The human resources crisis in humanitarian health care parallels that seen in the broader area of health care. This crisis is exacerbated by the lack of resources in areas in which humanitarian action is needed—difficult environments that often are remote and insecure—and the requirement of specific skill sets is not routinely gained during traditional medical training. While there is ample data to suggest that health outcomes improve when worker density is increased, this remains an area of critical under-investment in humanitarian health care. In addition to under-investment, other factors limit the availability of human resources for health (HRH) in humanitarian work including: (1) over-reliance on degrees as surrogates for specific competencies; (2) under-development and under-utilization of national staff and beneficiaries as humanitarian health workers; (3) lack of standardized training modules to ensure adequate preparation for work in complex emergencies; (4) and the draining of limited available HRH from countries with low prevalence and high need to wealthier, developed nations also facing HRH shortages.

A working group of humanitarian health experts from implementing agencies, United Nations agencies, private and governmental financiers, and members of academia gathered at Hanover, New Hampshire for a conference to discuss elements of the HRH problem in humanitarian health care and how to solve them. Several key elements of successful solutions were highlighted, including: (1) the need to develop a set of standards of what would constitute “adequate training” for humanitarian health work; (2) increasing the utilization and professional development of national staff; (3) “training with a purpose” specific to humanitarian health work (not simply relying on professional degrees as surrogates); (4) and developing specific health taskbased competencies thereby increasing the pool of potential workers.

Such steps would accomplish several key goals, such as: (1) more confidently ensuring that individuals hired for a given post would have the capacity to function at a commonly understood level of training; (2) greatly increasing the potential number and types of workers available for humanitarian work;(3) increasing the efficiency of human resources utilization in humanitarian projects; and (4) recognition that humanitarian work is a multi-disciplinary endeavor: these goals will contribute to ensuring that humanitarian health workers have a minimum training in broader humanitarian action, making them more effective team members in the field.

Efforts were made to highlight some promising pilot programs for human resource development in humanitarian work, to identify a future vision for humanitarian health as a profession, and to develop a human resources strategy for achieving that vision.

The landmark Humanitarian Response Review, commissioned by the United Nations Emergency Relief Coordinator in 2005, has catalyzed recent reforms in disaster response through the Inter-Agency Standing Committee. These reforms include a “cluster lead” approach to sectoral responsibilities and the strengthening of humanitarian coordination. Clinical medicine, public health, and disaster incident management are core disciplines underlying expertise in disaster medicine. Technical lead agencies increasingly provide pre-deployment training for selected health personnel. Moreover, technical innovations in disaster health sciences increasingly are disseminated to the disaster field through multi-agency initiatives, such as the Standardized Monitoring and Assessment of Relief and Transitions (SMART) initiative.

The hallmark qualification of competency to render an informed opinion in the health specialties remains specialty board certification in North American healthcare traditions, or specialty society fellowship in British and Australasian healthcare traditions. However, disaster incident management training lacks international consensus on hallmark qualifications for competency. Disaster experience is best characterized in terms of months of fulltime, hands-on field service. Future practitioners in disaster medicine will see intensified efforts to define competency benchmarks across underlying core disciplines as well as key field performance indicators.Quantitative decisionsupport tools are emerging to assist disaster planners and medical coordinators in their personnel selection.

As the humanitarian health response industry grows, there is a need for technical health expertise that can build an evidence base around outcome measures and raise the quality and accountability of the health relief response.We propose the formation of technical support units (TSUs), entities of health expertise institutionalized within humanitarian non-governmental organizations (NGOs), which will bridge the gap between the demand for evidencebased, humanitarian programming and the field capacity to accomplish it. With the input of major humanitarian NGOs and donors, this paper discusses the attributes and capacities of TSUs; and the mechanisms for creating and enhancing TSUs within the NGO management structure.

Presently, there is no shortage of methods for collecting data on populations requiring assistance from humanitarian health interventions. However, utilizing a working group, the authors of this paper have looked at these methods through a critical lens and found that there is need for improvement upon existing systems of data collection and analysis. The authors concluded that efforts to standardize the methods of data collection are needed to achieve universal uniformity, and that more funding should be allocated to analyze the data collected.

