In recent years, the development of disaster medicine has made rapid progress in China after the Wenchuan earthquake in 2008. China formed a more systematic and specialized health emergency force. In addition, the Ministry of Emergency Management was established In 2018, which demonstrated that the Chinese government is paying more attention to the disaster rescue work. In this report, the practice, experience, and prospect of disaster medicine in China was reviewed.

To explore the current status and prospects of disaster medicine development in China.

The literature research method was used to analyze literature at home and abroad. It was used to retrospectively analyze the rescue experience of Chinese medical rescue teams, sort out the current situation of disaster medical disciplines and rescue teams, and propose disaster medical development recommendations suitable for China’s national conditions.

After years of construction, China has formed a more systematic and specialized health emergency force, but the personnel, equipment, plans, and training of the professional rescue team need to be improved. The discipline system of disaster medicine in China is still lagging behind, and it is still unable to meet the needs of the rescue situation at home and abroad.

Disaster medicine is the area of medical specialization serving the dual areas of providing health care to disaster survivors and providing medically related disaster preparation, disaster planning, disaster response, and disaster recovery leadership throughout the disaster life cycle. It requires multidisciplinary intervention, integration, and application. A forward-looking perspective must be strengthened on the discipline and team building of disaster medicine.

Between 2000 to 2017, there were over 150 hospital evacuations in the United States. Data received from approximately 35 states were primarily concentrated in California, Florida, and Texas. This analysis will provide disaster planners and administrators statistics on hazards that cause disruptions to hospital facilities.

The aim of this study is to investigate US hospital evacuations by compiling the data into external, internal, and man-made disasters thus creating a risk assessment for disaster planning.

Hospital reports were retrieved from LexisNexis, Google, and PubMed databases and categorized according to evacuees, duration, location, and type. These incidents were grouped into three classifications: external, internal, and man-made. Both partial and full evacuations were included in the study design.

There were a total of 154 reported evacuations in the United States. 110 (71%) were due to external threats, followed by 24 (16%) man-made threats, and 20 (13%) internal threats. Assessing the external causes, 60 (55%) were attributed to hurricanes, 21 (19%) to wildfires, and 8 (7%) to storms. From the internal threats, 8 (40%) were attributed to hospital fires and 4 (20%) chemical fumes. From the man-made threats, 6 (40%) were attributed to bomb threats and 4 (27%) gunmen. From the 20 total reported durations of evacuations, 9 (45%) lasted between 2 to 11:59 hours, 6 (30%) lasted over 24 hours, and 5 (25%) lasted up to 1:59 hours.

Over 70% of hospital evacuations in the US were due to natural disasters. Compared to 1971-1999, there was an increase in internal and man-made threats. Exact statistics on evacuees, durations, injuries, and mortality rates were unascertainable due to a lack of reporting. It is critical to implement a national registry to report specifics on incidences of evacuations to further assist with disaster and infrastructure planning.

The National Strategy for Disaster Resilience (NSDR) characterizes resilient communities as having strong disaster and financial mitigation strategies, strong social capacity, networks, and self-reliance. Nonprofit organizations (NPOs) embrace many characteristics of a disaster resilient community. NPOs do not operate for the profit of individual members. Community groups like Lions and Rotary Club have long histories, and while not established to respond to disasters, they frequently have heavy involvement in preparing for or recovering from, disasters.

The study aims to address the question, “What is the potential role of nonprofit organizations in building community resilience to disasters?”

An applied research project was carried out, using theories of resilience, social capital, and the Sendai framework to conceptualize the frameworks and guide the process. Qualitative research methods, thematic analysis, and case studies helped identify Lions, Rotary, and Neighbourhood Houses Victoria strengths, barriers, and enablers.

Research demonstrated how NPOs made significant contributions to building communities’ resilience to disasters. NPOs facilitate three Sendai guiding principles of engaging, empowering, and enabling the community to build disaster resilience. Actions included raising awareness to disaster risk, reducing disaster risk, helping prepare for disasters, and contributing to long term disaster recovery. NPO strengths included local knowledge, community trust, and connections, which matched characteristics listed in the NSDR for a disaster resilient community. However, barriers to participation included traditional emergency services ignoring NPOs, lack of role definition, and lack of perceived legitimacy.

