Gap Analysis: the inclusion of people with disability and older people in humanitarian response

Key findings and gaps from academic and grey literature reviews

Authors

Dr Alex Robinson, Nossal Institute

Dr Manjula Marella, Nossal Institute

Ms Lana Logam, Nossal Institute

Contents

Gap Analysis: the inclusion of people with disability and older people in humanitarian response

About Elrha

Nossal Institute for Global Health, University of Melbourne

Arbeiter-Samariter-Bund

Abbreviations

Glossary

Acknowledgements

A. Introduction and approach

1. Introduction

2. Approach

2.1 Scope of the reviews

2.2 Search strategy

2.3 Mapping of articles

2.4 Quality assessment

B. Thematic mapping of articles

1. Introduction

2. Summary of mapping findings

2.1 Disability evidence mapping

C. Key findings

1. Introduction

2. Overall Summary

3. Findings by HIS

3.1 HIS 1. Data collection and identification

3.2 HIS 2. Access to humanitarian assistance, including accessibility

3.3 HIS 4. Meaningful participation

3.4 HIS 5. Inclusive mechanisms for feedback and complaints

3.5 HIS 6. Coordination of inclusive humanitarian assistance

3.6 HIS 7. Organisational learning for inclusive humanitarian assistance

3.7 HIS 8. Staff and capacity for inclusive humanitarian assistance

3.8 HIS 9. Managing resources for inclusive humanitarian assistance

4. Concluding remarks

Annex

Introduction

Section A. Summary of articles by HIS and sector

HIS 1. Data collection and identification

1. Disability

2. Older age

HIS 2. Access to humanitarian assistance, including accessibility

3. Disability

4. Older age

HIS 4. Meaningful participation

5. Disability

HIS 5. Inclusive mechanisms for feedback and complaints

6. Disability

HIS 6. Coordination of inclusive humanitarian assistance

7. Disability

8. Older age

HIS 7. Organisational learning for inclusive humanitarian assistance

9. Disability

HIS 8. Staff and capacity for inclusive humanitarian assistance

10. Disability

11. Older age

HIS 9. Managing resources for inclusive humanitarian assistance

12 Disability

13. Older age

Section B. Distribution of articles

Section C. List of guidelines

About Elrha

Elrha is a global charity that finds solutions to complex humanitarian problems through research and innovation. We fund and support work that goes on to shape the way in which people across the world are supported during a crisis. We are an established actor in the humanitarian community, working in partnership with humanitarian organisations, researchers, innovators, and the private sector to tackle some of the most difficult challenges facing people all over the world. We have supported more than 200 world-class research and innovation projects, championing new ideas and different approaches to find what works in humanitarian response.

Our Humanitarian Innovation Fund (HIF) aims to improve outcomes for people affected by humanitarian crises by identifying, nurturing and sharing more effective and scalable solutions. We fund innovations that aim to improve the effectiveness of humanitarian response. 

Our strategy includes a commitment to the inclusion of marginalised and excluded population groups within humanitarian response. As part of this commitment in 2019 we developed a new focus area on the inclusion of people with disabilities and older people. With funding from the UK Department for International Development (DFID) we will explore the barriers to, and support opportunities for, the inclusion of older people and people with disabilities in humanitarian response. We believe humanitarian innovation has much to contribute to this agenda. Last year we launched our first Innovation Challenge and are currently supporting four projects.

We strive to ensure our work is problem-led and evidence-based. For this reason, we commissioned a Gap Analysis on the inclusion of people with disabilities and older people in humanitarian response. This is the first of two reports and presents the findings of a systematic academic literature review and grey literature review. The final report, with additional findings from consultations, interviews, and case studies, will be published later in 2020.  

About the authors:

Nossal Institute for Global Health, University of Melbourne

The Nossal Institute works on practical solutions to pressing global concerns. We combine real-world experience with the scientific rigour of one of the world’s top universities. Our big picture perspective helps us to understand complexity and change and to integrate that understanding into country and regional strategies. Through our Disability Inclusion Team we deliver mainstream and targeted solutions to improve service delivery, strengthen data and measurement, and reduce risk for people with disability and others with access and functional needs.

Arbeiter-Samariter-Bund

Arbeiter-Samariter-Bund (ASB) is a German relief and social-welfare organisation established in 1888. ASB is engaged in a wide range of social service provision in Germany and abroad, including civil protection, rescue and social welfare services. ASB is a founding member of the Disability-inclusive Disaster Risk Reduction Network (DiDRRN) and ans official member of the UNDRR Disability Stakeholder Group: Thematic Group on DRR. Through DiDRRN, ASB leads collective efforts to influence inclusion and DRR in regional and global policy processes supported by practical lessons and evidence.

Suggested citation: Robinson. A, Marella. M, Logam. L, (2020) ‘Gap Analysis: the inclusion of people with disability and older people in humanitarian response’. Elrha: London.

@ Elhra 2020. This work is licensed under a Creative Commons AttributionNonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0). ISBN: 978-1-9164999-2-8

Edited and designed by Marsden/Mee

Abbreviations

ASB | Arbeiter-Samariter-Bund
CBR | Community-Based Rehabilitation
CMIST | Communication; Maintaining Health; Independence; Safety, Security, Self-determination; and Transportation. Access and functional needs assessment tool
CRPD | Convention on the Rights of Persons with Disabilities
DPO | Disabled People’s Organisations
DRR | Disaster Risk Reduction
HIS | Humanitarian Inclusion Standards for Older People & People with Disabilities
IASC | Inter-Agency Standing Committee
IDP | Internally Displaced Person
IMS | Incident Management System
IOM | International Organization for Migration
NGO | Non-Government Organisation
OCHA | Office for the Coordination of Humanitarian Affairs
OPD | Organisation of People with Disability
RCT | Randomised Controlled Trial
SADD | Sex and Age Disaggregated Data
WASH | Water, Sanitation and Hygiene
WGQ | Washington Group Questions
WHO | World Health Organization

Glossary

Administrative Data | Data for managing programmes and services, such as enrolment and record keeping
Athena | Athena functional needs flow chart. Triage tool
Medical Model | Understanding of disability that focuses on an individual’s health condition or impairment (c.f. Social Model)
Reasonable Accommodation | Adaptations to meet the accessibility needs of individuals with disabilities
Social Model | Understanding of disability that emphasises the disabling nature of barriers in society (c.f. Medical Model)
Sphere | Initiative that has developed the Humanitarian Charter and Sphere standards and handbook for humanitarian response.
Twin-track | Approach to disability-inclusion that includes mainstreaming activities to remove barriers alongside targeted interventions for people with disability
Universal Design | Designing programmes, goods, and services to be used equitably by all people

Acknowledgements

We want to thank everyone who has provided invaluable input to this report and Gap Analysis project. In particular, our dedicated Steering Committee, who engaged so enthusiastically, providing helpful feedback along the way.

This work was made possible by funding from the UK Government Department for International Development (DFID).

A. Introduction and approach

1. Introduction

It is now widely acknowledged that people with disability and older people are disproportionately impacted by disasters, conflict, and humanitarian crises. Yet for many working in humanitarian response, the inclusion of people with disability and older people remains an under prioritised or emerging area of work.

To build the evidence base on inclusion, and inform our priorities for innovation, the Elrha Humanitarian Innovation Fund (HIF) commissioned a Gap Analysis on the Inclusion of People with Disability and Older People in Humanitarian Response. This is the first of two reports from the Gap Analysis and summarises findings from the literature review components of this work. The second and final report, which will include findings from all components of the Gap Analysis, will be published in September 2020.

The Gap Analysis has been led by the Nossal Institute for Global Health at the University of Melbourne. The Nossal Institute team was supported by Arbeiter-Samariter-Bund’s Office for Indonesia and the Philippines (ASB) for the review of grey literature. The Gap Analysis process has been guided throughout by a dedicated Steering Committee co-Chaired by Elrha and the Nossal Institute. The Steering Committee is comprised of representatives from humanitarian organisations, organisations of people with disability (OPDs), and older people’s associations (OPAs).

This report begins by outlining the approach taken to the academic and grey literature reviews. This is followed by an overview of findings, which maps evidence from different sectors against thematic areas based on the Humanitarian Inclusion Standards for Older People and People with Disabilities (HIS).¹ Supplementary information is available as a separate accompanying annex.

The annex includes a summary of each article identified in the review arranged by HIS and sector; graphs showing the distribution of articles, including by year, humanitarian context, and geographical region; and a list of guidelines on the inclusion of people with disability and older people in humanitarian response.

2. Approach

While the inclusion of older people and people with disability is not yet standard practice in humanitarian response, there is a growing body of evidence on the impacts of humanitarian crises and disasters on people with disability and older people. Such impacts include higher mortality rates amongst people with disability and older people; 2 3 increased disability from injury caused by disasters 4; and evidence of increased incidences of chronic illness,⁵ malnutrition,⁶ and negative psychological impacts.⁷ 8 Because there is a growing understanding of impacts, the Gap Analysis focuses on the inclusion of people with disability and older people in responses to humanitarian crises, conflict, and hazard related disasters.⁹

2.1 Scope of the reviews

Reviews of academic and grey literature were conducted separately on people with disability and older people to ensure a wide body of evidence was identified. A previous literature review combining older age and disability identified a limited number of articles addressing the intersectionality of age and disability in humanitarian response.¹⁰

The findings presented in this report are separated accordingly. Though the reviews were conducted separately, and older people and people with disability have diverse lived experienced, we recognise that disability and older age intersect. Recognising these intersectionalities is a step towards improving inclusion outcomes for a diverse range of people.

The literature reviews were guided by the following research question, which was formulated in conjunction with the Steering Committee:

What is the evidence on the inclusion of people with disability & older people in humanitarian response?

The way humanitarian and disaster risk management terms are used in the literature is not always consistent. Similarly, the boundaries between different stages of humanitarian action are not clear cut. For example, a transition from response to recovery is rarely distinct in practice. Similarly, the difference between general preparedness and preventative activities and preparedness for response are not always clearly distinguished.

Preparedness for response activities, such as the training of emergency personnel and the advance positioning of emergency shelters, were included in the reviews. Preventative actions taken to avert a disaster or humanitarian response, such as evacuation due to flood or other hazard event, were not included.¹¹ Articles relating to shelter that may follow an evacuation were included. Figure 1 below summarises what was included and excluded from the literature reviews.¹²

[picture]

Figure 1. Overview of what was included & excluded from the reviews

Only articles published in English between the start of January 2010 and the end of January 2020 were included in the reviews. Articles focusing on combatants and war veterans were excluded, as were articles focusing on resettled refugees and returnees. Certain types of document were also excluded. These included policy briefs, opinion pieces, book chapters, and literature reviews.

2.2 Search strategy

Separate searches, as noted, were conducted to identify articles relating to the inclusion of people with disability in humanitarian response and the inclusion of older people in humanitarian response.

Synonyms and related terms were identified for ‘disability’, ‘older age’ and ‘humanitarian’. For example, a search for ‘humanitarian’ would be linked with ‘crisis’, ‘response’, ‘agency/ies’ and so forth. This process was repeated with related key words, such as ‘conflict’ and ‘disaster’, to create search strings. Search strings were then combined, trialled, and revised. Searches for academic literature were conducted in the four academic databases to ensure broad coverage of articles from different academic disciplines.¹³

A simplified set of search terms was used for the grey literature search. The grey literature search was conducted in Google using advanced search features. The search continued until saturation and no new articles were readily identified. Identified grey literature articles were reviewed to identify further articles in a snowballing process. Further articles were identified by the Steering Committee.

