The Rohingya refugee crisis in Bangladesh continues to overburden humanitarian resources and undermine the health and security of over 900,000 people. Spatial, sector-specific information is required to better understand the needs of vulnerable populations, such as women and girls, and to target interventions with improved efficiency and effectiveness.

The aim of this study was to create a gender-based vulnerability index and explore the geospatial and thematic variations in the gender-based vulnerability of Rohingya refugees residing in Bangladesh by utilizing pre-existing, open-source data.

Data sources included remotely-sensed REACH data on humanitarian infrastructure, UN Population Fund resource availability data, and the Needs and Population Monitoring Survey conducted by the International Organization for Migration in October 2017. Gaps in data were addressed through probabilistic interpolation. A vulnerability index was designed through a process of literature review, variable selection and thematic grouping, normalization, and scorecard creation. Pareto ranking was employed to rank sites based on vulnerability scoring. Spatial autocorrelation of vulnerability was analyzed with the Global and Anselin Local Moran’s I applied to both combined vulnerability index rank and disaggregated thematic ranking.

Twenty-four percent of settlements were ranked as most vulnerable, with 30 highly vulnerable clusters identified predominantly in the Upazila of Sadar. Five settlements in Dhokkin, Somitipara, and Pahartoli were categorized as less vulnerable outliers amongst highly vulnerable neighboring sites. Security- and health-related variables appear to be the largest drivers of gender-specific vulnerability in Cox’s Bazar. Clusters of low security and education vulnerability measures are shown near the refugee ingress point near Gundum.

The humanitarian space produces tremendous amounts of data that can be analyzed with spatial statistics to better target research and programmatic intervention. The critical utilization of these data and validation of vulnerability indexes is required to improve the international response to the global refugee crisis.

During 2005, Hurricanes Katrina and Rita struck the US Gulf Coast, displacing approximately two million people. With >250,000 evacuees in shelters, volunteers from the American Red Cross (ARC) and other nongovernmental and faith-based organizations provided services. The objective of this study was to evaluate the composition, pre-deployment training, and recognition of scenarios with outbreak potential by shelter health staff.

A rapid assessment using a 36-item questionnaire was conducted through in-person interviews with shelter health staff immediately following Hurricanes Katrina and Rita. Data were collected by sampling at shelters located throughout five ARC regions in Texas. The survey focused on: (1) public health capacity; (2) level of public health awareness among staff; (3) public health training prior to deployment; and (4) interest in technical support for public health concerns. In addition, health staff volunteers were asked to manage 11 clinical scenarios with possible public health implications.

Forty-three health staff at 24 shelters were interviewed. Nurses comprised the majority of shelter health volunteers and were present in 93% of shelters; however, there were no public health providers present as staff in any shelter. Less than one-third of shelter health staff had public health training, and only 55% had received public health information specific to managing the health needs of evacuees. Only 37% of the shelters had a systematic method for screening the healthcare needs of evacuees upon arrival. Although specific clinical scenarios involving case clusters were referred appropriately, 60% of the time, 75% of all clinical scenarios with epidemic potential did not elicit proper notification of public health authorities by shelter health staff. In contrast, clinical scenarios requiring medical attention were correctly referred >90% of the time. Greater access and support from health and public health experts was endorsed by 93% of respondents.

Public health training for sheltering operations must be enhanced and should be a required component of pre-deployment instruction. Development of a standardized shelter intake health screening instrument may facilitate assessment of needs and appropriate resource allocation. Shelter health staff did not recognize or report the majority of cases with epidemic potential to public health authorities. Direct technical support to shelter health staff for public health concerns could bridge existing gaps and assist surveillance efforts.

While the number of humanitarian health workers has grown considerably along with the emphasis on evidence-based humanitarian practice over the last 15 years, no organization exists to ensure ongoing professionalization of this area of expertise.

To determine whether and to what degree the community of humanitarian health workers self-identify as a professional group; whether a need for a professional society exists to support such a group; and if so, what fundamental elements and activities should it encompass and provide.

A humanitarian, listserv-based survey was undertaken to evaluate humanitarian professional self-identification, needs for and interest in professional support functions, and priorities toward developing a professional organization to provide needed services.

The resulting respondent population represented a broad distribution of age and experience with education and experience being equally important factors in defining humanitarian health professionals. Respondents viewed themselves as humanitarian professionals nearly to the extent they viewed themselves as health-specific technical experts who happen to work in humanitarian assistance; they expressed a strong desire to establish a professional society reflecting that self-identification; and that body should focus on activities of education and training, networking and dialogue, and developing and refining core competencies to support best practices.

Humanitarian health workers self-identify as professionals in humanitarian assistance and as technical experts. A professional organization with specific support functions would be of interest to many humanitarian health professionals.

The potential for outbreaks of epidemic disease among displaced residents was a significant public health concern in the aftermath of Hurricane Katrina. In response, the Mississippi Department of Health (MDH) and the American Red Cross (ARC) implemented a novel infectious disease surveillance system, in the form of a telephone “hotline”, to detect and rapidly respond to health threats in shelters.

All ARC-managed shelters in Mississippi were included in the surveillance system. A symptom-based, case reporting method was developed and distributed to shelter staff, who were linked with MDH and ARC professionals by a toll-free telephone service. Hotline staff investigated potential infectious disease outbreaks, provided assistance to shelter staff regarding optimal patient care, and helped facilitate the evaluation of ill evacuees by local medical personnel.

Forty-three shelters sheltering 3,520 evacuees participated in the program. Seventeen shelters made 29 calls notifying the hotline of the following cases: (1) fever (6 cases); (2) respiratory infections (37 cases); (3) bloody diarrhea (2 cases); (4) watery diarrhea (15 cases); and (5) other, including rashes (33 cases). Thirty-four of these patients were referred to a local physician or hospital for further diagnosis and disease management. Three cases of chickenpox were identified. No significant infectious disease outbreaks occurred and no deaths were reported.

The surveillance system used direct verbal communication between shelter staff and hotline managers to enable more rapid reporting, mapping, investigation, and intervention, far beyond the capabilities of a more passive or paper-based system. It also allowed for immediate feedback and education for staff unfamiliar with the diseases and reporting process. Replication of this program should be considered during future disasters when health surveillance of a large, disseminated shelter population is necessary.

In 2001, the Israeli government announced the construction of the West Bank barrier. The stated purpose of construction to prevent attacks by Palestinians on Israeli citizens. In a subsequent advisory opinion, the International Court of Justice decided the wall would block access to health care and education, and was “contrary to international law”.

The Barrier, with its limited number of gates, has been criticized by humanitarian agencies for limiting access of Palestinians to employment, health care, and education, but was defended by the Israeli government as an important security measure.

A survey of key informants was conducted in May 2004 at 78 health facilities and 121 schools in the northern West Bank districts of Jenin, Qalqilya, and Tulkarem, in order to assess the impact of the Barrier on access and use of health and educational services.

The Barrier negatively affected access to education and health care, in terms of statistically significant increases in distance and travel time to schools and health facilities. In several areas, service utilization, assessed by weekly visits to health facilities and student enrollment, was affected by barrier construction, although these findings were not statistically significant. A significant decrease in staff attendance was observed at health facilities and schools.

The Barrier may have long-term effects on access and utilization of health and educational services among Palestinians in the northern West Bank.