacks on health facilities like the bombing of the maternity hospital in Mariupol, disruption of transportation, and widespread displacement, risks to deliveries particularly for those that require surgical interventions, as well as risks to newborn health in terms of nutritional support, clean water, and mitigation of infectious diseases, will continue to rise.

In addition to safe delivery services, including emergency obstetric care, the Interagency Working Group on Reproductive Health in Crises through the United Nations places special emphasis on the need to ensure safe access to reproductive health and contraception as part of the Minimum Initial Service Package during emergencies.

This includes:
• Ensuring availability of a range of long-acting, reversible and short-acting contraceptive methods (including male and female [where already used] condoms and emergency contraception [EC]) at primary health care facilities to meet demand;
• Providing information, including existing information, education, and communication materials, and contraceptive counseling that emphasizes informed choice and consent, effectiveness, client privacy and confidentiality, equity, and nondiscrimination; and
• Ensuring the community is aware of the availability of contraceptives for women, adolescents, and men.

As is the case in most emergencies, whether as a result of conflict or disaster, the most effective delivery system for basic health interventions which save the disproportionate share of lives occurs in primary care settings. Sexual and reproductive health care is no different in this regard, which makes it even more essential to minimize attacks on civilian health services and ensure access to primary care as well as hospital services.

The post Analyzing the Scale of Ukraine’s Destruction appeared first on Direct Relief.

CrisisReady, a joint project of Harvard University and Direct Relief, has been analyzing mobility data from Meta, linked to an analysis of the Facebook social connectedness index. That analysis tends to indicate a pronounced westward flow of refugees towards areas of western Poland, Slovakia, and Hungary. This aligns well with social connectedness, as well as congregation occurring in major cities.

Warsaw and Krakow in Poland recently announced that reception of new refugees in those cities would be difficult, given the current numbers of arrivals. Increasingly Ukrainians are spreading throughout the European Union, particularly to the Czech Republic and Germany.

Recently the team at REACH, a humanitarian initiative providing data to aid actors, was able to conduct interviews with displaced persons at the border checkpoints for each neighboring country. According to their research, refugees were 85 percent female and 15 percent male. Seventy-three percent of interview respondents reported traveling principally in groups of one to four, with a much smaller number traveling alone (11%) or in groups of five or more (16%). Ninety percent of respondents were Ukrainian, with 4% of Russian nationality, 1% Moldovan, and 5% another nationality.  

In addition, just one percent reported traveling with a pregnant or lactating woman, and 4% reported traveling with a person with a disability. Eight percent reported traveling with an elderly person over the age of 65, with 49% traveling with children under 18. 

According to respondents, their principal destinations outside of the neighboring countries included Germany and the Czech Republic – and 56% intended to stay with family or friends – which aligns quite well with the social connectedness analysis above.

According to the Protection Cluster and the International Organization for Migration, the official number of internally displaced persons within Ukraine is approaching 2 million. Most of those people have fled from the north, east, and south of Ukraine, which are principally affected by Russian attacks and have moved towards areas bordering western Ukraine. Zakarpatska and Lvivska oblasts (districts) have received a disproportionate share of IDPs.

A range of humanitarian corridors continues to be opened up for Ukrainian cities under bombardment to allow civilians to flee. As of Tuesday morning, there were officially nine such corridors open across the country. However, according to repeated reports, those corridors are coming under attack or are otherwise declared unsafe for mass evacuations.

The situation in Mariupol is considered to be the most extreme, with accusations from the Ukrainian government and the Red Cross that the corridor for that city remains closed and that residents are at risk of starvation as a result.

Health Situation

According to the World Health Organization’s most recent situation report, issued on March 11, the principal public health issues facing Ukrainians remain physical trauma and conflict-related wounds. Following that concern, the WHO is calling attention to:

• Non-communicable diseases, particularly insofar as supplies of insulin for diabetics, cancer medications, and other supplies for cardiovascular disease are now disrupted or in extreme scarcity,
• Emergence and spread of infectious disease including polio due to the disrupted polio vaccination campaign; TB and HIV/AIDS due to disruptions of access to treatment facilities and drug supplies; Covid-19 due to low vaccination rates and the inability under current circumstances to practice most conventional infection control protocols; as well as risks of diarrheal diseases due to widespread damage to water and sanitation facilities,
• Mental health impacts related to displacement and war-related trauma,
• Protection issues including human trafficking and gender-based violence, and
• Risks posed specifically to pregnant mothers and newborn children. WHO is estimating that 80,000 infants will be born in the next three months within Ukraine.

WHO is working with Direct Relief and other humanitarian groups to solve many of the critical supply shortages for NCDs mentioned above. The organization says it has established logistical connections outside Ukraine to all major Ukrainian cities. It has also set up an emergency epidemic surveillance system, which focuses on event-based syndromic reporting, and is expanding its focus on mapping health facilities and integrating damage/status assessments into facility mapping.

Medical oxygen continues to be a high-priority need. A Ministry of Health/WHO working group on medical oxygen has been established and will be calculating needs and issuing guidance on oxygen distribution across the country. 

The WHO is establishing its first field hospital in Lviv and planning several others throughout western Ukraine.

Additionally, WHO facilities are being set up in the refugee-receiving countries to reduce pressure on the health systems in those countries. Medical supply assessments for each bordering country are ongoing and should be considered a priority. 

Food, Nutrition, and Logistics

The World Food Programme estimates that 12 million people within Ukraine require immediate food assistance. The most immediate concern in this regard is the situation in cities such as Mariupol, Kharkiv, Kherson, and parts of Kyiv, which are at least partially encircled and besieged, reducing sharply their ability to move food and other essential supplies into those areas. In addition to the closure of logistics corridors, an estimated 750,000 people have lost access to electricity or natural gas supplies, which has reduced their ability to cook and posed significant challenges for heating during a period of frigid temperatures.

Apart from the conditions within Ukrainian cities, the principal concern related to food remains the curtailment of international food shipments from both Ukraine and Russia. A couple of days ago, Russia announced that they would be suspending the export of most cereal crops, which affects a large share of the world population and depends on Russian and Ukrainian exports.

In a recent piece in The Guardian, representatives from the UN Food and Agriculture Organization called attention to the severe risks posed by rising food prices throughout many of the world’s poorest regions as a result of the ongoing war. Global wheat prices recently hit all-time highs, with additional concerns regarding corn and other crops. They also called attention to the central role of Russia and Ukraine as fertilizer exporters, which in turn has a ripple effect on agricultural production throughout much of the world. 

While the food crisis is not a top-level issue yet, the longer the war goes on, the more serious these disruptions will become, with longer-lasting effects across the world. 

Meeting Needs and Challenges

With five million people displaced in less than three weeks, the flood of Ukrainian refugees and internally displaced persons has grown faster than any crisis since World War II. For humanitarian aid organizations and multilateral agencies, the situation requires a similarly unprecedented speed and magnitude of response.

Direct Relief is doing what it does in every major disaster to which it responds, but at a much larger scale: mobilizing and delivering medicine and other medical aid to the people who urgently need it and providing support to trusted local health providers.

Because the human toll of the war will be long-lasting, Direct Relief is building channels for efficiently securing and delivering large volumes of medical aid over an extended period.

The organization is arranging direct deliveries from pharmaceutical manufacturers and warehouses across Europe to Ukraine, most often via Poland, securing space in pharmaceutical warehouses, including refrigerated facilities, and working closely with local logistics companies. The organization is also planning a series of chartered cargo flights from the US.

At least initially, securing medicine may be less of a hurdle than the logistics of getting it to the people who need it. Direct Relief has received unprecedented pledges of support from many of the world’s largest pharmaceutical manufacturers and medical supply distributors. Enough medical material has been offered in California alone to fill multiple chartered jumbo jets, which Direct Relief is now arranging.

Large aid shipments over the last two weeks have arrived safely in Ukraine. Still, with a flood of relief supplies headed to the region, there is an increasing risk of bottlenecks, including a limited supply of trucks, delays at border crossings, and security threats inside Ukraine.

To date, the largest recipient of Direct Relief aid in the crisis has been Ukraine’s Ministry of Health. Poland’s Government Agency for Strategic Reserves is expected to play an increasingly important role in upcoming shipments; it coordinates incoming aid deliveries and acts as a logistics agent to receive cargo and transfer it to Ukraine.

The post Ukraine War Is Becoming the Fastest-Growing Humanitarian Crisis Since World War II appeared first on Direct Relief.

In addition to the obvious human rights violations of deliberately targeting a maternity and children’s hospital, the attack highlights several gendered risks facing civilians in the Ukraine crisis. At such a moment, it’s essential to think about the role that gender and health play in conflict situations, and how best to respond to related needs.

Demographics in Ukraine

Prior to the war, Ukraine had a demographic profile that was highly skewed by gender: The overall population was composed of 54% women to 46% men.

That gendered disparity gets even wider when looking at the upper ends of the age distribution. Whereas the number of younger people in Ukraine leans slightly male, there is an extreme lean towards females in people above age 45.

By far the greatest disparity occurs between men and women in their 70s and 80s. Ukrainian men tend to live shorter lives than Ukrainian women, which is reflected in the proportion of men and women over the age of 70 in the country. On average, women tend to outlive men in Ukraine by about 10 years.

Displacement

The refugee evacuations from Ukraine have likely altered this demographic picture somewhat. Of the 2 million people who have fled the country since the war started, roughly half are children under the age of 18, and men between the ages of 18 and 60 are essentially not permitted to leave the country, given the needs of the Ukrainian war effort.

Men are far more likely to experience traumatic injuries because of combat, while women are more likely to face a host of other health risks and vulnerabilities. In part due to the highly skewed gender distribution of the Ukrainian population, the best current estimates from the U.N. High Commissioner for Refugees indicate that, prior to the conflict, nearly 60% of internally displaced persons within Ukraine were female. This surely continues to be the case today, and the number has likely increased somewhat during the conflict.

As a result, it is entirely reasonable to suggest that the health needs of displaced persons, whether they are in Ukraine or have fled the country, represent the needs of women to a great degree.

Non-communicable diseases

In addition to the issues of maternal health and gender-based violence, discussed below, it’s important to understand the problem of gendered differences in the incidence and risk factors of non-communicable diseases like diabetes, obesity, and hypertension. Differences in exposure to non-communicable diseases account for a significant amount of the overall gendered population disparity.

For example, the World Health Organization published a report in 2020 on non-communicable diseases in Ukraine, looking in part at disparities in risk factors such as smoking, diet, physical activity, obesity, and blood pressure. Here’s what the gender distribution looks like by age group for men and women – specifically, their likelihood of having three or more significant risk factors:

These risk factors tended to be somewhat more extreme for women and men in urban versus rural areas. Differences by income were minimal, and middle-aged men had higher rates of alcohol consumption. However, the main difference is that Ukrainian men tend to die of non-communicable diseases at an earlier age than women do. Older Ukrainian women tend to live with the consequences and higher incidence of non-communicable diseases.

Maternal Health

Over the past 20 years or so, Ukraine has made significant progress in reducing the risks to women in childbirth. During that time, the maternal mortality ratio went from 35 to 19 people per 100,000.

Access to and quality of health services increased steadily throughout Ukraine’s post-Soviet transition. The current maternal mortality rate places Ukraine at the bottom end of all countries in and around Europe, and roughly on par with the United States.

According to estimates from the Cooperative for Assistance and Relief Everywhere, roughly four percent of displaced people will be pregnant women, and 15% of those women will require emergency obstetric interventions.

Applying that number to the current 2 million refugees who have left Ukraine, and estimating roughly another 1 million internally displaced persons based on pre-war reports, that would mean there are currently around 120,000 displaced pregnant women in and around Ukraine, with about 18,000 in need of emergency obstetric interventions.

During the conflict, however, women are disproportionately at risk of being cut off to all aspects of quality maternal health throughout the entire cycle of care. On the most extreme level, women who were in the late stages of their pregnancies when the war in Ukraine started are now giving birth while displaced. Some have even given birth in bomb shelters, where they may lack not only skilled birth attendance but even the basic supplies required to give birth safely.

It’s important to remember that many women in Ukraine, particularly those in eastern separatist areas, have been facing the consequences of conflict-related disruptions since 2019. The World Health Organization recommended prioritization for women in these situations as follows:

• Improving access to reproductive, maternal, newborn, child, and adolescent health services for internally displaced persons and in the eastern regions affected by the crisis;
• Increasing the capacity of health care providers working in Mobile Emergency Primary Units by updating and organizing trainings with the inclusion of maternal and child health modules; and
• Strengthening services in emergency triage assessment and treatment of children.

These recommendations continue to apply in the current situation and should expand in scope relative to the size of the conflict-affected population.

Likewise, conflict tends to sharply reduce access to sexual and reproductive health services, while increasing women’s exposure to gender-based violence.

Gender-Based Violence

According to a 2019 study by UNFPA, roughly 75% of Ukrainian women reported having experienced some form of violence prior to age 15, with 30% reporting direct physical or sexual violence.

During situations of conflict and displacement, the risk of gender-based violence tends to increase dramatically. According to a 2020 Amnesty International report, Ukraine saw a severe increase in reports of domestic violence in separatist areas in 2018: 76% in the eastern region of Donetsk and 158% in Luhansk. These types of statistics are quite common in wartime situations, with reports of general violence against women, including rape and other forms of sexual abuse, increasing significantly.

Likewise, reports by UN Women, Human Rights Watch, Amnesty International, and others prioritize a focus on the human trafficking of women and girls, specifically as a result of forced displacement. This is because people tend to end up in difficult and insecure living situations over long periods of time due to conflict.

Ukraine is, of course, not unusual – every conflict sees these trends of disproportionate exposure to risks for women and girls. But because of the scale of the Ukraine crisis, which has already displaced millions, it is essential to prioritize gender as a lens through which to view the health impacts of the war.

Ukraine Relief

Direct Relief is working with Ukraine’s Ministry of Health and other groups in the region to provide requested medical aid, from oxygen concentrators to critical care medicines – while preparing to offer longer-term aid to people displaced or affected by the war. To date, Direct Relief has deployed more than 25 tons of requested medical aid to Ukraine.

The post Gender, Health, and the War in Ukraine appeared first on Direct Relief.

Cyclone Batsirai landed on Madagascar’s southeastern coast over the weekend, the equivalent of a Category 3 hurricane. Madagascar’s government and the U.N. have reported over 60,000 displaced. The NGO Operation Fistula, which supports fistula repair services throughout the central and southern parts of the country, reported a total loss of their main hospital. 

Reports from the U.N. Office for the Coordination of Humanitarian Affairs (UNOCHA) and other agencies indicate that 95% of property has been lost in the coastal city of Nosy-Varika, which is home to roughly 20,000 people inside a district of approximately 275,000. Image analysis from the United Nations Satellite Center (UNOSAT) shows massive amounts of flooding throughout the similarly sized city, Mananjary, and its surrounding district. 

These major storm impacts in central and southern Madagascar follow severe flooding from Tropical Storm Ana, which hit the capital city of Antananarivo at the end of January. At that time, 34 people were killed, an estimated 10,000 homes were destroyed, and huge amounts of critical infrastructure, including health facilities and schools, were either destroyed or rendered inaccessible.   

The combination of these two near-concurrent events means that, essentially, the entire country is now dealing with the consequences of major water-related emergencies all at once. This would be a serious situation under any circumstances, but Madagascar isn’t just any country. In the four months prior to these storm events, the country was already facing an entirely different sort of crisis. 

As of the first week of January 2022, southern Madagascar was in the throes of the worst drought on record, and its third year of drought in a row. 

This map, published by Fews.net – the Famine Early Warning Systems Network, looks at the solar reflectivity of green plant life as a principal measure of drought and plant health. Roughly 10 days prior to Tropical Storm Ana, southern Madagascar was experiencing some of the worst drought metrics ever recorded in that country.  

As a result, the U.N. and other agencies declared a food security crisis, prompting planning for emergency food relief for as many as 2 million people. 

But the storm impacts likely make this food security situation even worse. There are two principal reasons for this. First, transportation networks through the country, which are required to move goods and people where they are most needed, will be disrupted. Second, essential governmental and other resources will be diverted toward immediate storm recovery, rather than somewhat longer-term food security issues. 

It is worth noting that this rapid fluctuation between drought and flooding is precisely what most climate change models predict, indicating the worsening exposure of countries like Madagascar to growing threats from global climate change. 

Madagascar already faces any number of daunting structural health challenges, from low vaccination rates, which led to massive measles outbreaks in 2018 and 2019, to a resurgence of Covid-19 cases due to the omicron variant – case numbers per million shown in the map below – to low numbers of health workers and other aspects of essential health infrastructure.  

Added together, the crises in Madagascar from flooding, storm damage, drought, food insecurity, and weak health systems amount to one of the worst cumulative sets of crises faced by any group of people anywhere on earth.  Direct Relief has been in communication with health organizations working locally and is ready to support any needed medical requests as the post-storm situation unfolds.

The post In Madagascar, Multiple Crises Compound appeared first on Direct Relief.

The data science team at CrisisReady, a collaboration between Direct Relief and Harvard University School of Public Health, analyzed relationships between power outages and numbers of individuals in the Medicare program known to be users of electricity-dependent durable medical equipment (DME) to understand where medically vulnerable people might be most at risk due to winter power outages.

Areas with high rates of power outage correlated very closely with numbers of DME users, in part because the affected areas tended to be disproportionately rural and older. Direct Relief will be sharing this information with municipalities and emergency management personnel to inform local emergency responses.

Ohio

The state of Ohio experienced a continuous swathe of severe power outages throughout 20 counties across the south primarily along the border with West Virginia. In Hocking County, to the south of Columbus, over 55% of customers were without power as of Friday afternoon. The county has 451 electricity-dependent DME users, which accounts for 1.5% of the county’s population.

New York

Power outages were still being experienced in counties to the north of New York City on Friday afternoon. Ulster County still showed nearly 50% of users without power, and 1,386 DME users, just under 1% of the total population.

Pennsylvania

Counties just south of Pittsburgh were the areas hardest hit by power outages. Washington County on Friday still showed nearly 14% of households without power. Washington County has an exceptionally high number of DME users at 3,185 or 1.5% of the total population.

West Virginia

The most impacted area of West Virginia was located along the northern border with Ohio, including 10 counties that contain both high numbers of customers without power and high numbers of DME users. Hancock County for instance contains 685 DME users, which amounts to roughly 2.5% of the total population. As of Friday afternoon, over 25% of households in Hancock were still without power.

Tennessee

Counties surrounding the city of Memphis were especially hard hit by power outages. Fayette County to the east of Memphis still registered over 10% of households without power by Friday afternoon. Fayette is home to 327 DME users, just under 1% of the total population.

Texas

The most heavily affected areas of Texas lay to the northeast of the Dallas-Ft. Worth area. Hunt County still registered over 10% of households without power on Friday. Hunt County contains nearly 1000 DME users, over 1% of the total population.

The post For Medically Vulnerable, Winter Power Outages Across U.S. Increase Risk appeared first on Direct Relief.

People who use electricity-dependent durable medical equipment (DMEs), including wheelchairs, ventilators, insulin pumps, and other equipment, are at particular risk from power outages of varying durations. Devices which require continuous power may not be available, nor backed up to generators. Devices that require charging may become unavailable over time depending on the length of the outage.

Using data from the U.S. Department of Health and Human Service’s emPower program, which tracks durable medical equipment with power requirements for Medicare beneficiaries, and PowerOutages.us, which tracks outages at the county and city levels in real-time, the CrisisReady analytics team has identified six counties in Texas with relatively high numbers of electricity-dependent DME users which have been particularly affected by power outages.

Lamar, Delta and Fannin Counties in particular, along with the neighboring Hunt County, are part of a cluster of significant outages in northeastern Texas. In Lamar County in particular, with a population of just under 50,000 people, almost 2% of the entire population uses power-dependent medical devices. People in these areas are at higher risk for health complications during outage events.

Direct Relief and other members and supporters of the health care safety net will continue to monitor the exposure of medically vulnerable people to power outages throughout the ongoing winter storms.

The post Winter Storms Interrupt Power, Putting Medical Device Users at Risk appeared first on Direct Relief.

Early studies on omicron came principally out of South Africa and to some extent from the U.K. and the Netherlands, which were two of the countries furthest along in testing and sequencing. These studies suggested that omicron was both more transmissible and less severe than other variants. Now that more research has emerged, has this proved consistently true?

The answer is yes: Those early findings have basically held up everywhere.

There is now an enormous amount of data back from all over the world on the rate of transmission, and it now looks consistent that one omicron-infected person will, in turn, infect roughly between three and five people. This makes it an astonishingly infectious disease, and we have seen that infectiousness throughout the world, with a case count chart that looks like straight-line ascent.

This chart makes the point: Although the baseline number of cases varies, and the timing is slightly different in different places, there really is no significant exception to the trend of the straight-line ascent of cases in any region of the world:

Then there’s the matter of severity. Omicron presents as a much less severe form of the coronavirus, with lower rates of hospitalization, severe disease, and death than earlier variants. That’s particularly true for those who have been fully vaccinated – which, at the current moment in time, really means in practice that they’ve been both vaccinated and boosted. Of course, a disease that is half as severe but twice as transmissible keeps the same pressure on the health system, but the reduction in severity is still remarkable.

Recent data from The New York Times analyzed differences in daily average Covid-19 hospitalizations in two major metro areas hit early by the omicron wave: New York and Seattle, both areas with relatively high rates of vaccination and boosting. The media outlet found that, while hospitalizations increased for both vaccinated and unvaccinated patients, there was a dramatic difference in the level of risk for each. In New York City, the risk of hospitalization was about 16 times greater for those not fully vaccinated, and the risk of death was about four times greater. The disparity was less in Seattle, but the trend basically held.

The key idea is that what was known about omicron in December of 2021 hasn’t changed a whole lot – with a couple of important exceptions.

The first big change is that researchers now know more about why omicron seems to present as both more infectious and less severe. The answer appears to be that omicron evolved to be more of an upper respiratory than a lower respiratory infection, which means it’s more likely to live in the nose and upper airways than to embed deeply into the lung tissue. The best work to this effect is based on a series of animal studies, an excellent summary of which was recently published in the journal Nature. From the article:

“Difficulty entering lung cells could help to explain why omicron does better in the upper airways than in the lungs, says Ravindra Gupta, a virologist at the University of Cambridge, UK, who co-authored one of the TMPRSS2 studies. This theory could also explain why, by some estimates, omicron is nearly as transmissible as measles, which is the benchmark for high transmissibility, says Diamond. If the variant lingers in the upper airways, viral particles might find it easy to hitch a ride on material expelled from the nose and mouth, allowing the virus to find new hosts, says Gupta. Other data provide direct evidence that omicron replicates more readily in the upper airways than in the lungs.”

In other words, because it’s more likely to replicate in great numbers and remain up near the nose and mouth, it’s much more likely to be expelled in high numbers and transmitted to nearby hosts. At the same time, this adaptation means that the most severe effects on respiratory function are largely avoided since it interacts with the cells in the lungs to a lesser extent.

Basically, this is what one would expect from the normal course of a virus’s evolution. It means that omicron is evolving in ways that will eventually lead it to become endemic in the population, in much the way that colds are endemic in the population.

Eventually.

So, if all this has turned out to be true, it raises the question: Why is the U.S. in particular in such a catastrophic position once again? Here, it must be said clearly that, while the social and institutional dynamics that have spurred the pandemic have been evident since March of 2020 at the latest, they are especially pronounced in the present circumstances. The omicron pandemic wave is principally a social pandemic.

Here, the key piece of evidence has been the impact of mounting cases and hospitalizations on health care staff. This story is similar everywhere in the country, with some places worse off than others depending on where they are in the current wave. Health care workers have been at the principal interface of the pandemic, with very few breaks – especially given the need to “catch up” on deferred care for other conditions during Covid-19’s low points. They are tired and confronted with high rates of burnout.

This problem has only been exacerbated during the so-called Great Resignation. Health care has seen the second-highest number of employees quitting since September 2021 – after hospitality and food services – according to data released at the beginning of January from the Bureau of Labor Statistics. These workers have not been readily replaced, which means that there are simply fewer health care workers of all kinds on the job now throughout the country.

Furthermore, health care workers, despite relatively high vaccination rates, are themselves catching omicron-variant Covid-19 at significant rates. That means they have to be isolated for a period of time, even under asymptomatic conditions, so as not to spread the infection in health care settings.

Finally, unlike in previous waves, hospitals have generally attempted to keep seeing their “regular” patients, which means that bed occupancy and patient totals include both Covid-19 and other sorts of cases. Some of these cases do present incidentally with Covid-19 when they are tested upon entry to the hospital, which in turn triggers infection control protocols.

These dynamics are happening unevenly across the country, depending on the level of health care resources, the vaccination rate, the prevalence of remote work, masking, and other non-pharmaceutical interventions, etc. In other words, the drivers of this situation are largely structural and related to capacity. Staffing and space are principal among them.