[picture]

Figure 2. Articles identified in the literature reviews

2.3 Mapping of articles

A thematic analysis was completed to organise and map the articles. Both disability and older age articles were mapped across two sets of categories, which are presented in Section B.

The first set of categories are based on the Humanitarian Inclusion Standards for Older People and People with Disabilities (HIS), which were included in the Humanitarian Standard Partnership by Sphere in 2018.14 The HIS include nine key inclusion standards based on nine commitments in the Core Humanitarian Standard on Quality and Accountability.¹⁵ The second set of categories are based on humanitarian sectors or areas of work, such as shelter; water, sanitation and hygiene (WASH); or health.

Articles were allocated to individual HIS based on a ‘best-fit’ assessment of the relevance of the article’s key findings to that HIS. Efforts were taken to allocate articles to one HIS on the best-fit basis; however, four disability articles had substantive evidence relevant to two HIS and these articles were allocated to both HIS. Several older age and disability articles addressed inclusion broadly and had light evidence that may be of passing relevance to different HIS. These articles tended to address inclusion in terms of the removal of barriers and/or improving accessibility. As such, these articles were allocated to HIS 2 on access.

In contrast to the HIS categories, sectors were identified from the literature. Articles were grouped according to content and then sectors were identified and allocated by the researchers.¹⁶ Sectors were either explicitly mentioned in an article or were inferred. If an article was crosscutting or broad in nature it was classified as general. Allocations to both HIS and sector categories were jointly made by the researchers. In the case of differing opinions, agreement was reached by majority decision from the three researchers.

Using the HIS and sectors as thematic categories facilitated the mapping of evidence against recognised standards on inclusion and by area of work. This assists in providing a practical overview of how evidence is distributed across areas of humanitarian practice and in identifying key gaps. To ensure the focus of each HIS is clear to the reader, the titles of individual HIS have been adapted from the original in the following sections and accompanying annex.

2.4 Quality assessment

All selected articles were assessed on the quality of evidence they contain. The process of assessing quality is invariably subjective and the quality markers assigned to articles in this document should be treated as a guide rather than being definitive. It is worth noting the purpose of the Gap Analysis is to better understand the overall evidence base rather than judge the merits of individual articles.

Articles identified in the reviews varied substantially. This included differences in disciplinary backgrounds, focus, research methods, and respondent groups. As such, the assessment criteria needed to be used with diverse articles while still providing an indication of overall research quality.

All articles were rated against criteria in four categories. The categories were: design, transparency, limitations (of the research), and logical clarity. Criteria within these categories were marked yes or no and a simple count of results completed. This approach favoured articles that collected primary data with descriptive articles scoring lower.

2.4.1 Criteria for quality assessment

Category 1: Design

Does the study acknowledge existing research? (Yes or No)

Does the study pose a research question or outline a hypothesis? (Yes or No)

Does the study have a clear target/respondent group? (Yes or No)

Does the study present a clear research design or method? (Yes or No)

Category 2: Transparency

Is the context in which the study was conducted clear? (Yes or No)

Does the study declare sources of support/funding? (Yes or No)

Category 3: Limitations

Does the study note its limitations in design/method? (Yes or No)

Does the study note its limitation in transferability of findings? (Yes or No)

Category 4: Logic

Are the conclusions clearly based on the study’s results? (Yes or No)

Table 1: Quality assessment categories and criteria

Articles were then organised by score into three groups or tiers.

These tiers are used as quality markers in the findings that follow and in the accompanying annex.

2.4.2 Scoring for quality markers

Tier 1: 7-9

Tier 2: 4-6

Tier 3: 1-3

Table 2: Scoring for quality markers

Note 1. Age and Disability Consortium (CBM, HelpAge, Humanity & Inclusion). 2018. Humanitarian inclusion standards for older people and people with disabilities. https://reliefweb.int/report/world/humanitarian-inclusion-standards-older-people-and-people-disabilities

Note 2. Fujii K. 2015. The Great East Japan Earthquake and persons with disabilities affected by the earthquake. Why Is the mortality rate so high? Interim Report on JDF Support Activities and Proposals.

Note 3. Flaherty J, Dong B, Wu H et al. 2011. Observational study of 1-year mortality rates before and after a major earthquake among Chinese nonagenarians. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences. 66(3):355-61.

Note 4. Iezzoni L I, Ronan L J. 2010. Disability legacy of the Haitian earthquake. Annals of Internal Medicine. 152(12):812-4.

Note 5. Nagayoshi Y, Yufu T. 2018. The impact of a severe natural disaster on elderly patients with chronic heart failure. Circulation. 138(1).

Note 6. Beier D, Brzoska P, Khan M. 2015. Indirect consequences of extreme weather and climate events and their associations with physical health in coastal Bangladesh: a cross-sectional study. Global Health Action. 8(1).

Note 7. Takada S. 2013. Post-traumatic stress disorders and mental health care (lessons learned from the Hanshin-Awaji Earthquake, Kobe, 1995). Brain and development. 35(3).

Note 8. Ishiki A, Okinaga S, Tomita N et al. 2016. Changes in cognitive functions in the elderly living in temporary housing after the Great East Japan Earthquake. PloS one. 11(1).

Note 9. The Gap Analysis is guided by the following from Elrha: The term ‘humanitarian response’ is used as an umbrella term for all types of humanitarian response, including but not limited to crises, conflict, and natural hazard and climate related disasters. We also include related preparedness activities that facilitate a humanitarian response. See Elrha’s Humanitarian Innovation Guide for more information: https://higuide.elrha.org/humanitarian-parameters/humanitarian-contexts/

Note 10. HelpAge & London School of Hygiene and Tropical Medicine. 2018. Missing millions: how older people with disabilities are excluded from humanitarian response. From https://www.helpage.org/newsroom/latest-news/millions-of-older-people-with-disabilities-risk-being-excluded-from-humanitarian-assistance-new-helpage-report-reveals/

Note 11. There is a growing body of related preparedness literature on people with disability and older people, including: Butler K, Kuligowski E, Furman S et al. Perspectives of occupants with mobility impairments on evacuation methods for use during fire emergencies. Fire Safety Journal. 91. Ishigaki T, Asai Y, Nakahata Y et al. 2010. Evacuation of aged persons from inundated underground space. Water Science and Technology. 62(8). Brown L, Dosa D, Thomas K et al. 2012. The effects of evacuation on nursing home residents with dementia. American Journal of Alzheimer’s Disease & Other Dementias. 27(6).

Note 12. Examples of literature reviews relating to disasters and people with disability or older people include: Willoughby M, Kipsaina C, Ferrah N et al. 2017. Mortality in nursing homes following emergency evacuation: a systematic review. Journal of the American Medical Directors Association. 18(8). Megan Baxter M D. 2017. An oxymoron of long-term care- sheltering-in-place during an evacuation: a literature review of the best practices of evacuation & sheltering-in-place for long-term care facilities. Journal of Emergency Management. 15(3). Malpass A, West C, Quaill J et al. 2019. Experiences of individuals with disabilities sheltering during natural disasters: an integrative review. Australian Journal of Emergency Management. 34(2). Quail J, Barker R, West C. 2018. Experiences of individuals with physical disabilities in natural disasters: an integrative review. Australian Journal of Emergency Management. 33. Parente M, Tofani M, De Santis R et al. 2017. The role of the occupational therapist in disaster areas: systematic review. Occupational Therapy International. 2017.

Note 13. Embase, MEDLINE, Scopus, and Web of Science.

Note 14. Age and Disability Consortium (CBM, HelpAge, Humanity & Inclusion). 2018. Humanitarian inclusion standards for older people and people with disabilities. https://reliefweb.int/report/world/humanitarian-inclusion-standards-older-people-and-people-disabilities

Note 15. CHS Alliance. 2014. Core Humanitarian Standard on Quality and Accountability. https://corehumanitarianstandard.org/files/files/Core%20Humanitarian%20Standard%20-%20English.pdf

Note 16. The sectors identified largely aligned with the UN Office for the Coordination of Humanitarian Affairs (OCHA) led cluster system. However, the researchers were guided more by the content of the articles than by the existence of the OCHA clusters. See: https://www.humanitarianresponse.info/en/about-clusters/what-is-the-cluster-approach

B. Thematic mapping of articles

1. Introduction

The following sections describe findings from the mapping process. Articles included from the literature reviews were mapped against HIS and humanitarian sectors as described in Section A.2.3. The matrices and findings presented below combine articles from the academic and grey literature reviews. Use of the term ‘article’ in the following refers to both academic (peer-reviewed) and grey literature. Separate matrices and findings are presented on the inclusion of people with disability and the inclusion of older people in humanitarian response. In the following discussion and matrices, the number of articles identified in the literature reviews are taken as an indicator of the availability of evidence against the HIS and humanitarian sectors.

In the two matrices, the nine HIS are listed horizontally at the top and the sectors are listed vertically on the left in alphabetical order. As the sectors were identified from the two literature reviews on disability and older age, there are differences in the sectors included in the matrices. For example, food security was identified as a sector in the review on older people but not in the review on people with disability.

The total number of articles identified for each sector and HIS are indicated by a figure in a circle at the intersection of an HIS and sector. A larger circle indicates more articles were identified for that HIS and sector. Smaller circles indicate fewer articles. Where there are no circles at an intersection, no articles were identified for that HIS and sector.

Four disability articles, as noted earlier, were assigned to two HIS. As such, the total of figures in the disability matrix is 50 and not 46 as per the total number of articles identified. Several articles addressed the inclusion of both people with disability and older people in humanitarian response. These articles were included in both reviews and are included in findings on disability and older age.

2. Summary of mapping findings

2.1 Disability evidence mapping

Overall, disability articles were widely dispersed across the HIS. No evidence was identified under HIS 3 on building resilience and preparedness for people with disability through inclusive humanitarian response. Very little evidence was identified under HIS 4, 5, and 6 on the meaningful participation of people with disability in humanitarian response, inclusive mechanisms for feedback and complaints by people with disability, and coordination of inclusive humanitarian assistance respectively. By sector, very little evidence was identified on disability inclusion in WASH in humanitarian settings and in camp management. In comparison to the mapping of older age articles, no evidence was identified relating to disability inclusion in food security or the logistics sectors in humanitarian response.

Most disability articles related to HIS 2 on access to humanitarian assistance and accessibility followed by HIS 7 on organisational learning for inclusive humanitarian assistance. By sector, most articles related to communications and to health, including under HIS 2 on access. Limited evidence was found across sectors under HIS 1 on data and identification of people with disability, HIS 8 on staff and capacity, and HIS 9 on managing resources for inclusive humanitarian assistance.

The following figures show the distribution articles by type (academic peer reviewed or grey literature) for each HIS (Figure 3) and the quality markers for articles under each HIS (Figure 4) for disability.

[picture]

Figure 3. Disability article type by HIS 17

Most of the disability articles identified were from peer reviewed journals (35 out of 46). Across seven of the eight HIS with identified evidence, most articles were peer reviewed. HIS 5 on inclusive mechanisms for feedback and complaints had one peer reviewed and one grey literature article.

