Is there any point other than public relations in dispatching emergency field hospitals knowing they won't arrive in time to save lives that are in emergency situations? International donors want aid based on local needs but if only one third of needs assessments contain information about the local population or their health needs, is the humanitarian aid being applied effectively?

The first academic thesis in Sweden on international health assistance in disaster zones shows that international assistance is often sent to disaster areas without any prior needs assessment having been made of the affected population.

Dr Johan von Schreeb has carried out needs assessments in a number of disaster situations. He examined the need for international medical assistance after the terrorist action in a school in Beslan, Russia, in 2004, and the low-intensity conflict in the Palestinian territories in 2002. He also studied the use of Foreign Field Hospitals in the natural (sudden impact) disaster zones of Bam (Iran) in 2003, Haiti and Aceh (Indonesia) in 2004 and Pakistan (Kashmir) 2005.



What he discovered was a lack of understanding of people’s needs subsequent to the disaster and that international assistance takes inadequate account of existing resources. International field hospitals specializing in life-saving trauma care were dispatched to four areas of natural disaster. Not one arrived within the 48 hours in which lives could still be saved.

If appropriate assistance is to be provided, organizers need access to information about the disaster, the affected area, the size of the population, the socio-economic situation and the available local and regional resources. International donors of humanitarian assistance have jointly decided to distribute the money on the basis of local needs.

There are well-described methods of making needs assessments, but the results are too rarely used. One of Dr von Schreeb’s sub-studies examined the extent to which Sida took account of needs assessments in its decisions to fund humanitarian health projects in 2003. Only one third of these decisions contained information about the size of the population to be helped or other factors reflecting their health needs.

“My interpretation of this is that it’s difficult to provide funding on the basis of needs,” says Dr von Schreeb. ”Other procedures are needed for having needs govern funding decisions.”

During his time as medical coordinator for Medecins Sans Frontieres (Doctors without Borders) in Kashmir, Dr von Schreeb was able to test a new rapid method of gathering needs assessment data in a disaster area. After the 2005 earthquake in Kashmir, he interviewed people at health facilities. His interviewees were geographically representative of the studied population, and the early estimated death and injury toll compared well with the results of a later study in which everyone living in the area was interviewed.

“The interviews gave a good, immediate idea of what people needed – in this case to have their houses repaired before the winter,” says Dr von Schreeb.

Thesis: "Needs assessments for international humanitarian health assistance in disasters", Johan von Schreeb, Department of Public Health Science, Karolinska Institutet

The public defence will be taking place at 9.00 am on 23 November 2007 at Karolinska Institutet Campus Solna, Stockholm.