As the first Australia research to scientifically analyze the contributions of these NPOs to build community resilience, before, during and after disaster, this study enhances understanding and recognition of NPOs and assists in identifying means to facilitate their disaster resilience activities and place them more effectively within Emergency Management strategic processes. Greater utilization of such assets could lead to better community outcomes.

Emergency medical services (EMS) is a high-stress profession, which can lead to deterioration in provider mental health over time. EMS providers may find themselves in a situation where they are not only treating the general public, but also each other. Until now, there has been no active training or emphasis on provider mental health. This has taken its toll and can lead to PTSD (post-traumatic stress disorder) in field providers and managers alike.

Identifying and managing stressors is crucial to longevity in the field of EMS. Managers must have the ability to broach sensitive matters with their subordinates, and effectively debrief them following such stressful incidents.

Magen David Adom held a two-day seminar for its administration, from which they learned signs and symptoms of PTSD, how to approach teams who had been in stressful situations, and how to properly debrief the teams. The seminar culminated in mass casualty incident (MCI) drills, where there were 4 active scenes. Scene 1 had a team that was physically injured. Scene 2 had a team which cared for the team from scene 1. Scene 3 had a team suffering from emotional stress and ceased to function. Scene 4 had only wounded civilians. The drill focused on provider emotions and used actors and props to simulate an exceedingly complex MCI situation.

Following the drill, a debriefing was held and it was found that all of the points of interest had been noted and properly dealt with.

Holding a successful drill assisted in providing participants with an accurate sense of such stressful situations in which their subordinates find themselves on a daily basis. The debriefing session succeeded in identifying potential stressors for field providers and teaching the participants the appropriate way to approach such sensitive matters.

The World Health Organization’s (WHO) minimum standards are used to verify Emergency Medical Teams (EMTs) internationally. The National Critical Care and Trauma Response Center (NCCTRC) was one of the first few EMT 2 verified teams globally.

The NCCTRC aims to innovate and provide leadership in the provision of best practice clinical care in the EMT 2 setting in disaster-affected countries.

The NCCTRC developed a clinical governance framework and committee with a view of improving practice in the deployed environment. A gap analysis against the Australian National Standards was done and a decision was made to proceed with accreditation against the ACHS EQUIP 6 framework.

The process of accreditation required a self-assessment that identified gaps in our guidelines and care processes thereby leading to innovative projects to meet the criterion in a sustainable way for the deployed field hospital environment. The NCCTRC has developed adapted clinical tools to manage pressure injury, falls risk, handover, hand hygiene, audits, and consumer feedback.

The deployed field hospital environment can meet national accreditation standards for clinical care. The WHO minimum standards were introduced in 2013 and serve as a marker of the minimum requirements in the field. The challenge is to do better than the minimum. This study demonstrated that it is possible to adapt hospital accreditation standards to the field environment and provide a higher, safer quality of care to affected populations. EMT teams should maintain their clinical care standards from their home environment wherever possible in the field hospital environment. Striving to provide the best and safest care is the duty of care for vulnerable populations.

Clinical diagnostics in sudden-onset disasters (SOD) has historically been limited. With poor supply routes, lack of a cold chain, and challenging environmental conditions, many diagnostic platforms are unsuitable.

We set out to design, implement, and evaluate a mobile diagnostic laboratory accompanying a type II emergency medical team (EMT) field hospital.

Available diagnostic platforms were reviewed and selected against infield need. Platforms included HemoCue301/WBC DIFF, i-STAT, BioFire multiplex RT-PCR, Olympus BX53 microscopy, ABO/Rh Grouping, and specific rapid diagnostic tests (RDT). This equipment was trialed in Katherine, Australia and Dili, Timor-Leste.

During the initial deployment, validation of FilmArray rt-PCR multiplex tests was successful on blood culture, gastrointestinal, and respiratory panels. HemoCue301 (n = 20) haemoglobin values were compared on Sysmex XN 550 (r = 0.94). Analysis of HemoCue WBC DIFF samples had some variation when compared to Sysmex XN 550, (neutrophils r = 0.88, lymphocytes r = 0.49, monocytes r = 0.16, eosinophils r = 0.70, basophils r = 0.16). i-STAT showed non-significant differences for CHEM4 (n=10), CG8 (n = 10), and TnI (n = 5) against Vitros 250. A further trial of BioFire rt-PCR testing in Dili, Timor-Leste diagnosed 117 causative pathogens on 168 FilmArray test cartridges.