[picture]

Figure 4. Quality assessment of disability articles by HIS

The quality of disability articles was mixed across the HIS. While most disability articles fell under HIS 2 on access, most of these articles scored low on quality (Tier 3 = 8). Although fewer articles were identified under HIS 8 on staff and capacity and HIS 9 on managing resources compared to HIS 2, these two HIS included higher quality articles.

Mapping of disability articles by sector & humanitarian inclusion standards

Evidence was identified over six sectors (camp management, communications, health, protection, shelter, and water, sanitation and hygiene (WASH)), plus one general category.

Evidence is mostly related to HIS 1: Data, HIS: 2 Access, HIS 7: Organisational learning, HIS 8: Staff and capacity, and HIS 9: Management of resources.

No evidence was identified under HIS 3: Preparedness and resilience.

Little evidence was identified under HIS 4: Participation, HIS 5: Feedback, and HIS 6: Coordination.

HIS 2: Access has the most articles. HIS 2 is arguably the broadest HIS. The large number of articles is more reflective of the breadth of evidence than the depth of evidence.

No evidence was identified under food security and logistics (c.f. older age).

By sector, most evidence related to communications followed by health.

Little evidence was identified for camp management.

Very little evidence was identified for water, sanitation and hygiene (WASH).

2.2 Older age evidence mapping

Fewer articles were identified on the inclusion of older people in humanitarian response compared to the inclusion of people with disability. Older age articles were also scattered across the HIS and sectors. As with disability, no evidence was identified under HIS 3 on building resilience and preparedness for older people through inclusive humanitarian response. Also, no evidence was identified under HIS 4 on the meaningful participation of older people in humanitarian response, HIS 5 on inclusive mechanisms for feedback and complaints by older people, and HIS 7 on organisational learning for inclusive humanitarian assistance. Most older age articles were also under HIS 2 on access to humanitarian assistance and accessibility (see Section A.2.3). Then followed by HIS 9 on managing resources for inclusive humanitarian assistance. Limited evidence was identified under HIS 1, 6, and 8 on data and identification of older people, coordination of inclusive humanitarian assistance, and staff and capacity respectively.

By sector, most older age articles were general without a specific sector focus followed by camp management and shelter. In comparison to the sectors identified for disability, no older age articles were identified under protection as a sector.

The figures below show the distribution of articles (from peer reviewed and grey literature) by HIS (Figure 5) and the quality of articles under each HIS (Figure 6) for older age.

[picture]

Figure 5. Older age article type by HIS 18

Except for HIS 2 on access, which included mostly grey literature articles, all other older age articles under the remaining HIS were peer reviewed journal articles.

[picture]

Figure 6. Quality assessment of older age articles by HIS

Although fewer in number, the older age articles scored higher on quality overall compared to the disability articles. Most older age articles scored highest on quality (Tier1). Only a few articles under HIS 2 on access and HIS 9 on managing resources scored the lowest on quality (Tier 3).

Mapping of older age articles by sector & humanitarian inclusion standards

Evidence was identified over seven sectors (camp management, communications, food security, health, logistics, shelter, and water, sanitation and hygiene (WASH)), plus one general category.

Overall, less evidence was identified on the inclusion of older people in response than for people with disability.

Evidence is mostly under HIS: 2 Access and HIS 9: Management of resources.

No evidence was identified under HIS 3: Preparedness and resilience, HIS 4: Participation and HIS 5: Feedback.

Little evidence was identified under HIS 1: Data, HIS 6: Coordination and HIS 8: Staff and capacity.

No evidence was identified under protection (c.f. disability).

By sector, most evidence was general followed by shelter.

Little evidence was identified for communications and health (c.f. disability).

Very little evidence was identified for food security, logistics and WASH.

Note 17. For reference: HIS 1 data, HIS 2 access, HIS 3 resilience, HIS 4 participation, HIS 5 feedback mechanisms, HIS 6 coordination, HIS 7 organisational learning, HIS 8 staff and capacity, HIS 9 managing resources.

Note 18. For reference: HIS 1 data, HIS 2 access, HIS 3 resilience, HIS 4 participation, HIS 5 feedback mechanisms, HIS 6 coordination, HIS 7 organisational learning, HIS 8 staff and capacity, HIS 9 managing resources.

C. Key findings

1. Introduction

The following sections summarise key findings for each HIS. A summary of overall findings is provided followed by more detailed findings under individual HIS categories. In line with the matrices in Section B.2, only the HIS with identified articles are included. Both articles from the academic and grey literature searches are included. Findings on the inclusion of people with disability and older people are presented separately under each HIS.

A summary of the count of types of article (per reviewed or grey literature), geographical region, humanitarian context, and quality markers (Section A.2.4) is provided at the start of each HIS. These summaries are based on the total of articles under the HIS and may be read as indicating further gaps in evidence. For example, if no articles address conflict or all articles are based in research in one country. Following a summary of evidence for each HIS, gaps in the evidence are outlined. These are presented as potential areas for improving practice or for future research. The gaps identified and described in this report are not exhaustive. They provide a basis for reflection and, we hope, some inspiration.

More detailed information on individual articles arranged by sector under each HIS is available in the annex accompanying this report. Where names of authors are provided in the following sections, the reader is referred to the authors’ article in the annex for further information. For brevity, only the first three authors are named. Where articles address more than one country, they are listed as ‘multiple’. However, regions are used where possible to provide more information. For example, the ‘Asia’ category may be used where these is one article on Indonesia, and one article on Bangladesh and Myanmar. The annex also includes additional information on the distribution of articles, including by geographical region and humanitarian context.

2. Overall Summary

Despite growing awareness of the importance of inclusive humanitarian response, there is limited evidence that people with disability and older people are being included.

There is limited evidence on institutional barriers to the inclusion of people with disability and older people in response or on why known inclusion principles and approaches are not widely adopted in response.

Most of the literature notes an absence of inclusive interventions. Relatedly, many articles tend towards advocating the importance of inclusion in humanitarian response.

The current evidence base on the inclusion of people with disability and older people in response is highly diverse in terms of research topics, approach, quality, and scope. Evidence is spread broadly and there is little depth of quality evidence for any sector under any HIS.

There is little critical analysis of the utility and effectiveness of existing inclusive approaches and tools being applied in humanitarian response.

There is no clear evidence on positive impacts or outcomes for people with disability and older people resulting from inclusive humanitarian response. Although impacts may be measured effectively in different ways, no randomised controlled trial studies were identified.

There is evidence that the humanitarian sector has an outdated understanding of disability and tends to approach disability from a Medical Model rather than a Social Model or rights-based understanding.¹⁹

There is no evidence relating to the costing of the inclusion of people with disability or older people in humanitarian response or similar cost-benefit analyses on the most appropriate interventions.

There is limited evidence on the meaningful participation of people with disability and older people in planning and decision-making in response.

The disability literature emphasises the importance of engaging with the representative organisations of people with disability in response. Aside from engaging with ‘elders’, no mention of an equivalent mechanism or approach to engaging with older people was identified.

There is evidence that humanitarian actors mistakenly link social standing and older age. For example, by identifying, and coordinating with, ‘elders’ who may not represent older people more broadly.

There is a lack of nuanced understanding and critical analysis of the diversity of older age beyond 60 years of age in humanitarian response.

Limited evidence on the intersectionality between disability and older age, and other social factors. A few articles address specific groups, such as women with disability, but there is little detailed gender analysis and almost no evidence detailing other considerations, such as race, ethnicity, or class.

There is a lack of research led by people with disability or older people. Two articles were authored by individuals who self-identified as Deaf. No other articles are known to be authored by people with disability or older people.

There is limited evidence on the effective use of data for inclusive response. The collection of data does not in itself lead to change.

3. Findings by HIS

3.1 HIS 1. Data collection and identification

3.1.1 Disability

a. Key info

Six articles. Peer reviewed (5), grey literature (1). (2015 to 2018).

Asia (3), USA (2), global (1).

Earthquake (1), Tropical Storm (2), General (3).

Communications (1), Health (1), Shelter (2), General (2).

Quality markers: Tier 1 (1), Tier 2 (3), Tier 3 (2).

b. Evidence summary

Overall, limited evidence on data collection and the identification of people with disability in humanitarian response.

Majority of articles focus on identification of individuals with disability and triage tools, including in health and shelter settings.

Limited evidence on the identification and measurement of barriers to participation in response.

Emerging evidence that the Washington Group Questions on disability (WGQ) can be effective for measuring disability prevalence post-disaster.²⁰

Despite interest in use of the WGQ to disaggregate data by disability, no evidence was identified demonstrating positive outcomes for people with disability in response compared to people without disability.

Challenges of using the WGQ effectively are becoming apparent, such as the need for sufficient training of data collectors. Also, organisations may not fully consider their data needs before using the WGQ.

Indications of some resistance to using the WGQ in conflict situations as it may result in the identification of a large number of people with disability (Leonard Cheshire, Humanity and Inclusion, 2018).

Some evidence that people with disability should be included as data collectors in response.

Framing data collection in terms of access and functional needs may improve the utility of data collected from the identification of people with disability (Fannin A, Brannen D E, Howell M, et al, 2015). Similarly, considering barriers to accessing and acting upon information can help guide data collection and the application of data in programming (Sloman A, Margaretha M, 2018).

Administrative data available pre-disaster, such as census data, may be used to inform response. However, pre-disaster data may not capture the full extent of specific needs of people with disability post-disaster (Springer J, Casey-Lockyer M, 2016).

Privacy and data protection concerns can prevent sharing of official data for preparedness and response purposes. This can persist after revisions to legislation to allow sharing of information in disasters have been made (Takamaya K, 2017).

C. Gaps

Understanding the effectiveness of different disability prevalence measurement tools, including shortened WGQ sets, in different humanitarian situations.

Identification or development of complementary data collection tools to measure barriers to participation in response.

Identification or development of data collection tools for specific purposes in different sectors beyond triage in shelter and health. For example, simple screening tools for protection purposes.

Identification of strategies to ensure data on people with disability and their specific needs are in place prior to a disaster and usable during response.

Establishment of effective processes, and safeguards, for sharing official data collected prior to a disaster to assist response.

Understanding impacts of disability inclusive response on people with disabilities in comparison to people without disability.

3.1.2 Older age

a. Key info

Three peer reviewed articles. (2013-2017).

Ethiopia (1), USA (1), Global (1).

Drought (1), Tropical Storm (1), General (1).

Food Security (1), Health (1), General (1).

Quality markers: Tier 1 (3).

b. Evidence summary

Limited evidence on data and the identification of older people in response.

Despite recognition of the need for age (and gender) disaggregated data in the humanitarian sector, this data is still not routinely collected or used to inform humanitarian decision making (Mazurana et al, 2013).

Some evidence on the effective use of administrative data in allocation of food aid (Azadi H, De Rudder F, Vlassenroot K, et al, 2017) and to identify older people with specific health needs (diabetes) (Lee D C, Gupta V K, Carr B G, et al, 2016).

Some evidence the utility of administrative data can be improved by geographical analysis (Lee et al, 2016).

c. Gaps

Data disaggregation by age for people over 60 years old (or equivalent cut-off).

Use of data to understand the different and specific needs of older people by different age groups.

Effectiveness of disability focused tools and approaches, such as the WGQ and access and functioning needs approach, for identifying the specific needs of older people.

Understanding barriers within humanitarian agencies to better collecting and applying age disaggregated data.

