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.

I congratulate the authors of this article for their beneficial and much-needed work. I consider this work to be a bright shining light in a dark tunnel and a brave move in the right direction. The true value of this work is far beyond the treatment of 71 patients; it implants hope where there is confusion, promotes love where there is hate, and initiates trust and confidence where mistrust is common. Today, humanitarian aid groups and relief organizations face unique, difficult conditions, and sometimes must answer obscure questions and respond to new problems. History tells us that the war ends when the cease fire starts, that humanitarian organizations are well-received and protected, and that victims and patients respect and trust those providing medical treatment, regardless of their nationality. However, current reality reveals that a cease fire sometimes marks the start of a different war with a different strategy. The number of victims after the cease fire may exceed the number of conventional war victims. Some politicians generalize, classify, and reclassify people, creating mistrust, a lack of confidence, and confusion. It is sad to see victims who need treatment, while nearby there are well-meaning people willing to treat them but who are unable to do so without great risk.

The Palestinian emergency healthcare system faces numerous difficulties in its efforts to develop and improve patient care. The Emergency Medical Assistance Project, a four-year, emergency health capacity-building project, is described in this report. The factors contributing to the current lack of inhospital emergency care and the measures performed to improve the situation are highlighted. The authors surveyed 48 emergency healthcare providers in the West Bank and Gaza Strip on key emergency care development indicators and compared the level of emergency health development with those of Israel and the United States using a model of structured development criteria. Survey results and project observations provide a basis for future recommendations in education and infrastructure.

In recent years, numerous catastrophic disasters caused by natural hazards directed worldwide attention to medical relief efforts. These events included the: (1) 2003 earthquake in Bam, Iran; (2) 2004 earthquake and tsunami in Southeast Asia; (3) Hurricanes Katrina and Rita in the southern United States in 2005;(4) 2005 south Asian earthquake; and (5) 2006 Indonesian volcanic eruption and earthquakes. Health disparities experienced by women during relief operations were a component of each of these events. This article focuses on the response of the Turkish Red Crescent Society's field hospital in northern Pakistan following the South Asian Earthquake of October 2005, and discusses how the international community has struggled to address women's health issues during international relief efforts. Furthermore, since many recent disasters occurred in culturally conservative South Asia and the local geologic activity indicates similar disaster-producing events are likely to continue, special emphasis is placed on response efforts. Lessons learned in Pakistan demonstrate how simple adjustments in community outreach, camp geography, staff distribution, and supplies can enhance the quality, delivery, and effectiveness of the care provided to women during international relief efforts.

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.

The evaluations following the Tsunami that affected 12 countries (December 2004) and the earthquakes in Bam, Iran (2003), and in Pakistan (2005) offered valuable lessons for public health preparedness against all types of risks (natural, complex, or technological) in all countries (regardless their level of development).

The lessons learned, needs assessments, effectiveness of external life-saving assistance, disease surveillance and control, as well as donations management, were reviewed.

Although hundreds of surveys or studies were conducted, the needs assessments were partial and uncoordinated. The findings often were not shared by individual agencies.

The evaluations in each of the three disasters point to some additional issues:

1. Foreign mobile hospitals rarely arrived in time for immediate trauma care. Existing international guidelines for the use of field hospitals often were ignored and must be updated and promoted. Local and neighboring facilities are best at providing immediate, life-saving care;

2. Occassionally, the risk of epidemics was grossly overestimated by the agencies and the mass media. Surveillance and improved routine control programs work without resorting to costly, improvised immunization campaigns of doubtless value. Improving or re-establishing water and sanitation must be the first priority;

3. Health donations were not always appropriate, nor did they follow the World Health Organization guidelines. The costly destruction of inappropriate donations was a recurrent problem; and

4. Medical volunteers from within the affected country were abounding, but did not benefit from the external logistical and material support. The international community should provide logistical and material support before sending expatriate teams that are unfamiliar with the area and its health problems.

Investing in the preparedness of the national health services and communities should become a priority for disaster-prone countries and those assisting them in their development.

From time to time, one has the opportunity to read a truly informative and sensitive piece of work on disasters and women's health. This article deserves both comment and praise. It is very rare in the literature that a publication genuinely captures “lessons learned” from the field with insight and appreciation of both cultural and gender sensitivity. This article addresses the social imperative for the inclusion of gender as a socio-cultural construct in emergency response and recovery, with particular attention to the unique need for respectful interventions in traditional, conservative societies which value sexual modestyand female vulnerability.

Orthopedic injuries are predominant among combat casualties, and carry the potential for significant morbidity. An expert consensus process (Prehospital care of military orthopedic trauma: A consensus meeting, Israel Defense Forces Medical Corps, May 2003) was used to create guidelines for the treatment of these injuries by military prehospital providers. The consensus treatment guidelines developed by experienced orthopedic trauma personnel from leading trauma centers in Israel are presented in this paper.

For victims with open fractures, the first priority is hemorrhage control. Splinting, irrigation, and wound care should be performed while waiting for transport, or, in any scenario, in the case of an isolated limb injury. The use of traction splints was advocated for both the rapid transport scenario (up to one hour from the time of injury to arrival at the hospital) and the delayed transport scenario. In the urban setting, traction splints may not be necessary. Any victim experiencing pelvic pain following a high-energy mechanism of injury should be presumed to have an unstable pelvic fracture, and a sheet should be tied around the pelvis. The panel agreed that field-reduction of dislocations should be avoided by the medical officer unless it is anticipated that the patient will need to go through a long evacuation chain and the medical officer is familiar with specific reduction techniques.