The effectiveness of humanitarian programs normally is evaluated according to a limited number of pre-defined objectives. These objectives typically represent only selected positive expected impacts of program interventions and as such, are inadequate benchmarks for understanding the overall effectiveness of aid.This is because programs also have unexpected impacts (both positive and negative) as well as expected negative impacts and expected positive impacts beyond the program objectives.The authors contend that these other categories of program impacts also should be assessed, and suggest a methodology for doing so that draws on input from the perspectives of beneficiaries. This paper includes examples of the use of this methodology in the field. Finally, the authors suggest future directions for improving this type of expanded assessment and advocate for its widespread use, both within and without the field of disaster response.

To assist field workers in program evaluation and to explicitly discuss program strengths and weaknesses, a practical method to estimate the effectiveness of public health interventions within the existing program capacity was developed. The method and materials were tested in seven countries (Afghanistan, Zimbabwe, Tanzania, Uganda, Guatemala, the Philippines, and Ghana). In this method, four core components are assessed using a questionnaire: (1) the efficacy of the intervention; (2) the level of existing human resources (i.e., quality of recruitment, training, and continuing education); (3) the infrastructure (i.e., supplies, salary, transportation, and supervision); and (4) the level of community support (i.e., access and demand). Using the assessment tool provided, program staff can determine if all necessary elements are in place for a successful program that can deliver the specific intervention. Based on the results of the assessment program, weaknesses can be identified, explicitly discussed, and addressed.The usefulness of this tool in humanitarian relief may be twofold: (1) to assess the design and implementation of effective programs; and (2) to highlight the inevitable need for capacity building as the disaster situation evolves.

Information is needed to support humanitarian responses in every phase of a disaster. Participants of a multilateral working group convened to examine how best to meet these information needs. Although information systems based on routine reporting of diseases are desirable because they have the potential to identify trends, these systems usually do not deliver on their promise due to inadequate organization and management to support them.

To identify organizational and management characteristics likely to be associated with successful information systems in disaster settings, evaluations of the Integrated Disease Surveillance and Response (IDSR) programs in 12 participating countries were reviewed. Characteristics that were mentioned repeatedly in the evaluations as associated with success were grouped into nine categories: (1) human resources management and supervision; (2) political support; (3) strengthened laboratory capacity; (4) communication and feedback (through many mechanisms); (5) infrastructure and resources; (6) system design and capacity; (7) coordination and partnerships with stakeholders; (8) community input; and (9) evaluation. Selected characteristics and issues within each category are discussed.

Based on the review of the IDSR evaluations and selected articles in the published literature, recommendations are provided for improving the shortand long-term organization and management of information systems in humanitarian responses associated with disasters. It is suggested that information systems that follow these recommendations are more likely to yield quality information and be sustainable even in disaster settings.

The effectiveness of humanitarian response efforts has long been hampered by a lack of coordination among responding organizations. The need for increased coordination and collaboration, as well as the need to better understand experiences with coordination, were recognized by participants of a multilateral Working Group convened to examine the challenges of coordination in humanitarian health responses. This preliminary study is an interim report of an ongoing survey designed by the Working Group to describe the experiences of coordination and collaboration in greater detail, including factors that promote or discourage coordination and lessons learned, and to determine whether there is support for a new consortium dedicated to coordination. To date, 30 key informants have participated in 25-minute structured interviews that were recorded and analyzed for major themes. Participants represented 21 different agencies and organizations: nine non-governmental organizations, eight academic institutions, two donor organizations, the US Centers for Disease Control and Prevention, and the World Health Organization.

Common themes that emerged included the role of donors in promoting coordination, the need to build an evidence base, the frequent occurrence of field-level coordination, and the need to build new partnerships. Currently, there is no consensus that a new consortium would be helpful.

Addressing the underlying structural and professional factors that currently discourage coordination may be a more effective method for enhancing coordination during humanitarian responses.