3.2 HIS 2. Access to humanitarian assistance, including accessibility

3.2.1 Disability

a. Key info

Nineteen articles. Peer reviewed (12), grey literature (7). (2010-2019).

Asia (6), Haiti (1), Italy (1), South Sudan (1), USA (2), Multiple (4), Global (4).

Conflict (4), Earthquake (6), Tropical Storms (1), General (8).

Camp Management (1), Communications (5), Health (4), Protection (3), Shelter (1), WASH (1), General (4).

Quality markers: Tier 1 (6), Tier 2 (5), Tier 3 (8).

b. Evidence summary

Most articles address a lack of access and accessibility in humanitarian response.

More articles relating to access in communications and health than other sectors.

Communication articles mostly address the information access for Deaf people and/or use of technology/media to improve access to information.

Evidence on use of social media to improve access to information and strengthen support networks is mixed. A recent example of improving access to post-disaster information for Deaf people in Italy was positive (Rotondi L, Zuddas M, Marsella P, et al, 2018). Low use of social media in emergencies found in an earlier study in USA (Morris J T, Mueller J L, Jones M L, 2014).

Effective use of social media to improve access to information post-disaster requires considering compatibility and the ability to share information across multiple platforms (Kent & Ellis, 2015).

Online media and technology-based interventions more effective at improving access to information/communication when multiple media are used.

Specific interventions, such as sign language on television, can raise wider awareness of barriers to access among the public (McKee, 2014).

All health articles addressed access to rehabilitation with a focus on medical rehabilitation rather than community-based rehabilitation (CBR).

Evidence of benefits of providing rehabilitation services in response, including prevention of complications, and opportunities to strengthen rehabilitation and relieve pressure on wider health system.

People who acquire injuries/disability more likely to receive attention and access services than people with pre-existing disability in humanitarian response (Hunt M R, Chung R, Durocher E, et al, 2015).

Most services for people with disability in response are health focused. Humanitarian agencies need to look beyond a narrow focus on health services for people with disability and ensure access to services across sectors (Pearce E, Paik K, Robles O J, 2016).

Improving access to services for children with disability also needs consideration of parents’ welfare, including respite services (Jones N, Hamad B A, Odeh K, et al, 2016).

People with disabilities’ access to services is determined by both location, such as shelter type, and social standing in that location (Brittingham R, Wachtendorf T, 2013).

The importance of applying broader inclusion approaches in response is noted, including universal design, reasonable accommodation, twin-track approach, and promoting leadership of people with disability.

c. Gaps

Understanding the effectiveness and impact of inclusion approaches, such as a twin-track approach, to improving access to humanitarian response for people with disability.

Understanding institutional barriers to humanitarian actors adopting holistic & established approaches to improving access.

Cost-benefit analyses of improving access for people with disability across sectors in response.

Long-term sustainability of interventions to improve access for people with disability initiated during response.

How to better integrate access to health alongside wider socio-economic interventions for people with disability in response.

Existing studies on social media and technology use in humanitarian contexts may be rapidly out of date. There is little evidence on the benefits of integrating social media into larger information systems, including supplementing and facilitating face-to-face communications.

3.2.2 Older age

a. Key info

Fifteen articles. Peer reviewed (6), grey literature (9). (2010-2019).

Africa (2), Asia (7), England (1), USA (1), Multiple (2), Global (2).

Conflict (4), Drought (2), Earthquake (3), Tropical Storms (1), Volcanic Eruption (1), General (4).

Camp Management (4), Communications (2), Logistics (1), Shelter (1), WASH (1), General (6).

Quality markers: Tier 1 (9), Tier 2 (4), Tier 3 (2).

b. Evidence summary

Evidence that awareness of the importance of including older people in response is increasing (Amnesty International, 2019; Elrha, 2019). However, implementation remains ad hoc (Barbelet V, Samuels F, Plank G, 2018).

Majority of evidence points to a lack of access and little consideration of the diversity among older people over 60 years old.

Barriers to accessing general services persist alongside a lack of interventions to meet the specific access needs of older people.

By sector, most articles on access for older people relate to camp management in conflict.

Evidence of exclusion due to the inflexibility of systems, such as registration processes in camps (Chemali Z, Borba C P, Johnson K, et al, 2018).

When considering access, organisations may over-romanticise older age (Barbelet V, Samuels F, Plank G, 2018). Older age is not synonymous with higher status in communities and ‘elders’ who liaise with responders may not be representative of older people (Humanitarian Policy Group, HelpAge, 2016.)

Changes to older people’s roles and influence in communities post-disaster and lack of access to information can increase psychological impacts and risk for older people.

Caring for older people in disasters (UK) often falls to women; however, these informal solutions do not offset shortcomings in formal response system (Dominelli L, 2014).

Older people should be consulted to improve physical and social access to humanitarian services and delivery systems.

c. Gaps

More nuanced understanding of how general access needs of older people differ from younger people and may differ from people with disability.

Understanding specific access needs of different groups of people over 60 years old, including by gender, age, disability, and socio-economic status.

Identifying and understanding the effectiveness of different approaches to improving access to humanitarian response for older people.

Understanding institutional barriers among humanitarian agencies to prioritising the specific access needs of older people in response.

Improved understanding on how a lack of independence and increased support needs of older people may impact on families and communities.

3.3 HIS 4. Meaningful participation

3.3.1 Disability

a. Key info

Two peer reviewed articles. (2011, 2018).

New Zealand (1), Multiple (1).

Conflict (1), Earthquake (1).

Camp Management (1), General (1).

Quality markers: Tier 1 (1), Tier 2 (1).

b. Evidence summary

Little evidence directly addressing the meaningful participation of people with disability in humanitarian response; however, the importance of consulting with and including people with disability in decision making is a recurring theme (also HIS 2: Access).

Growing awareness of disability in humanitarian sector since the 1980s (Mirza M, 2011), but this has not resulted in comprehensive engagement with people with disability in response.

No clear evidence of people with disability contributing to decision making in, and planning of, humanitarian response.

Examples of people with disability mobilising and advocating for inclusion as a response to a lack of disability-inclusive initiatives in camp settings (Mirza M, 2011).

Following the Christchurch earthquake, 2011, people with disability engaged with local government in response and recovery (Hay K, Pascoe K M, 2018).

Advocacy for meaningful participation of people with disability in response needs to be ongoing otherwise disability-inclusion can drop off the agenda (Hay K, Pascoe K M, 2018).

Also, see case studies in Palmer T, Bertozzi E, Dominik G, et al, 2019 under HIS 2: Access.

Also, Takamaya K, 2017 on how Deaf people responded to meet their specific needs in their community under HIS 7: Staff and Capacity. Also, see Rotondi L, Zuddas M, Marsella P, et al, 2018 on how members of the Deaf community helped establish a Facebook page in response to a lack of information post-earthquake (HIS 2: Access). Note, these are independent initiatives in response to a lack of access, rather than people with disability being included and participating in the wider response system.

c. Gaps

The extent to which the participation of people with disability in planning and decision making during response may improve overall inclusion across a humanitarian response.

Identification of positive impacts and outcomes resulting from the increased participation of people with disability in response.

The potential for, and barriers to, building on and incorporating ad hoc initiatives by people with disability in crises and emergencies into the wider response system.

Understanding the roles and effectiveness of organisations of people with disability (OPD) for ensuring the meaningful participation of people with disability in response.

How to ensure representation of diverse groups of people with disability in humanitarian response, including in places where OPDs are not present.

The extent to which employment of people with disability in humanitarian agencies may positively impact on disability inclusion in response.

3.4 HIS 5. Inclusive mechanisms for feedback and complaints

3.4.1 Disability

a. Key info

Two articles. Peer reviewed (1), grey literature (1). (2010, 2019).

China (1), South Sudan (1).

Conflict (1), Earthquake (1).

Camp Management (1), Communications (1).

Quality markers: Tier 1 (1), Tier 3 (1).

b. Evidence summary

Little evidence addressing inclusive mechanisms for feedback and complaints. No articles addressed this HIS as the article’s main focus.

One article notes a camp feedback mechanism for people with disability being criticised by users with disability. Users felt their complaints should go directly to camp managers instead of via representatives of people with disability or the protection desk. (International Organization for Migration, 2019)

Some indication that technology has the potential to improve two-way communication and feedback mechanisms (Fu K W, White J, Chan Y Y, Zhou L, et al, 2010). See notes on use of technology and social media under HIS 2: Access.

c. Gaps

Identification and development of different feedback mechanisms and understanding of their appropriateness.

Understanding challenges to establishing whole-of-response feedback mechanisms across sectors, including monitoring of follow up actions.

How best, and in what circumstances, to apply existing and emerging technologies to improve people-centred feedback mechanisms.

Understanding the extent to which inclusive end-to-end feedback mechanisms may best contribute to demonstrable change across sectors in response.

Understanding how the social (human interaction) aspect of technology-based systems may impact adoption and use by people with diverse information access needs.

3.5 HIS 6. Coordination of inclusive humanitarian assistance

3.5.1 Disability

a. Key info

One peer reviewed article. (2012).

Japan.

Earthquake.

Health.

Quality markers: Tier 3 (1).

b. Evidence summary

Very little evidence on coordination of inclusive humanitarian assistance for people with disability; however, the general need for better coordination in response is noted in several articles (also see HIS 9: Management).

Ad hoc coordination amongst civil society actors improved supply of items required by children with disability and their families post-earthquake.

Establishment of regional coordinators to improve volunteer-led inclusion initiatives in response.

c. Gaps

Identifying and/or developing different coordination mechanisms and how they can best support inclusion and promote the participation of people with disability in response.

Understanding the roles of, and potential to integrate, both formal and informal coordination mechanisms to improve inclusion in response.

Understanding how OPDs and people with disability may best contribute to coordination mechanisms to improve inclusion across response.

3.5.2 Older age

a. Key info

Two peer reviewed articles. (2011, 2018).

USA (2).

Flood (1), Tropical Storm (1).

Health (1), General (1).

Quality markers: Tier 1 (1), Tier 2 (1).

b. Evidence summary

Little evidence on coordination of inclusive humanitarian assistance for older people.

Need to better consider and prioritise residential care facilities for older people in incident management systems and local and regional response plans (McCann D G C, 2011).

Study of local disaster response networks shows low levels of collaboration to support older people. Need to restructure and strengthen local and community response networks to better support older people in response (Ashida S, Zhu X, Robinson E L, et al, 2018).

c. Gaps

Identifying and/or developing different coordination mechanisms and how they can best support inclusion and promote the participation of older people in response.

Understanding the role and effectiveness of both formal and informal coordination mechanisms to improving inclusion for older people in response at community, local and national levels.

How to better integrate older age support services and residential care facilities into local and national response plans.

3.6 HIS 7. Organisational learning for inclusive humanitarian assistance

3.6.1 Disability

a. Key info

Nine articles. Peer reviewed (8), grey literature (1). (2011-2019).

Haiti (1), USA (3), Multiple (2), Global (3).

Chemical Incident (1), Conflict (3), Earthquake (1), General (4).

Communications (1), Health (3), Protection (2), Shelter (2), General (1).

Quality markers: Tier 1 (3), Tier 2 (3), Tier 3 (3).

b. Evidence summary

Evidence relevant to organisational learning for inclusive humanitarian assistance was identified, but no articles directly focus on this topic.

Long-standing awareness of the need for organisational change to increase disability inclusion, but barriers, including outdated perceptions of disability, persist (Twigg J, Kett M, Bottomley H et al, 2011).