This mobile laboratory represents a major advance in SOD. Setup of the service was quick (<24hr) and transport to site rapidly. Training was simple and performance consistent. Future deployment in fragmented health systems after sudden onset disasters with EMT2 will now allow broader diagnostics.

Quality assurance of Emergency Medical Teams (EMTs) is a world concern. The World Health Organization (WHO) published an international guideline for EMTs in 2013 and started the global EMT classification, a quality assurance program for EMTs, in 2015. There are 16 classified EMTs in the world as of October 2018. The Association of Southeast Asian Nations (ASEAN) region is a disaster-prone area. Therefore, the need for EMTs is relatively high. However, there is no classified EMT in the ASEAN region. Factors that prevent the global classification of EMTs in the ASEAN region are unknown.

The objective of this study was to analyze the inhibitory factors of the global EMT classification in the ASEAN region.

A questionnaire survey was taken to the 10 national groups of ASEAN countries. Each group consisted of EMT-related personnel. They were 39 participants for the third AMS Training of the ARCH Project held in May 2018. 10 national groups were asked to answer whether governmental EMT of their country is able to meet the criteria for the EMT global classification. The criteria were written in the WHO-provided minimum standard self-assessment checklist for the Type 1 fixed EMT.

Among 39 categories in the self-assessment checklist, 5 were the most difficult categories to meet the criteria: [Core Standards] Self-sufficiency, Sanitation, and Waste Management; Indemnity and Malpractice; [Technical Standards] Logistics; EMT Capacity.

There are some limitations to the study. Non-governmental EMTs were not covered. Participants of the training were not at the official EMT focal point for the global EMT classification. Logistical requirements may be inhibitory factors of the global EMT classification in the ASEAN region.

The Minimum Data Set (MDS) developed by the World Health Organization (WHO) has been widely used among medical practitioners in International Emergency Medical Team (I-EMT) as tools to collect health information and statistics in disaster health management. The I-EMT submits MDS to the Emergency Medical Team Coordination Cell (EMTCC) for the planning of responses. The Project for Strengthening the Association of Southeast Asian Nations (ASEAN) Regional Capacity on Disaster Health Management (ARCH Project) is the ASEAN’s project that has applied MDS to its activities with the main purpose of strengthening informational management during a disaster.

The study aims to evaluate the performance of MDS after being utilized in the Regional Collaboration Drill (RCD) organized by the ARCH Project in July 2017.

The performance of MDS has been evaluated by ten International Emergency Medical Team (I-EMT) of ASEAN Member States who participated in the RCD.

The assessment forms were returned by ten I-EMTs, and all respondents addressed several points for the revision of MDS (10/10), including the format and the content of the MDS. Concerning the format, respondents stated that the fonts are too small (3/10), and spaces for recording additional information are needed (3/10). On the other hand, the majority of respondents suggested that some of the contents within the MDS are still unclear or some terminologies are needed to be further clarified (6/10), especially with the referral form (5/10).

The current version of the MDS utilized for the EMT coordination should be edited and revised for its optimal usage. Applying MDS to disaster simulation is an efficient approach to test its application.

This descriptive study explored barriers and difficulties faced by an international disaster relief team from China, which took part in two types of international disaster relief missions.

Data was collected since the founding of the Chinese international disaster relief team, including information on team composition, operational hours, and average number of patients rescued and treated by staff per day, etc.

Overall, thirteen disaster relief missions utilizing the Chinese disaster relief team occurred in eight countries. All the operations were divided into two kinds of models: Urban Search and Rescue mission, and Emergency Medical service. The first model consisted of search, rescue, and emergency medical services on site. The ratio of medical staff on the team accounted for 18.8%. According to the six international health-based operations, the team was deployed ten days following the disaster, with an average working time of 17.8 days, and benefiting around 6,812 wounded and sick persons per operation. Compared with these two models, medical-based operations deployed more staff after the disaster and had a longer window of operation. The beneficiaries of medical-based operations are ten times greater than those of rescue-based operations. The differences are distinct.

Missions will better meet the needs of international relief by enhancing organizational coordination among medical teams around the world, and by contributing to the communication between teams. They will further benefit from technical capacity building, regional coordination trainings, formatting the standard of teaming building, and evaluation of the work.