When will this wave peak and decline? The answer will vary across the country. In the areas initially hit by the omicron wave, especially in the Northeast and the upper Midwest, case rates are likely to peak and start to decline in the next week to 10 days.

But things could get dicey in other places. Taking the state of Mississippi as an example, CDC data currently shows a total of 1,093 Covid-19 hospitalizations – over 20% of which have led to ICU admission. In turn, slightly fewer than half of those ICU admissions have led to ventilator usage. Mississippi has a vaccination rate below 50% and is seeing the arrival of the omicron wave somewhat later than other states.

By comparison, the state of New York currently has 12,022 Covid-19 hospitalizations, but only 13% of those have led to ICU admissions. New York is also much further along in the current wave, has a much higher vaccination rate, and has more hospital and ICU beds per capita.

The post What We Know About Omicron – And What’s Likely to Come Next appeared first on Direct Relief.

As of now, cases of this variant have been detected in the United States (California), and in at least 23 other countries. The highest number of confirmed Omicron variant cases is in the province of Gauteng in South Africa, where at the moment almost all new cases are of this variant. Last Saturday, over 3,200 cases were reported, up from 300 two weeks prior. Daily cases in South Africa exceeded 26,000 during July, during the Delta variant-driven surge.

The Omicron variant is causing a high level of concern due to the number of mutations detected on the so-called “spike protein” of the virus, which is the protein that allows the virus to enter and affect human cells. 

The high number of mutations does not necessarily imply that this variant will lead to a major wave of infections or increased rates of hospitalization and death. But given where these mutations occur in the viral protein, and the significant number of them all clustered together, there is high concern that Omicron could develop quickly into the most serious variant since Delta earlier this year, which led to havoc in India and other nations around the world.

According to the WHO, many fundamental questions remain surrounding this new variant, including crucial data points such as its rate of transmissibility, its virulence, and whether or not it will evade protections from the current Covid-19 vaccines. Current tests are detecting the new variant.

The emergence of new variants was anticipated by scientists, responders, and policymakers, who were concerned that the rate of vaccination in lower-resource areas of the world has been far too slow, particularly when compared to wealthier areas. This has enabled the virus to spread more widely in those areas, allowing more opportunities for it to mutate.

South African epidemiologists have placed all states at the status of “increased local monitoring,” which in previous waves led to subsequently high peaks:

The South African Covid19 Modeling Consortium has reported that each state in South Africa, except for Northern Cape, is seeing significant upward shifts in their forecast curve:

Currently, the only state in South Africa demonstrating an uptick in new hospitalizations is Gauteng:

Beyond immediate concerns about infection and mortality rates for the new variant, another major concern in southern Africa is the impact of the travel restrictions. Reports are already coming in for instance that South African labs are running low on reagents for testing, and resupply is complicated by the lack of plane access to the country.

Direct Relief is continuing to monitor the latest reports and accept requests from global partners in their response to continuing Covid-19 pandemic.

Direct Relief has delivered over $3 billion in medical aid, including more than 6 million vaccines, during the Covid19 pandemic. For more information click here.

Additional reporting contributed by Noah Smith.

The post New Covid-19 Variant Causes Concern Globally, Found in U.S. appeared first on Direct Relief.

Establishing ground truth is the first step in preparing for and responding to a disaster. Health systems throughout the world find themselves unable to verify or accurately estimate ground truth in real-time. California is no different. Direct Relief and the California Primary Care Association principally support community health centers in California and have a shared interest in determining the degree to which these health centers are prepared for the increasing threats posed by wildfires and power outages.

While California’s health centers have adapted and become more resilient to “wildfire season,” over the past few years, California’s crises have increased to include record-breaking heat waves, rolling blackouts, historic wildfires and poor air quality. The California Primary Care Association reached out to health centers in all fire-prone areas and has learned that many had to close operations due to evacuation orders, poor air quality and power outages.

In October 2019, California’s largest electric utility shut down its power grid in 34 of California’s 58 counties, leaving an estimated 2 million people without power and some customers cut off for up to a week. To CPCA’s knowledge, there were approximately 180 health center organizations with over 500 sites in these counties where power was shut off or was scheduled to be shut off. Losing access to power has become a recurring challenge for health centers as California’s utility companies plan to continue intentional power shutdowns during periods of extreme fire danger.

California’s power outages have forced the cancellation of thousands of patient visits at community health centers due to closure. Community health centers that lost power, but were still able to open, found themselves crippled by the loss of power, forced to slash services, close units like dental clinics, and attempt to operate without the computer systems that are the backbone of modern healthcare. Even if a health center stays in operation without power, without electronic health records, the doctors can’t access lab results, records of current prescriptions, schedules for screening tests like mammograms, blood pressure and cholesterol level records, or reports from specialists.

Based on the information gathered to date, health centers with generators could keep their doors open to serve patients as usual. However, it is not yet clear how many health centers experienced challenges with storing medications that require refrigeration, pharmacy refills, or accommodating patients in need of medical services during the Public Safety Power Shutoff (PSPS). Loss of access to health care, including medications, is one of the most least-understood risks from natural or human-caused disasters.

California’s widespread power shutdowns have revealed a hidden weakness in our health care safety net, and PSPS events are likely to become more commonplace as California’s utility companies seek to prevent destructive wildfires during periods of extreme risk.

Deployment

In January 2021, Direct Relief and the California Primary Care Association (CPCA) initiated an engagement with Macro-Eyes to apply machine learning to understand individual health facility and health safety network capacity and readiness for managing Covid-19 vaccinations for the communities they serve – specifically focused on federally qualified health centers (FQHC) and look-alike health centers in California.

The first phase of this project was a rapid two-month deployment of the Macro-Eyes health readiness product, Striata, which uses artificial intelligence (AI) to machine learn the current state of infrastructure at each FQHC while generating data on the catchment population. Striata learns about health infrastructure from publicly available data and data derived through a set of proprietary learning tools that power the platform. Providing insight quickly without accessing proprietary health data enables rapid response and maintains health data safety and sovereignty.

The three leading indicators for site readiness included in the initial deployment were as follows:

• Back-up power capacity. Identify presence of back-up power generation capabilities: solar, battery installation, generator.
• Refrigeration capacity. Identify capacity and reliability of refrigeration.
• Catchment population. Learn socio-economic indicators of site-specific catchment population.

These data-driven insights allow decision-makers to allocate resources and make precision investments in essential infrastructure rapidly. Every dollar and scarce resource available for health – especially during natural disasters and pandemics – can be used effectively.

In the context of health systems broadly and COVID readiness specifically, Striata becomes a resource mapping and investment planning tool where decision-makers can see in real-time which facilities have a higher proportion of the population at risk of not being able to access a vaccine and which sites currently have low resiliency to power outages where investment may improve their ranking.

Results

In January 2021, the status of refrigeration capacity and backup power availability across the California health safety net was known in 8% of facilities. Six weeks into deployment, Striata provided visibility into 100% of federally qualified health centers (FQHC) and lookalike sites in California – each rapidly updating in real-time.

Striata yielded insight into 100% of community health centers included in the master facility list compared to 3-8% at the beginning of the project. This was achieved over two months. Predictive accuracies for refrigeration and backup power were 71-85%% and 68-83.6%, respectively, while catchment population insights yielded results using defined vulnerability criteria and machine-learned predictive vulnerability. The technology continues to learn from new data and improve predictive accuracy the longer it is run.

Striata found that out of 2059 sites, 1258 (61%) were without any form of back-up power (meaning no generator and/or no battery), while 212 (10%) were without refrigeration (170 of those are administrative and 42 are health service delivery sites.) 721 sites (35%) had both refrigeration and some form of back-up power.

These results, overlayed with counties at greatest risk for wildfires, clearly highlight a need to invest in infrastructure in those counties most at risk of fires and associated power outages to ensure uninterrupted services at CHCs serving the most vulnerable populations.

Methods and Uncertainty

Macro-Eyes machine learning models were validated retrospectively using standard train-valid-test data splits. This rigorous machine learning and model development framework ensured that the models were evaluated on data they never encountered during the training phase. Additional prospective validation has been done at a limited set of sites and is actively expanding. This is done through user validation and access to other labeled data newly entered in the public domain.

With every 100 pieces of labeled data – which refers to a data point known to be accurate and can also be referred to as ground truth data – the machine learning system can leverage at least twice that amount of unlabeled data. A 1:2 to 1:3 leverage is expected. At the level of current accuracy – 80% – if the machine learning system predicts ten refrigerators at a site, the actual number of refrigerators will be between 8 and 12. Interpreted another way, 80% of predictions of refrigerators will be off by only 1 out of ten.

Impact

Visibility is resilience. This level of insight has near-term and long-term strategic implications. The health safety net is ever-changing, as are those who seek care. Shifts in population and environment require health systems to adjust the care delivery infrastructure and strategy. System leaders’ ability to respond rapidly to disasters, pandemics, or other influences relies on knowing the reality on the ground. Visibility from Striata can support targeted investment in the health safety net and identify sites ready to deliver essential services dependent on reliable refrigeration (such as a mass vaccination campaign) and locations able to continue offering and providing care services during power outages or times of restricted access. This is especially significant in regions where natural disasters are an annual occurrence.

In California alone, 2020 saw a total of 9,917 wildfires, according to the California Department of Forestry and Fire Protection, or CALFIRE. During the same timeframe, the Gulf Coast saw a total of 12 named storms or hurricanes.

In 2021 the state of Texas experienced a power grid failure resulting in 4.5 million homes and businesses left without power over several days. Together, at the height of the Covid pandemic, these events could have impacted 5087 CHCs and 15,798,766 uninsured people.

With these statistics in mind, Striata quickly becomes a resource mapping and investment planning tool where you can see in real-time which facilities have a higher proportion of the population at risk of not being able to access health services and which sites currently have a low resiliency to power outages where investment may improve their ranking. The results of this process are linked to a user interface where decision-makers at the state and local level can extract data to inform decision-making. The user interface allows decision-makers to quickly see where there may be a need to invest in infrastructure improvement or allocate resources at a given point in time. Users can zoom in to a region and scroll over sites to understand whether that site has a particular infrastructure in place. A user might focus on an area with a lower percentage of eligible population vaccinated and then zoom in to see what the site-level infrastructure is for that region. Users can then click to share feedback or correct information, allowing validation and learning over time.

Vista Community Clinic validated infrastructure readiness via an email exchange between DeeAnne McCallin (CPCA) and Dr. Sue Ann Park (Vista Community Clinic). It was conveyed that Dr. Park understood the importance and value of the data: “This is good information to know, will help to keep COVID vaccine safe if there is a power outage.”

Challenges

The project encountered several challenges. Some of these were addressed, others required more time, and some were circumstantial:

• Although simple and quick to validate data for rural FQHCs, it was a longer process for health centers with multiple sites to validate data. Health center organizations range from having 1 site to more than 20 sites. For those health centers with more sites, it was difficult to navigate the map and having to individually validate the site data. In response to this, the project developed a search and filter functionality to facilitate ease of navigation and to reduce the time required to zoom in to facilities of interest.
• One regional area consortium point of contact replied that this information should be easy to get through reporting to Vaccines for Children (VFC) and Vaccines for Adults (VFA) programs. It was suggested that data validation continue via other avenues, such as the California Department of Public Health (CDPH) and myCAvax. In response to this, the project found that these sources of information were not readily available or were not stored in a digitized central location. We would recommend further exploration of public dataset availability as part of ongoing validation and learning. Indeed, the application of machine learning can allow decision makers to bypass time consuming traditional data collection which can involve up to 90 days turn around for freedom of information requests.
• Timing is a key consideration. Late winter 2020 into early spring 2021 was a busy time for CHCs and not ideal for soliciting input due to COVID-19 vaccination efforts. In response to this we included a search functionality so that validation could be carried out more quickly.
• Another key timing response from an FQHC, after having been asked about their cold storage capability was that CDC changed cold storage requirements for Pfizer so that ultra low cold storage is no longer required. Striata reflects this by including all refrigeration capacity. Further, the findings as will be discussed next have applications beyond the immediate context of COVID and thus refrigeration capacity remains relevant.

Opportunities for Scale

After the rapid deployment or build phase of the work, there is an opportunity to scale to include additional infrastructure elements, answer broader questions around resiliency, add features that emerged during stakeholder engagement, and optimize ease of use for all stakeholders accessing the interface. While the use cases extend well beyond Covid, it is worth noting that the pandemic is far from over, and the idea of equitable access becomes more important the further we get into the vaccination campaign, especially when this is combined with a natural disaster.

Striata can pinpoint populations most at risk of wildfires and power outages alongside the existing user interface. This provides insight into whether the health center is fire-ready, what capacities need to be built, and whether they can improve resilience. It can cost a health center hundreds of thousands of dollars to be down for weeks at a time, making the return on investment of resiliency significant.

Striata can empower regional associations to have a more influential role in allocating resources and decision-making power, positioning visibility as an advocacy tool. The ability to see into the current state of that infrastructure can generate enormous efficiencies for the CPCA and similar associations to provide a single source of ground truth for dialogue.

Finally, as daily vaccination rates continue to drop, the cost of vaccinating 70% of the population is no longer just about getting vaccines to sites; it’s also about incentivizing people and ensuring that the infrastructure is in place to meet the demand and avoid wastage where possible.

The post Predicting Community Health Center Power and Cold-Chain Readiness in California appeared first on Direct Relief.

The pandemic has disproportionately affected not only their public health conditions, but also the broader conditions of markets, prices, government revenues, and international trade.

Some of this disparity can now be seen in terms of the price of food in many poorer countries.

The World Food Programme’s food price monitoring map, above, shows the aggregated average percentage change in prices over three months for a basket of staple food products (wheat, rice, maize, meat, cooking oil, etc.), relative to the baseline national measures of pricing for those goods.

The key takeaway is that people in large portions of the world, particularly in Sub-Saharan Africa, have seen extreme changes in their ability to purchase essential calories. This is most severe in Lebanon, for reasons closely related to economic collapse. But there are similar, if slightly less catastrophic trends, occurring in Ethiopia, Sudan, South Sudan, and across most of the Sahel region to Nigeria and Cameroon.

Southeastern Africa is showing similar problems. In southern Madagascar, this is principally related to drought-affected crop failures on top of regional conditions that are potentially connected to climate change. In Mozambique, similar factors are combined with ongoing conflict.

These changes in pricing are compounded by pandemic-related job losses. Studies in South Africa, for example, have shown broad decreases in employment since the start of the pandemic. One study in particular shows an employment decline of roughly 40%.

FEWS NET’s measures of short- and medium-term food insecurity make the picture even clearer.

In East Africa, food insecurity is at emergency levels in the Tigray conflict zone, but in crisis levels across most countries. In West Africa, the conflict area of northern Nigeria is experiencing emergency levels of food insecurity. So are other pockets, particularly in Mali and Burkina Faso.

In Southern Africa, food insecurity is at emergency levels in southern Madagascar, northern Mozambique, eastern Congo, and pockets of Malawi.

Food insecurity emergency levels are found throughout Central America and the Caribbean. Direct Relief partners that operate nutrition programs have reported increased need in their communities. For example, on the island of Roatan, off the coast of Honduras, one partner reported that approximately half the island’s households had lost a source of income due to the pandemic. Several partners have indicated plans to implement food programs to meet increased needs among their patients.

The World Bank now estimates that roughly 97 million people globally will be pushed into extreme poverty this year, due to a combination of the pandemic and related economic shocks. Low Covid-19 vaccination rates across many poorer countries are compounding these issues by delaying or slowing economic improvements.

Should severe disasters – such as Hurricanes Eta and Iota, which devastated areas of Central America last year – occur in these areas, all of these measures are likely to become more severe.

The post Data Show Food Prices, Insecurity Rising Around the World appeared first on Direct Relief.

This uptick mirrors a global trend, according to a World Health Organization briefing held yesterday. WHO data shows the greatest increases in new Covid-19 cases occurring in the Americas and across Europe and the Middle East — regions which accounted for 80% of the world’s cases last week. Globally, there were 3.28 million new cases and more than 60,000 deaths over the past week. This case count reflects a rise for the fourth straight week. The death rate is a 3% increase from the previous week, the first such increase in four weeks. Overall, the WHO reports 125.2 million cases and more than 2.7 million deaths from Covid-19.

In the Americas, which have seen the most total cases during this pandemic, Brazil, Peru, Paraguay, and Chile are currently facing the biggest challenges. Brazil has had the second-highest number of confirmed cases, after the U.S., and is facing transmission over wide swaths of the country. It is also contending with a major Covid variant, P.1, which appears to be driving regional growth. In Peru and Chile, most new cases are concentrated in their urban, capital regions of Lima and Santiago, respectively. Paraguay is facing “overwhelmed” hospitals and has only obtained 63,000 vaccines for its population of 7 million.

In Europe, the B117 variant is thought to be responsible for the current surge across the continent — with the exception of Russia. Several governments, including those of France, Germany, Italy, and the Netherlands, have decided to either extend or reimplement business closures and curfews. The increases have also led European countries to restrict export of vaccines outside the European Union. Growth in the Eastern Mediterranean is also closely linked to the B117 variant, with the most serious situations occurring in Jordan, Iraq, Kuwait, Libya, and the Palestinian Territories.

India and Bangladesh have seen the biggest number of new cases in Southeast Asia. Some smaller countries, such as Maldives, have also seen recent spikes. In the Western Pacific region, a main cause for concern is an outbreak in the Philippines, which appears to be principally concentrated in the capital, Manila.

A global bright spot, relatively, is Africa, which has largely moved past the large peak of new cases it saw in late December and early January. However, some countries, including Ethiopia, Kenya, Cote d’Ivoire, and Botswana are currently experiencing an increase in case counts. South Africa, which has led the region in confirmed cases and is home to the more contagious N501Y variant, continues to see declines.

More information about Direct Relief ‘s Covid-19 response can be found here.

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The past year has been beset by crises like no other in recent history. For most people worldwide, the COVID-19 pandemic and the associated restrictions in movement and business activity have been in the foreground of daily life at least since February.  Against that backdrop, an enormous number of other events around the world also demanded a response from public health and humanitarian agencies. From unprecedented wildfires in Australia to a record number of named storms in the Atlantic, the last year has proved relentless on several fronts.

Like many organizations, Direct Relief regularly relies on several large-scale data resources published by Facebook Data for Good to respond to emergencies. These datasets, from tracking population mobility, displacement, and density, to forecast models of COVID-19 case incidence to surveys on health attitudes and behaviors, have become genuinely invaluable resources.

As cases of COVID-19 spread like wildfire around the world in February and early March, for instance, Direct Relief helped convene urgent discussions with colleagues at Facebook and the network of collaborators on Data for Good about data resources that would prove valuable to assist the response. An emergency call was convened through Facebook Data for Good on Saturday morning, March 14th, to begin sorting out the major issues and requirements for immediate impact, from stakeholder networks to data pipelines, methods, and work products. Participants included several academic infectious disease epidemiology community members, the World Bank, UNICEF, the Gates Foundation, other NGOs, and the data team from Facebook.

That meeting sparked a global effort to help contain COVID-19 by providing real-time mobility data and analysis resources at scale to public sector health agencies, leading to a greater understanding of physical distancing policies being implemented. The effort came to be called the COVID-19 Mobility Data Network. In part, with support from Facebook team, it provided direct analytical support to over 40 different countries, states and cities throughout 2020.

This data-driven approach to critical needs for the pandemic response was only one among dozens of efforts by hundreds of researchers, development institutions, environmental agencies, and humanitarian organizations throughout the world that leveraged data provided by Facebook Data for Good. Teams at UNICEF used survey data from the Facebook platform to drive risk communications around childhood vaccinations. Researchers at the Cadasta Foundation responded to critical issues of land tenure and eviction with granular population density data. Economists in Peru, Chile, and Costa Rica helped inform targeted economic recovery efforts and used population data to support sustainable livelihoods.

While driving social impact through data is neither easy nor straightforward, the many projects here achieved significant positive results despite the myriad challenges with translating analysis into operational progress. This report, then, enhances our understanding of how that impact happened and what we must still do to advance these projects further. More than that, though, the report is a resource for the future, which we hope will provide ideas and inspiration for problem solvers everywhere.

Click to access Facebook-Data-for-Good-2020-Annual-Report-1.pdf

The post Did Data Make a Difference? Reviewing the COVID-19 Crises with Facebook Data for Good appeared first on Direct Relief.

The first wave of infections began in early March and peaked towards the end of April. The second wave began around the second week of June and peaked at the end of July at a much higher daily average case count than the first.

The third wave appears to have begun during the second week of September. Its peak is nowhere in sight. But already average daily case totals are higher, at over 80,000, than the peaks of either of the first two.

In some respects, despite the enormous costs already incurred from Covid-19 in terms of lives, jobs, health, and well-being, the current wave is of greater concern than either of the first two. That is in part because the geographic area affected is substantially larger and more diverse.

The March-April period saw case spikes principally in major urban centers like New York, Boston, Detroit, Chicago, Atlanta, New Orleans, Miami, Seattle and Los Angeles. The June-July period saw a combination of regional hotspots driven by industries like meat packing and agriculture, plus enormous numbers of new infections across the Sunbelt, from Florida and the Carolinas to Texas, Arizona, Nevada, and much of Central and Southern California.

The current wave, however, appears to be spreading broadly throughout most areas of the country, including several that previously had brought the pandemic largely under control.

According to the latest model published by Facebook’s AI Research team, or FAIR, the country as a whole is likely to see as many as 1 million new infections between Oct. 26 and Nov. 8. (Direct Relief has published a dashboard of the results here.)

Comparison with actual changes in case counts in specific areas since Oct. 26 indicates that this forecast is likely to be largely accurate overall, even potentially conservative, although with variations in accuracy in different local areas.

Given the case fatality rate of 2.5% that has marked the Covid-19 pandemic in the United States thus far, an additional 1 million cases would equate to roughly 25,000 additional deaths by Nov. 8.

Viewed in terms of absolute growth in total case numbers, the areas most at risk during this larger, rising third wave include some of the key hotspots from the first two, particularly Chicago, Los Angeles, Houston, Dallas, Phoenix and Miami. In combination, those six cities alone represent a forecast increase of almost 100,000 cases over roughly the next week.

However, viewed in terms of percentage rate of change the map of expected Covid-19 impacts grows much larger, and includes many counties with relatively poor access to hospitals and other health services.

From Wisconsin and the upper half of Michigan, across Minnesota, the Dakotas, Montana, and down through Wyoming, Nebraska, Kansas and Oklahoma, communities representing a diverse mix of urban and rural areas are projected to see dramatic increases in Covid-19. These areas tend to be disproportionately older, with lower access to hospital beds and health resources than in major urban centers.

It is notable as well that Direct Relief has received a significant number of new requests for medical support throughout this area over the past two weeks, backing up anecdotally the underlying dynamics of the forecast model.

In some respects, the areas of greatest concern for the current wave, where high total projected case growth also represents high percentage change, are a pair of urban areas which thus far have not been at the forefront of the pandemic.

One of those is the city of El Paso, Texas. As of Oct. 26, more than 43,000 individuals in El Paso had been infected with Covid-19. The FAIR forecast calls for an increase of over 13,000 new cases by Nov. 8, which represents an increase of nearly one-third. News reports from El Paso, as well as feedback from Direct Relief partners, indicate that the influx of Covid-19 cases is causing enormous strains in the health system there, with hospital rationing and other measures already in place.

Like El Paso, Salt Lake City in Utah is expected to see an increase of over 9,000 new cases by Nov. 8, representing an increase of roughly 20% in only a few days. Hospitals and clinics in the Salt Lake City area are seeing similar strains and burdens.

Direct Relief continues to monitor a range of epidemiological models and datasets to make sure that the U.S. health care safety net is resilient and effective, particularly for the most vulnerable. The Facebook AI Research dashboard is a valuable resource for this effort. The forecast will be updated weekly for the foreseeable future.

The post As Covid-19 Cases Rise Again Across the United States, Where Should We Be Most Concerned? appeared first on Direct Relief.

According to data from Facebook Data for Good, as of Oct. 6, there were at least 2,600 people still displaced from Calcasieu Parish, home to the city of Lake Charles, which bore the brunt of Hurricane Laura. That number equals close to 2% of the total population of the Parish, with true numbers likely being somewhat higher than the Facebook sample alone indicates.

The current displacement totals are improvement of more than 33% since the 20th of September, meaning nearly 100 people per day in the Facebook sample have been returning to their homes. However, with a second storm bearing down on them their return to any sense of normalcy may be significantly delayed.

The geographic spread of displacement from Hurricane Laura was very wide, with individuals dispersing from New Orleans, Louisiana, in the east, all the way to Dallas, Texas, in the west. The most common destinations apart from those two cities included Baton Rouge and Lafayette in Louisiana, as well as Jefferson, Beaumont, and Houston in Texas. Although Texas is not expected to see much impact from Hurricane Delta, many areas of coastal and central Louisiana are expected to see major wind and water damages.