This paper focuses on the dilemma that humanitarian non-governmental organizations (NGOs) face in their efforts to gain access to populations caught up in current wars. Narrow and broad concepts of humanitarian protection are discussed and it is argued that despite high levels of professionalism, the space for humanitarian action has constricted sharply since the events surrounding the attacks of 11 September 2001. Increasingly, aid workers are now being viewed with suspicion as agents of the great powers and assertions of humanitarian neutrality are not heeded or rejected. Non-governmental organizations have evolved a range of options to address this problem, but there is an urgent need to work collectively to find more durable and coherent solutions.

During humanitarian response efforts, the mass media serves as the primary informational intermediary informing donors, policy makers, and the nonaffected public. A lack of professional standards within the current culture of journalism, the politics of media ownership, and media manipulation by governments has distorted reporting on humanitarian crises, with possible detrimental effects on response efforts. Humanitarian response organizations must assume a proactive, leading role in the management and sharing of information with each other as well as with donors, policy makers, and the public. This will require working with the media as partners, as well as exploring innovative methods of mass communication. A multi-stakeholder, cooperative communication initiative could help improve media involvement, and harness the media as a credible and knowledgeable communication tool for response efforts. A professional publication dedicated to the discipline of humanitarian relief also could optimize efforts, communicate the perspectives of beneficiaries, and manage the underutilized resource of the general public.

Disaster preparedness and response have gained increased attention in the United States as a result of terrorism and disaster threats. However, funding of hospital preparedness, especially surge capacity, has lagged behind other preparedness priorities. Only a small portion of the money allocated for national preparedness is directed toward health care, and hospitals receive very little of that. Under current policy, virtually the entire funding stream for hospital preparedness comes from general tax revenues. Medical payers (e.g., Medicare, Medicaid, and private insurance) directly fund little, if any, of the current bill. Funding options to improve preparedness include increasing the current federal grants allocated to hospitals, using payer fees or a tax to sub- sidize preparedness, and financing other forms of expansion capability, such as mobile hospitals. Alternatively, the status quo of marginal preparedness can be maintained. In any event, achieving higher levels of preparedness likely will take the combined commitment of the hospital industry, public and private payers, and federal, state, and local governments. Ultimately, the costs of pre- paredness will be borne by the public in the form of taxes, higher healthcare costs, or through the acceptance of greater risk.

After Hurricane Katrina struck the Gulf Coast of the United States on 29 August 2005, it became obvious that the country was facing an enormous national emergency. With local resources overwhelmed, governors across the US responded by deploying thousands of National Guard soldiers and airmen. The National Guard has responded to domestic disasters due to natural hazards since its inception, but an event with the magnitude of Hurricane Katrina was unprecedented. The deployment of >900 Army National Guard soldiers to St. Bernard Parish, Louisiana in the aftermath of the Hurricane was studied to present some of the operational issues involved with providing medical support for this type of operation. In doing so, the authors attempt to address some of the larger issues of how the National Guard can be incor- porated into domestic disaster response efforts. A number of unforeseen issues with regards to medical operations, medical supply, communication, preventive medicine, legal issues, and interactions with civilians were encoun- tered and are reviewed. A better understanding of the National Guard and how it can be utilized more effectively in future disaster response operations can be developed.

The aim of the study is to evaluate the self-administered Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria-based inventory for the screening of post-traumatic stress disorder. Due to its low sensitivity (57%) and high specificity (88%), it could be useful as a second step of a screening procedure in combination with other validated, self-report instruments. The clinical implications of the findings and the limitations of the study are discussed.

Vicarious traumatization is now a well-known entity and may have negative influences on those that are involved in rescue efforts in any disaster or traumatic events. Healthcare workers work with trauma survivors and witness an immense array of gruesome and ghastly images. This work has the potential to cause those engaged in rescue efforts to become affected subconsciously.

Job-related stress may cause psychological symptoms in care providers who provide support and listen to the survivors' account of trauma. A therapist working in disaster situations may become a victim of psychological anguish—undermining their physical and mental well-being as well as their profession, adversely affecting their traumatized patients, and leading to a counter-productive therapist-survivor relationship.

This significant theme of secondary trauma must be recognized in relief workers at early stages and must be addressed at an individual as well as organizational level. The key may lie in turning to social supports, adapting positive coping mechanisms, and subsequently seeking mental health consultation. Further research is required in this area to determine the best resolution.