Currently, Technical Advisors of the World Health Organization’s (WHO) Emergency Medical Teams (EMT) Secretariat are conducting standardized verification work for international emergency medical teams in various countries and organizations. However, a uniform and standard training course for an International EMT is lacking.

To design a training course model based on knowledge structure, teaching, and evaluation methods for an International EMT.

The first and second level catalogue defined as chapters and sections for the International EMT training curriculum were drafted based on literature and summaries of fragmentary experience. The teaching syllabus with the method of teaching and evaluation was initially outlined. The expert consultation form was designed and validated. Experts from International EMTs from various countries were consulted and investigated. The Delphi method was used, and the chapters and sections were adjusted and weighed according to experts’ advice through the Analytic Hierarchy Process. The teaching and evaluation methods for each knowledge module were obtained based on suggestions from experts.

A total of 25 experts were consulted. By 2 rounds of consultation with a Kendall coordination coefficient W value of 0.210 and chi-square value of 78.61 (p<0.05), consensus about the knowledge structure for the curriculum was achieved, which consisted of 6 chapters: (1) introduction of International EMT, (2) Disaster medicine, (3) Global health, (4) Care in austere condition, (5) Medical technology, (6) Field training, with the weights of 0.1415, 0.1584, 0.1536, 0.1827, 0.1728, and 0.1909, respectively, and 32 sections. Teaching methods for different knowledge modules were determined, which included lecture, demonstration, discussion, drills, and tabletop simulation. The evaluation methods were affirmed via a quiz, written examination, skill test, and teamwork test assessed by intra-group and inter-group evaluation.

Through scientific investigation of experts from International EMTs, a training course model for International EMT was established.

Nepal experienced a massive earthquake on 25th April, 2015 measuring 7.8 Richter scale followed by large aftershock on 12th May that further added to the destruction, especially in Sindhupalchowk and Dolakha. On request of Government of Nepal, international community extended financial and technical assistance to overcome the impact of the earthquake. Foreign Medical Teams (FMTs); now known as emergency medical team, from different countries and volunteers from within the country had helped in health service delivery.

to get a clear picture of Strengths, Weaknesses/Gaps and Areas of Improvement that would be very important in making the response better in any future events of such scale when discussed and shared with all relevant stakeholders in Nepal.

It was a multi-method study. Both quantitative and qualitative approaches were used to have an in-depth overview of the research question and the objectives set for the study. Records and reports relating Foreign Medical Team Coordination Committee (FMTCC) and meeting minutes of Health Emergency Operation Centre were reviewed.

Total of 8,962 deaths and 22,302 injuries occurred following earthquake of which 8,864 deaths and 21,156 injuries occurred in the most affected 14 districts of Nepal. In FGD and KIIs, most of the participants highlighted the earthquake had a huge impact on infrastructures. A large number of casualties were reported immediately after earthquake. Health facilities were overloaded with injured patients. One hundred and thirty-seven FMTs from 36 countries worked in Nepal to provide medical relief.

Timely preparation and readiness of the procedures to handle the FMTs including their registration process, medical licensing procedures, procedures of coordinating mechanisms with the district, case management and treatment guidelines to be followed by the FMTs are crucial to have a better health sector response including that of FMTs.

The Project for Strengthening the Association of Southeast Asian Nations (ASEAN) Regional Capacity on Disaster Health Management (ARCH Project) is the project under the collaborative framework between the National Institute for Emergency Medicine, Thailand, Ministry of Public Health, and Japan International Cooperation Agency. The project aims to strengthen disaster health management focusing on the International Emergency Team (I-EMT) operation and coordination in ASEAN by using various mechanisms, for example, regional collaboration meeting, regional collaboration drill, training, etc.

The study aims to evaluate the outcomes which ARCH Project’s activities have been facilitating to strengthen the ASEAN disaster health management.

A comparative study is utilized to see the improvement of the ASEAN disaster health management of the current situation and the project’s outputs compared to the previous survey in 2015.

Recent ASEAN disaster health management has been strengthened in three distinctive dimensions: (1.) national capacity of each ASEAN Member States is being strengthened through the project’s training courses; (2.) the ASEAN I-EMT coordination platforms have been set up to the extent that the progress of developing the toolkits such as the Standard Operating Procedures for the Coordination of EMT in ASEAN is at its eighty percent, while the Database of the EMT and their Minimum Requirements and Qualifications are now at its ninety percent; and (3.) Standard reporting forms (medical record and health need assessment form) for all ASEAN member state (AMS) has been developed and fully completed.