Perceptions remain that disability inclusion is the responsibility of specialised agencies (Hunt M R, Chung R, Durocher E, et al, 2015).

Established approaches to disability inclusion, such as the twin-track approach and universal design, yet to be widely applied in humanitarian response (Rohwerder B, 2013).

The humanitarian sector remains largely influenced by the Medical Model of disability (Berghs, 2015). Organisational change is needed to align with the Social Model and rights-based approaches to disability inclusion.

It is not clear the extent that humanitarian agencies go beyond voluntary commitments, such as Sphere standards, and are informed by international humanitarian law and the Convention on the Rights of People (CRPD) (Priddy, 2019).

Management and staff practices (and attitudes) are a barrier to ensuring the accessibility of shelters (Twigg J, Kett M, Bottomley H et al, 2011). Organisations need to look beyond just the physical accessibility of shelters and other infrastructure.

Humanitarian agencies need to update internal and sector specific processes and standards to prioritise disability inclusion (Chilcott R P, Larner J, Durrant A, et al, 2018; Casey-Lockyer M, Myers S, 2017).

Organisational change will be needed to benefit from the application of future technologies to improving response. This will include increased co-design with people with disability (Bennett D, Phillips B D, Davis E, 2016).

c. Gaps

Identification of barriers to, and sources of inertia preventing, humanitarian actors from adopting more inclusive approaches.

Effectiveness of different approaches to ensuring disability inclusion in response beyond voluntary commitments to consideration of mandatory codes of practice at international or national levels.

How to change organisational behaviour and overcome perceptions that disability inclusion is the responsibility of specialised agencies. Also, that barriers to inclusion are not just physical.

3.7 HIS 8. Staff and capacity for inclusive humanitarian assistance

3.7.1 Disability

a. Key info

Six articles. Peer reviewed (5), grey literature (1). (2013-2017).

Japan (1), USA (3), Multiple (2).

Conflict (2), Earthquake (1), General (3).

Communication (3), Health (1), Protection (1), General (1).

Quality markers: Tier 1 (4), Tier 2 (2).

b. Evidence summary

Evidence of the need for training first responders and humanitarian staff in disability inclusion; however, limited evidence on the most effective training delivery or content.

Hearing responders should be trained to communicate with the Deaf, including developing cultural competence (Takamaya, 2017; Kamau P W, Ivey S L, Griese S E, et al, 2017; Engelman A, Ivey S L, Tseng W, et al, 2013).

Deaf people should be trained in psychosocial first aid to better support other Deaf people in disasters (Takamaya, 2017).

Need to co-design trainings with people with disability and increase availability and affordability of trainings for responders (Kamau P W, Ivey S L, Griese S E, et al, 2017).

Specialist staff, such as sexual and reproductive health workers, need training in disability inclusion (Tanabe et al, 2015) and should not be overlooked.

Reflective learning changed negative attitudes of gender-based violence practitioners to working with people with disability (Pearce, 2015).

Online simulations can be a viable medium for teaching disability inclusion to responders (Wolf-Fordham et al, 2014).

c. Gaps

Understanding the effectiveness of different trainings and capacity development on improving inclusion in humanitarian response across sectors.

Assessing the potential for alternatives to formal trainings for improving staff capacity in disability inclusion, such as mentoring and access to resource networks for humanitarian ‘generalists’ and not just for inclusion specialists or focal points.

Development of trainings and capacity development for humanitarian workers on the specific needs of people with different and diverse disabilities in different sectors. This is distinct from trainings and capacity development on disability inclusion in general.

3.7.2 Older age

a. Key info

Two peer reviewed articles. (2017 & 2018).

USA (2).

General (2).

Communications (1), Shelter (1).

Quality markers: Tier 1 (0), Tier 2 (2), Tier 3 (0).

b. Evidence summary

Little evidence on staff and capacity for inclusive humanitarian assistance for older people.

One article focused on older people (Holle C L, Turnquist M A, Rudolph J L, 2018). The other focused on people who are Deaf with reference to older people (Kamau P W, Ivey S L, Griese S E, et al, 2017).

Shelter personnel need to be equipped to distinguish between dementia, depression, and delirium to ensure referral for treatment as required (Holle C L, Turnquist M A, Rudolph J L, 2018).

Older people should be involved in the design of trainings for first responders (Kamau P W, Ivey S L, Griese S E, et al, 2017).

c. Gaps

Development of trainings and staff capacity development on the inclusion of older people in humanitarian response.

Development trainings and staff capacity development on both the general and specific needs of older people of different ages across sectors.

Assessing the potential for alternatives to formal trainings for improving staff capacity on the inclusion of older people, such as mentoring and access to resource networks for humanitarian ‘generalists’ and not just for inclusion specialists or focal points.

Assessing the effectiveness of trainings and capacity development on improving the inclusion of older people in humanitarian response.

3.8 HIS 9. Managing resources for inclusive humanitarian assistance

3.8.1 Disability

a. Key info

Five peer-reviewed articles. (2010-2017)

China (1), India (1), Iran (1), Japan (2).

Conflict (1), Earthquake (4).

Communication (1), Health (3), Shelter (1)

Communications (1), Health (3), Shelter (1).

Quality marker: Tier 1 (3), Tier 2 (1), Tier 3 (1).

b. Evidence summary

Limited evidence on managing resources for disability inclusive humanitarian response.

Most articles related to the health sector, including rehabilitation, mental health, and feeding support.

Neglect of mental health needs of people with disability in conflict affected area due to limited availability of formal services. Informal and ‘traditional’ systems can contribute to providing mental health support in communities. (Joseph J et al, 2017).

Collaboration efforts between rehabilitation agencies improved management and availability of resources across rehabilitation centres post-earthquake (Liu M, Kohzuki M, Hamamura A, et al, 2012).

Multidisciplinary feeding support teams effective at meeting the nutritional and well-being needs people with disability and older people in shelters (Maeda K, Shamoto H, Furuya S, 2017).

Humanitarian agencies need to comply with existing building codes. Also, better consider egress and safety in shelters design and construction (Aryankhesal A, Pakjouei S, Kamali M, 2017).

Need to prioritise restoration of mobile and related communication infrastructure post disaster, including power sources for charging mobile phones and devices (Fu K W, White, J, Chan Y Y, Zhou L, et al, 2010).

c. Gaps

Identification of management strategies to overcome institutional inertia and improve the allocation of resources to promote disability inclusion within humanitarian agencies and across sectors.

Understanding the perspectives of responders and the management challenges they face in ensuring the inclusion of people with disability in response. Also see Hunt M R, Chung R, Durocher E, et al, 2015 under HIS 2: Access.

Assessment of the advantages of deploying multidisciplinary teams with shared responsibilities for disability inclusion across sectors. In contrast to individual or sector specific focal points for inclusion

Understandings of costs and resourcing requirements to better ensure disability inclusion in different sectors, for example to ensure shelters and WASH facilities are constructed using universal design principles.

3.8.2 Older age

a. Key info

Six peer-reviewed articles (6). (2010-2018).

Australia (1), Japan (2), USA (3).

Earthquake (2), Tropical Storm (2), General (2).

Health (1), Shelter (4), General (1).

Quality markers: Tier 1 (4), Tier 3 (2).

b. Evidence summary

Limited evidence on managing resources towards the inclusion of older people in humanitarian response.

Most evidence related to the improvement of access to, and services in, shelters for older people.

Use of spatial modelling and geographic information systems can improve the positioning of shelters by reducing transportation time optimising site accessibility for older people (Horner M W, Ozguven E E, Marcelin J M, et al, 2018).

Multidisciplinary feeding support teams effective at meeting the nutritional and well-being needs and older people and people with disability in shelters (Maeda K, Shamoto H, Furuya S, 2017).

Need for better considerations of access in shelters and longer-term planning needed as older people may be among the last to leave shelters (Japanese Red Cross, HelpAge, 2013).

Relocating older people to temporary housing can lead to a deterioration in physical strength and functioning if there are limited opportunities for moving around or for going outside to access services, such as shops (Ishii T, Ochi S, Tsubokura M, et al, 2015).

Planning and allocation of resources for older people in response can be improved by drawing on experts, such as gerontologists (Cloyd E, Dyer C B, 2010).

An over-reliance by emergency managers on residential care facilities, which are often under-prepared, to effectively support older people in emergencies may result in negative outcomes for older people (Astill S, 2016).

c. Gaps

Identification of management strategies to overcome institutional inertia and improve the allocation of resources to promote the inclusion of older people in humanitarian response.

Understanding the perspectives of responders and the management challenges they face in ensuring the inclusion of older people in response.

Assessment of the advantages of deploying multidisciplinary teams with shared responsibilities for older age inclusion across sectors.

Assess the potential for identifying and drawing on experts, such as gerontologists in response.

Understanding costs and resourcing requirements to better ensure the specific needs of older people are planned for and met in response.

Identification and development of protocols to ensure teams across all sectors allocate resources to including older people in response.

4. Concluding remarks

The humanitarian sector’s increasing awareness of disability has been noted since the 1980s (Mirza M, 2011). However, most of the literature identified in the reviews on the inclusion of people with disbaility in humanitarian response has been published since 2015. 21 In recent years There has also been an increase in the number of publications on the inclusion of older people in humanitarian response. Additionally, there is a growing body of evidence on the impacts of humanitarian crises and disasters on older people and people with disability (as noted in Section A).

Despite these developments, the inclusion of people with disability and older people is still not common practice in humanitarian action. The evidence base on inclusion also remains limited in both breadth and depth.

The HIS were recently established and mapping articles against the HIS, as we have done in this review, has its limitations. However, the integration of the H I S into the Humanitarian Standards Partnership (see Section A.2.3) signals the need for dedicated efforts to include people with disability and older people in humanitarian response. The evidence supports this. It also highlights a need to look beyond general approaches to improving access towards considering what institutional or structural changes may be required across the humanitarian system. Examples include shifting the understanding of humanitarian actors towards social and rights-based approaches to inclusion; increasing staff skills and capacities beyond raising awareness on the importance of inclusion; and mandating, and requiring accountability for, the allocation of resources at all levels of management and coordination.

Viewed across sectors, the evidence clearly points to this being an emerging area of work, and supports the need for increased investment in inclusive practice and related research. The lack of evidence on protection may encourage debate on whether the Protection Cluster should be viewed as the natural lead for the coordination of inclusion in response situations. Similarly, while it may be expedient to combine inclusion efforts for people with disability and older people in practice, this may lead to insufficient attention being given to the specific needs of individuals during response. Further consideration of when and under what circumstances broader inclusion strategies are effective, and for who, is needed.

This is the first report from the Gap Analysis on the Inclusion of People with Disability and Older People in Humanitarian Response. The second report will build on the evidence from the literature reviews and explore the extent to which humanitarian actors and other stakeholders are using available information and resources.

The findings outlined in this report, and in the accompanying annex, provide a firm basis for consideration of key gaps in practice and understanding and, crucially, how they can be filled.

Note 19. See glossary. The Medical Model focuses on ‘fixing’ the individual and their impairment. The Social Model emphasises removing barriers in society and provides the foundation for the CRPD.

Note 20. For information on the Washington Group questions, see: http://www.washingtongroup-disability.com/

Note 21. See the Annex accompanying this report for further information on the distribution of literature and for summaries of each article by sector and HIS.