Of particular concern may be a set of smaller parishes to the north of Lake Charles, including Vernon, Allen, Rapides, Evangeline, and St. Landry, which hosted a significant number of displaced persons in the aftermath of Hurricane Laura and which find themselves once again directly within the uncertainty cone for Delta.

This is also a relatively poor and socially vulnerable part of Louisiana, with roughly 45% of households reporting an income under $35,000 annually.

The national shelter system is reporting that the four shelters currently open for Hurricane Delta are located entirely within this inland area to the north of Calcasieu. However, recent data from the national shelter system throughout the Gulf shows that shelter occupancy rates remain very low relative to historical trends for similar events, with peak occupancy for Hurricane Laura topping out at only a few hundred individuals, as opposed to a baseline expectation of several thousand.

Many individuals who would otherwise have been housed in shelters have been housed in hotels, although given the duration of their displacement these alternate shelter arrangements may themselves be stretched to the limits.

The post Many Displaced from Hurricane Laura Are Now in Path of Hurricane Delta appeared first on Direct Relief.

The lower half of the United States is now in the grip of spiking Covid-19 case totals. The state of Florida has averaged around 1,200 cases per day over the past week, a rate not seen there since March. Arizona just saw three of its highest case counts in the past six days. Texas experienced its highest one-day case total, 2,750 new cases, on June 10. And on June 11, Alabama recorded its highest daily coronavirus case total, 848 new cases, which builds upon several weeks of steady growth since early May.

Like much of the rest of the country, the bulk of total cases in Alabama have occurred so far in cities. Roughly one-third of Alabama’s total case count of 22,474, as of June 11, has occurred in the three counties which contain the three largest cities of Birmingham, Montgomery and Mobile. But by examining areas where rapid growth is happening, attention turns towards Monroe.

Over the past three days, Monroe and its neighboring county, Conecuh, have seen a rolling average case growth rate of over 10%, which places them in the highest growth areas of the country. Already, these two counties have a total case rate of 485 per 100,000 population, which places them significantly above the state average of 462 per 100,000. On June 10 and 11, these two counties recorded 42 new coronavirus cases. Each day was more than double their previous highest daily totals, and in combination greater than all the cases recorded in this area prior to May 19. Since mid-May, their case growth trajectory looks increasingly exponential.

The growth rate and case totals are only part of the reason for worry in rural areas like Monroe. What is most alarming is the intersection here between coronavirus infection dynamics, risk factors in the population, and the relative lack of essential health infrastructure. Between Monroe and Conecuh, the diabetes rate in this part of Alabama is just slightly below 20%. Their rate of heart disease is alarmingly high at 466 cases per 100,000 population. Roughly 20% of this area is over the age of 65.

And yet, should the citizens of Monroe and Conecuh require intensive care services, they have only 16 total ICU beds.

While the public health community stays alert throughout the United States and the rest of the world to the signs of continued or resurgent growth of Covid-19,  it is imperative not to lose sight of the risks faced by smaller and poorer communities as the pandemic continues.

The post Covid-19’s Second Wave in the U.S. is Reaching Rural Areas Like Monroe, Alabama appeared first on Direct Relief.

Direct Relief’s introduction to the Covid-19 pandemic happened in mid-January, a few days before the Chinese government closed access to Wuhan. According to early reports, health care workers at Wuhan Union Hospital were treating so many patients with severe complications from the novel coronavirus, they were at risk of running out of personal protective equipment, or PPE. Resupply through commercial channels within China was proving difficult, which prompted the call for humanitarian assistance. This was surprising, not only because of the novelty, speed and scale of the disease, but also because shortages in basic equipment like N95 masks were being reported in the heartland of the Chinese manufacturing colossus.

Health workers were among the most at risk. Eventually, thousands of health workers in China would be infected, hundreds hospitalized, and dozens killed. This was a familiar pattern from many previous outbreaks, like Ebola in West Africa, as those on the front lines bore the brunt of the crisis.

Direct Relief was immediately able to send hundreds of thousands of pieces of PPE to 50 different health care sites, to protect front line health workers. At the time, this seemed like an enormous response in a country that rarely allows outside humanitarian assistance. But it was only the very beginning.

Age, Co-Morbidities and the Linked Burdens of Covid-19 and Non-Communicable Diseases

During the response in China, the initial risk profile for Covid-19 became clear: people 65 and older, often with co-morbidities, tended to require hospitalization and acute medical care including ventilation, at far higher rates than the rest of the population.

The data from China fed immediately into Direct Relief’s response in the United States. In addition to having a health care system which is especially fragile for those with lower incomes, the U.S. is also home to a very large population of people who are aging and managing one or more chronic illnesses. As early as mid-February, it was clear that, should Covid-19 reach the U.S., the impact could be severe.

Data from the U.S. Center for Disease Control and Prevention presents the strong connection between coronavirus, age and co-morbidities. Hospitalization rates, for instance, increase steadily for each 10-year age bracket above 65, with 12.2% of Covid-19 cases hospitalized for those between the ages of 65 and 74, rising to 17.2% for those over 85. 89% of all patients hospitalized for Covid-19 had at least one underlying medical condition, rising to 94.4% for patients over 65. The most frequently reported conditions, as in China, were hypertension, obesity, diabetes and asthma.

Medical Vulnerabilities and Social Vulnerabilities

Covid-19 transmission risk evidently intersects with chronic illness, demographics and economics to produce well-defined landscapes of social vulnerability to the pandemic. For example, current estimates show that diabetes among African Americans and Latinos averages between 17-18%, more than double the rate for non-Hispanic whites. These same groups are also more likely to work in occupations that are deemed during the pandemic as “essential,” such as the middle and lower ranks of health care or in services and logistics, which means they are less able to socially distance. These factors mean a higher risk for hospitalization and acute complications from Covid-19.

Direct Relief routinely supports safety net health facilities, many of which are located by law in “medically underserved areas,” which follow broader lines of medical and social vulnerability throughout the country. Most often the composition of the health workforce reflects the composition of the surrounding community. That means that health workers, in general, are more likely to be exposed to the virus, and that health workers in African American and Latino communities are more likely to experience acute complications.

Poverty, Food Security and Immunocompromised Patients in the Global South

As the geography of the virus now shifts to poorer areas in the Global South, so too must the understanding of risk and vulnerability. While risks associated with age and chronic disease burden may not shift dramatically, what is shifting are the secondary effects from mobility controls and medical shortages in poorer countries, along with an elevated set of risks associated with the high number of people in the Global South living with immune-compromised conditions, particularly as a result of HIV/AIDS.

The UN World Food Programme predicts that as many as 265 million people may be at risk of famine as mobility controls disrupt access to basic calories and nutrition, and increasing food insecurity degrades the immune systems of people of all ages. While countries in the Global South tend on average to be much younger than Europe, China, and the U.S., they also face the world’s highest burdens of chronic HIV and endemic tuberculosis and malaria.  In Sub-Saharan Africa at the moment, an estimated 24 million people are living with HIV. Each one of them, regardless of age, occupies the highest risk group for acute complications from Covid-19.

At the same time, dozens of countries have placed export controls on essential supplies of PPE, which has caused increasing prices globally.  Governments now find themselves struggling to allocate scarce health budgets to cover rising costs.

In order to meet the challenges of the pandemic, we must continue to adapt our understanding of who is most at risk, based not only on the characteristics of the virus, but on the characteristics of our societies.

The post As the Covid-19 Pandemic Expands, Our Understanding of Who is Most at Risk is Changing appeared first on Direct Relief.

California had to impose drastic movement restrictions, known in public health circles as “non-pharmaceutical interventions,” or NPIs, in order to create more physical distance between people, slow the spread of the virus, and reduce pressure on already stressed hospital and primary care systems. Without vaccines or treatments available, NPIs, like physical distancing, are the only tool available to mitigate the virus and “flatten the curve” of new cases.

Californians followed these orders at high, but varying, rates throughout the state. Urgent questions presented themselves. Was it possible that some of that increased mobility which occurred in the day immediately prior to the stay at home order may have played an inadvertent role in spreading the virus, simply by temporarily increasing the number of individual points of contact? How could one know if that was the case? Why did people in some places appear to move more than others? And if it turned out to be the case afterward that the messaging of distancing orders played some role in viral spread, might it also be possible to design future distancing orders, which might have to be re-imposed periodically depending on the course of the pandemic, with greater precision?

Mapping Physical Distancing

We know this uptick in movement took place in the lead-up to March 19, in the aggregate, because of a new set of measures and maps being generated from the distributed activity of hundreds of thousands of mobile devices using the Facebook app with location history enabled. Facebook compiles this information into “disease prevention maps” which locate large numbers of users into blocks of space which are 600 meters on a side and updates the distribution of those locations every eight hours throughout a crisis event.

Direct Relief and many other researchers have been using these types of maps for a couple of years to do things like monitoring evacuations from wildfires and coastal flooding. During Covid-19 response, they have become even more important as a constant barometer of the progress of non-pharmaceutical interventions to slow the pandemic.

These maps can now be viewed here with daily updates at the county level.

Two new measures from Facebook Data for Good are being used to track changes in population mobility. One, called “relative mobility,” looks at the frequency with which users have traveled outside their home location compared to a baseline frequency from the month of February, before physical distancing policies began to be applied across the country. Another, called “staying put,” looks at the proportion of all users with location history enabled who remained in their home location for an entire 24-hour time period. Whereas “relative mobility” calculates a percentage increase or decrease in the amount of movement occurring compared to a previous “normal” period, “staying put” is an absolute measure of the proportion of users on any given day who have significantly constrained movement patterns. The two measures are highly correlated, but they are not identical.

Based on these two measures we can see that practically everywhere across the country has seen some level of decline in mobility since the middle of March. Americans have measurably slowed down in response to distancing orders. However, there is considerable heterogeneity in the data.  As of mid-April, in California for instance, only 10 counties out of 58 are below the state average for mobility reductions.  These 10 are concentrated almost entirely on the coast – in the Bay Area, Los Angeles, Orange County, San Diego and Riverside. More rural areas have seen reductions, but far less than the major urban centers. This gap between urban areas and the rest of the state has increased in California over the past two weeks at least, and in some states for longer.

Rural and Urban Relative Mobility

The gap between urban and rural rates of mobility has echoed throughout the country.

States that contain higher proportions of rural areas than the national average, from Arkansas and Alabama to Idaho and Montana, have higher overall rates of relative mobility, compared to baseline, than their more urbanized counterparts. The average rate of mobility reduction in New York and New Jersey, for instance, remains more than three times greater than in Idaho, Montana and South Dakota. This gap raises important concerns about relative risk exposure over time, even if more rural areas are not quite at the forefront of the case curves yet.

It is important not to jump to conclusions about exactly why rural areas may be exhibiting lower rates of mobility reduction. This is a multi-dimensional problem. For instance, rural areas simply have lower rates of population and infrastructure density, which means people need to travel further to reach services like grocery stores and pharmacies. Likewise, rural areas tend to have fewer jobs which lend themselves to being virtualized; if you’re working in agriculture or warehousing and logistics, you do need to show up for work in person.

These kinds of in-person contacts are one reason that rural areas remain at considerable risk of Covid-19 infection; lower rates of distancing adherence may prove to be of increasing concern over time in terms of public health impacts and health system pressures.

Like the rural-urban divide, evidence also exists of correlation between areas with higher percentages of people over the age of 65 and lower reductions in rates of mobility. In many states, including California, the higher the proportion of people over 65, the more one’s county tends to move around relative to baseline. In part, this may be because urban areas tend to have higher proportions of younger people, who also may tend to work in occupations that are easier to do remotely.  It may be due to the probability that older people live in areas of lower density, which is also correlated with more movement.

Nevertheless, it’s still the case that this correlation exists, and that it remains a cause for concern, given that age above 65 remains among the strongest predictors of the likelihood that individuals will not only become infected with Covid-19, but also become hospitalized and experience acute complications.

Helping the Public Sector by Coordinating the Covid-19 Mobility Data Network

As Facebook’s CEO Mark Zuckerberg argues, the new types of mobility data being created now for real-time analysis of society are potentially a kind of “superpower” for pandemic response, but only if we can get them quickly into the hands of people who can use them to set and modify health policies.

For the past several weeks, Direct Relief has helped to bring insights and information concerning aggregated rates of population mobility to the attention daily of health officials and policymakers throughout the U.S. and other parts of the world. In California, Direct Relief is participating daily as part of the data team informing the governor’s Covid-19 response policies. At the same time, Direct Relief has helped to create and co-coordinate, along with colleagues at the Harvard T.H. Chan School of Public Health, the Covid-19 Mobility Data Network, which links together dozens of infectious disease experts and data scientists in a voluntary effort to provide operational analytical support to key public decision-makers throughout the Covid-19 response.

Since the beginning of March, teams of researchers in this network have supported public actors from New York City and the state of California, to Massachusetts, Florida, Michigan, Illinois and Kentucky. Important new work was done in Seattle, Washington, in collaboration with the Gates Foundation and IDN at the outset of the crisis to begin understanding how the reduction in mobility might be reducing mortality from the virus.

Researchers across the Covid-19 Mobility Data Network have been supporting in Italy, Spain, and the UK in the same fashion, while booting up support across India, and increasingly, in Latin America as well, from Santiago, Chile, to Mexico City. The number of locations requesting and receiving support continues to expand almost every day. The number of new data sources also continues to expand, allowing researchers to compare Facebook’s location data with related data from ad tech firms, traffic patterns, financial transactions, and points of interest data which help to fill out the picture of real-time social activity.

Privacy and Data Protection Remain Crucial

The main reason it’s important for nonprofits like Direct Relief, and for the academic research community more broadly, to work with this type of data to inform public actors is to ensure that insights from this data can quickly reach the right people in positions to use them, without violating privacy and data protection laws and policies.

There is no need to spy on everyone in order to use research-based data agreements to improve understanding of who may be following physical distancing guidelines as part of pandemic mitigation. These agreements were created for the express purpose of allowing vital data to be used without creating conditions where private data is simply being funneled unfiltered to government actors.

As we move into a probable future over the next 18-24 months where distancing guidelines may have to be relaxed and re-imposed on a semi-regular basis in order to reduce pressures on health systems, aggregated human mobility data will be one of our best and in some cases only guides as to whether these policies are working and having their intended effects.

Direct Relief in other parts of its program activity works to keep health workers safe through increased access to personal protective equipment, to expand access to testing, and to keep frontline health centers operational even while they’re experiencing massive economic shocks. But all these efforts depend, for their long-term success, in part on reducing case counts and working together with public sector and private tech company colleagues, like those at Facebook.

Analysis of aggregated mobility data will continue to be in itself one of the most important contributions we can make to the broader fight against Covid-19.

The post Mobility Data Essential to Stopping Covid-19, Reopening Cities and Counties appeared first on Direct Relief.

The fires currently show little sign of abating, due to extremely hot, dry and windy conditions, which provide exceptionally opportune circumstances for rapidly spreading wildfires.

Evacuations have moved quickly in many areas, both towards the coast, as fires have raged down to the shoreline, and away from heavily populated areas, many of which are surrounded by forests and national park lands.

Direct Relief is working with Quantas Airlines to ship 500,000 N95 masks to partners in eastern Australia working to protect communities from the impact of wildfire smoke, including the Australian Red Cross and the Department of Health and Human Services of Victoria.

Facebook Disaster Maps Population Data

Using Facebook’s Disaster Maps data, the rate at which population densities have decreased and increased in certain areas throughout New South Wales, particularly in the dense coastal zone from Wollongong to Bega, can be seen in the images below. Each map shows a snapshot of the relative density of Facebook users with location services enabled at 4 p.m., local time, that day. All users who are part of the data set have opted-in to location tracking and their data has been anonymized.

Data from Facebook Disaster Maps has proven extremely useful during many wildfire events in determining the areas most at risk from fires and smoke in order to optimize distribution plans for masks and other health supplies.

Dec. 29, 2019

Dec. 30, 2019

Data from December 29 and 30 demonstrate high relative population densities all along the coastal area south of Sydney.

Dec. 31, 2019

Jan. 1, 2020

On December 31, 2019, and January 1, 2020,  severe wildfires spread to the Bateman’s Bay area. Rapid evacuations can be detected, with many residents moving both south and north along the coast, as well as inland towards Canberra.

Jan. 2, 2020

Jan. 3, 2020
By January 3,  evacuation areas along the coast had spread up to Nowra, with Canberra seeing very significant rates of increase throughout most of the city.

Jan. 4, 2020

Jan. 5, 2020

Jan. 6, 2020

As of the afternoon of January 6, there is some evidence of returnees in areas to the south and north of Bateman’s Bay, although evacuations persist.

As additional information becomes available with daily updates to Facebook Disaster Maps, more maps will be posted to this ongoing story.

The post Australian Bushfires: Mapping Population Dynamics appeared first on Direct Relief.

At the stroke of midnight on December 31, 2019, only 10 more years will remain to meet two enormous global targets: the Sustainable Development Goals and the Intergovernmental Panel on Climate Change recommendations to keep average global temperature change below 1.5 C.

According to experts gathered last week at the 9th annual United Nations Global Humanitarian Policy Forum in New York, convened by the UN Office for the Coordination of Humanitarian Affairs and the UN Foundation, hosted at the Ford Foundation headquarters, the two are braided together as one. Without rapid and massive changes in energy systems, with corresponding efforts to mitigate crises and adapt societies to the effects of climate change, poverty may grow, instability may increase, and the Sustainable Development Goals may appear out of reach.

This will be true for everyone to some degree, but especially so for the poorest, who contributed least to the predicaments facing human civilization.

Global Norms are Breaking; That’s Both Good and Bad

At this moment of decisive planetary-scale change, one of the crucial networks tasked with meeting these challenges, the “humanitarian system,” is facing its own moment of crisis.

The “humanitarian system” refers to a complex set of international relationships between government foreign assistance, UN agencies, non-governmental organizations, foundation funders, and, to an increasing degree, private corporate funders, aimed at improving well-being and reducing suffering experienced by communities experiencing conflict, displacement, disaster, disease or some combination.

According to representatives from UN-OCHA, if we measure the health of this system based on the success of UN appeals for crisis response, things have arguably never been more promising. The world has never been more generous with its support. Total humanitarian funding is up over 2 billion dollars in the past year alone.

While humanitarian budgets may be rising, the scale of crises is also rising, in some cases much faster. Extreme weather events are intensifying in frequency and ferocity. Displacement is affecting tens of millions. New technologies like artificial intelligence, genetic engineering and quantum computing are emerging in ways that make their effects felt faster than most people have a chance to understand. The pace of change is accelerating to a disorienting degree.

At the same time, the core set of principles which structures and animates the global humanitarian system appears under threat from what several speakers referred to as the rising tide of “norm breakers.” By this, they meant a new wave of nationalists and populists rising to power in countries throughout the world, many of them claiming to prioritize parochial interests over global collaboration. These “norm breakers,” some claimed, may have already undermined systems like international peacekeeping and conflict mediation, not to mention the Paris climate accords, by refusing to share commitments to the core principles expressed in foundational humanitarian documents like the Geneva Conventions and the Universal Declaration of Human Rights.

But “norm breaking,” several participants pointed out, cuts more than one way. The humanitarian system contains norms that are well worth breaking. Some norms may even be essential to break if the world is to meet the twin targets of the Sustainable Development Goals and climate change mitigation.

Take humanitarian budgets, for instance. While increasing financial support for humanitarian action is, in many ways, a good thing, those same budget dollars are still too often locked up in large scale organizations and incentives which prioritize the authority of headquarters in the global North over communities and decision-makers in the global South. Meanwhile the consensus of the World Humanitarian Summit in 2016, at this point largely unfulfilled, was that localization of humanitarian assistance is vital to assure that resources are spent effectively and with accountability by and for the communities most in need.

Achieving true localization of the humanitarian system will require more “norm breaking,” not less, even while some norms such as those expressed by the Universal Declaration have become more relevant to defend than ever.

The Key Problem is Global Inequality

When pressed to name the single issue that will most affect the future of humanitarian action over the next decade the participants responded in no uncertain terms: Inequality. What did this mean? Many different things.

Clear evidence now exists that even as many countries are becoming wealthier, they are also becoming more economically unequal. Among the consequences of this change is that a lower share of GDP may be available to improve conditions for those who are most vulnerable and may be squeezed the most by societal changes, in turn increasing the pressure on international systems to fund development and fill gaps during crises.

New dimensions of inequality have begun to impact the capacity of communities to respond and adapt to crisis. For example, harsh recent laws passed against the rights of sexual minorities in East Africa, some participants claimed, has undermined health programs, including HIV-AIDS spending, while increasing pockets of deprivation which are increasing social vulnerabilities throughout some of the world’s poorest regions.

Recent protests, from Hong Kong to Iran to Chile, were cited as a clear sign that inequality within nations, in some cases exacerbated by lack of accountable governance and the effects of climate change such as long-term drought, is driving a new round of global instability which may increase demands on the humanitarian system, without increasing resources.

Technological change may likewise be among the culprits in rising inequalities, although the outcomes of rapid technological changes are very much up for debate. While some participants foregrounded exciting new bottom-up innovation efforts happening among young people in Africa, for example, others sounded the alarm about the ways “big data” and artificial intelligence may be increasing digital divides and concentrating power and knowledge in systems and institutions rooted in the global North. Without strong and clear attention to global inequalities, organizations may find it increasingly challenging to unlock powerful new technological capacities to assist the health and well-being of the poorest.

No Magic Solutions

Issues of technological change, for better or worse, usually both at once, were threaded throughout the day’s discussions.

A discussion of 3D printing for hyper-localization of supply chains and highly adaptive health logistics also raised important issues of the responsibility of regulatory authorities to ensure safety of medical products produced in and for humanitarian settings.

A discussion of artificial intelligence as a means of automating complex modeling which may be essential to understand complex intersections between social change and climate change turned towards serious concerns with unaccountable algorithms and black-box systems.

A discussion of the remarkable power of social media as a force which enables communities to organize and express their needs and discontents with authorities turned towards disquiet over privacy rights, disinformation and the accumulation of striking new forms of power in large scale data corporations.

The theme running through all these debates was that although technological change will indisputably be a core part of any effort to solve the twin challenges of the SDGs and global climate change, there will simply not be any magical solutions which emerge from new technologies. All new developments also have significant concerns. For any new technology to affect genuine social improvement for those at the lowest ends of society it must be embedded within strong ethical frameworks and effectively localized applications.

The idea that no magic solution exists to the massive problems confronting humanity over the next ten years could be interpreted practically as a sign of despair, in the sense that no one, and no thing, is coming to the rescue.

On the other hand, the time is at hand when we may finally realize the solutions to global problems are not beyond us – they are up to us. The tools have been built to prevail in these challenges if people can behave equitably and ethically, learn from history, break the norms that need breaking, preserve the values which need preserving, and develop societies locally, with accountability and responsibility.

No magic solutions exist perhaps, but real solutions may be found, nonetheless.

The post Climate Change and Inequality Take Center Stage at UN Policy Forum appeared first on Direct Relief.

Prior to 2014, according to FEMA, California saw an average of about six to seven federal disaster declarations every five years. From 2014 to the present, that rate more than doubled. From January 2014 until this month, California registered a total of 17 major disaster declarations. One of those was an earthquake in Napa County in 2014. Five were severe wildfire events. The other 11 were related to flooding primarily caused by severe winter storms, in many cases occurring on the heels of wildfire burns to produce deadly mudslides.

Beyond the sheer number of events recorded, the number of people affected, lives lost, and property damaged or destroyed has skyrocketed since 2013, principally due to the severity and scale of fire events. The vast majority of the largest and most destructive fires in California history have occurred since the turn of the century, according to the Legislative Analyst’s Office of the California State Legislature. That trend has accelerated since their report was issued.

To make matters even more concerning, as Mary Ellen Carroll, executive director of the City of San Francisco’s emergency management agency pointed out, California residents are still living in the time before the worst effects of climate change have started to be felt.

California’s complex geography and social landscape compounds the risk landscape. The state’s emergency managers focus on impacts faced not just by a few, but by every community in the state. That means everything from tiny rural towns in the hills of Alpine County to the urban core of the Los Angeles metroplex. An example of virtually every ecosystem on Earth is present somewhere in California, usually in fragile, disaster-prone conditions.

The state is home to more millionaires and billionaires than almost any other single sub-national area on Earth. Yet it hosts roughly 130,000 homeless people, or 33 out of every 10,000 individuals, almost 70% of whom sleep on the streets. Rural communities are aging quickly and struggling with chronic illnesses, while urban areas trend disproportionately young and struggle more with things like the cost of housing and economic precarity. Ecological and economic complexity are matched by cultural diversity. The richness of California’s heritage and history of migration means that dozens of languages and dialects are spoken by hundreds of different communities in every corner of the state.