The ARCH Project has been facilitating the strengthening of the ASEAN disaster health management through its capacity building endeavors and the creation of collaborative mechanisms for operations and coordination. These activities should be maintained either under the existing or newly created mechanisms in order to build a sustainable collaborative framework.

Collaboration between Foreign Medical Teams (FMT) and Host Health Personnel (HHP) is a core standard for healthcare in a medical response to disaster,1 but descriptions of its application from recipient nation HHP are rare. This paper details the findings from a qualitative study on the experience of collaboration between International Foreign Teams (IMT) and HHP in Gorkha, Nepal since the 2015 earthquake.

To present findings from a study that explored the experience of collaboration by Nepal health workers working with IMT since the 2015 earthquake.

A qualitative study design using semi-structured interviews regarding the experiences and perspectives on collaboration of 12 Nepali health workers was used. The interviews were transcribed, translated, and collated using Nvivo software by QSR international, and themes regarding collaboration were identified.

Data collection is not yet complete. However, preliminary results from early analysis indicate that collaborative practice is not uniformly applied by IMT. HHP Satisfaction with IMT appears highly dependent on collaboration. Emerging themes are that rigid organizational procedures, language and cultural barriers, and intimidating leadership inhibit collaboration. Objectives were assumed to align immediately post-disaster, with evidence of objectives increasingly diverging over time. IMT leadership that was experienced, responsive to suggestions, and regularly involved HHP in planning, implementing, and reviewing activities were highly appreciated.

Emerging themes indicate the time-critical nature of many disasters, along with cultural/institutional/administrative barriers, make the building of collaborative relationships difficult despite being foundational for successful missions. Participants in IMT must proactively involve HHP in the objectives setting, planning, implementation, and reviewing of activities. Successful IMT participation is not only clinically competent but actively seeks collaborative relationships with HHP throughout the mission.

Midline shift (MLS) in the brain is a life-threatening emergency, which requires immediate surgical intervention following diagnosis. Currently, CT Brain is accepted as the gold standard in detection of MLS. Unfortunately, the diagnosis may be delayed when the patient is unable to undergo a CT Brain immediately due to several reasons. This has led to a constant endeavor to identify and develop other methods for detection of MLS, among which Transcranial Sonography (TCS) is included.

To validate point-of-care TCS for detection of MLS in neuro-emergency patients in the Emergency Department, and compare it to CT values of MLS.

This double-blinded prospective study was conducted from March 2018 to August 2018 in the Emergency Department of VIMS Hospital, Salem. All patients above the age of 18 who required a CT Brain were included, and a TCS was performed. MLS on TCS was calculated by measuring the distance between the outer table of the skull and the third ventricle on both sides, through the temporal window using a 2.8 MHz Sector Probe. MLS on CT was defined as the difference between ideal midline and septum pellucidum.

A total of 87 patients were included in this study. The MLS (mean ± SD) was 0.21cm ± 0.31cm using TCS, and 0.20cm ± 0.34cm using CT. The Pearson’s correlation coefficient between CT and TCS was 0.97 (p < 0.01). The area under the ROC curve for detection of a significant MLS using TLS was 83.7%. Using 0.5cm as a cut-off, the sensitivity, specificity, and positive likelihood ratio were 86.7%, 98.6%, and 61.92, respectively.

This study concludes that Transcranial Sonography could detect Midline Shift with reasonable accuracy, and can be used as a point-of-care tool in the Emergency Department to facilitate early diagnosis of MLS and intervene accordingly in neuro-emergencies.

The 2017 Montreal Half-Marathon was held on September 24th despite a record-breaking, out-of-season heatwave. The Urgences-santé Corporation (USC), Quebec’s largest emergency medical service (EMS), was tasked with coordinating and delivering prehospital response for over 15,000 runners at a time when the province’s paramedics were on strike.

USC’s mission was to ensure runner safety under extreme conditions with limited staffing. In conjunction with the event’s medical teams, we implemented a new approach that oriented patients to the event’s clinic with the aim of limiting ambulance transports off-site and thus optimizing resources by promoting a “treat and release” principle.