Annex

Introduction

This annex is supplementary to the first literature review report of the Elrha Humanitarian Innovation Fund (HIF) study:

Gap Analysis on the Inclusion of People with Disability and Older People in Humanitarian Response.

The annex provides additional reference information. It is recommended that the main literature review report is referred to for background information and to provide context. There are three sections as follows.

Section A provides further summary information on each article included in the two literature reviews on disability and older age. The articles are grouped based on the Humanitarian Inclusion Standards for Older People and People with Disabilities (HIS)²² and by sectors. The sectors were identified during the literature reviews on disability and older age. Where no evidence clearly addressing an HIS was identified, that HIS is not listed.

Further information on the quality tiers listed in the tables below are available in the accompanying report. Note that for brevity only the first three authors are listed in the tables below. The number of articles listed in the tables below and the overall number of articles identified in the literature review vary slightly. This is due to some articles being relevant to, and listed under, more than one HIS. This also applies to graphs that are based on HIS categories in Section B.

Section B provides graphical representations of general findings from the literature reviews. These include distributions of articles by date, geographical region, sector, and humanitarian context.

Section C provides a list of guidelines on the inclusion of people with disability and older people in humanitarian response.

Note 22. Age and Disability Consortium (CBM, HelpAge, Humanity and Inclusion). 2018. Humanitarian inclusion standards for older people and people with disabilities. https://reliefweb.int/report/world/humanitarian-inclusion-standards-older-people-and-people-disabilities

Section A. Summary of articles by HIS and sector

HIS 1. Data collection and identification

1. Disability

1.1 Disaster relief and crisis intervention with Deaf communities: lessons learned from the Japanese Deaf community

Author: Takamaya K

Sector: Communications

Year: 2017

Region: Japan

Context: Earthquake

Overview: Describes challenges and interventions post-earthquake for Deaf people. Deaf communities and professionals mobilised quickly to conduct needs assessments. Communication barriers, including with responders, led to some Deaf people sheltering in cars or damaged homes. Lack of data sharing hampered response.

Quality: Tier 2

Relevant findings: Despite relaxing of data protection laws in emergencies, government reluctant to share data on Deaf people with Deaf associations.

1.2 Responding to the health and rehabilitation needs of people with disability post-Haiyan

Author: Benigo M R, Kleinitz P, Calina L, et al.

Sector: Health

Year: 2015

Region: Philippines

Context: Tropical Storm

Overview: Outlines use of WHO individual needs assessment form and establishing a directory of services. With support, provision of rehabilitation services by regional hospital increased. Community awareness of disability increased through CBR programmes. Rehabilitation necessary and effective post-disaster.

Quality: Tier 3

Relevant finding: Include people with disability in post-disaster health assessments.

1.3 Evolution of a nursing model for identifying client needs in a disaster shelter: a case study with the American Red Cross

Author: Springer J, Casey-Lockyer M

Sector: Shelter

Year: 2016

Region: USA

Context: Tropical Storm

Overview: Describes use of three tools to identify needs of people with disability in shelters. Needs identification should be conducted at arrival and be ongoing. Includes observation, check-ins, and use of screening tool (CMIST). Access and functional needs in shelters can be higher than indicated by census data. Needs can go identified for days

Quality: Tier 3

Relevant finding: Data collection to identify health and related needs should be ongoing in shelters. Not only on arrival.

1.4 Using functional needs and personal care assistance rather than disability status during chronic care triage in community mass care

Author: Fannin A, Brannen D E, Howell M, et al

Sector: Shelter

Year: 2015

Region: USA

Context: General

Quality: Tier 2

Overview: Simulation comparing three triage processes to identify arrivals’ access and functional needs at a shelter. The Athena tool that considers client preferences, staff capacity to transfer the client, and availability of a carer proves more effective. Also, need to better consider design, policies, and provision of assistance in shelters.

Relevant finding: Triage that considers the availability of personal assistance is more effective towards meeting specific needs and maintaining rights.

1.5 The Washington Group Short Set of Questions on Disability in disaster risk reduction and humanitarian action: lessons from practice

Author: Sloman A, Margaretha M

Sector: General

Year: 2018

Region: Indonesia, Philippines, Bangladesh

Context: General

Overview: Benefits and challenges of using the Washington Group Questions (WGQ) in disaster risk reduction and humanitarian action. WGQ are an important tool for improving data collection and disability inclusion in response. Combines WGQ with a practical model (Information-Action Model) to guide programme design and delivery.

Quality: Tier 1

Relevant finding: Include people with disability in data collection and ensure sufficient training of data collectors.

1.6 Disability data collection: a summary review of the use of the Washington Group Questions by development and humanitarian actors (G)

Author: Leonard Cheshire, Humanity and Inclusion

Sector: General

Year: 2018

Region: Global

Context: General

Overview: Use of WGQ is contributing to positive institutional change. Challenges remain. Need for additional training on data collection and analysis for advisors and programme staff. Some have concerns that use of the WGQ in conflict can identify high numbers of people with disability due to injury. Also, data collection can be hard or data quickly out of date post-disaster.

Quality: Tier 2

Relevant finding: Organisations need to be clear on the purpose of data collection and use of the WGQ.

2. Older age

2.1 Targeting international food aid programmes: the case of productive safety net programme in Tigray, Ethiopia

Author: Azadi H, De Rudder F, Vlassenroot K, et al

Sector: Food security

Year: 2017

Region: Ethiopia

Context: Drought

Overview: Assesses allocation of food aid in a national programme by socio-demographic factors in response to persistent food insecurity. Most direct support goes to older people, which is consistent with targeting aims. Also, more women than men are beneficiaries of the programme.

Quality: Tier 1

Relevant finding: Age and gender disaggregated data improves targeting of aid and identifying at-risk groups.

2.2 Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy

Author: Lee D C, Gupta V K, Carr B G, et al

Sector: Health

Year: 2016

Region: USA

Context: Tropical storm

Overview: Geographical analysis of medical data to identify diabetic patients post-disaster. Can help target response interventions. Diabetic patients need rapid support to access medication, aftercare post-surgery, and to optimise cardiovascular health to reduce risk of heart attacks.

Quality: Tier 1

Relevant finding: Administrative data and geographical analysis can be effective to identify high risk groups with acute needs.

2.3 How sex- and age-disaggregated data and gender and generational analyses can improve humanitarian response

Author: Mazurana D, Benell P, Walker P

Sector: General

Year: 2013

Region: Global

Context: Drought

Overview: Humanitarian sector remains driven by anecdote and can benefit from better sex and age disaggregated data (SADD). Agency and sector requirements to collect SADD, but rarely done. SADD improves targeting of aid, understanding barriers, and better integrating protection measures.

Quality: Tier 1

Relevant finding: SADD improves response by addressing information gaps that hinder critical decision making.

HIS 2. Access to humanitarian assistance, including accessibility

3. Disability

3.1 Disability and inclusion survey (G)

Author: International Organization for Migration

Sector: Camp Management

Year: 2019

Region: South Sudan

Context: Conflict

Overview: Assesses IDPs with disabilities’ access to services. Barriers include distance, lack of information, physical access, and discrimination. Broad overview of sectors. Reports of people with disability selling food rations to pay for transport to access food distribution sites.

Quality: Tier 3

Relevant finding: Inaccessible humanitarian services lead to multiple disadvantages for people with disability.

3.2 A Facebook page created soon after the Amatrice Earthquake for Deaf adults and children, families, and caregivers provides an easy communication tool and social satisfaction in maxi-emergencies.

Author: Rotondi L, Zuddas M, Marsella P, et al

Sector: Communications

Year: 2018

Region: Italy

Context: Earthquake

Overview: In response to a lack of accessible information, describes the establishment of a Facebook page for Deaf people and their families. The page included sign language safety videos, news, and service numbers. Information was accessible to hearing relatives. Usage and requests for information high, including in non-affected areas.

Quality: Tier 2

Relevant finding: Social media is a cost-effective way to provide quick access to safety information post-disaster for Deaf people.

3.3 People with disability and new disaster communications: access and the social media mash-up.

Author: Kent M, Ellis K

Sector: Communications

Year: 2015

Region: Global

Context: General

Overview: Social media is a ‘mash-up’ of linked platforms. If any platform is inaccessible, linked content can be inaccessible for people with communication needs. Use of inaccessible social media platforms to communicate disaster information increases risk for people with disability.

Quality: Tier 3

Relevant finding: Access to each part of an online social media network needs to follow universal design principles.

3.4 Use of social media during public emergencies by people with disability.

Author: Morris J T, Mueller J L, Jones M L

Sector: Communications

Year: 2014

Region: USA

Context: General

Overview: Comparison of social media use by general population and people with disability. Use of social media low in both groups overall. Younger people used social media more than older people. Deaf and hard-of-hearing respondents were more likely to use social media than other disability types.

Quality: Tier 1

Relevant finding: Use multiple media types to ensure emergency information is accessible to all.

3.5 Breaking news: sign language interpreters on television during natural disasters.

Author: McKee, R

Sector: Communications

Year: 2014

Region: Australia, New Zealand

Context: General

Overview: Use of sign language interpreters in television emergency broadcasts. Describes experiences of interpreters and perceptions from the public. Wider public perceptions were mixed with some finding it ‘distracting’. Positive response from Deaf people.

Quality: Tier 3

Relevant finding: Sign language use on TV raises public awareness of accessibility needs.

3.6 Leveraging online social networks for people with disability in emergency communications and recovery.

Author: Bricout J C, Baker P M

Sector: Communications

Year: 2010

Region: USA

Context: General

Overview: Analytical model for exploring the potential of online social networks to enhance emergency communications for people with disability. Necessary components include civic participation, evidence-based approaches, and policy change.

Quality: Tier 3

Relevant finding: Online networks widen access to resources, reinforce sense of community, and improve two-way emergency communications.

3.7 The outcomes and impact of a post-earthquake rehabilitation program in China: a qualitative study

Author: Chung E Y

Sector: Health

Year: 2017

Region: China

Context: Earthquake

Overview: Post-earthquake CBR programme enhanced functional independence, physical status, and psychosocial well-being. Also effective at mobilizing volunteers and raising awareness. Some people with disability faced challenges adapting to community life later. The original project was not sustained following hand over to local government. This was partly due to introduction of fees.

Quality: Tier 1

Relevant finding: Need better consideration of the sustainability of interventions that improve access to services post-disaster.

3.8 Lessons from the 2015 earthquake(s) in Nepal: implication for rehabilitation

Author: Sheppard P S, Landry M D

Sector: Health

Year: 2016

Region: Nepal

Context: Earthquake

Overview: Medical rehabilitation important in immediate post-disaster phase. Rehabilitation professionals, alongside health staff can facilitate smoother and safe discharge of injured patients and prevent complications.

Quality: Tier 3

Relevant finding: Rehabilitation improves access to healthcare by reducing demand on health system.

3.9 Haitian and international responders’ and decision-makers’ perspectives regarding disability and the response to the 2010 Haiti earthquake

Author: Hunt M R, Chung R, Durocher E, et al

Sector: Health

Year: 2015

Region: Haiti

Context: Earthquake

Overview: Respondents identified people with disability as among the most at-risk. Disability was highlighted early in the response and made visible. Certain disability types (new amputations and spinal cord injuries) received significant attention. Others did not. Despite awareness of disability, limited focus on broader disability inclusion.