“Don’t Meet for the First Time on the Battlefield”

How does one meet the linked challenges of California’s increasing exposure to natural disaster, cultural complexity and social vulnerability? One way is by finding new and creative means to draw upon the extraordinary, but in important senses, under-utilized, intellectual, financial, personal and technological communities housed in California’s institutions, from tech giants to universities to global nonprofits like Direct Relief.

This call to creative support for emergency management throughout the unruly state of California is the reason why the crowd was gathered last week on the second floor of a South-of-Market office hub to listen to speakers like Director Ghilarducci and Mary Ellen Carroll. They were assembled by the combined efforts of philanthropic and social investing teams at Facebook, Google and AirBnB, among other leading tech companies, to weigh in on what a new kind of disaster response might require and entail in the future. Their exhortation was to share ideas and experiences while strengthening networks, because as speaker after speaker emphasized, the worst time to meet is “on the battlefield” of escalating natural disasters.

Each of the three tech companies which convened the Silicon Valley Disaster Response Forum maintains an active “data for good” and emergency response program with different focus areas. Facebook’s emphasis is on leveraging the power of its enormous networked user base through efforts like Disaster Maps, Safety Check and Community Help to provide individuals and responders with better decision support tools. Google’s emphasis lies in emergency alerting, getting targeted useful information out to affected communities and organizations at the right times and places to improve their actions. AirBnB’s response efforts are premised on the power of their platform to connect individuals who have housing resources they are willing to share with disaster-affected individuals who need housing assistance in times of emergency.

The Right Information to the Right People at the Right Time

One of the core principles of emergency response under conditions of the kind of complexity and diversity faced by California is that not everyone has the same needs or experiences during a disaster. Indeed, often what makes an event into a “disaster” is precisely this variance in capability and need, with some social vulnerabilities like age, poverty and disability producing a much more adverse set of circumstances.

During a discussion of the increasing importance of disaster alerting technologies, the question arose as to what responsibility might be owed to individuals with specific medical needs or social vulnerabilities to provide information directly relevant to their circumstances as opposed to the standard practice of providing disaster alerts focused solely on the physical event itself and the locations of evacuations and shelters. What kind of alert might be more appropriate for an 80-year-old as opposed to a 20-year-old, or a wheelchair user as opposed to someone not living with a disability? What kinds of relief resources might be more useful to alert a person with Type 1 diabetes as opposed to someone with normal levels of blood sugar?

Whereas many of the government representatives expressed significant hesitation about this kind of vulnerability-targeted alerting, some going so far as to say that this was largely the domain of individual, rather than public, responsibility. But Google’s Ruha Devanesan emphasized that this kind of informational need cannot simply be placed on individuals to figure out, given substantial variances in individual capacity to manage information. While individual privacy is always an important concern, it might be possible in the future for people with special medical needs or social vulnerabilities to opt into a customized set of alerting information tailored to help them most effectively.

Sean McGlynn, Santa Rosa’s city manager, made an impassioned plea for improved spatial data resources, as their experience of two major fires in four years has laid bare the gaps in what the city needs to know in order to prepare its citizens for disaster and coordinate resources effectively during response and recovery. Facebook’s Disaster Maps program is targeted specifically at this need by making available novel real-time mapping resources of population and connectivity dynamics during crisis. This is likely to be successful with public sector institutions if nonprofits like Direct Relief can help to mediate data access and privacy issues, while building mapping capabilities and the ability to interpret large and high-speed volumes of emergency-relevant data in tandem with agencies that may have very different capabilities.

Just as individuals have significant and variable challenges with information management, so do political administrations and organizations. These challenges open opportunities for partnerships to build new kinds of responsive, democratic digital capacity. In the next phase of disaster response, where crisis accelerates and scales across dynamic and diverse landscapes like the state of California, success or failure is likely to turn on the degree to which we can collaborate to build precisely tuned responses to the range of situations faced by citizens, communities and governments.

The Looming Power Crisis: What California Can Learn from Global Disaster Response

Maybe the most challenging question facing the group was what to do when the power goes out. All agree that access to unprecedented levels of information and insight into what people need and how they’re reacting to crisis events is a good thing. But if you can’t charge your phone, let alone your insulin pump, or you can’t get online, then systems may not be as resilient as they appear. Representatives from PG&E, the state’s largest provider of power, have stated publicly that they expect anticipatory power shut-offs to occur for at least the next decade.

The urgency of these questions clearly derived from the experience of the Kincade Fire in Sonoma County, and the public safety power shut-offs which accompanied and amplified the consequences of that event throughout Northern California. As one audience member wryly put it, his biggest recent lesson learned for emergency management was “don’t have a major wildfire and a major blackout in the same place at the same time.” Nevertheless, several participants described the experience of the Kincade Fire as a kind of informational black hole, in which needs and chaos increased suddenly and dramatically, but the ability to communicate and coordinate declined precipitously.

There are global lessons from which California can draw, however.

The United Nations, for instance, maintains an entire section of the global cluster system devoted to emergency telecommunications, with groups like Ericsson Response and Nethope (of which Direct Relief is a member) leading at times months-long efforts to maintain tenuous communications and power systems for response agencies in disaster zones. It’s often shocking to Americans to learn that the time may be at hand when the scenes faced in parts of the Caribbean, South Asia and Sub-Saharan Africa may confront them as well. But it’s just as possible to face that possibility with a renewed sense of purpose, in the knowledge that many, many other people have dealt with the kinds of situations experienced in Sonoma County, and have developed effective means of response and adaptation.

When Santa Rosa officials spoke up about their own stories of neighbors pitching in to collaborate with one another, citizens’ organizations stepping up to help government and vice versa through the chaos of the fires and power cuts, others in the room were quick to point out that, throughout the world, compelling examples of this kind of community-based resilience can be found. In the Philippines, for instance, one of the most disaster-affected countries on the planet, each of the 43,000 barangays, or neighborhoods, has elected officials and individuals responsible for hyper-localized disaster coordination. These people maintain strong networks, even in the face of severe infrastructure damage, with citizens doing their best to lead from below. California can, and should, learn from the Philippines how they have built and maintained this kind of community-based response system.

The most hopeful vision of the turbulent future, which seems to be arriving all too soon, may well turn out to be a hybrid.

Hope lies in uniting these diverse social and technological visions, with local communities building new offline means of collaboration and coordination even as companies like Facebook, Google and AirBnB, along with partners in the nonprofit and government sectors, find new online means to make targeted, timely and useful information available to all those in crisis who need it.

The post The Future of Disaster Response in California is Digital, Democratic and Diverse appeared first on Direct Relief.

According to the most recent reports from the Ministry of Health and the World Health Organization, three districts in the province of Cabo Delgado (Pemba, Mecufi and Metuge) have seen outbreaks of cholera since Cyclone Kenneth made landfall.

The coastal city of Pemba is the center of these outbreaks, with 108 total cases, followed by Metuge with 19, and Mecufi with 10.New cases are being detected regularly, with the most recent reporting, on May 9, recording one of the highest total case loads since the storm.

In addition to patient treatment with antibiotics and rehydration, Mozambique’s second mass cholera vaccination campaign of the year is scheduled for the end of this week.According to the most recent epidemiological bulletin, “Over 516,000 doses of the Oral Cholera Vaccine (OCV) were received by the authorities and health partners in Pemba on 12 May, for the vaccination campaign scheduled to start on 16 May.” The previous cholera vaccination campaign in Beira saw over 900,000 individuals vaccinated across three districts in the path of Cyclone Idai.

The 516,000 doses, administered in single-dose format to maximize the reach of the current supply, covers a considerable swath of the population in Cabo Delgado. However, health authorities remain vigilant to any potential changes in the geography of case detections, which might alter calculations of the total at-risk population and the scope and focus areas for vaccines.

Epidemiologists at Harvard School of Public Health, with whom Direct Relief, Nethope, Facebook’s Data for Good team, and the Northwestern University School of Medicine have been collaborating since the aftermath of Cyclone Idai, have updated their model to understand how the emergence of cholera cases may spread using a very simple gravity model, in order to make it better suited to possible tactical planning efforts for cholera vaccination. More detail about the model and its methodology can be found here.

Case counts for new cholera detections can be input variably. The model combines cases with a gravity model (simulated population movement based on population estimates from before the flood), flood extent, previous cholera incidence and El Nino sensitivity measures, to rank surrounding areas with respect to risk of cholera emerging there. As new case totals are updated, the probability of future outbreak areas may change in significant ways, alerting health authorities to the need for revised planning estimates. The model uses district boundaries for population. Therefore, new case detections recorded at the sub-district level need to be combined into district-level totals for estimation.

Members of the health cluster, including the World Health Organization and the Mozambique Ministry of Health, have been briefed on the details and functionality of this model. Documentation is in the process of being translated to Portuguese to ensure that local actors are fully informed. As the campaign is rolled out over the coming weeks, and new information becomes available, additional modeling efforts can be adapted and revised to reflect improved understanding of the outbreaks.

Click here to explore the model.

The post Predicting the Spread of Cholera in Mozambique as Case Count Rises appeared first on Direct Relief.

Just six weeks after Cyclone Idai devastated the country and sparked a cholera outbreak that has so far resulted in over 6,300 cases and 8 deaths – despite a successful mass vaccination campaign that reached 900,000 people in four districts – Cyclone Kenneth threatens a repeat of those events in an area that, in many ways, is just as large, complex and vulnerable to disaster.

Cholera has not yet emerged as an active threat in the area likely to be most affected by Cyclone Kenneth. However, particularly in the wake of recent events in Beira after Cyclone Idai, it is clearly a risk. Flood waters and high winds lead to the loss of homes, displacement of population, damaged health infrastructure and, perhaps most seriously from the standpoint of waterborne diseases, damaged sanitation systems which can quickly spread the bacteria which cause cholera.

Can we already know enough precisely about the factors which may lead to cholera outbreaks, including the combination of those factors which may specifically exist in northern Mozambique, in order to focus attention, prioritize key geographic areas and possibly begin planning now for the scale, form and location of health emergency response which may be required?

Modeling Cholera Risk for the Aftermath of Cyclone Kenneth

To help identify the areas in Mozambique at greatest risk from the storm and its aftermath, a team of researchers led by Dr. Caroline Buckee, Dr. Ayesha Mahmud and Rebecca Kahn from Harvard University School of Public Health, in collaboration with Direct Relief, Nethope Crisis Informatics, Facebook Data for Good and Jen Chan from Northwestern University School of Medicine, developed an initial model-based estimation of likely cholera in the region.^1,2

The model highlights several key areas primarily in the Cabo Delgado province, as well as areas of Tete, Zambezia and Sofala provinces, at the highest risk for potential cholera outbreaks following Cyclone Kenneth. Collectively, the five districts considered by the results of this model to be most at risk represent a population of nearly 1.2 million people.

Key factors included in this spatial disease-risk model include the previous cholera incidence for this area, estimated severity of flood impacts, and the likelihood of increased cholera incidence during El Nino years. Previous cholera incidence was based on modeled estimates derived from cholera outbreak data and ecological data from Lessler et al. on cholera hotspot detection for Africa, published in The Lancet in 2018.³ Flooding impact estimates were based on the most recent weather information available, with the highest severity in the northernmost districts. Sensitivity to the effects of El Nino was based on work from Moore et al published by the Proceedings of the National Academy of Sciences (PNAS) in 2017.⁴

Details of the Cholera Risk Model

Risk scores for each variable were scaled between 0 and 1, and maps were produced which show both the averaged effect for all variables and the individual impact of each variable in isolation. For Cyclone Kenneth, the projected overall cholera risk is an average of the flooding index, El Niño sensitivity index and previous cholera incidence.

Additional model outputs have also been produced for the Beira area in central Mozambique which is the location of the current cholera outbreak. In addition to the factors which have been identified for the Cyclone Kenneth area, the Beira model includes a “gravity model” which estimates the likelihood of population movement from the area where most infected individuals are located out to areas where those individuals may travel. The gravity (diffusion) model assumes that travel from Beira occurs based on the population size of Beira, the population size of the receiving district and the geodesic distance between Beira and the receiving district according to the formula:

The goal of this additional model output for Beira is to determine the likelihood that despite what appears to be the containment of the current outbreak, the disease may move along with travelers who leave that region and arrive elsewhere in the country. The “gravity model” simulates human movement, in the absence of detailed mobility data, and has been used previously in epidemiological models (for example, in Xia et al in the American Naturalist in 2004).⁵ High resolution population data was deployed from Facebook.⁶

Focusing Attention and Planning on Emerging Health Risks

As additional flooding and cholera case data becomes available, in the event of actual cholera outbreaks, these models can and will be updated to reflect changing predictions based on new information and new circumstances.

Direct Relief, Nethope and colleague organizations involved in health emergency response activities in Mozambique and other potentially affected countries will be continuing to pay close attention to any signs that communities may be seeing outbreaks of cholera in the days and weeks to come, as southern Africa copes with what is already the most serious sequence of storm-based disaster impacts for this region in recorded history. The modeling work performed by our colleagues at Harvard is an extraordinarily valuable guide to the risks which may still lie in the future. Additional modeling analysis is also in the works for areas of southern Malawi which have already been affected by Cyclone Idai and which lie in the inland path of Cyclone Kenneth.

The data, code and methodology which drives these models will be posted in the coming days to GitHub so that other researchers and interested parties may use these models, reproduce their results, and help us to improve our collective focus on and response to the enormous set of health risks faced by communities in Mozambique and elsewhere.

External Resources:

1. The R-Shiny web application containing output of the cholera risk model
2. Cyclone Kenneth Cholera Modeled Maps
3. Lessler et al, “Mapping the Burden of Cholera in Sub-Saharan Africa and Implications for Control: An Analysis of Data Across Geographic Scales,” The Lancet, vol. 31, issue 10133, May 12, 2018
4. Moore et al, “El Nino and the Shifting Geography of Cholera in Africa,” Proceedings of the National Academy of Sciences of the United States of America, 114 (17) 4436-4441, April 10, 2017
5. Xia et al, “Measles Metapopulation Dynamics: A Gravity Model for Epidemiological Coupling and Dynamics,” The American Naturalist, vol. 164, no. 2, August 2004
6. High-resolution population data set from Facebook
7. GitHub Repository: Cholera and Mozambique

The post If Cyclone Kenneth Leads to Cholera in Mozambique, Who Is Most at Risk? appeared first on Direct Relief.

Over 112,000 cases were reported to start this year, as opposed to just over 28,000 from the beginning of 2018. That year likewise saw a significant gain as compared to 2017. Although still not close to the shocking levels of the mid-20th century, when tens of millions of children were infected and millions died, the trend for new measles infections seems to be inexorably and frustratingly on the rise.

This trend places children under the age of 10, particularly in poor and conflict-affected parts of the world, at increasing levels of entirely avoidable risk.

The Global Measles Resurgence

One of the most common explanations in the media for the measles resurgence has to do with a set of beliefs promoting reluctance to follow through with childhood vaccinations. The WHO earlier this year labeled this emerging reluctance one of the world’s “top ten” threats to global health.

The spread of misinformation about childhood vaccination is leading to a wave of what the World Health Organization calls “vaccine hesitancy.” Over time, declining tendencies to follow through on evidence-based public health recommendations may threaten long-established successful practices, which have improved the health of children since the mid-20th century.

In parts of California, New York and Washington State, for instance, there is evidence that relatively small outbreaks have been correlated with reduced vaccination rates due to anti-vaccine misinformation combined with novel introduction of the virus, often through travelers.

Globally, however, how can the disease’s resurgence be explained? Without question, the world needs to remain vigilant to any possibilities that the consensus around childhood vaccination may be undermined over time by rising “vaccine hesitancy.” However, large numbers of people around the world are still not able to access the vaccinations they both want and need.

Measles, Conflict and Health Systems

In addition to the effect of vaccine hesitancy, we need look no further than the WHO’s own country-level data on the locations and growth trends of measles cases.

Almost all the enormous jump in measles cases from 2017 until the beginning of this year is attributable to a handful of places. This year, almost two-thirds of the entire reported global measles caseload is attributable to just two countries: Ukraine and Madagascar.  These two countries are highly instructive as to the true reasons why we should pay attention to measles as something like a “canary in the coalmine” for the underlying weaknesses of public health systems.

Let’s start with Ukraine, which may appear, at first glance, to be the most puzzling.

Why should a middle-income country on the edge of Europe, with a historically reliable, near-universal public health system, suddenly become a kind of poster child for the rampant spread of infectious childhood illnesses for which immunization exists? The answer is pretty simple: conflict.

Prior to 2014, Ukraine maintained a measles vaccination rate of 95 percent, generally considered the gold standard level for herd immunity. Then, conflict broke out between Ukraine and Russia. As a result, the Ukrainian Ministry of Health budget was frozen and measles vaccination procurement largely ceased until late 2015. By 2016, Ukraine’s vaccination rate had plunged to just 41 percent, one of the lowest rates on the planet.

In subsequent years, the vaccination rate in Ukraine crept back up close to its pre-conflict levels, with about 91 percent coverage achieved last year. But the damage had been done. A multi-year cohort of Ukrainian children had lost their immunity to the disease. Combined with widespread disruption of the primary health care system, and the physical effects of conflict on large numbers of communities, measles took root again quickly and began to spread.

Some of the migration of measles from the Ukraine epidemic has apparently gone international, with cases in New York, Israel and elsewhere traced directly to index cases of travelers from Ukraine.

Elsewhere, in places from Yemen to Nigeria, one can also detect the sharply negative impact of conflict on basic health system capacities and measles infection rates. The lessons of the Ukrainian measles epidemic, as is also the case with these other countries, are not only that it doesn’t take much to fundamentally disrupt a well-functioning health system and produce an otherwise preventable outbreak. Disruptions to health systems in one country, given high levels of global mobility through air travel, can quickly be felt in many places throughout the world.

The Peril of Under-Funding Health Care

The ongoing situation in Madagascar, which Direct Relief continues to respond to with local partners including the Ministry of Health, is quite different from that in Ukraine. Madagascar is one of the least developed countries, with a Human Development Index (HDI) that ranks 161st out of 189 measured countries. Its public health budget has been constantly under pressure for many years simply due to the tradeoffs required to manage multiple emerging health threats to rapidly changing communities. As a result, the measles vaccination rate in Madagascar has fallen to one of the world’s lowest at 58 percent.

Vaccination is not the only element of the health system that leads to increased likelihood of measles contagion.  Poor nutrition leads to weakened immune systems for children and diminished capacity to resist infection. This is one of the key reasons why Direct Relief has been assisting with distributing of high-dose vitamin A to strengthen immune systems for vaccinated and unvaccinated children alike.

Weak primary care systems also present challenges to ensuring that all children are regularly seen by a physician and that suspect cases of measles are quickly identified and treated. Combined with low vaccination rates and persistent under-nutrition, weak primary care and disease surveillance can allow cases to multiply well before there is a chance to identify and intervene.

The Kindling that Sparks an Outbreak

Measles is well suited to epidemics given these system weaknesses. The reproduction rate for measles, the number epidemiologists use to measure the likelihood that one infected person infects others in the absence of counter-measures, is very high.

A systematic review in The Lancet from 2017 confirmed an average reproduction rate of 18, with considerable observed variance depending on contextual factors including poverty and the strength of health systems. That means a single measles infection may commonly produce at least 18 new infections in the absence of counter-measures. Likewise, measles is infectious for 7 days prior to the individual becoming symptomatic, which means that infections can easily spread undetected. That astonishing rate of transmission, including challenges with early detection, is what constantly threatens to transform measles outbreaks into exponentially growing epidemics.

In addition to defending the core public health value and practice of mass vaccination, we still have a long way to go to achieve genuine universality of vaccine access, not to mention the related health systems interventions that maximize the chances of children to resist infectious diseases. That lack of equitable access threatens the most vulnerable in those countries most of all. But it threatens communities far outside their borders too given the fluency of global trade and travel.

Weak primary health systems, whether born of conflict, poverty or, as is often the case, a combination of both, remain among the greatest threats to human health everywhere.

The post The Global Measles Epidemic Isn’t (Just) About Measles appeared first on Direct Relief.

Over 1,200 miles of Mozambique’s midsection, including some of the country’s most fertile agricultural lands, were inundated with salty flood waters just prior to harvest. Conditions now exist for one of the world’s worst food security crises.

Hundreds of people, and potentially many more, were killed in the initial impact. Tens of thousands were displaced from their homes. Thousands more structures were badly damaged or destroyed including at least 57 critical health facilities. Roads, bridges and other logistical routes were cut off for many days, severely hampering the search and rescue and relief efforts.

Long term risks from cholera, malaria and measles to safe delivery for pregnant mothers continue to rise throughout an enormous area including not only Mozambique but parts of neighboring Zimbabwe and Malawi as well.

By some estimates, at least $1 billion in property damage has been inflicted upon these three countries. Each is more poorly placed than most countries to bear the burden of sudden shocks from natural disasters, particularly tropical cyclones. In terms of financial and human costs the 2018-19 cyclone season is now the worst ever recorded for the southern Indian Ocean region.

Tropical Cyclones and Climate Change in the Southern Indian Ocean

There is little doubt about the scale of impact from Cyclone Idai. But what made this cyclone so powerful, high-impact, and in many ways unusual, relative to most of the recorded past of the southern African continent?

Southern Africa is not subject traditionally to significant cyclone events. Prior to 1994, Category 5 storm events were entirely unknown in this region, according to research published in the Southern African Journal of Science. This relative paucity of strong storm events stands in stark contrast to the northern Indian Ocean and particularly the northeastern Bay of Bengal which is one of the most active storm zones on the planet.

Unlike these more northern waters the southern Indian Ocean is a vast expanse of open water, containing far more water volume, requiring significantly more energy to heat up. This area lies closer in proximity to the Antarctic ice shelves which cool the ocean temperatures and temper the likelihood of storm occurrence. The presence of the enormous Madagascar land mass further diminishes wind shear and makes massive storm formation in the area where Idai struck even less probable.

Nevertheless, research published in the journal of the American Meteorological Society strongly indicates the presence of an unusual and accelerating warming trend throughout the western Indian Ocean over the past century. In “The Curious Case of Indian Ocean Warming,” Mathew Roxy and other authors argue that the likelihood of sea-surface temperatures at or above 28 Celsius, where storm events tend to increase in frequency and strength, has increased steadily along the entire African coastline for a complex combination of reasons. The increase in sea surface temperatures is correlated with increase since the early 1990s in the number and severity of southern African cyclones.

Cyclone Idai made landfall as a Category 3 storm, which would have been serious under any scenario. What made this storm so catastrophic was the extremely high atmospheric moisture content leading to heavy rains, on top of an immediately prior storm which had already caused flooding throughout the Zambezi River basin.

Echoing many of the reasons for Hurricane Harvey’s devastation of eastern Texas in 2017, the issue with Cyclone Idai was less the presence of high winds than the sheer amount of water pushed into the area through overlapping storm systems and coastal surge over an area of low-lying topography. This is the reason for describing the post-storm landscape as a kind of “inland ocean.”

Many climate models indicate that the combination of factors making tropical cyclones more likely in the southwestern Indian Ocean which saw very few such events in the past will tend to increase over time. This means that countries like Mozambique, Malawi, Zimbabwe and South Africa are looking at a future under climate change where even within global mean temperature increases in the 1.5C range, well below what the Intergovernmental Panel on Climate Change recommends as a “safe” limit for climate change mitigation, Cyclone Idai level events must be factored regularly into the risk horizon.

How Prepared is Southern Africa for Increasing Natural Disasters?

Disaster preparedness always involves some degree of transference of present resources to reduce the risk from events that have not yet happened, in the future. To prepare for an event which hasn’t happened yet means spending scarce resources now to avert future impacts that would conceivably be far worse without the present investment in preparedness.

This is one of the key reasons why disaster preparedness is such a wrenching debate in the poorer areas of the world, like southern Africa. Countries like Mozambique and Malawi must make tough choices in terms of development priorities, with current public budgets already under “normal” scenarios being insufficient to provide adequately for necessities like full-scale vaccination, affordable housing, strong public health systems, universal access to clean water and effective sanitation. The more serious the future risk horizon looks then the more challenging these present allocation problems will appear to be.

To some degree, smart public investments can double as disaster preparedness. Basic primary health care is a good example. During the response to Cyclone Idai, public health care workers have played key roles, with local clinicians essentially being drafted dynamically into the role of “first responders.”

Likewise, the more the primary health system under non-disaster conditions can reduce exposure to health risks such as safe delivery and reduction of childhood diarrheal illness the more resilient those populations will tend to be in times of crisis. Investing in basic primary care is therefore not only smart on its own terms, it’s also a good argument for effective disaster preparedness.

Not every investment choice is the same as primary care though in terms of its dual impacts. Countries throughout southern Africa also need to build up the specialized emergency management capacities required to respond effectively to events like Cyclone Idai, regardless of how frequently those capacities may be utilized in any given year. Mozambique’s emergency management agency, INGC, has been a leader in the field, as it looks to strengthen core operational capabilities and add innovations like drone mapping which proved essential in the recent flood response by enabling rapid assessment and targeting of affected areas. Even INGC though is under-resourced compared with wealthier countries, and still has a long way to go to meet basic standards of disaster readiness. Neighboring countries are struggling perhaps even more seriously than Mozambique.