Emergency response was organized around the event’s clinic, which offered a level of care comparable to proximate emergency departments, including mass-cooling capacities. This capacity allowed us to modify provincial protocols, and thus prioritize treating patients on-site instead of transporting them to a hospital. Consequently, the prehospital response on the course could be assured with only 15 ambulances (staffed by managers) and a single team deployed at the event’s clinic, acting as transport officers. Heatstroke identification protocols were reinforced for the safety of the runners and spectators.

A total of 1,071 participants received medical attention, including 24 who were treated for a heat-related incident. On the course, 32 were evaluated by paramedics and 20 were transported to the event’s clinic. Only 7 patients were transferred from the clinic to a hospital, of which only one was for a heat-related incident. No deaths resulted from the race.

By anticipating and preparing for the extreme heat, the coordinated prehospital response safely reduced off-site transports, minimizing treatment delays for patients, and maximizing the use of on-site resources. We attribute this success to a strong collaboration with the race organizers, the presence of an on-site clinic, and an increase in prehospital resources.

A heatwave hit the Greater Montreal area during the week of July 1 to July 8. The Urgences-santé Corporation (USC), Quebec’s largest emergency medical service (EMS), saw its crews struggling to respond to a record-breaking number of emergency calls while going door-to-door to make sure the at-risk population was not overburdened by the heat.

USC’s mission was to ensure its population’s emergency medical care and safety under extenuating conditions. In conjunction with our municipal partners and the public health services, we deployed an aggressive communication strategy, urging people to only call 911 in the case of a life-threatening emergency, with the aim of limiting ambulance transports.

Ambulance resources were increased (> 20% compared to the same period in 2017). More than 60 media interviews were given. Paramedic supervisors were sent to emergency departments to contain the offload delays. USC’s community response team was going door-to-door in pre-identified urban heat islands (UHI), bringing medical attention directly to those in need.

Despite our communications efforts, a record-breaking 1,568 calls (> 37% compared to the same period in 2017) were received in a 24 hour period. Through the door-to-door campaign, 12 people in need received medical attention. More than 90 people are suspected to have died as a result of a July heat wave in Quebec, with figures showing that 60 deaths in the cities of Montreal and Laval alone may be linked to elevated temperatures.

Through strong collaboration with our municipal and provincial partners, and the public health services, an important communication strategy and additional resources were deployed. Crews were able to prevent additional deaths. With the observed increase in extreme weather events, this strategy will definitely be useful in the future.

Due to the heatwave in Japan, the number of patients with heatstroke transported via ambulance hit the highest record according to the Tokyo fire department in 2018. Now, heatwaves are thought to be a natural disaster. Emergency medical professionals located in a Tokyo suburb covering 40,000 individuals experienced a wide range of challenges in patient care with heatstroke.

To assess the impact of the 2018 Japan heatwave on community emergency medical service.

Patients (aged ≥ 16 years) with heatstroke and who were transported to our hospital by ambulance from June to September of 2018 were included. Data were derived from prehospital records and electronic medical records. Weather data was referenced from a Japanese meteorological agency.

The number of all-cause cases was 1,764, and the total number of heatstroke cases was 51 (2.9%). Heatstroke cases were concentrated in July and August of 2018. The rate of males was 69%. The average age was 63 ± 23 years. Physical labor was associated with 31% of cases, such as sports in 7.8%. Hospitalization was required in 24%. ICU admission was required in 9.8%. There was no fetal case directly caused by heatstroke in this survey.

The risk factors of heatstroke considered to be male and elderly. About one-half of heatstroke patients were over 70 years old, and it may have been related to regional characteristics. As mentioned in the Heatstroke STUDY 2012 (Miyake, 2014), most cases which occurred inside residences were found that there was no air conditioner use. There was also an increased number of patients with heatstroke who made emergency visits by themselves. Further investigation is needed annually to estimate the effect of climate change. It is important to make a strong recommendation from public health agency about heatstroke prevention, including air conditioner use during hot weather.

It is critical to understand how gender relations shape women’s and men’s lives to enhance their resilience toward disaster because women and men have different roles, responsibilities, and access to resources. Unequal participation between women and men in a disaster risk reduction program will influence how each can be affected by various hazards, and how they will cope with and recover from disaster. Even though women are often considered to have incredible resilience and capacity to survive in the face of disasters, they also experience a range of gender-specific vulnerabilities.