Quality: Tier 1

Relevant finding: People with pre-existing disability have less access to response services than people who acquired disability in the disaster.

3.10 Responding to the health and rehabilitation needs of people with disability post-Haiyan

Author: Benigno M R, Kleinitz P, Calina L, et al

Sector: Health

Year: 2015

Region: Philippines

Context: Tropical Storm

Overview: Outlines use of WHO individual needs assessment form and establishing a directory of services. With support, provision of rehabilitation services by regional hospital increased during response. Community awareness of disability increased through CBR programmes. Finds rehabilitation necessary and effective post-disaster.

Quality: Tier 3

Relevant finding: Disaster response is an opportunity to strengthen rehabilitation services.

3.11 Adolescent girls with disabilities in humanitarian settings

Author: Pearce E, Paik K, Robles O J

Sector: Protection

Year: 2016

Region: Multiple

Context: Conflict

Overview: Project experiences involving adolescent girls with disability. Notes increased risk of violence against girls and women with disability in crises. Compounded by exclusion in programming beyond addressing disability related health needs. Recommendations include prioritising right to participation, seeing the girl (not the disability) first, and working with caregivers.

Quality: Tier 2

Relevant finding: Move beyond health-related interventions for women and girls with disability towards broader disability inclusion.

3.12 Disability inclusion: translating policy into practice in humanitarian action (G)

Author: Pearce E, Buscher D

Sector: Protection

Year: 2014

Region: Multiple

Context: Conflict

Overview: Assessment of UNHCR Guidance on Working with Persons with Disabilities in Forced Displacement. Finds discrimination against children with disability common; lack of support networks to protect adolescents with disabilities from violence; concerns over gender based, physical, and psychological violence.

Quality: Tier 2

Relevant finding: Apply twin-track approach, ensure physical security, and equal access to information.

3.13 Post-traumatic stress disorders and mental health care (lessons learned from the Hanshin-Awaji Earthquake, Kobe, 1995)

Author: Takada S

Sector: Protection

Year: 2012

Region: Japan, Indonesia

Context: Earthquake

Overview: Drawing on impact data from Kobe earthquake, describes establishing a ‘Children House’ for children with disability in Indonesia post-earthquake in 2006. The House provided a safe space, exchange of information from children in the two countries, and visiting therapists.

Quality: Tier 3

Relevant finding: Information sharing between children with disability reduces psychological impacts of disaster.

3.14 The effect of situated access on people with disabilities: an examination of sheltering and temporary housing after the 2011 Japan Earthquake and Tsunami

Author: Brittingham R, Wachtendorf T

Sector: Shelter

Year: 2013

Region: Japan

Context: Earthquake

Overview: Access to information and services post-disaster. Situated access draws on the idea of situational justice and refers to location (and shelter type) and social standing in that location. People with disability face inequitable access and ability to utilise information and resources due to both location and social standing.

Quality: Tier 1

Relevant finding: Shelters should follow universal design principles. Reasonable accommodation should be applied to relief distribution.

3.15 Rapid review of disability and older age inclusion in humanitarian WASH (G)

Author: Elrha

Sector: WASH

Year: 2019

Region: Global

Context: General

Overview: Summary of rapid review of evidence gaps. Limited research and few quantifiable outcomes. However, isolated examples of good practice exist. Organised around collection of information, barriers, participation and resilience, and coordination.

Quality marker: Tier 2

Relevant finding: Further research needed to understand what works in improving access to WASH.

3.16 Inclusion of persons with disabilities in humanitarian action: 39 examples of field practices, and learnings from 20 countries, for all phases of humanitarian response (G)

Author: Palmer T, Bertozzi E, Dominik G, et al

Sector: General

Year: 2019

Region: Multiple

Context: General

Overview: Case studies supplementing the Inter-Agency Standing Committee Guidelines on the Inclusion of Persons with Disabilities in Humanitarian Action. Organised around preparedness, data, participation, barriers and coordination. Summary recommendations provided.

Quality: Tier 3

Overview: Accessibility, via universal design and reasonable accommodation, is a pre-requisite for inclusion.

3.17. Missing millions: how older people with disabilities are excluded from humanitarian response (G)

Author: HelpAge, London School of Hygiene and Tropical Medicine

Sector: General

Year: 2018

Region: Multiple

Context: General

Overview: Older people with disability are often neglected in humanitarian response. Limited access to social protection, healthcare, rehabilitation, food, and essential needs. Compounded by poverty, discrimination, insecurity, threats to dignity, and institutional barriers.

Quality: Tier 1

Relevant finding: Access can be improved via strong leadership and low-cost adaptations.

3.18 ‘Working to improve our own futures’: inclusion of women and girls with disabilities in humanitarian action (G)

Author: Women’s Refugee Commission

Sector: General

Year: 2016

Region: Multiple

Context: General

Overview: Although 75% of respondents reported including women and girls with disabilities in response, gaps exist. These include need for greater accountability, support for organisations of women with disability, and the promotion of leadership by women and girls with disability in humanitarian action.

Quality: Tier 2

Relevant finding: Leadership by women with disability can change norms and improve access.

3.19 Every child counts: understanding the needs and perspectives of children with disabilities in the State of Palestine (G)

Author: Jones N, Hamad B A, Odeh K, et al

Sector: General

Year: 2016

Region: Palestine

Context: Conflict

Overview: Children with disability face multiple challenges and limited access to services. Good practices, mostly from rehabilitation organisations, include a child focus and community outreach. Care provided by mothers with little respite. Families’ awareness of rights low.

Quality: Tier 1

Relevant finding: Policy change, resource allocation, and engagement with families needed to improve access to services.

4. Older age

4.1 ‘Fleeing my whole life’ Older people’s experience of conflict and displacement in Myanmar (G)

Author: Amnesty International

Sector: Camp Management

Year: 2019

Region: Myanmar, Bangladesh

Context: Conflict

Overview: Older people at heightened risk in conflict. Rohingya response becoming more inclusive, but camp facilities not meeting specific health, including medication, and WASH needs of older people. Little diversity in diets, lack of access to cooking facilities and food distributions. Preserving dignity and respecting rights important.

Quality: Tier 2

Relevant finding: Consider diversity of people over 60 years and specific access needs. Consult with older people and ensure programmes do not discriminate.

4.2 Needs assessment with elder Syrian refugees in Lebanon: implications for services and interventions

Author: Chemali Z, Borba C P, Johnson K, et al

Sector: Camp Management

Year: 2018

Region: Lebanon

Context: Conflict

Overview: Limited access to services, food, and medications for older people. Many remain unregistered. Additional health needs, including high rates of depression, among older people. Older people may provide emotional support role for wider community.

Quality: Tier 1

Relevant finding: Simplify registration to allow access to camp services, including less (or no) need for official documents that may be lost.

4.3 Older voices in humanitarian crises: calling for change (G)

Author: HelpAge

Sector: Camp Management

Year: 2016

Region: Lebanon, South Sudan, Ukraine

Context: Conflict

Overview: Older people reported limited access to information and services and not being consulted. Few health services for age-related needs and poor psychological health among older people.

Quality: Tier 2

Relevant finding: Systematically engage with all affected people and identify age-appropriate access solutions.

4.4 Older people in displacement: falling through the cracks of emergency responses (G)

Author: Humanitarian Policy Group, HelpAge

Sector: Camp Management

Year: 2016

Region: South Sudan

Context: Conflict

Overview: Older people’s roles change in displacement. Older women may care for orphans. Loss of resources, such as land, can reduce influence and access to community support. Community respect stems from social standing and is not inherent to age. ‘Elders’ who engage with responders may not be representative of ‘older people’.

Quality: Tier 1

Relevant finding: Need more nuanced understandings of older age to ensure appropriate and effective response.

4.5 Exploring the information worlds of older persons during disasters

Author: Pang N, Karanasios S, Anwar M

Sector: Communications

Year: 2019

Region: Indonesia

Context: Volcanic eruptions, storms

Overview: How older people seek and share information in disasters. Access to institutional information needed, but older people may not seek information outside immediate networks. Informal encounters with responders, including in shelters, provided opportunities to access information. Use of broadcast media common. Low use of Internet and social media.

Quality: Tier 1

Relevant finding: Availability of responders improves ‘social access’ to information. Technology based interventions need to also consider social access.

4.6 Disturbed social recognition and impaired risk judgement in older residents with mild cognitive impairment after the Great East Japan Earthquake of 2011: the Tome Project

Author: Akanuma K, Nakamura K, Meguro K, et al

Sector: Communications

Year: 2016

Region: Japan

Context: Earthquake

Overview: Examines older people’s understandings of post-disaster television news and their subsequent decision making. Older people found news hard to understand- not only those with cognitive impairments and dementia. May lead to increased risk-taking behaviour, such as through low awareness of aftershocks.

Quality: Tier 2

Relevant finding: Information access initiatives should consider difficulties some people have interpreting images and visual information.

4.7 How does accessibility to post-disaster relief compare between the aging and the general population? A spatial network optimization analysis of hurricane relief facility locations

Author: Marcellin J M, Horner M W, Ozguven E E, et al

Sector: Logistics

Year: 2016

Region: USA

Context: Tropical Storm

Overview: Analyses location of relief distribution facilities in relation to older people who do not evacuate and the general population. Proposes a spatial model to reduce transportation time and improve access to relief supplies for older people sheltering in place. Based on a scenario where people travel to the facility themselves. Notes direct delivery also needed.

Quality: Tier 1

Relevant finding: Equitable access to relief supplies requires consideration of older people in distribution system design.

4.8 Displacement and older people: The case of the Great East Japan Earthquake and Tsunami of 2011 (G)

Author: Japanese Red Cross, HelpAge

Sector: Shelter

Year: 2013

Region: Japan

Context: Earthquake

Overview: Older adults displaced post-earthquake. Hard to access and utilise shelters, WASH facilities, and distributions. Distributed food and clothing inappropriate or unfamiliar. Positively, new friendships reported. Older people may be last to leave shelters.

Quality: Tier 1

Relevant finding: Consider both immediate and longer term physical and social age-related access needs of older people in shelters.

4.9 Rapid review of disability and older age inclusion in humanitarian WASH (G)

Author: Elrha

Sector: WASH

Year: 2019

Region: Global

Context: General

Overview: Summary of rapid review of evidence gaps. Limited research and few quantifiable outcomes. However, isolated examples of good practice exist. Organised around collection of information, barriers, participation and resilience, and coordination.

Quality marker: Tier 2

Relevant finding: Further research needed to understand what works in improving access to WASH.

4.10 What older people say about their experiences in humanitarian situations: findings from rapid needs assessments and interviews with older people (G)

Author: HelpAge

Sector: General

Year: 2019

Region: Various

Context: General

Overview: Rapid needs assessment summary. Highlights limited access to food, shelter, health, income and issues of safety, dignity and mental health for older people. Calls for better inclusion of older adults in humanitarian response.

Quality: Tier 3

Relevant finding: Enough evidence exists to prioritise improved access for older people in response.

4.11 Rapid need assessment for older people - (RNA-OP) report (G)

Author: HelpAge

Sector: General

Year: 2019

Region: Pakistan

Context: Drought

Overview: Assesses older age and disability inclusion across sectors. Respondents dependent on others for basic needs, unable to reach distributions sites, and limited access to services across sectors. No organisation identified specifically addressing the needs of older people and people with disability.