The Imperative to Build Southern African Disaster Resilience

Six days following Cyclone Idai, the government of Zimbabwe announced that it had gotten the message loud and clear and would be creating for the first time a national emergency operations center in Harare. Local Government Minister July Moyo is urging rapid innovation in disaster management for Zimbabwe. “We want to set a permanent disaster management center so that we have all the information systems including the technology that other countries are now using, to predict or retrieve information when a disaster occurs,” Moyo said.

Elsewhere local, national and international groups are urging investments in early warning systems, improved training and technologies for better coordination. Broad popular education in how to react to emergency events is critical, much like public health education campaigns have helped to increase basic preparations like hand washing and vaccination. Each of these elements is crucial and should be thought of in concert as a package of interventions to boost social readiness.

International organizations can play key support roles as well, as the current cyclone response displays in abundance. Yet it’s clear that priorities in emergency resilience need to be driving from the local and national level for greatest effectiveness. Organizations like Direct Relief seek to bolster those local capacities as they develop but ultimately cannot and should not substitute for developing locally-driven resilience efforts.

As we look towards a shared future in southern Africa where events like Cyclone Idai become more likely, it’s incumbent upon us in the international community, just as for national governments, to boost key investments and innovations that will make countries like Mozambique, Zimbabwe and Malawi more resistant to the worst impacts of disasters. Even so, the immediate health and development priorities which countries must deal with on a daily basis also need to be understood in part as a way to reduce the costs of trade-offs between present needs and future risks.

Direct Relief is working with local partners to help make sure not only that current needs are met in the aftermath of Cyclone Idai, but also that we aid with rebuilding in a way that ushers in more disaster-prepared systems for the next storms.

The post Rethinking Disaster Preparedness in Southern Africa After Cyclone Idai appeared first on Direct Relief.

The land around Beira was already saturated with flood waters when Idai arrived. With the additional heavy rains from the storm, as well as storm surge cresting as high as 7.5 feet, Cyclone Idai produced an “inland ocean” which stretched for thousands of square miles, soaking the homes, roads and belongings of some of the world’s most impoverished communities.

The official death toll from the initial impact is already in the hundreds, with search and rescue operations ongoing. Many more than that total may ultimately lose their lives.

Despite the heavy losses of the storm’s landfall, the highest risks for people living in Mozambique and neighboring Zimbabwe still lie in the future.

Communities in the storm-affected area face many of the planet’s most pressing health crises. Now they must do so under conditions where transportation and communications networks have been disrupted, agricultural fields have been inundated with salt water, homes have been lost, and food is scarce.

Mozambique’s health care system was already fragile. Now, in many places, it has been rendered non-functional. In Sofala province, 28 out of 157 health facilities have been either entirely or partially destroyed.

Waterborne Diseases

The muddy storm waters of Cyclone Idai contain multiple risks to human health. Cholera is foremost among these. The area from Quelimane to Beira and inland across the border into Zimbabwe includes numerous areas which are considered under standard conditions to be high risk for cholera infections. Central Mozambique saw outbreaks of the disease in 2015 and again in 2017.

Cholera is caused by the infection of water supplies with sewage which may contain the vibrio cholerae bacteria. Flooding from Cyclone Idai has severely affected sanitation throughout the region.

Areas which have seen cholera infections in the recent past may see a rapid resurgence of the bacteria. According to reports from IFRC, the first cases in the inundated area have already been detected.

Along with cholera, risks of waterborne illness include bacterial infections causing acute watery diarrhea, and typhoid, both of which are endemic throughout the storm-affected zone.

HIV and TB

Mozambique suffers from one of the most severe HIV burdens of any country. Current estimates place their HIV prevalence rate at 12.5% of the population. HIV, although it is transmitted by viral infection, is now considered largely to be a chronic illness given access to anti-retroviral drugs which can control the severity of the disease and bring patients’ viral loads into manageable ranges.

However, under conditions where drug supplies may be disrupted as a result of natural disaster patients may not be able to access health facilities nor receive access to HIV medications. As a result, many patients are at serious risk of experiencing complications from the disease.

Likewise, Mozambique has among the highest burdens of TB, at 552 cases per 100,000 population. Much like HIV, tuberculosis can be controlled through the administration of antibiotics and other medicines, but often requires direct observation of the patient over regular periods.

Disruption of health systems is an exceptional problem for patients who may have active tuberculosis. Likewise, the conditions of the disaster produce the increased probability that people with TB may come into contact with others and risk the spread of the disease.

Malaria and Dengue

Cyclone-strength storm winds tend to disrupt insect populations and may have an initial effect of reducing exposure to vector-borne diseases. However, central Mozambique has high burdens of malaria, dengue, chikungunya and other infections which are transmitted by mosquitos. Mozambique has the 10th highest malaria rate in the world at 337 cases per 100,000 population.

As the storm waters recede and mosquito breeding grounds re-establish themselves, it is likely that people throughout this area may see spikes in vector-borne diseases. For those currently being treated for malaria and other illnesses, the disruption of access to medicines may make their conditions more severe than otherwise would be the case.

Maternal and Child Health

Pregnant women in Mozambique are among the most at-risk under normal circumstances. The country’s maternal mortality rate is 489 per 100,000 deliveries, which is the world’s 21st highest. Among the leading causes of risk for safe deliveries is the lack of access to a skilled birth attendant, usually at a health facility.

Given the scale of impact to the health infrastructure of this area women will experience reduced access and therefore higher rates of risk that complicated pregnancies may result in severe injury or death.

Obstetric fistula as a result of prolonged obstructed labor is among the most common birth injuries suffered by women in Mozambique. According to the “Find a Fistula Repair Center” Application, some of the busiest providers of obstetric fistula care for the country are in Beira and Quelimane, where between 100 and 150 fistula repair surgeries are provided annually.

As is often the case in crises, children under the age of five face some of the most severe health risks, including respiratory illnesses, diarrheal disease and other infectious diseases including cholera, malaria and measles. Mozambique’s child mortality rate is among the world’s highest at 72.4 per 1000.

Food Security and Nutrition

Access to food ranks among the most urgent post-disaster issues for people affected by the storm. Major shortages are being reported throughout Sofala and Zambezia as transportation logistics have been cut off and communities struggle to meet their basic nutritional requirements.

Food security is, however, perhaps even more serious as a concern over the medium to long term. The midsection of Mozambique is a significant agricultural production region. Most families make their livelihoods here as smallholder farmers.

The wind-speed of the cyclone badly damaged tens of thousands of acres of staple crops. Even worse, the surge of salt water into key production regions may take those areas offline in terms of viable agricultural production for the remainder of this year until the fertility of the soil can be restored.

Long-term disruption of food security has implications not only for the communities directly affected by the storm but potentially for the entire country which will have to figure out how to replace what has been lost.

Direct Relief is stepping up medical aid shipments throughout the affected area and will be closely tracking health risks to the people of Mozambique as they continue to change throughout what promises to be a long and challenging recovery effort.

The post Health Risks Rise in the Wake of Cyclone Idai appeared first on Direct Relief.

Given that residents of this area are among the poorest in the world, with significant health challenges under ordinary circumstances with HIV, malaria and other vector-borne diseases, respiratory and diarrheal illnesses, as well as persistent challenges with maternal and child health care, the risks to the health of the population over the coming weeks are very high.

According to news reports and situational updates from the few humanitarian agencies that have been able to reach Sofala district and the coastal city of Beira, which took the immediate force of the storm, the area has been transformed into an “inland ocean.” Flooding across Beira, home to over 500,000 people, appears to be not only widespread but very deep, approaching the roof lines or entirely submerging thousands of structures.

Damage outside the city may be considerably higher but assessments in the more rural areas will take significant time to complete. The primary road into Beira is considered impassable and aid is reported being delivered by helicopter.

Power and communications have been cut almost entirely for the nearly 20 districts surrounding Beira. Small pockets of cellular coverage remain available far inland near the cities of Chimoia and Mutare on the border with Zimbabwe, but even these areas remain tenuous and oversubscribed over the course of the day.

Direct Relief is coordinating with local partners in Mozambique including the Real Medicines Foundation and the provincial Ministry of Health for Zambezia to move emergency medical supplies into the affected area.

The post Cyclone Idai Inundates Mozambique, Leaves Devastating Wake appeared first on Direct Relief.

One of the key unknowns is how people are likely to behave in the face of disaster. How are communities throughout this area responding to this severe threat to their lives and homes? Are they able to move out of harm’s way? And is there any evidence of them already doing so?

Facebook disaster maps allows a certain kind of window into these questions. Through aggregated and anonymized data on the locations of Facebook users over 8-hour time intervals during crisis, Direct Relief and others can look at how at least a subset of crisis affected populations may behave in near-real-time. Given Facebook’s exceptionally large global user base, even relatively poor areas like coastal Mozambique display some signal of movement during crisis events.

In the case of Cyclone Idai, density maps can show the percentage change in population, measuring how a certain fraction of the population is moving. On March 12 at 7 p.m., the well-traveled route between the cities of Beira and Mutare display an expected high-density pattern, with high percentage change as compared to the baseline measure of three months ago.

On March 13, however, that density pattern shifts dramatically, with the traffic corridor between Beira and Mutare showing much lower density but the areas further towards the outskirts of the wind swathe displaying upward shifts in population density. There is, in other words, some evidence detectable within the Facebook disaster maps data of an evacuation pattern taking place away from Beira towards outlying areas.

In this case certain significant caveats do apply. First, the population sample represented in the Facebook data is somewhat small, containing just shy of 6,000 individuals out of a potential baseline population numbering in the hundreds of thousands. Second, given the poverty and inequality of this area it is probable that the population being measured as Facebook users is more likely to be a more mobile population. Therefore, the population density shifts displayed in these maps should not be understood as necessarily indicative of the population movement patterns of the entire affected area.

Nevertheless, as is so often the case, there is no other meaningful source of information available to humanitarian responders, especially in areas like coastal Mozambique, regarding the movement dynamics of populations during times of crisis. As Direct Relief continues to monitor this situation and reach out to partners across the region for possible emergency health care support, the Facebook disaster maps data is an invaluable guide among other core datasets to how Direct Relief may need to adapt the focus of assistance to meet the needs of the most vulnerable.

The post Cyclone Idai: Analyzing Population Movement in Mozambique with Facebook Disaster Maps appeared first on Direct Relief.

Like many individuals and institutions, humanitarian organizations are also contending with these at-times-bewildering shifts in perception, policy and technology.

Rather than simply celebrating social media uncritically or disengaging from it given certain dystopian fears, it may be possible to find a more productive engagement with social media as a force for good. Humanitarian organizations can use these services in striking new ways, by focusing on what can be learned from the data being produced at greater-than-ever scale and speed.

Direct Relief, for instance, not only delivers messages through its social channels; it also derives insight from social media data sources to inform its understanding and advance its core mission of strengthening the health and well-being of people in situations of crisis and poverty. By drawing analytically upon these novel sources of data for good, Direct Relief and others have begun to see the outlines of an alternate future for how social media – treated ethically and responsibly – may play a more realistic and hopeful role in humanitarian operations.

The Best (and Worst) of Times for Social Media

To see what’s possible in the future, it’s useful to understand more about the recent past.

Social media has existed for about 15 years. For most of that time, the platforms which marked its rise, including Facebook, Twitter and similar services, emphasized scaling personal communications and expanding new forms of marketing. The business model popularized by Google, and then later by Facebook, of monetizing user data to create targeted advertising, has been ascendant within and beyond the technology sector for the better part of two decades. Harvard professor emeritus Shoshana Zuboff goes so far as to describe it in her book, “The Age of Surveillance Capitalism,” as an emergent economic system where profitability has been re-founded upon pervasive, commercially-focused monitoring by networks of apps, databases and mobile devices.

During the first decade of social media’s rise, the creation of these new forms of digital interaction and commerce were viewed with near-utopian reverence. That sentiment shifted dramatically in recent years. Election hacking and Black Mirror-style social rating systems, among other things, have taken some of the proverbial bloom off the social media rose.

One of the key answers to this best-of-times/worst-of-times dilemma for social media in the humanitarian space has been for companies to create “data for good” programs. Rather than just using the tools on their own, “data for good” programs promote structured access by analysts to the core data resources. Through data sharing and protection agreements, companies with valuable private data can enable its use at enormous scale and frequency to conduct analysis and guide programs for the public benefit.

Direct Relief now engages in several corporate “data for good” efforts, from social media to location intelligence to news publication and healthcare. These different services, on their own and in combination, are opening new possibilities for answering timeless questions about people and communities in crisis, their needs, and changes over time, especially during emergencies.

The Thomas Fire & Facebook Disaster Maps

Direct Relief’s first experience with social media data for humanitarian use was a trial by fire.

In December 2017, the hills above Santa Barbara, where Direct Relief is headquartered, were an inferno. The Thomas Fire, at that time the largest in California’s history, tore through neighboring Ventura County and carved its way north at an astounding rate. The air, right down to the shores of the Pacific Ocean, was a choking cloud of smoke, filled with particulate pollution. Direct Relief responds to many such wildfire events each year, but this one was different because of the scale, and its proximity to its headquarters.

In collaboration with the Santa Barbara and Ventura County Public Health Departments, Direct Relief staff fanned out to distribute thousands of N-95 masks for protection from the smoke.

Where should these masks be distributed for maximum effect? The fire was dynamic, changing literally with the winds. How could staff know where people would be at different times, and how many masks they might need?

A few weeks earlier, Nethope.org hosted a webinar for a new product from Facebook’s Data for Good team called “Disaster Maps.” Facebook’s user base is massive and spread out in dense patterns over virtually the entire planet. If people opt into a setting called location history on their mobile phones, Facebook is able to anonymize and aggregate this data at a neighborhood level and determine how, when and where populations move. Using these aggregated insights, Facebook can create maps of astonishing clarity about the dynamics of entire populations, in real time.

Facebook Disaster Maps are comprised of aggregated user locations within grid squares that are 600 meters on a side and are updated daily. The implications of these data for humanitarian aid are profound.

With access to such maps, which Facebook provides for free to organizations like Direct Relief that sign data-sharing agreements, questions about where and when to maximize things like N-95 mask distribution could start to be answered in new ways. Evacuation patterns could be analyzed to understand the degree to which people were evacuating their neighborhoods or staying behind. The ebb and flow of population density around planned distribution sites or health centers could be tracked throughout the day. The smoke plume pouring off the hills could be overlaid on that movement pattern to determine how many people were in areas of heightened respiratory risk.

Before too long, Direct Relief was making maps routinely from the Facebook data. Daily briefings filled with news of populations in motion. Connections emerged between these mobile clusters of people and information about pre-existing social vulnerabilities, which led to more detailed assessments of areas in need. The town of Montecito was hit in January 2018 with deadly mudslides. Within hours, Facebook disaster maps revealed the residents’ movements, or lack thereof, in the affected area. Questions could be posed empirically of how those numbers lined up with official evacuation zones.

Social Media as an Operational Humanitarian Platform

When the emergencies of late 2017 and early 2018 finally subsided, a threshold had been crossed. Instead of making do with hypothetical assumptions about how people should behave during emergencies, humanitarian agencies like Direct Relief could base their actions on how people actually behave.

With each passing event, more can be learned about how to respond effectively and anticipate the needs of people in crisis, but it’s not enough for it to reside at the 30,000-foot analyst view. For data like Disaster Maps to be truly impactful, it must get to the operational levels of humanitarian response. For Direct Relief, that means figuring out new ways to get data, and, more importantly, interpretations of that data, into the hands of people best placed to use it. By April and May 2018, workshops had been hosted with non-profit primary health centers in Texas to help them prepare for the upcoming hurricane season. The workshops demonstrated how Facebook Disaster Maps might have helped during Hurricane Harvey, had the tool been available at the time.

Simple insights from social media data could be revelatory in the right context. During Hurricane Harvey, the outlying areas of Houston saw elevated population levels for days. In contrast to news about overcrowded shelters downtown, the health centers in retrospect saw their broader lived realities reflected in the Facebook data. Resources were often needed most in the suburban and exurban zones, far from the city center. The same pattern played out later in the year with Hurricane Florence in the Carolinas and Hurricane Michael in Florida, where enormous pockets of need aligned with areas of high social vulnerability, in outlying areas, and away from the urban cores.

Part of the operational dimension of social media for humanitarian aid lies in linking new analytical capacities with the coordination capacity of the more familiar elements of the platforms. In the case of Facebook, Direct Relief piloted the use of groups to encourage coordination among health centers as well as a venue for distributing Disaster Maps. Through Facebook Groups, positive feedback loops emerged, helping guide analytical insights to those on the front lines of crisis while learning from them about the ground-level realities of events and the impacts of their actions.

Facebook Community Help, a service of Facebook Crisis Response that allows individuals to post their needs during an emergency and others to post their ability to meet those needs, also points the way towards a new humanitarian future where the services we’re using to communicate resemble price signaling marketplaces. The demand for and supply of assistance can become increasingly precise and knowable even under the most chaotic conditions. Direct Relief secured the ability of primary health centers to post information into Community Help as institutions rather than individuals, which means that in upcoming emergencies real-time maps of need, supply, and response activity might be feasible.

Learning from Facebook Data for Good

Privacy concerns for all these new developments need to be kept front and center, given the recent cascade of revelations around privacy failures. How do humanitarian actors use granular information about populations in crises without jeopardizing them even more through the release of information which might be used to target or take advantage of them? Here too, the Data for Good team at Facebook arguably marks out a kind of best practice in the field. In order to access Disaster Maps or the underlying datasets of Community Help, Direct Relief agrees to stringent data protection protocols. Strong limits are placed on access, even blocking the use of APIs, to prevent unplanned or unwanted release of information. Companies that deal in private data could take more than one lesson in proper information management from the standards and trade-offs governing Facebook Data for Good.

Towards the end of 2018, after engaging with Facebook Data for Good for the better part of the year, Direct Relief began seeing an uptick in conversations with businesses about how their core datasets could likewise become useful during humanitarian response. Financial services, location intelligence, news media, healthcare and many other sectors began posing interesting questions about the terms, conditions and use cases that might transform their data assets into social goods for communities experiencing disasters.

Each company requires an answer that’s distinctive to their corporate culture and the content of their data. Taken together though, these private datasets, which track money, health and the whereabouts of large-scale populations on a near-constant basis, and which in many ways now hold the highest value for humanitarian response, may find their way into a new common operational picture, at once public and private. When and if they do, humanitarian actors need to make sure that picture is governed by reasonable standards of privacy and effective information management, of the sort marked out in part by the Facebook Data for Good team.

To the surprise of the world, which at the close of 2018 seemed practically consumed by newfound fears of social media, and a repudiation of the earlier utopian impulses, perhaps the true legacy of Facebook’s Data for Good initiative might be to illuminate a third path. It’s possible that with the right guidance, ethics and emphasis on localized results, efforts like Disaster Maps will form a bridge between the private data which increasingly governs public life and the social good, which can be engaged through careful collaborative action.

Future social media users may be so fortunate one day to re-think these tools in their entirety from such a hopeful point of view.

The post “Data for Good” and the New Humanitarian Future appeared first on Direct Relief.

“When it comes to helping families experiencing food insecurity to smooth out their exposure to risk,” recounted Dr. Kelsey Jack. “A dollar spent at the point where households are most vulnerable is simply worth more and can make a bigger impact than a dollar spent at other times of the year.”

Dr. Jack’s work focuses on the challenges faced by rural agricultural communities in the global South, many of whom receive virtually their entire annual income in a single moment following the harvest and need to make that income last all year, depleting it steadily as the next harvest approaches. If an external shock such as a natural disaster impacts these communities when their resources are lowest, they are generally far less prepared than at other times to respond effectively.If one provides assistance, either in the form of development or relief, the timing of that assistance makes an enormous difference in terms of its relative value to the affected communities.

A dollar of aid spent at the right time is not the same as a dollar spent at other times.

This same basic insight about time and aid applies to crisis affected communities in the U.S. as much as to rural farmers in Zambia. Dr. Mark Buntaine, reflecting on the work of his colleague, Dr. Sarah Anderson, who studies wildfire preparedness and response in California, described the tendency of assistance to flow to communities not based on the magnitude of future risks but instead based on experiences with recent events. “When communities have been recently affected by wildfires they tend to receive the most attention,” he said. “Resources for wildfire mitigation tend to follow along with this attention, even though these same communities may face lower risks given the exhaustion of fuel sources which drive the fires.” Once again, timing makes all the difference. If we can invest ahead of the attention curve in effective disaster mitigation, those dollars may be worth more overall to potentially impacted communities.

Dr. Buntaine’s own work focuses on “resilience” to disasters. Time plays a central role in defining the central idea of disaster resilience. According to standard models, a community has a pre-existing level of welfare which is reduced sharply over a short period of time during a crisis event. Infrastructure is destroyed, livelihoods are suspended, and health declines. Over time, and with help, communities invest to rebound at least to pre-existing standards. The level of community resilience is bound up with the time required to accomplish this rebound. If the investment curve is steeper, especially the rate at which that investment is absorbed, the time to recovery is faster. While one needs to spend at peak moments of crisis to minimize the effects of an event, one can also spend over longer durations to minimize potential damages.

The value of dollars spent to reduce damages may actually be greater than the value of dollars spent to minimize effects given price changes and reduction of harm to livelihood. At the same time, and in line with Dr. Jack’s insights, the value of assistance to communities is greatest at the point of immediate harm, when their capacities are lowest. The balance of these relative priorities is therefore a central concern for how we manage the social consequences of increasing vulnerability to disaster.

Given these concerns over relative time, investment and resilience, how can one measure the impact of different events and strategies?

One way Dr. Buntaine and his team are approaching this question is to apply techniques from remotely sensed satellite image analysis to determine relative changes in welfare compared to the impacts of disaster events. Using the illumination of lights at night across the Earth’s surface researchers can detect proxy measures of economic activity which may be affected significantly by disasters.

When Hurricane Maria struck Puerto Rico the island experienced not only the longest blackout in US history but also one of the most serious adverse events in terms of mortality and morbidity due to crisis. The blackout was directly correlated with the scale of impact. By measuring how the nighttime illumination changes in areas researchers can also measure the differential impact of investments made to promote recovery.

Over the anticipated future time marked out by climate change, events like Hurricane Maria appear to be increasing in terms of frequency and severity. How can we predict what the shape of this future is likely to look like?

Dr. Kyle Meng and Dr. Ashley Larsen approach this question from different points of view based alternately on economics and ecology, yet each contributes to understanding new ways that those of us who respond to crisis may be able to get at least somewhat ahead of the impact curve.Dr. Meng looks at historical trends linking violence and global temperatures and discovers that the temperature oscillations associated with El Nino events, in which the tropics see significant warming, tend to be associated with dramatic spikes in violence. Knowing this, it’s an open question as to whether efforts to counter the effects of violence ought to be associated with projections of temperature patterns.

Dr. Larsen on the other hand looks at the ecology of insect pests and their impact upon food security.As global temperatures change the habitats of insect pests change, which in turn impacts the geography and severity of food security. Projection of these changes is not a simple matter though of noting variance in temperature and moisture. As insect habitats change, they face changing food sources, predators and other factors that impact their survival and reproduction rates. This is true for agricultural pests as much as for insects like mosquitoes and ticks which serve as disease vectors impacting human health. To get ahead of these curves and improve social adaptation to future climate changes requires careful modeling and broad collaboration across many different groups and agencies.

The future of much of Direct Relief’s own work promoting efficient and effective resilience and recovery will be informed by insights being generated by researchers like those at UCSB’s Bren School. In that sense, the timing for better collaboration with our academic colleagues couldn’t be better.

The post Climate Change, Disasters and Time: A Discussion with UCSB Bren School Faculty appeared first on Direct Relief.

How Much of a Factor is Climate Change?

The most common refrain heard in recent commentary on the California fires is that the climate is changing faster and more pervasively than our social systems or thought processes have been able to adapt. In the case of wildfires what this means is that over time the weather is consistently getting hotter and drier for longer durations than we have figured out what to do with socially.

According to an analysis by Robert Rohde, the chief scientist at Berkeley Earth, the long-term tendency is clear: California’s fire season has migrated steadily from being ordinarily cool and wet at the beginning of the last century, towards a current state of being normally hot and dry. As these consecutive hot and dry years accumulate the likelihood that vegetation becomes susceptible to sparks, and that the resulting blazes quickly consume large amounts of vegetated land goes steadily up.