This study aims to evaluate women’s participation in current efforts of the Disaster-Resilient Village Program and to develop a conceptual framework for implementing gender-based a disaster resilience program at the community level.

This study employed a mixed-method approach and adopted several major activities including literature review, interview, focus group discussion, and a questionnaire survey with a total of 300 respondents. Three selected villages in Aceh Besar District, Aceh Province, were the study area of this study.

By using descriptive and inferential statistics, this study proposed a gender-based framework for implementing Disaster-Resilient Village Program.

This framework contributes to the emerging literature on gender-based disaster risk reduction and may assist policymakers in formulating regulations related to the community-based disaster risk management program. On the practical front, this study provided indicators to practitioners regarding some conditions that should be taken into account when mainstreaming gender in community-based disaster risk management programs. This study offered an original contribution to the existing bodies of knowledge on gender studies in disaster risk reduction efforts.

Globally, women are considered to be more vulnerable during disasters. South Asia including India, Pakistan, Bangladesh, Sri Lanka, Myanmar, and Nepal experience many disasters, and are also ranked lowest on the gender equality index. Women of these countries tend to face many health challenges while staying at evacuation centers after disasters.

This study highlights the health challenges South Asian women face while staying in evacuation centers after disasters.

A narrative review was conducted using the keywords, “women after disaster,” “evacuation centers,” and “emergency health care.” Literature identified from the references were also added until reaching saturation. 47 articles were obtained through Elsevier, Google Scholar, Scopus, and ProQuest.

Women in shelters in South Asian countries experienced many health challenges including genito-urinary tract infections (studies from India, Sri Lanka and Bangladesh), increased maternal mortality (Nepal and Pakistan), and sexual assault with resulting unwanted pregnancies and sexually transmitted diseases, including HIV (Nepal). Factors that contributed were the unavailability of separate toilets, inadequate sanitation, lack of sanitary supplies, and inadequate childbirth and maternity care resources. Rape victims at the shelters of Myanmar received delayed medical treatments, causing long-term health complications. Post-disaster stress and trauma were evident among women at the shelters initiated by insecurity, fear of abuse, and unfair relief distribution.

Women face certain challenges when staying in evacuation shelters in South Asian countries, which impacts their wellbeing after disasters. It is important to recognize women’s special requirements and to preserve women’s rights while developing disaster preparedness strategies. Socio-cultural perspectives of the disaster-prone areas should be considered at the policy planning level to ensure an effective and practical health-safety system. Additionally, further research focusing on women’s wellbeing at the evacuation centers is required to inform and overcome health challenges faced by women living in the shelters.

An estimated two billion people are currently affected by war, with civilian populations increasingly exposed to the hazards of armed conflict. While the effect of explosive remnants of conflict is well documented, the impacts of the toxic remnants of war on civilian health are less well understood.

This study was a scoping review examining the human health impacts of exposure to toxic remnants of war. Toxic remnants of war refer to any toxic or radiological substances arising from military activities. In this study, however, the focus was limited to the health effects of exposure to toxic substances and explosive by-products from munitions fired, dropped, or abandoned during conflict. The following databases were searched: Embase PubMed, Scopus, and Web of Science. The Mixed Methods Appraisal Tool (MMAT) was used to assess the methodological quality of studies that met the inclusion criteria.

Common toxicants reported on were Tetrachlorodibenzo-p-dioxin TCDD, white phosphorus, depleted uranium, lead, mercury, and sulfur mustard. Common health effects included respiratory diseases as well as cutaneous, cardiovascular, reproductive, and congenital effects. Posttraumatic stress disorder, depression, anxiety, cognitive impairments, and decreased quality of life were also commonly reported. The evidence base, however, is mixed with heterogeneity in study design and outcome measures. Lack of baseline data and inadequate exposure models make establishing an adverse causal relationship between an agent and a disease challenging.

Civilian exposures to toxic remnants of conflict remain understudied and under-addressed. The study suggests assessment of the human health impacts of toxicants should be part of a post-conflict response, especially given the potential long-term intergenerational effects. The current lack of recognition of the human health impacts of toxic remnants of conflict also limits the amount of global resources assigned to post-conflict decontamination.