Rohde’s conclusions are supported by a recent interview with UCLA climate scientist Daniel Swain who argues the fires are driven by the confluence of wind, excessive heat and dryness, indirectly driven by long-term climate trends. “Part of what we’ve been seeing with all of these big fires is there are two big weather or climate factors at play—very strong offshore winds, which in California can be extremely strong in localized canyons, especially along the western slopes of the Sierra Nevada and the canyons of coastal areas, where both of the fires are now burning. Those really strong winds can push a fire extremely quickly. The other part is what the vegetation is actually like. How dry is it? If it is at summer-like dryness levels, as it is now, then that fire is going to behave much differently than if we had experienced the rain that we typically experience come beginning of November. There is the primary climate connection. What’s really happening is an indirect effect, but a powerful one through the dryness of the landscape and dryness of the vegetation.”

Analysis from Yale Climate Connections expands on possible climate change connections blowing in the winds. Citing a 2006 paper in Geophysical Research Letters, they argue that the famed hot and dry Santa Ana winds are pushing steadily later in the year towards the winter, expanding the annual risk period for southern California in significant ways. Likewise, disappearing sea ice in the Arctic due to increased global warming has tended to disrupt the jet stream, the primary wind pattern regulating temperature and moisture in the northern hemisphere. Drastic changes underway in the Arctic are leading to a wavier oscillation and increased production of high-pressure ridges off the California coast which keeps needed rain offshore and contributes to the frequency and duration of hot and dry conditions.

As usually is the case, it’s impossible to attribute all the extreme weather patterns feeding the lengthening and intensifying California fire season, let alone these specific events occurring now. Nevertheless, strong and accumulating scientific evidence exists to say with high confidence that climate factors are unmistakably worsening the risk of wildfires throughout the state, and ensuring that when wildfires do happen, they will occur in an increasingly favorable environment for those fires to rapidly spread across large areas of dry vegetation.

The Urban Interface and Social Vulnerabilities

While it is doubtless true that forest management could stand to be improved, there is little evidence in the current circumstances that deteriorating conditions on forested land, most of which is managed by the federal government, played a central role in spawning the size, speed and impact of the current fires. As the Pasadena Fire Association recently noted on Twitter, the current fires were all spawned at what’s called the “urban interface” where the edges of settlements have pushed deeper into land which previously might have been forested or densely vegetated.

Out on the fringes of the urban interface, the meeting between human civilization, including the spreading electrical power lines and substations of SoCal Edison which appear to have been the proximate spark in the case of the catastrophic Woolsey Fire, is far more unsettled and dynamic than either in core urban or deeply forested areas. According to the National Institute of Standards and Technology this “wildland-urban interface” is growing nationally at a rate of 4000 acres per day and now constitutes the country’s single greatest wildfire risk.

Part of the pressure to continuously expand the wildland-urban interface, in California in particular, comes from economic development priorities and shortages of affordable housing in more prosperous urban areas. As housing prices continue to skyrocket in places like the Bay Area, for instance, more people search for housing alternatives in areas further and further from the urban core. Eventually, they arrive in reasonably high numbers in areas like Paradise in Butte County, CA which was entirely consumed by the Camp Fire this month.

Complicating matters along this wildland-urban periphery is the increasing confluence of areas of high wildfire risk with areas of high social vulnerability. For instance, a 2016 study published in the International Journal of Wildland Fire found that, while regions in the southeastern US in the wildland-urban interface zone were not necessarily more socially vulnerable in general than other areas, at least 10% of the total housing stock in these areas was both occupied by the most socially vulnerable households and in the areas of highest wildfire risk. People with the highest levels of social vulnerability are those who are least able to evacuate from fires, are most likely to suffer long-term adverse economic impacts, and to be afflicted with one or more chronic illness which might well be exacerbated either by the fires themselves or by the effects of long-term displacement due to the fires.

Notably, where social vulnerability appears to meet most significantly with wildfire risk is in areas with disproportionate shares of racial and ethnic minority populations. A recent study published in The Conversation found that “communities that are majority Black, Hispanic or Native American are over 50 percent more vulnerable to wildfire compared to other communities. Native Americans, in particular, are six times more likely than other groups to live in the most vulnerable communities.” These communities also displayed the lowest capacities for adaptation to changing wildfire landscapes.

Toward a Fire-Resilient Future

While there is no single solution to improving social resilience in the face of the growing threat of wildfires, a few key themes can be persistently found. For example, a 2016 study in the journal BioScience, “The Science of Firescapes: Achieving Fire-Resilient Communities,” argues that wildfire resilience requires a potent mix of wildland management to control burn zones, public education to integrate risk and hazard modeling into broad social awareness and policy systems, and improving community building design to mitigate fire hazards and expand long-term planning incentives which incorporate resilience thinking. Obviously, reducing the threat from escalating levels of carbon in the atmosphere, along with the myriad secondary effects from climate change would also be helpful.

Changing how we produce electrical energy in these interface areas can also boost resilience in significant ways. Localized power generation through renewable sources like solar and wind not only positively impacts the production of carbon pollutants driving global warming but also minimizes the need to extend higher risk grid-based systems into areas of high wildfire risk.

Beyond these sorts of long-term planning and risk mitigation issues, we can continue to improve access to primary medical services which can cut the specific health risks to populations posed by wildfire activity, including acute asthma. Community health centers, free clinics and other institutions in the medical safety sphere can play an invaluable role in promoting this kind of health resilience, which in turn feeds into the improved likelihood of meeting the health needs of the most vulnerable during wildfire events. Direct Relief continues in this sense to support robust community health both for its own sake and as a way to strengthen the emergency systems that socially vulnerable populations will rely on in a future where wildfires on the scale of the Camp Fire and Woolsey Fire seem to be increasingly likely.

The post Reading the California Wildfires appeared first on Direct Relief.

Click the image above to explore the dashboard. (Map by Andrew Schroeder and Kristin Cothern/Direct Relief)

The current Ebola virus outbreak in the North Kivu area of eastern Democratic Republic of Congo is already the second worst in that country’s history. As of the October 16 update from the Congolese Ministry of Health, 216 cases of Ebola virus have been recorded in the area and 139 people have died from the disease.

Although epidemic control efforts have been underway since early August, case detections have accelerated in recent weeks following a deadly attack by rebel groups in the City of Beni, the epicenter of the outbreak. Thirty-three cases, just over 15 percent of the total, were recorded just in the last full week alone.

As the security situation in the area has deteriorated, contact tracing and vaccination efforts have been halted. The World Health Organization and the U.S. Centers for Disease Control and Prevention have been forced to withdraw health experts who have been leading the response efforts. Meanwhile, evidence is mounting that many of the same problems which spurred the massive West Africa outbreak in 2014 are happening once again in affected areas of DRC, including attacks on health workers, avoidance of epidemic control teams and reluctance or in some cases outright refusal by local communities to follow recommended Ebola prevention practices including safe burial and isolation.

The World Health Organization met today in crisis session in Geneva to determine whether the current outbreak ought to be named a health emergency of international concern. While they declined at this point to declare an international health emergency, citing low probability of the spread of the virus beyond, the region, the expert committee nevertheless cited high levels of concern that Ebola cases could be seen in countries which border DRC, with Uganda at the top of the priority list.

Epidemic preparedness efforts will likely begin in neighboring countries proximate to North Kivu, according to the official statement issued by the committee: “Because there is a very high risk of regional spread, neighbouring countries should accelerate preparedness and surveillance, and request partners to increase their support. For example, they should consider vaccination of health care workers and front-line workers in high-risk districts neighbouring DRC.”

In the context of the recent events, it’s important to remember some of the lessons from past crises, namely that the most crucial element to epidemic control is collaboration with and trust from local communities. Without re-establishing security conditions in North Kivu it will be nearly impossible to track viral contacts, administer vaccinations, and provide care to those infected with the Ebola virus. And security is unlikely to be restored without with the active participation of affected communities.

Direct Relief is supporting medical facilities in the region with ongoing shipments of medical aid, and stands ready to assist with Ebola prevention efforts if needed.

The post Ebola Crisis Accelerates in the Democratic Republic of Congo appeared first on Direct Relief.

Tropical Cyclone Sagar is churning through the Gulf of Aden and is expected to make landfall on the coast of the Horn of Africa and parts of southern Yemen on Saturday, bringing with it high winds and heavy rainfall.

Direct Relief is in the process of moving medical material aid into the region which may be used by storm impacted communities in the coming weeks. Five pallets of hospital and fistula treatment-related medications and supplies are headed for Edna Adan Hospital in Somaliland, which is in the center of the predicted storm path.

A 40-foot container of medical goods is also bound for Borama Fistula Hospital in Borama, Somaliland, and for the maternity hospital in Tog Wajalleh, which is the only functional hospital in that area and may see a significant influx of patients, depending on the flooding impact.

A second container of medical products from Direct Relief arrived in the port of Aden in Yemen a few weeks ago, with another departing from Direct Relief’s warehouse this past Tuesday. These shipments contain mostly cholera prevention and treatment drugs and supplies as well as emergency response backpacks intended for use by partner organization Yemen Aid.

Cyclones in this part of the world are considered rare given the hot dry air which normally flows out over the Arabian peninsula and acts as a natural wall against storm formation. In this case, however, communities from southern Yemen into Djibouti, Somaliland and Somalia are expected to receive deluges equal to nearly a year’s worth of their total rainfall in only a few days, which would trigger high risk of flooding and landslides for some of the most vulnerable communities in Africa.

Current predictions are that six inches of rain could fall on the parched landscape of Somaliland just on Saturday. In many other parts of the world this might be a routine event, but the Horn of Africa is not only home to hundreds of thousands of people living in extreme poverty, it is also an area in extreme drought which limits the ability of the land itself to absorb large amounts of rainfall over a short time period.

In addition to the physical risk from extreme precipitation, there is significant concern that the sudden onset of wet conditions in the countries which border the Gulf of Aden may trigger a return of the epidemic cholera conditions which have prevailed throughout Yemen for nearly the past 18 months.

Yemen has been torn by conflict for the past few years, which contributed to a cholera epidemic that has been described by the World Health Organization as “the worst cholera outbreak in the world” affecting over 1 million people. The rate of new cases has slowed considerably since the onset of the dry season in January, but Cyclone Sagar would bring those more favorable conditions to an end, enabling a resurgence of this deadly disease.

The post Yemen, Somaliland Brace for Cyclone Sagar appeared first on Direct Relief.

On May 3, local health authorities reported a mysterious cluster of 21 unexplained illnesses in the Bikoro Health District, located in the Equateur Province of the Democratic Republic of Congo. Seventeen of those 21 infected people died.

Two days later, a rapid response team was dispatched from Kinshasa to examine these cases, many of which presented with the classic symptoms of the Ebola virus, including fever, severe vomiting and bleeding. By May 7, a number of these cases tested positive for the Ebola virus at laboratory facilities of the Institute National de Recherche Biomedicale. Subsequently, a formal outbreak was declared by the Congolese Ministry of Health.

In the current outbreak, a total of 39 cases have been recorded, 29 of them in Bikoro, with a total of 19 deaths equaling a case fatality rate of 48.7 percent.

The Democratic Republic of Congo is the birthplace of Ebola, with the virus itself being named after the Ebola River that runs through the country. Since the first recorded outbreaks in the 1970s, most have been both vicious and short-lived, with the very remoteness of the landscape and the means of viral transmission (through direct contact with the body fluids of infected patients) providing a kind of natural buffer.

All of that changed back in 2014 with the massive outbreak that spread throughout the West African nations of Liberia, Sierra Leone and Guinea.

The current outbreak is in a relatively remote area, with poor roads that both slow transmission and slow the access of responders as well. However, it is being taken very seriously given the recent history of Ebola outbreaks and proximity of this area to the Congo River, linking local populations to the major cities of Kinshasa, Brazzaville and Bangui.

Direct Relief is closely monitoring this outbreak situation in conjunction with healthcare partners at the UCLA-DRC Health Research and Training Program which is conducting Ebola virus research at the Institute National de Recherche Biomedicale.

Elsewhere in the Democratic Republic of Congo, Direct Relief is also supporting the efforts of Save the Children to respond to the needs of displaced people, and continues to be in dialogue with Congolese health authorities in terms of where best to meet health needs throughout the country.

The post Direct Relief Monitoring Ebola Outbreak in the Democratic Republic of Congo appeared first on Direct Relief.

Since the end of December, the countries of Liberia and Nigeria in West Africa have experienced significant outbreaks of the viral hemorrhagic disease Lassa fever.

Nigeria’s outbreak is the largest in that country in almost 50 years, with 102 people killed in just over four months. Liberia’s outbreak is growing fast as well, with 69 total suspected cases and 19 deaths distributed over six counties through the midsection of the country, and 25 of those cases, or 36 percent, have been detected just in the past month. At a case fatality rate of over 28 percent, concerns are growing that Lassa fever may soon become a significant public health emergency.

The virus that causes Lassa fever spreads primarily through human contact with a species of rodent that lives primarily in West Africa. The disease may also spread, however, through direct contact with body fluids of infected persons. Healthcare workers are at particular risk, with 27 confirmed in Nigeria to have been infected in the current outbreak. Personal protective equipment is extremely important in treatment and infection control efforts.

Direct Relief’s partner ELWA Hospital in Monrovia, Liberia, is seeing suspected Lassa fever patients and has engaged elevated infection control protocols, including expanded use of protective equipment for clinical staff.

Patients infected with Lassa become symptomatic roughly six to 21 days after initial exposure. The first stages of the disease express like many other viral fevers, with elevated temperature as well as body aches, vomiting, diarrhea and cough. If the disease goes untreated, it can enter an acute phase which results often in bleeding from the nose, mouth, vaginal tissues and other areas, with significant risk of death after 14 days.

Although there is no vaccination available for Lassa fever, it may be effectively treated with aggressive hydration, especially early in the disease, and administration of the antiviral drug Ribavirin.

Direct Relief maintains active partnerships throughout the affected area and will continue to monitor the situation to determine possible expanded needs for support.

The post Tracking West Africa’s Lassa Fever Outbreak appeared first on Direct Relief.

Recent studies have shown that while cholera risks exist throughout Africa, that burden is concentrated in a limited number of very specific places, which face vastly disproportionate risks overall. Uneven distribution of the disease is both a significant problem, and an opportunity to focus efforts on cholera control more precisely than in past efforts.

As Justin Lessler and his team from Cholera Dynamics at the Johns Hopkins Bloomberg School of Public Health wrote in an article for The Lancet in March, “prioritising high-risk areas could substantially increase the efficiency of cholera control programmes.”

This year’s outbreaks are especially serious and widespread. The World Health Organization reports that 11 countries distributed across virtually all parts of Africa, from Nigeria to Somalia to Zambia, are right now in the grip of cholera outbreaks of varying size and intensity. Of the 58 total emergency health events currently being monitored in Africa, roughly 20 percent are cholera outbreaks.

Since August 2017, WHO reports 21,465 cases and 419 deaths in the cholera-affected countries.

The worst epidemics in terms of suspected case totals are happening in the Democratic Republic of Congo, Zambia, Mozambique, Kenya and Uganda.

While in every instance problems with water and sanitation lie at the base of the outbreak, DRC’s and Uganda’s outbreaks are also being driven by conflict and displacement. In DRC, all but two of the country’s 26 districts have reported cases, with fatality rates ranging from 1.5 percent to over 5 percent. The worst impacted areas are proximate to parts of the country afflicted by conflict, but in January the disease reached the capital Kinshasa, home to nearly 10 million people, many of whom live in conditions at high risk for cholera transmission.

In Uganda, the epicenter of the outbreak is in Hoima district, which has seen large numbers of refugees from the Democratic Republic of Congo. So far in the northern part of the country, home to hundreds of thousands of refugees from South Sudan, no outbreaks have occurred. Nevertheless, vigilance remains high in these districts to ensure that potential outbreaks are detected and stopped early.

Of all the events currently being monitored by the World Health Organization, the highest cholera case fatality rate is in Malawi, where 3.1 percent of all suspected cases have resulted in death. In Malawi, the area of greatest concern lies in the capital, Lilongwe, where the rate of cases detections and fatalities has been persistently and unusually high for the past 15 weeks.

Direct Relief is targeting efforts in Malawi towards the UNC Project Malawi in Lilongwe, which is focusing primarily on fortifying Kumuzu Central Hospital with needed supplies and medications. A shipment of cholera control supplies arrived in Lilongwe in early March and is in the process of being deployed to frontline health centers. Two cholera treatment tents have been set up at Kumuzu Central Hospital and are daily receiving significant numbers of patients.

Direct Relief’s support in Uganda over the upcoming months will be flowing to the Real Medicines Foundation, both along the Congolese border near the epicenter of the active outbreak, and in the northern refugee camps, including Bidi Bidi, to boost epidemic preparedness in anticipation that new cases might spring up there with the return of the rainy season in April and May.

The post Emergency Response: Mapping Cholera Hot Spots in Africa appeared first on Direct Relief.

In parternship with @DirectRelief, a 20 pallet Cholera medication shipment arrived to Al-Thawra Hospital in #Hodeidah City. #Yemen pic.twitter.com/f4HVpBKQZ2

— Yemen Aid US (@YemenAid_US) December 12, 2017

Hodeidah is a governorate that accounted for more cholera cases in 2017 (135,000) than were reported by the World Health Organization across the entire world during 2016 (132,000.)

The specific reason for this remarkably rapid spike has still not fully been absorbed, but hinges on severe damage to water and sanitation infrastructure, destruction of health facilities and sharp curtailment of the flow of people and goods into and out of war-torn communities.

The cholera epidemic in Yemen, now one of history’s fastest spreading, began a little over a year ago, in October 2016. The country’s civil war was over a year-and-a-half old at that point. A report on Oct. 6 from health officials in the country’s capital city of Sana’a indicated that 11 of 25 acute diarrheal disease cases had just tested positive for the presence of cholera. This was sobering news given the severely damaged conditions of health and sanitation services throughout the country, and the significant challenges posed to the movement of goods and people across the war zones, but it was not evidence enough in itself to forecast what would happen over the next year.

What began as 11 cases in the capital city in the fall of last year spread to over 35,000 cases over dozens of districts by late spring of 2017.

On May 22, the number of cases began a dramatic trend upward.

From then until the beginning of November, cholera has spread like wildfire throughout the country. That serious outbreak of 35,000 cases metastasized into a world historic event, with Yemen’s millionth suspected cholera case expected to be announced sometime before the end of 2017. Almost every populated area of the country has been touched by the disease, most particularly the densely settled coastal areas along the Gulf of Aden.

That shipment from Direct Relief, much like those of dozens of other aid groups, was delayed over the past few weeks by the imposition of a blockade on Yemen’s borders imposed by the government of Saudi Arabia.

Although the blockade on humanitarian goods has been partially lifted, allowing shipments like Direct Relief’s for cholera response to enter the country through two seaports or via UN air transport into the airport in Sana’a, the blockade remains in place for non-humanitarian shipments of goods. This remains a critical problem, given that over 80 percent of all food and medicine consumed in Yemen must be imported. The United Nations and other international agencies are calling for the blockade to be lifted entirely so as to avoid famine among roughly 8 million of Yemen’s 25 million citizens.

Famine is by no means a “natural” or inevitable occurrence. In the case of Yemen, it is the specific consequence of war tactics, which prevent citizens from accessing basic goods and services, placing them, in effect, into a state of siege.

In addition to the cholera outbreak and potential famine, Yemenis are increasingly at risk of additional infectious spread, including measles and a recently detected outbreak of diphtheria. Nearly 200 cases of diphtheria, a serious respiratory illness that can result in paralysis and death, have been reported as of Dec. 1. Diptheria and measles are both vaccine-preventable diseases, which disproportionately affect children. One of the key reasons they are spreading now is that vaccines, like other goods, have been prevented from distribution to health centers and hospitals, which would ordinarily conduct childhood vaccinations. With at least the humanitarian blockade lifted, now is a crucial time to ensure that these other infections do not spread the way cholera has over the past year.

Turning the Tide of Cholera

As terrible as this year has been for Yemenis afflicted by war, disease and poverty, there have been important, but underreported, signs of progress as well. One of the most significant is in the capital Sana’a, where the outbreak began. Sana’a’s case totals were on a steady linear ascent, similar to many of the surrounding governorates, when in late summer of this year an enormous acceleration occurred. Aid was mobilized relatively quickly, including a widespread awareness campaign, and that huge spike was blunted. Cases continue to increase, but at a much slower pace than would have occurred in the absence of timely action. By the end of August, the UN was reporting reductions in cholera incidence, and not only in Sana’a.

Perhaps even more important has been the total flattening out of death totals from cholera in Sana’a. Since this past August, not one death from the disease has been reported in the capital, indicating again that timely medical intervention works. With the year coming to a close and the winter months holding additional challenges, it is vital that we in the international humanitarian community do all that we can to build on the successes that have occurred in Yemen, and make sure that 2018 represents a year of recovery and rebuilding rather than a year of famine and worsening epidemics.

The post Cholera Treatment Supplies Arrive at Yemeni Hospital appeared first on Direct Relief.

This surge of activity arrives alongside an array of equally daunting and growing long-term crises throughout the world that require significant attention, careful thought, and enormous resources. Regardless of the immediate news cycle, the need for humanitarian services globally has in many ways never been greater.

Direct Relief, along with colleague and partner organizations, remains deeply committed and involved in a large number of these ongoing events.

For a sense of the scale and scope of contemporary crises, here’s a brief and very partial survey of some of the key locations across the global humanitarian landscape and Direct Relief’s role in response:

Bangladesh: The Cox’s Bazar district in southeastern Bangladesh has seen an influx of nearly a half-million Rohingya Muslim refugees from neighboring Myanmar. Hundreds of thousands more are on the way and arriving daily.

Cox’s Bazar is home to many different refugee settlements. Discussions are now underway to merge a number of the Rohingya areas into what would become the world’s largest refugee camp. Even so, conditions in the camps are reported as being extremely harsh, with overcrowding, infectious disease transmission, poor nutrition, water and sanitation, and lack of physical security.  Flooding disasters and the coming Indian Ocean monsoon season compound what is already a dire situation that may become the largest humanitarian crisis in Bangladesh’s history.

Direct Relief is supporting Hope Hospital in Cox’s Bazar, near one of the largest refugee areas, with medical material focused on improving maternal and child healthcare, as well as increased mobile healthcare for the Rohingya.

East Africa: Drought and conflict across the East African region, from Somalia and Ethiopia to South Sudan, Uganda and northern Kenya has produced one of the world’s worst refugee crises, as well as massive increases in reported malnutrition and infectious disease. In northern Uganda, a continuing flood of refugees from South Sudan, now well over a million people, has transformed the rural hamlet of Bidi Bidi into a teeming city of the displaced.

Were it not for the size of the Rohingya crisis, Bidi Bidi would be considered unquestionably the largest refugee camp in the world, by a pretty significant margin.

Direct Relief continues to provide essential medical aid to people in northern Uganda and South Sudan through our partner Real Medicines Foundation, which acts on behalf of UNHCR as the lead healthcare implementer for the Bidi Bidi camp.

Madagascar: A fast-moving outbreak of pneumonic plague has killed 63 people and sickened hundreds of others over the past few weeks. Ordinarily, plague is a vector disease spread through rodents and tends to be restricted to remote areas.  In this case, a more serious version is spreading through airborne transmission and is threatening to spread to Madagascar’s cities, evoking urgent comparisons to the Ebola outbreak in West Africa.

The World Health Organization and Medecins Sans Frontieres emergency health teams have been dispatched to the country, and Direct Relief is in consultation with the country’s ministry of health and the United Nations Populations Fund regarding health commodity needs required to treat plague victims, protect health workers and halt the spread of the disease.

Yemen: A seemingly intractable civil war in the Middle East’s most impoverished country, which has taken on significant regional implications given direct military involvement by countries like Saudi Arabia, has resulted in the world’s largest infectious disease crisis. A massive cholera epidemic continues to tear through Yemeni communities.

The outbreak is nearing 1 million cases, including 600,000 children. Logistical blockades have fueled this crisis, but the World Food Programme and the UN Logistics Cluster have been leading efforts to open up aid flows. Direct Relief continues to work with UN partners to move cholera response kits to healthcare providers including Save the Children.

United States: An epidemic of addiction and overdose from opioid painkillers has arguably become this country’s most pressing public health crisis since the emergence of HIV/AIDS in the 1980s and 1990s.  According to the U.S. Centers for Disease Control and Prevention over 90 people are dying every day in the United States from opioid overdose, with rates of opioid overdose having increased over 400 percent annually since 2000.

Direct Relief is continuing to work with Pfizer and with community health centers throughout the country to improve awareness of the problem and increase the supply of the life-saving anti-overdose drug Naloxone.

As the unremitting 2017 hurricane season hopefully draws to a close over the next few weeks, Direct Relief will be helping to bring public attention back to these and many other areas of humanitarian work, which require all of us to remain engaged for the long term in improving the lives and well-being of the world’s most vulnerable people.

The post Beyond Hurricanes, Earthquakes and Fires: The Other Humanitarian Crises appeared first on Direct Relief.

How severely were they affected? Had the flood waters receded? Were structures still intact?

Direct Relief regularly supports the network of non-profit Federally Qualified Health Centers (FQHCs) in Puerto Rico, which often serves the role of first responder for low-income and uninsured people in times of disaster.

Deploying Digital Humanitarians

One of the first, somewhat experimental, steps was to expand Direct Relief’s analytics and mapping capacity by activating the Digital Humanitarian Network (DHN). The DHN is a confederation of professionals working in humanitarian aid, data analytics and information technology, which helps ensure a reasonably efficient process for building response capacity with digital volunteers.

In this case, DHN was acting as the managing connection for humanitarian agencies to Planet, one of the world’s leading remote sensing companies. Planet operates a network of small satellites that capture images of Earth’s land area every single day. It was also one of the first sources of data for determining post-hurricane conditions in Puerto Rico.

Remote sensing is the use of non-localized sensor technology, usually a camera, to collect data and analyze conditions at some point on the planet’s surface.  If you’re unable to be physically present to observe an area, then it may still be possible to use orbital or other technologies to examine it from a great distance.  Planet has built a fluid online interface that allows users to filter and select imagery based on the type of sensors available, the amount of cloud cover in the imagery, the data and time it was taken, and the proportion of an area of interest covered by that single image. By dragging and dropping images into an online comparison tool, we could determine at least general conditions in that place relative to a pre-storm, undamaged baseline image.

The DHN played a crucial role in connecting Direct Relief to GIScorps, a group comprised of Geographic Information Systems (GIS) professionals who volunteer their time, especially during crisis response events, to improve the use of spatial information by humanitarian agencies. GIScorps connected us with a total of 7 remote sensing professionals within roughly 24-36 hours of Direct Relief’s initial request. The volunteers jumped in immediately by following a simple workflow to identify where the clinics were located and which imagery was available. Then they used a simple grading system to assign a probable damage level to the area – in some cases down to the building level.

Strengths and Weaknesses of Remote Sensing

The process of remote sensing damage to Puerto Rico’s FQHC network faced some challenges right away.  The first of these was cloud cover. This is a relatively obvious but important point for post-storm satellite-based remote sensing. Hurricanes are basically giant high-speed swirling clouds, often with long tails of precipitation. That means that looking through them to the ground level requires waiting for the clouds to clear, which in this case took several days.

Compounding that problem of cloud cover is the issue of sensor resolution. The core advantage of Planet’s satellites is that they’re regularly taking pictures of vast areas. Those pictures are very timely and organized in such a way that it makes comparison across space and time relatively fast and easy to do. However, the imagery is best used for analysis of broad spatial trends given the size of the pixels, which are generally 3m – meaning that each pixel on screen represents a 3-meter x 3-meter area on the ground.  That’s probably too coarse for most building damage assessments, but it works quite well for viewing the impact of flood waters or destruction of vegetation from the wind. Planet imagery will be significant in the weeks and months to come given its ability to monitor the situation on a daily basis.

As the days went on, we also had to call upon additional sources of imagery from Digital Globe, which produces high-resolution satellite photos, and the Civil Air Patrol, which flew a series of small planes over Puerto Rico, taking pictures all the while of critical areas of interest. Each of those had an upside and a downside. On the one hand, Digital Globe Sensors were much higher resolution with smaller areas per pixel, allowing for something more like building damage assessments than area impact assessments.

Sometimes, visual analysis isn’t enough. One of the key tools in the remote sensing toolkit is to utilize the full light spectrum to make different features of the landscape show up with greater or lesser intensity in the image. Various types of objects, from plants and water to structures, tend to reflect different parts of the light spectrum in different ways. This lets you see more than what the unaided eye can see. A false-color image like the one below, for a relatively low-damage area around one of the clinics in Puerto Rico, displays vegetation through reflected reds and darker water areas, revealing a better-defined view of key features compared to a typical photograph.

Watching Over the Health Infrastructure of Vulnerable Communities

The end product of the digital volunteers is the creation of an online map, which is being regularly updated with new imagery to show the locations and damage assessments of FQHC areas. Impacted areas are still being graded according to the level of damage to the surrounding area within a roughly 2km radius, in some cases less depending on image resolution. That’s too large to determine operational capacity but helpful to triage, especially areas which have not been reached in person, relative to their physical conditions.

This map is the first effort by Direct Relief to work through the kinks of remote sensing for post-disaster public health planning, so it has seen its’ fair share of ups and downs. But the promise of using satellites to ensure that we can keep watch over the healthcare centers that treat the most vulnerable is undeniably one of the most promising yet still least well-utilized data sources available to humanitarians today. We’ll be sharing the results and looking towards new ways shortly to make sure that imagery is an active part of disaster response analytics.

The post Assessing Storm Impact in Puerto Rico with Remote Sensing and Digital Volunteers appeared first on Direct Relief.

• While storms of 2017 didn’t increase in number compared to years past, they increased in strength.
• Whether 2017 storm season is “new normal” remains uncertain.
• True resiliency for health systems means planning for crisis, not just bouncing back.

On Sept. 13, 2017, the National Hurricane Center began monitoring an atmospheric trough near the northern coast of South America. Three days later, right around the Lesser Antilles, that long low-pressure zone coalesced and built up enough power to be named a tropical storm. Two days after that, unusually warm waters in the Atlantic, approaching 86 F, fed a massive increase in the storm’s power and sent it hurtling northward towards the Leeward islands on the eastern edge of the Caribbean Sea.

This was Hurricane Maria. It made landfall with devastating force on the island of Dominica and then again with a direct hit at Category 4 strength across the island of Puerto Rico. When Maria struck Puerto Rico, it was the strongest storm there in nearly a century, knocking out in one massive blow all electricity and most telecommunications, ripping roofs, doors and windows from buildings, sending torrents of flood water throughout the river systems which flow like veins through the mountainous interior. Core infrastructure on the island will take months to recover.

Maria was the 13th named storm of the current Atlantic hurricane season and the third to make landfall in highly populated areas at Category 4 or above. Governments, citizens, journalists and relief workers of all kinds expressed not only sorrow and support for the victims, but a kind of exhausted bewilderment at the remarkable succession of events, made all the more intense by concurrent earthquakes not too far away in Oaxaca and then again in Mexico City.

Old questions arose with fresh urgency: Was this year different? Have we arrived finally at the outpost of a long-predicted “new normal” in which climate change fuels increasing frequency and ferocity of storms at levels and speeds beyond the design of our infrastructures and our historic capacities to respond?

A Tipping Point?

The answer to these questions is at once straightforward and impossible to determine. On the one hand, the science is clear and unambiguous: there is no doubt that the buildup of greenhouse gasses in the atmosphere is raising air and water temperatures, altering wind and current flows, and steadily increasing the frequency and ferocity of major storms. It’s not only in the Atlantic where this is happening, but throughout the world, where in the same time period marked by the furor of Hurricanes Harvey, Irma, Jose and Maria, large parts of West Africa and South Asia also saw nearly unprecedented and deadly flooding.

The Atlantic season measured in number of hurricanes is high, but hardly without precursors. Yet measured in terms of the total amount of energy mustered by these storms, it marks a first of its kind in the annals of recorded weather data. We’re not sure whether it happened exactly this year, or over the past ten, but we’ve arrived at an anticipated but desolate outpost of our epoch, confronting a turbulent new landscape ahead of us.

The thing about turbulence is that specific consequences can be hard to predict with great certainty. Will the 2018 or 2019 seasons be worse than 2017? Should we now expect three or more storms at Category 4 or above each year? Should we move away from the coasts this very minute? On these points, in the near term, it’s really anyone’s guess. Storm seasons vary in frequency and intensity. They always have and they always will.

Possibly the curvature of the variation on all the metrics that matter is bending steadily upwards. But the fact of variation, much like the fact of carbon emissions’ impact on global temperatures, is not in doubt. Next year could be better or it could be much worse. We don’t, and can’t, really know. It’s wise in that sense not to get too fixated on the immediate prognostication game.

In any event, prognostication of the immediate future, although it seems to be laden with immense urgency, can also easily distract from the more pressing questions of our time. What can practically be done to prepare ourselves for the new patterns of variation which are surely to come? What does a society which is equitably and honestly prepared for the climate changed future even look like? I ask these questions not as someone involved in climate science or the policy of energy systems, but in humanitarian relief and global health. I ask them in terms of operational activity and in terms of the universal values upon which humanitarianism is based.

It certainly seems that the variations are going to get wilder over time, with profound implications for the health of individuals and communities, and for the infrastructures of power, communications, water, food and shelter upon which we all depend. Maybe not next year, or even the year after, but the signs of the landscape are unmistakable – this new world has in some sense arrived already, and we would ignore the signs only at the cost of great ignorance and peril.

The Meaning of Resilience

“Resilience” is buzzword often used to described this sense of needing to prepare for, or brace against, an unruly future. It’s also an odd word choice. To be “resilient” as a personality type is to be someone who takes what life throws at them and makes of it what they will. It emphasizes recovery, being able to “bounce back” to retain whatever it is that the storm had washed away. It places the burden of planning not so much on hardening ourselves to deflect impact, but on bending in the face of mounting adversity, though never quite breaking. Despite these nuances, there’s something missing from “resilience.”

What “resilience” fails to convey is the sense that societies of the future may need to be different than societies of the past. “Bouncing back,” in other words, may not be sufficient.

Among the most obvious examples is post-Maria Puerto Rico. While the island does need to regain the capacity to generate electricity for all of its citizens, replicating the same electrical grid in the same way would be self-defeating. The Puerto Rican power systems should not “bounce back,” nor should it “bounce back better.” What is needed, from the standpoint of power generation, is a new approach that distributes capacities across many different sources and modes of generation, preventing the knock-out blow just witnessed, while at the same time considering how, for what and for whom we are generating power.

The grid pre-Maria functioned poorly and failed to serve the island’s residents equally. Complaints were issued constantly, from many quarters, regarding not only outages, but also the inefficiency and inconvenience of an opaque and convoluted system. The healthcare system faces many of the same problems and choices. Prior to Hurricane Maria, even by official estimates, the system wasn’t working well. Of 78 municipalities on the island, 73 were considered by the federal government to be “medically underserved.”  In Maria’s aftermath, healthcare workers throughout Puerto Rico are struggling to provide what care they can at the highest standards they are capable of. For them and the communities they serve, to just “bounce back” isn’t enough. Doing so would, at the most, return people to precarious place they were before the hurricane.

The turbulence of our climate, whether next month or next year, or years to come, poses enormous challenges of both practical design and imagination. Roads must be cleared, hospitals and clinics must be restocked, communication networks must be repaired, and the lights need to come back on. But that’s not enough to avoid a repeat of this crisis. We also must imagine new forms of infrastructure and systems that can withstand the future and serve everyone equally.

The post Relentless Storm Season Reinforces Need to Rebuild Differently appeared first on Direct Relief.

• Warmer Weather = More Emergency Room Visits: The medium-term weather forecast is not looking favorable to the health of Puerto Ricans. Not only will the power not return for some time, but temperatures are likely to remain near or above record highs for several days longer at least.If the heat continues and the generators fail, there will surely be many people whose health risks start to rise dramatically.
• Power. Water. Food: Power plants were among the first structures laid low by Maria, but electricity is hardly the only concern. Potable water and food supplies are already in short supply. Puerto Ricans already imports about 85 percent of their food, and the farms that produce that remaining 15 percent have been totally destroyed.
• Zika Virus Outbreak: Puerto Rico lagged far behind not only in treatment options but in basic vector control measures as well, which resulted in very high levels of local disease transmission. By the time mosquito populations have a chance to recover from the destruction of their breeding grounds sometime next year, similar effects may be felt.
• Crippling Debt: Prior to Maria’s landfall, Puerto Rico was wedged into fiscal austerity measures. That meant both short term and long term cuts to basic health services.

Rising Temperatures, Lack of Power Increase Health Risks for Puerto Rico’s Most Vulnerable

Several days after Hurricane Maria tore through Puerto Rico, the heat index is reaching 102 F, and the entire island is still without power. Given the extent of damage to an already fragile electrical grid, the best estimates are that power will be out for most of Puerto Rico for the next six months, in some parts longer. Generators strain to run critical machinery, including air conditioning and fans for medically vulnerable, hospitalized or elderly people. Some studies have found a direct correlation between sustained high heat index levels and visits to emergency rooms, with rates of medical emergencies being highest for those who are elderly or otherwise in medical need.

With that in mind, the medium-term weather forecast is not looking favorable to the health of Puerto Ricans. Not only will the power not return for some time, but temperatures are likely to remain near or above record highs for several days longer at least. Clinical and nursing home staff are watching nervously as fuel supplies for generators dwindle. Hope for resupply, especially in the harder to reach areas outside the capital San Juan, is uncertain at best. Inland Puerto Rico is a terrain of steep hills and valleys, with many interior regions being normally hard to reach.

If the heat continues and the generators fail, there will surely be many people whose health risks start to rise dramatically.

Puerto Rico’s power grid was especially exposed to Hurricane Maria because virtually all of their generation capacity was clustered on the southeastern coast, where the storm initially made landfall. Power plants were among the first structures laid low by Maria, virtually all in the exact same moment.

Electricity is hardly the only concern. Potable water is already in short supply throughout much of Puerto Rico, with reliable estimates indicating as much as 60 percent of the population now lacking access to clean drinking water.  Likewise, food supplies are running short in many places and agriculture has been decimated.  Puerto Ricans already imports about 85 percent of their food, but that remaining 15 percent has been totally destroyed. Vegetation on the nearby island of Vieques, for instance, normally a lush growing region, has been stripped down to the topsoil. And communications have been decimated, with virtually all cell phone communications still cut off due to a combination of wind damage to cell towers and power outages.

Much has been made already of Puerto Rico’s crippling public debt burden. It’s easy to overstate those risks, especially given the infusions of disaster aid that are sure to come even from the delayed federal effort, some of which will likely offset local spending shortfalls. But it’s worth pausing for a moment to understand how the debt burden impacts Puerto Rico’s post-hurricane health system.

Prior to Maria’s landfall, Puerto Rico was wedged into fiscal austerity measures, called the PROMESA agreement, which forced severe cutbacks in public services in order to reduce spending and divert funds toward repayment of the island’s creditors. That meant both short term and long term cuts to basic health services, including wage and job cutbacks across the health sector.

During the recent Zika virus outbreak, Puerto Rico lagged far behind not only in treatment options but in basic vector control measures as well, which resulted in very high levels of local disease transmission. By the time mosquito populations have a chance to recover from the destruction of their breeding grounds sometime next year, similar effects may be felt.

The peculiar form of fiscal austerity, which puts Puerto Rico’s health system at risk through public budget cuts has a lot to do with the peculiar status of Puerto Rico as a U.S. territory, and therefore as an administrative and geographic unit somewhere in-between a sovereign country and a state among others in the United States. Although Puerto Ricans are American citizens and entitled to federal disaster relief funds just as any other state, they lack representation in Congress. Likewise, Puerto Rico cannot simply default on its debt like a sovereign country might in its circumstances. Instead, the territory is caught between options and is required to follow most, if not all, of the instructions of their creditors, which in this case are mostly large hedge funds.

The long-term rebuilding of Puerto Rico as a disaster resilient society will require many different efforts simultaneously. It will require rethinking the power grid so that generation capacity is more distributed and no longer clustered in such a way that all of it can be knocked out by a single storm. Water, food and communications systems will require patient investment during challenging economic circumstances to regrow their profitability and sustainability.  And healthcare systems will require additional staff, supplies, and structural rehabilitation.  All of these will require support from individuals, organizations, and corporations, both within and without Puerto Rico, to ensure short-term alleviation of suffering at the apex of crisis.  They will also require an alternate pathway out of austerity so that public systems can come back online stronger than they were before. It’s a combination of social, philanthropic and political will that all of us, not only Puerto Ricans, may need to get behind to genuinely recover from the devastation of Hurricane Maria.

The post The Real Risks in Puerto Rico Have Only Just Begun appeared first on Direct Relief.

As of 5 p.m. Eastern time, river gauges near the town of Comerio, located in the middle of the island towards the eastern side, were registering flood waters over 78 feet, compared to the previous record at that location of 29 feet and official flood declaration happening at 11 feet.  Similar effects could be seen throughout much of the rest of the island as well.  Rio Grande near the city of Arecibo topped its flood record by more than 3 feet.  Rio Grande de Manati near the town of Ciales, towards the western side, hit 42.9 feet of water as compared to the previous record of 25 feet and a flood level of 10 feet.

Damage reports are still coming in.  With power out across Puerto Rico, it may be challenging to determine the full impact of Hurricane Maria for days. Direct Relief maintains partnerships with health facilities throughout the island and is actively trying to determine the status of their facilities, staff and patients.

Estimates from the Puerto Rican power authority are now indicating that restoration of electricity to many residents could take as many as four months. With the territory $70 billion in debt and public services including health care already suffering from budget cutting austerity measures, the impact of extended power outages on the population could easily rival or exceed the effects of the storm waters.

Hospitals and health clinics with back-up power generators are able to weather limited outages, but the plans for extended time in the dark are uncertain at best. That could severely impact health services ranging from oxygen concentration to dialysis to basic lighting and service delivery.  With 73 of Puerto Rico’s 79 municipalities already classified by the federal government as “medically underserved areas” the broad based recovery of the island’s health system promises to be an enormous undertaking.

The post Puerto Rico’s Gone Dark. Here’s What We Know. appeared first on Direct Relief.

Hurricane Irma, the Category 4 hurricane moving at high speeds towards Florida, won’t affect all communities in the same way.

The impact of flooding may be felt much more intensely in areas with large numbers of elderly or disabled people, who may have mobility impairments or special medical issues. Areas with higher rates of poverty often experience significant challenges with access to basic necessities under normal circumstances, which may be exacerbated in times of emergency.

For example, the northwestern side of Miami-Dade County, from Hialeah to Miami Gardens, as well as the south side of Tampa, are high on the vulnerability scale. Immokalee, which is inland in southern Florida, is also has high vulnerability.

Communities with large numbers of recent immigrants or persons for whom English is not their first language may be less well integrated into existing resilience structures, or in some cases experience social isolation and discrimination. Many other factors, such as housing and transportation, also exist. When looked at collectively, they indicate a community’s “social vulnerability” to disasters.

As Direct Relief and partner clinics in Florida prepare to respond to the imminent landfall of Hurricane Irma, predicted to strike at Category 4 force and produce a dangerous combination of high winds, heavy rains and coastal storm surge when it makes landfall Sunday, we are paying particular attention to places which may be socially vulnerable for one reason or another. Using this mapping application, Direct Relief can identify areas of social vulnerability proximate to the storm path and to community clinics, as well as variations in the reasons for their vulnerabilities.

The data which drives Direct Relief’s social vulnerability application is based on the U.S. Centers for Disease Control and Prevention’s Social Vulnerability Index model, updated as of the end of 2014. The model uses census data at the census block level to understand relationships between different ways that disaster-affected communities may experience significant challenges in response and recovery in order to tailor resources, communications and planning to their needs.

The post Who’s Most Vulnerable to Hurricane Irma? Those Vulnerable the Day Before appeared first on Direct Relief.

Hurricane Harvey, the Category 4 hurricane moving at high speeds towards the Texas Coast, won’t affect all communities in the same way.

The impact of flooding may be felt much more intensely in areas with large numbers of elderly or disabled people, who may have mobility impairments or special medical issues. Areas with higher rates of poverty often experience significant challenges with access to basic necessities under normal circumstances, which may be exacerbated in times of emergency.

For example, the City of Corpus Christi, which lies in the immediate path of Hurricane Harvey, is home to five clinics that Direct Relief supports. One clinic, the Amistad Community Health Center, lies on the upper edge of the city towards the water and serves an area with significant vulnerabilities related to language, minority communities, and lower socioeconomic status. They have some concerns over elderly and disabled populations but in general, don’t find themselves at the top end of that spectrum.

Two partners more towards the southern end of the city are in an area of much higher socioeconomic status, but still experience key challenges related to their elderly and disabled population, and may, therefore, have subtly different disaster response and health needs.  Over time their recovery challenges may also be strikingly different.

Communities with large numbers of recent immigrants or persons for whom English is not their first language may be less well integrated into existing resilience structures, or in some cases experience social isolation and discrimination. Many other factors, such as housing and transportation, also exist. When looked at collectively, they indicate a community’s “social vulnerability” to disasters.

One other way in which socially vulnerable communities in Corpus Christi faced additional risks from Hurricane Harvey lies in their potentially elevated exposure to industrial pollutants which may be released by unusually high flood waters. The Texas Coast is pockmarked with Superfund sites, a large number of which are located near communities with large numbers of poor and minority residents. One such site containing barium, cadmium, mercury and other toxic substances, for instance, lies just to the north of downtown Corpus Christi in an area where the population is over 70 percent minority residents.

As Direct Relief and partner clinics in Texas prepare to respond to the imminent landfall of Hurricane Harvey, predicted to strike at Category 3 force and produce a dangerous combination of high winds, heavy rains and coastal storm surge, we are paying particular attention to places which may be socially vulnerable for one reason or another. Using this mapping application, Direct Relief can identify areas of social vulnerability proximate to the storm path and to community clinics, as well as variations in the reasons for their vulnerabilities.

The data which drives Direct Relief’s social vulnerability application is based on the U.S. Centers for Disease Control and Prevention’s Social Vulnerability Index model, updated as of the end of 2014. The model uses census data at the census block level to understand relationships between different ways that disaster-affected communities may experience significant challenges in response and recovery in order to tailor resources, communications and planning to their needs.

The post Hurricane Harvey: Who’s Most at Risk? appeared first on Direct Relief.

Cholera is spreading so fast that the World Health Organization was forced in July to cancel a planned million-dose cholera vaccination campaign. The WHO judged that the epidemic was spreading too fast for a vaccination campaign to make enough of an immediate impact to justify the security risks amid ongoing conflict.

As a result, the WHO and other global health authorities are urging a rapid and distributed scale-up of conventional infection control methods, including water purification and aggressive rehydration.

While the ongoing armed conflict in Yemen compounds the difficulty of controlling the epidemic, it is still possible to get assistance to areas in need. Several national and international NGOs like Save the Children are providing essential aid in the most affected areas, and Direct Relief is continuing to supply critical medical resources needed to treat cholera.

In February of this year, the UN Secretary General announced that over 20 million people in four countries from West Africa to the Middle East were on the cusp of famine. The four countries of Nigeria, South Sudan, Somalia and Yemen all share a tragic confluence of conflict, drought and disease, which accelerates underlying issues of poverty, inequality and weak infrastructure at sufficient scale to create conditions for what the UN and many others soon named “the worst humanitarian crisis since WWII.”

Since February, conditions for these four countries have not markedly improved, nor have humanitarian funding targets come close to being met. For Yemen, the poorest country in the Middle East, famine only accelerates the country’s descent into crisis. At the end of May, the cholera epidemic in Yemen was already quite serious but still within manageable bounds, with over 35,000 suspected cases and 361 total deaths. Since that point, the cholera epidemic has reached runaway proportions as the world’s fastest moving and deadliest infectious disease outbreak.

The country has averaged over 5,600 new cases and almost 20 deaths every single day. As of Aug. 13, there were 503,484 suspected cases and 1,975 confirmed deaths, with no end in sight. Yemen’s total population is a little more than double that of Guinea’s, but the rate of disease transmission remains highly alarming. Compared to Ebola, controlling cholera should be straightforward. There wasn’t a vaccine at all for Ebola, for instance, during the 2013 outbreak. Ebola treatment also calls for stringent quarantine procedures and measures to protect health workers that go well beyond the requirements of cholera.

Given that cholera is a bacterial infection associated with contaminated drinking water and poor sanitation, basic handwashing, access to clean water and timely medical treatment can halt the formation and spread of the disease. More than 99 percent of people sick with suspected cholera and who are able access health services are now surviving, according to a July 26 statement from UNICEF, WHO and the World Food Programme.

As simple as these steps may be, they still require security for health workers and sufficient medical resources, both of which are in short supply in Yemen. Direct Relief continues to supply partners in Yemen with cholera treatment kits that enable care for hundreds of patients. The kits were designed using WHO guidelines for cholera treatment and prevention. The next Direct Relief shipment is scheduled to arrive in the coming weeks, and is being coordinated with the World Food Programme.

The risks can’t be overstated. At the same time, the cost of inaction is steep. If the global health community is not able to act soon, Yemen could find its place among history’s worst infectious outbreaks.

The post Cholera in Yemen on Track to Kill More People Than Ebola Did in Guinea appeared first on Direct Relief.

As of February 2017, the United Nations formally declared famine in parts of Southern Sudan. The global Famine Early Warning System (Fews.net) forecasts food security crisis conditions over roughly 80 percent of the country throughout the period from February to May this year. In the Northern Bahr and Unity states, food security crisis verges on catastrophe. Many households in these areas are unable to cope with basic needs on a daily basis absent rapid and large-scale humanitarian assistance.

The South Sudanese famine is an extreme crisis in its own right, producing severe malnutrition throughout areas long considered safe from conflict, along with deep physical and emotional stresses for children and pregnant women in particular.

But famine doesn’t occur in a vacuum; it is produced by complex social forces and abetted by the state failure.

In the context of the ongoing South Sudanese war, the famine is both the product and the accelerant of larger systemic failures cascading throughout the country’s social life. In terms of infectious disease alone, South Sudan has within the past year been hit by significant outbreaks of cholera, malaria, leishmaniasis and hemorrhagic fever, among other conditions.

Each one of these disease outbreaks has required targeted and coordinated international public health emergency response based on the degrees to which national and local health care systems have been overwhelmed.

In this stark context, Direct Relief is stepping up efforts to bolster the South Sudanese medical system in some of the most at-risk areas by supporting the professional medical outreach teams of Dr. Joseph Dumba and the Healing Kadi Foundation. Dr. Dumba came to the United States as a refugee in the late 1990s and put himself through medical school. He formed the Healing Kadi Foundation in 2013 as a way to give back to his home country some of what he gained through his life as a refugee in the United States.

Based in the southern district of Kajo Kadi on the Ugandan border, an area of critical food insecurity and persistent low-level violence, Healing Kadi sends teams of medical professionals to remote areas to provide high-quality frontline health care for the most vulnerable. Often these mobile medical workers are the only linkage between remote communities and formal health care provision of any kind.

Since 2013, Direct Relief has provided roughly $3 million of life-saving medicines to communities in Kajo Kadi. The current shipment to Healing Kadi, which will be received in country by Mar. 15, is valued at over $600,000 and includes critical medical materials for wound care, blood pressure control, anti-infective agents and birth control. Corporate partners like GlaxoSmithKline, Ethicon, Inc., and Teva have all made critical donations to support ongoing healthcare in South Sudan.

Together with Dr. Dumba’s mobile medical outreach efforts, the materials in this shipment will go towards strengthening the operations of the foundation’s clinic, helping to build a functional referral network in one of the world’s toughest conflict zones.

The post Direct Relief Aims to Alleviate Medical Pressures from War, Famine in South Sudan appeared first on Direct Relief.

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Over the next six months over 3600 Angolans in all 18 of the country’s provinces would be sickened with this virus. More than 360 of those affected would die, making the outbreak the worst in over four decades for Angola. By May it would start spreading at an alarming rate through both urban and rural areas of neighboring Democratic Republic of Congo (DRC), straining global vaccine supplies and sparking international concerns of a runaway epidemic.

Yellow fever is a virus transmitted through Aedes and Haemogogus mosquitoes. Although most people recover on their own after an initial symptomatic phase of just a few days, a significant number, if untreated, experience a secondary phase of extreme viral toxicity which results in death for roughly 50% of those affected. During this secondary phase patients can become severely jaundiced in the eyes and skin, conferring the distinctive “yellowing” effect and making yellow fever one of the most feared tropical diseases on the planet.

Despite its deadly reputation, yellow fever can be controlled relatively cheaply and effectively with a combination of vector control efforts and vaccination. One dose of yellow fever vaccine confers lifelong immunity. If between 80% and 90% of the population in at-risk areas can be vaccinated the virus ceases to be a significant threat even for the unvaccinated.

During the current outbreak in Angola and DRC vaccination campaigns have had to scale up so quickly, across such large populations and geographies that global vaccine production has struggled to keep up. The World Health Organization (WHO) in July released 19 million doses of yellow fever vaccine to Angola alone from emergency stockpiles. Given that global production is restricted to only four labs and 80 million doses annually, the world’s defenses against yellow fever are stretched thin.

If the disease continues to spread through DRC and other neighboring nations, there may be limited capacity remaining to stop the virus. Furthermore, reports out of DRC indicate complementary shortages of needles and syringes needed to deliver the vaccine, which complicates efforts to scale their vaccination campaigns sufficiently.

As the world’s climate heats up, populations increase and rising numbers of people live in dense urban areas of significant tropical disease risk, it will become more important than ever before to develop effective defenses against emergent epidemics. Much like Zika virus in the Americas, yellow fever in southern and central Africa is posing fundamental questions of our capacity as a global civilization to identify and contain dangerous infectious diseases.

The post Crisis Alert: Yellow Fever in Angola and DRC appeared first on Direct Relief.

Bangkok, Thailand

“Thank god,” says the well-dressed man in the back of the Swissotel Bangkok ballroom, “that the year of frameworks is almost behind us. Now the real work begins — to figure out what in these new frameworks will actually be of use.” It hadn’t struck me until right about this moment, but the man’s right – the world is awash in new frameworks for aid and development. Yet so far I haven’t heard anyone actually connect them all together. Collectively, from the Sendai Framework to the COP21 climate negotiations, they make up what’s being called the “post-2015 development agenda.”

Observed from the global landscape view this agenda seems enormous, unruly, at times a little over-technical and unnecessarily boring, undoubtedly ambitious and altogether tough to get one’s head around entirely. It seems like something genuinely significant is happening. Climate change is being framed by the UN as the signature global emergency, within which all other frameworks must be measured. Coherence between anti-poverty, global health, disaster response and ecological investments is being encouraged in new ways within the horizon of climate change. The policy field within which humanitarian innovation and practice takes shape, like the ebb and flow of CO2 in the atmosphere, is shifting all around us.

I’ve been brought out to Bangkok this week by the United Nations Development Program (UNDP) to talk about the implications of new robotics technologies for aid and development. But all I can think about now is this labyrinthine global pathway through the frameworks.

Sendai, Japan — The Sendai Framework on Disaster Risk Reduction

To get the full picture, you have to rewind roughly to March in Sendai, Japan. At that time, the UN member states met at the World Conference on Disaster Risk Reduction, culminating a series of inter-ministerial meetings. They came to an agreement, formally endorsed by the UN General Assembly, on what’s called the Sendai Framework for Disaster Risk Reduction.

The Sendai Framework lays out a 15-year set of targets and priorities intended to make the world less vulnerable to losses of life and property as the result of natural disasters. It reaffirms, as one might expect from a UN agreement, that that nation-states have sovereign priority and primary responsibility for reducing exposure to natural hazards. But it also says quite clearly, and in contrast to previous similar agreements, that the actual process of building resiliency in the face of disasters goes beyond the nation-state to include the full range of NGOs, private sector companies, and local communities, each of whom have specific and defined roles to play before, during and after disaster events.

The Sendai Framework recognizes that for a number of reasons disaster risk appears to be growing — in some areas to an alarming extent, that preventive investments must be made to reduce these new risks, that those investments must be made on the basis of improved, publicly shared data and scientific modeling, and that shared public, private and non-profit responsibility for those investments must exist in order to reduce risk exposure in meaningful ways for the most vulnerable.

Addis Ababa, Ethiopia — The Addis Ababa Action Agenda

Fast forward to mid-July in Addis Ababa, Ethiopia. With an elaborate new set of Sustainable Development Goals (SDGs) set to take the place of the previous Millennium Development Goals (MDGs) after 2015, the key topic becomes, how in the world are we going to pay for all of this? In UN-speak, this question is called, “Financing for Development.” The outcome of the July meetings is called the Addis Ababa Action Agenda (AAAA).

While it contains the usual litany of promises and proposals around increasing bilateral and multilateral aid, the big takeaway from Addis Ababa is that the lion’s share of financing for the SDGs will need to come from the taxation powers of nation-states. That means that not only with economic growth need to be maintained or improved, but that growth must occur within a context where nation-states are effectively and equitably able to use public revenues from taxation of that growth. This seems almost like a no-brainer except for the simple fact that the past three decades of neoliberal growth models have often seen tangible erosion of state capacity to generate and to use public revenues. According to the AAAA, that trend will need to be reversed, alongside a renewed commitment to foreign assistance and improved harmonization between aid, development and climate funds.

New York, USA — The Sustainable Development Goals

With an admittedly imperfect but functional agreement on the financing framework for the SDGs established in Addis Ababa, the next stop in the global frameworks tour was New York City in September. During this past September’s General Assembly week, when the UN body reconvened for work, the new SDG framework was officially unveiled.

The SDGs are in many ways a recognition by the UN, member states, and other negotiators that the business of global crisis management (from the intertwined problems of poverty, inequality and gender imbalance to global health, conflict, natural disasters and climate change) has become just fiendishly complex. When you take a look at the mammoth new SDG framework, with its 17 target areas and 169 sub-targets (which translate potentially to over 1000 evaluative metrics), it’s actually hard to disagree with any particular one of the targets. I mean, seriously, how could one claim to have a reasonable agenda for sustainable development and omit climate protection, or jobs, or gender, or water, or food, or …? So I see how we got to this point. At the very same time, it’s quite difficult to see how the SDGs will ever be achieved in practice. Not only are there almost certainly more goals than any given nation-state will be able to focus on, lacking any obvious prioritization scheme, but the actual goals tend to be framed so vaguely that it’s often unclear what actual progress towards the goals would look like.

Geneva, Switzerland — The World Humanitarian Summit

Regardless of the pragmatics, at the conceptual level it’s important and interesting to note that the SDGs echo the overall trend from Sendai and Addis Ababa of linking traditional development goals like poverty alleviation with humanitarian crisis response and climate change into a kind of three-legged geo-political stool.

The World Humanitarian Summit (WHS), which undertook its final global consultative process this past October in Geneva, Switzerland, aims to reconceive how humanitarian response to crisis events might occur within the context of that three-legged stool. Although recent remarks from Stephen O’Brien, the newly appointed Under-Secretary-General of UN-OCHA, raised alarm bells that the humanitarian system may be oddly complacent in the face of enormous global changes, there are reasons to be encouraged within the WHS agenda. specifically around calls for predictable humanitarian financing tied to risk reduction efforts, and increasing localization of disaster response.

Paris, France — The COP21 Climate Change Conference

The grand year of post-2015 frameworks, from Sendai to Addis Ababa to New York and Geneva, is culminating right now in Paris, France with the COP21 climate change negotiations. The outcomes of this meeting are still in doubt, at least in terms of concrete targets for reduction of greenhouse gasses, but the significance of climate change to the entire emerging global architecture is not.

Climate change, at the level of the global humanitarian system, is being positioned as the horizon within which all other considerations will be measured. It touches and informs literally everything. Reduction of greenhouse gasses are not simply an ecological priority but also a priority for health and development, and the master framework within which disaster risk reduction investments will take place. In many ways this is the most remarkable thread which runs throughout the labyrinth of frameworks — follow that thread and you might just find your way out.

Meanwhile, back in Bangkok … Rise of the Humanitarian Robots?

My own role at the workshop was not to do any of this contemplation about the emerging multitude of post-2015 frameworks but instead to talk to the assembled DRR practitioners about the increasing importance of robotics to the field of humanitarian innovation. It’s maybe not an obvious connection. Robotics tends to have an association with job-killing automation or person-killing military drones. However (as I’ve previously detailed here, here, here and here) the last couple of years has seen a significant rise in the use of unmanned aerial vehicles for key tasks by humanitarian agencies. Data collection via remote sensing has a long history in disaster relief, but drones are making that practice increasingly customized, regularized and localized. Humanitarian logistics likewise already includes elements of automation at the warehousing level, particularly for gargantuan entities like the World Food Program. But now, automation looks to become increasingly prevalent in areas formerly thought off-limits, such as physical goods movement in the field.

I’m up here with my colleague Michael Perry from DJI who’s discussing a project DJI supported along with the UAViators Humanitarian UAV Network in Nepal. That project focused on the training of young Nepali engineers and cartographers on the use of drones for structural modeling which contributes to post-earthquake reconstruction. The assembled crowd seems universally impressed and eager to figure out how to do more.

In our breakout “ideation” session, we run a series of UNDP country representatives through thought exercises to help them understand how their own programs could better deploy emerging robotics technologies. The ideas arrive fast and furious, starting with high-resolution risk modeling and extending all the way through pretty exciting but somewhat far-off ideas about distributed sensor integration paired with drones to transform the physical world into a kind of searchable database.
The future of humanitarian robotics, much like the most alarming climate thresholds and the post-2015 development frameworks is arriving faster than we may think. My conclusion at the end of three exhausting days in Bangkok is that I have quite a bit more homework to do.

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I’ve been invited to this citadel of globalism by the organizers of the 2015 Nethope Summit, an annual gathering of technology corporations and NGOs to discuss the roles of information technology, network connectivity, data and analytics in the work of global non-profits for relief, development, health and conservation. Direct Relief has been a member of Nethope since 2012. I founded the Nethope working group on humanitarian UAVs (“drones”) back in mid-2014.

A Gathering of the Humanitarian Informatics Tribes

Down on the bottom floor of UN City when I arrive on Monday the first session is already underway. Gisli Olafsson, Nethope’s peripatetic emergency response director, is recounting an astonishing year of technologically informed crisis response.

Let’s think back to January 2015, shall we? The world, West Africa most centrally, appeared poised on the precipice of almost unimaginable horror. The ebola virus was spreading ferociously through a landscape of remote villages, sprawling African metropoles and distant hospitals in the US and EU which received a small but steady influx of deadly contagions. Nethope’s role was primarily to work with member NGOs, the Emergency Telecommunications Cluster (ETC) and the various host country governments to scale up emergency network bandwidth access. (Direct Relief at the time was able to secure satellite access for more than one of our partner locations this way.) Then a couple months later, well before the ebola crisis was resolved, the category 5 Cyclone Pam laid waste to the island nation of Vanuatu. Shortly thereafter, a massive earthquake struck Nepal. And throughout it all the war in Syria generated casualties and refugees at rates not seen since the end of WWII.

All of this upheaval occurred for global humanitarian organizations and their supporters in the midst of yet another year of massive and incessant technological change, from cloud computing to mobile spatial informatics to the ongoing emergence of consumer robotics, which even under “normal” conditions ought to prompt serious rethinking of how we leverage networks, information technology and data analysis to relieve suffering, improve conditions for the global poor, and promote humanitarian values.

Despite the enormous challenges major progress has been made in the last year on all of these issues — perhaps with the exception of Syria. Without gatherings like this one to help make sense out of the chaos the world might actually seem a bit overwhelming.

The Impasse of Crisis Informatics

Over lunch I join a discussion with Jennifer Chan, Nethope’s remarkable director of crisis informatics. Our topical thread picks up pretty much right where Gisli left off. How do we as members of the global humanitarian community effectively share information, resources and perspectives in order to improve the collective outcomes of our work? What prevents us from acting more in unison? Can new technological or analytic solutions help to advance the social potential of collaborative, cross-sectoral mobilization during and after emergencies?

Frankly, despite Jen’s best efforts, and her team’s exceptional recent deployments of Tableau and ArcGIS Online, the conversation is at least as frustrating as it is informative. I feel a creeping sense of deja vu. Precisely this impasse seems to be a kind of strange attractor, pulling us in the NGO world back again and again to the same sort of imaginative cul de sac, where information is produced in the form of organizational “reports” which always arrive too late, with the wrong information, absent relevant context, in a form that makes them difficult for others to derive value.

So I raise my hand and pose a simple question.

“During the ebola response we at Direct Relief had a difficult time getting access to information about the operational status of clinics, hospitals and ebola treatment units. We, like I think many others here, knew where they were, but we didn’t know much else, for quite a while, about what they were doing or whether they were providing services. None of the reports we read, from any organization, contained this information. That made it very hard to gauge our medical logistical response. But c’mon, how many NGO staff were based in Guinea, Sierra Leone and Liberia at that time? Thousands? And we’re all smart people right? What if, instead of writing reports on our own specific projects for our specific organizations we also reported whether the health facilities we drove past that morning appeared open? Maybe we could snap a picture showing medical staff present and post it online? You know, like crowdsourcing, only with aid workers. What if we didn’t care whether our organization was the one to help out any particular facility? In other words, what if WE became the ‘crowd’ which could generate the sort of information spontaneously that none of our organizations seemed to produce, or to share if they did produce it? What more could we have done to stop ebola as a result?”

I’m met by uncomfortable silence at first, and then some strong words of encouragement from Gisli and Jen about the need to disrupt humanitarianism and to try new ways to address old problems. I also get pushback from someone who rises to the defence of the current UN cluster system as a “viable” means of coordination. Afterwards I have a polite conversation with a man sitting next to me about how although he supports my position personally it will take a new generation of “young people” like myself to produce the kind of change that the current generation hasn’t produced. I don’t have the heart to tell the nice gentleman that I’m actually 44 years old and have multiple advanced degrees.

Refugees, Sustainable Development Goals (SDGs) and Humanitarian Robotics

On Tuesday morning I’m genuinely moved by the keynote address of Jan Egelund, the Secretary General of the Norwegian Refugee Council. Some time ago, he says, he was living in Colombia. He made a number of friends in a fairly remote village. Then he left Colombia and went on with his life. For a long time he lost touch with those people because he had little way short of in-person travel to communicate with them. He learned to his shock and dismay years later that many of the friends he had made were massacred in a brutal battle at the hands of the FARC rebels. Their story wasn’t told. In part due to lack of connectivity their lives were lost in the mists of history. It is stories like this, he says, which the world needs to recall now in the midst of the Syrian vortex. Communications cannot by themselves stop the misery, but without better communicative capacity we find ourselves lost in a disorienting field of absences, gaps, rumors, half-truths and a paralysis of incomplete information. Bearing witness is one way to stop massacres. And today that requires bandwidth. It’s one of the most deeply felt pleas I’ve heard for the power of humanitarian networking.

Somewhat less powerful is the case being made for the UN’s new Sustainable Development Goals (SDGs). Nethope has just produced a new report on the implications of information and communications technologies for achieving the SDGs. They’re joined on stage by a group of folks who review various aspects of the goals. Perhaps most notable, there are a heck of a lot of SDGs — 17 total, with 169 sub-goals. Of course, I agree with a great many of these goals, from reducing global inequality to universalizing access to health care. But having so many goals up there feels disorienting to most of the people at the Summit who I talk to. The one interesting, if not exactly convincing, case made on their behalf comes from the Oxfam representative who describes the SDGs not as a single exhaustive list but rather as building blocks for multiple theories of social change, like Lego bricks for global development. Depending on who’s using them for which purpose one can selectively emphasize different aspects and relationships to make a case for the kinds of change which needs to happen. I like Legos for sure, but it does still seem like more prioritization could have gone into the formation of the SDGs.

By the end of Thursday we arrive at my own 45-minute session on unmanned aerial vehicles (UAVs) for humanitarian response. I prefer to describe the field as “humanitarian robotics” these days, in part to prepare for the explosion of new robotics technologies now brewing in research labs and corporations across the globe. UAVs or “drones” are the first of these robotics technologies to have a tangible impact on humanitarian response, global development and conservation. I detail the work which went into a recently completed project in Nepal with the UAViators humanitarian UAV network, DJI, the world’s leading producer of small commercial drones, and Pix4D, one of the leaders in photogrammetry software. Over the course of 5 days in September they trained local Nepalis on drone mapping and then actually went out and mapped the highly impacted town of Panga just outside Kathmandu in 3-dimensions. The imagery will contribute to detailed rebuilding and reconstruction efforts, helping the local people prioritize how to respond to the effects of the earthquake on their built environment. Framing this effort in terms of emergent forms of collaboration I tie the Nepal work back to the UAV training event which directly preceded this year’s Summit.

With the workday hours counting down on an overcast Friday afternoon I bid goodbye to the fair city of Copenhagen and board yet another airplane, this time for Helsinki, Finland and UNICEF’s Innovations for Children Summit

To the Postmodern Finland Station: UNICEF’s Innovations for Children Summit

Helsinki is not Copenhagen, that’s for sure. On Monday morning it’s darker outside than it has any right to be given the time of day. I’m not sure I’m entirely awake as I fill my second cup of coffee in the lobby of the building where UNICEF’s first global summit on innovations for children is being held. In slow motion I manage to mingle with the crowd. At one point my friend Chris Fabian, the director of UNICEF Innovation Labs pulls me over and says he has to introduce me to someone. Standing there at one of the round standing tables is a European gentleman with a half smile who responds to my question about who he is and what he does by saying, “Most recently? I helped land a spaceship on a comet.” “Oh really … that’s it huh? Spaceship on a comet?” It’s going to be that kind of morning.

What does space travel have to do with UNICEF, with children, with poverty or with conflict? As it turns out, my coffee companion from the morning is also the first of the main plenary speakers, a member of the multinational team which recently concluded a 10-year long project to land the Rosetta spacecraft on the enigmatically named 67P/Churyumov–Gerasimenko comet

Full confession — I’m nerd starstruck.

While the assembled crowd, myself included, seems to know precious little about astrophysics and space travel the topic of his talk on the challenge of long-term planning strikes a nerve. We in the humanitarian and development communities seem to have real difficulties responding to crises which are just around the corner, let alone planning and executing consistent 10-year projects with high budgets and reasonably significant failure risk. From that point of view, maybe space travel actually was an excellent launching point for the next couple of days.

Realities Both Virtual and Physical — Proximate and Remote

Next to the entrance of one of the mini plenary sessions I’m scheduled to attend on “The Future of Emergencies” a group is sitting in quiet, meditative contemplation. Large plastic devices are strapped to their faces. I almost burst out laughing as the participants reach to touch invisible scenes before them like ghostly apparitions. But I resist spoiling the mood. I get the rundown from the curator of this exhibit, Barry Pousman, a film director who’s been creating virtual reality films recently for UN agencies. The one this group is watching was filmed in Syria. The idea is to immerse viewers in the remote “reality” of the lives of Syrians fleeing the conflict in order to promote feelings of empathy and hopefully spark personal investment in helping to assist those in need, if not necessarily to end the conflict itself, which of course requires a political solution. While I’m a bit skeptical of the premise, I decide to take a quick look for myself.

I settle into one of the comfortable modernist chairs, strap the device to my head and place the earbuds in my ears. At once I’m transported to the room of an adolescent Syrian girl, and then to a small restaurant where bread is cooking in a refugee camp. It’s difficult to focus on the narrative because I’m constantly being distracted by small visual details, like the plastic fan which sits on the girl’s shelf, or the gaze of the children back at what feels now like my body floating in space. Then again, in the back of my mind I think, maybe that’s what empathy is built from — small details that you’d miss in a different story medium. I’m not sure how long I’ve been sitting here when all at once I’m wrenched back into Helsinki as someone bangs into my legs. It’s a very odd sensation — in the few minutes I was sitting there I lost track of where exactly I was located in physical space. The effect is far more immersive than I was expecting, and the possibilities for this type of narrative seem far more intriguing than I gave credit for initially. For just a few minutes the remote reality of the Syrian crisis really did seem almost proximately juxtaposed with the dark chill of the Finnish morning.

Unstrapping the device from my head I wander back to the more conventional conference reality. In the room to my right is a discussion of the types and scales of emergencies which now seem to be afflicting communities in crisis around the planet, along with the types and scales of responses which might change how the international community approaches their resolution. My friend Abi Weaver from the American Red Cross makes an impassioned plea that all of us in this room, right here and now, immediately quit our jobs. The crowd audibly gasps. Well, not exactly quit our jobs, but make a commitment to reaffirm that our true accountability ought to lie with communities in crisis, and that the possibilities and necessities of global emergency response would look quite different to us if we did so. Next to her, a top UNHCR representative from Lebanon describes the almost impossible scale of the refugee problem, in which the total number of Syrian children who need to be enrolled in school in Lebanon this year exceeds the number of Lebanese children by almost 100%. Even in virtual reality the magnitude of the challenge is hard to get one’s head around. It’s not clear that anyone in this room actually has a “solution,” although at least they’re trying.

By the end of the day I’m gathered in a small conference area with about a dozen people from different organizations, including the communications director of UNICEF Finland and my newfound friends from UNICEF Malawi who are on the verge of launching a remarkable new pilot project to transport dried blood samples via drone in order to cut the time-to-diagnosis for children potentially infected with HIV down from weeks to mere days. Their work is part of a global movement to begin implementing novel robotics solutions, such as automated aerial payload delivery systems, within the most challenging environments and complex problems the world has to offer.

My colleague Judith Sherman from UNICEF Malawi makes an eloquent case for the UAV as today’s direct counterpart to SMS for rural clinics and public health labs. SMS has made a huge impact already in the ability to return test results in a timely manner even to the most remote settings. I talk again to the assembled group about the work in Nepal and urge during a free-ranging, deep-diving discussion to those present to get involved in the global movement to collaborate on the most challenging social good issues with the new wave of smart machines now emerging from all corners of the globe.

In all, it’s been a fascinating 10 days on my innovation summit European tour. While there are some clear misses, both on the programmatic and the technological sides, I find even the sight of my colleagues pawing at virtual Syrian phantoms to be strangely touching in retrospect. The world is right now divided in drastic ways — at once brimming over with creativity and energy around the new conceptual, narrative and analytic possibilities of information and communications technology, yet at the same time beset by profound, interlocking crises from Syria to the impact of global climate change. At least some of that creativity and energy, probably not nearly enough, and definitely not always well prioritized, is being channeled towards the people that need it most.

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