Quality: Tier 3

Relevant finding: Need for disability and age sensitive distributions and sector wide inclusive response.

4.12 Missing millions: how older people with disabilities are excluded from humanitarian response (G)

Author: HelpAge, London School of Hygiene and Tropical Medicine

Sector: General

Year: 2018

Region: Multiple

Context: General

Overview: Older people with disability are often neglected in humanitarian response. Limited access to social protection, healthcare, rehabilitation, food, and essential needs. Compounded by poverty, discrimination, insecurity, threats to dignity, and institutional barriers.

Quality: Tier 1

Relevant finding: Access can be improved via strong leadership and low-cost adaptations.

4.13 The role and vulnerabilities of older people in drought in East Africa: progress, challenges and opportunities for a more inclusive humanitarian response (G)

Author: Barbelet V, Samuels F, Plank G

Sector: General

Year: 2018

Region: Ethiopia, Kenya, South Sudan

Context: Drought

Overview: NGO study of impacts and role of older people in drought. Older people contribute to livelihoods and as community facilitators. These roles may change in drought. Warns of over romanticising community roles of older people. Progress on inclusion of older people, but actions often ad hoc.

Quality: Tier 1

Relevant finding: Adopt existing inclusion standards. Link with development organisations working on social protection policies and safety net programmes.

4.14 Mind the gap: built infrastructures, sustainable caring relations and resilient communities in extreme weather events

Author: Dominelli L

Sector: General

Year: 2014

Region: UK

Sector: General

Overview: Informal caring in extreme weather events for older people in two villages. Highlights the role women play as carers when the state fails to respond in emergencies. Community roles were gendered with men assuming first responder roles.

Quality: Tier 1

Relevant finding: Care roles assumed in communities do not offset shortcomings in government response.

4.15 Older people’s needs following major disasters: a qualitative study of Iranian elders’ experiences of the Bam earthquake

Author: Ardalan A, Mazaheri M, Naieni K H, et al

Context: General

Year: 2010

Region: Iran

Context: Earthquake

Overview: Four major issues faced by older people post-earthquake: inappropriate service delivery; affronts to dignity; physical safety; and emotional distress. Older people side-lined by response agencies.

Quality: Tier 1

Relevant finding: Prioritisation and age appropriate plans required to ensure relief goods and services are accessible to older people.

HIS 4. Meaningful participation

5. Disability

5.1 Disability and humanitarianism in refugee camps: the case for a travelling supranational disability praxis

Author: Mirza M

Sector: Camp Management

Year: 2011

Region: Thailand, Somalia, Uganda

Context: Conflict

Overview: Outlines evolving awareness of refugees with disability in the humanitarian sector since 1980s. Notes this has not translated into inclusive practice. Provides examples of advocacy by people with disability in camps in response to slow institutional change in the sector.

Quality: Tier 2

Relevant finding: Grassroots activism by people with disability in camp settings is a response to a lack of attention by humanitarian organisations.

5.2 Disabled people and disaster management in New Zealand: examining online media messages

Author: Hay K, Pascoe K M

Sector: Communications

Year: 2018

Region: New Zealand

Context: Earthquake

Overview: Review of online media on disability and disasters over 10 years. Limited coverage of people with disability. Barriers for people with disability in a paradigm that encourages people to self-manage in a disaster. Disability groups engaged with government post disaster, but advocacy needs to be ongoing.

Quality: Tier 1

Relevant finding:People with disability engage with government to improve accessibility post-disaster.

HIS 5. Inclusive mechanisms for feedback and complaints

6. Disability

6.1 Disability and inclusion survey (G)

Author: International Organization for Migration

Sector: Camp Management

Year: 2019

Region: South Sudan

Context: Conflict

Overview: Assesses IDPs with disabilities’ access to services. Barriers include distance, lack of information, physical access, and discrimination. Broad overview of sectors. Describes a feedback mechanism for people with disability.

Quality: Tier 3

Relevant finding: Complaints from people with disability should go directly to camp management. Instead of via the people with disability committee or protection desk.

6.2 Enabling the disabled: media use and communication needs of people with disability during and after the Sichuan earthquake in China

Author: Fu K W, White, J, Chan Y Y, Zhou L, et al

Sector: Communications

Year: 2010

Region: China

Context: Earthquake

Overview: Media use by people with disability post-earthquake. High demand for information. TV and fixed line phone use dropped. Radio, mobile phone, and newspaper use increased. Little use of Internet. Face to face communication important. Peer-to-peer mobile network established pre-disaster reported effective.

Quality: Tier 1

Relevant finding: Potential for media to provide grievance mechanisms between government and affected people.

HIS 6. Coordination of inclusive humanitarian assistance

7. Disability

7.1 Issues in the support and disaster preparedness of severely disabled children in affected areas

Author: Tanaka S

Sector: Health

Year: 2012

Region: Japan

Context: Earthquake

Overview: Experiences of (non-government) response for children with disability. Some parents of children using respirators preferred to shelter in cars so the noise would not disturb others. Recommendations for preparedness for future response, include respite systems for parents and siblings; pre-stocking of medicine and related items (diapers, wipes etc); alternative power supply for respirators; and regional coordinators to manage volunteers.

Quality: Tier 3

Relevant finding: Effective coordination widens access to services for parents and availability of items for children with specific needs.

8. Older age

8.1 A review of hurricane disaster planning for the elderly

Author: McCann D G C

Sector: Health

Year: 2011

Region: USA

Context: Tropical Storm

Overview: Focuses on people with chronic diseases, dialysis dependent, or in residential care. Emphasises importance of an incident management system (IMS) for effective response. Low awareness of IMS amongst care facilities. Need to ensure care facility plans are incorporated into local and regional response plans and give care facilities the same priority for utilities, including electricity, as hospitals in emergencies.

Quality: Tier 2

Relevant finding: Care facilities need to be incorporated into response plans with the same status as hospitals.

8.2 Disaster preparedness networks in rural Midwest communities: organizational roles, collaborations, and support for older residents

Author: Ashida S, Zhu X, Robinson E L, et al

Sector: General

Year: 2018

Region: USA

Context: Flood

Overview: Network analysis of organisations in local disaster coalitions and their support to older people. Stronger collaboration in assessment, planning, and disaster response. Weaker collaboration on equipment acquisition and co-sponsoring of programs. Collaborations to support older residents low.

Quality: Tier 1

Relevant finding: Coalitions should consider their structure, such as use of sub-committees for specific areas of work, to increase the effectiveness of their network.

HIS 7. Organisational learning for inclusive humanitarian assistance

9. Disability

9.1 The future of accessibility in disaster conditions: how wireless technologies will transform the life cycle of emergency management

Author: Bennett D, Phillips B D, Davis E

Sector: Communications

Year: 2016

Region: USA

Context: General

Overview: Using 2015 trends, considers how wireless technologies may improve accessibility in emergency management and response in 2050. For example, wearable technologies to protect first responders; drones and robo-bugs for search and rescue; way finding technology to navigate shelters; hologram technology for communicating with Deaf people. Benefits will include quicker and safer response.

Quality: Tier 2

Relevant findings: Collaboration with disability organisations, prioritisation, and allocation of resources required to maximise benefits.

9.2 Evaluation of US Federal guidelines (Primary Response Incident Scene Management [PRISM]) for mass decontamination of casualties during the initial operational response to a chemical incident

Author: Chilcott R P, Larner J, Durrant A, et al

Sector: Health

Year: 2018

Region: USA

Context: Chemical

Overview: Evaluates decontamination processes for mass casualty chemical emergencies. People with disability included in the simulation. Considerably more time needed for decontamination of people with disability. Need to develop more effective incident response processes for at-risk individuals. Including increasing availability of assistance to speed up overall decontamination time.

Quality: Tier 1

Relevant finding: Increasing availability of assistance for people with disability reduces overall decontamination time.

9.3 Haitian and international responders’ and decision-makers’ perspectives regarding disability and the response to the 2010 Haiti earthquake

Author: Hunt M R, Chung R, Durocher E, et al

Sector: Health

Year: 2015

Region: Haiti

Context: Earthquake

Overview: Respondents identified people with disability as among the most at-risk. Disability was highlighted early in the response and made visible. Certain disability types (new amputations and spinal cord injuries) received significant attention. Others did not. Despite awareness of disability, limited focus on broader disability inclusion.

Quality: Tier 1

Relevant finding: Barriers include costs, disability seen as responsibility of specialised agencies, and perceived inequity by community members if people with disability prioritised.

9.4 Radicalising ‘disability’ in conflict and post-conflict situations

Author: Berghs M

Sector: Health

Year: 2015

Region: Global

Context: Conflict

Overview: Applies a radical social model view of disability to examine how disability is viewed in humanitarianism. Challenges medical humanitarianism as a dominant approach leading to a narrow implementation of the CRPD, including through Sphere guidelines. Calls for better consideration of social justice and emancipatory approaches.

Quality: Tier 2

Relevant finding: Reconsider health and rights in response and better address the social process of inclusion.

9.5 Disability and armed conflict (G)

Author: Priddy A

Sectior: Protection

Year: 2019

Region: Democratic Republic of Congo, Colombia, Palestine, Ukraine, Vietnam

Context: Conflict

Overview: Examines International Humanitarian Law (IHL) and the CRPD. Core Humanitarian Standards on Quality and Accountability fall short of CRPD non-discrimination commitments. Cautions the focus of IHL on limiting effects of conflict differs from CRPD aim of wider societal change. Reminds the CRPD, alongside IHL, continues to apply in conflict situations.

Quality: Tier 1

Relevant finding: Extent humanitarian actors’ responsibilities extend beyond voluntary initiatives, such as Sphere, is under researched.

9.6 Engaging organizations of persons with disabilities in humanitarian responses

Author: Buscher D

Sector: Protection

Year: 2018

Region: Multiple

Context: General

Overview: NGO experience of disability inclusion over 10 years. Disability expertise widely exists but is not utilised. Women and girls with disability rarely engaged. Isolation increases risk and exposure to violence. Women with disability may not be connected to DPOs. DPOs have limited resources and capacities to engage with humanitarian sector.

Quality: Tier 2

Relevant finding: Engaging with DPOs can provide the disability expertise humanitarian actors lack.

9.7 Disability integration throughout the disaster cycle of prepare, respond and recover

Author: Casey-Lockyer M, Myers S

Sector: Shelter

Year: 2017

Region: USA

Context: General

Overview: Draws on CMIST model (communication, maintaining health, independence, safety, and transportation) to discuss allocation of people to general or medical shelters or health care facilities. Shelters should improve provision of medical supplies, accommodate dietary needs, and provide personal assistance services.

Quality: Tier 3

Relevant finding: Agencies need to review and update shelter standards.

9.8 Disability and public shelter in emergencies

Author: Twigg J, Kett M, Bottomley H et al

Sector: Shelter

Year: 2011

Region: Global

Context: General

Overview: Shelters fail to meet the needs of people with disability. Caused by management and staff failings alongside structural weaknesses in disaster management. People with disability invisible to responders and attitudes to disability outdated.

Quality: Tier 3

Relevant finding: Update understandings of disability and improve organisational planning at strategic and operational levels.

9.9 Intellectual disabilities, violent conflict and humanitarian assistance: advocacy of the forgotten

Author: Rohwerder B

Sector: General

Year: 2013

Region: Global

Context: Conflict

Overview: People with intellectual disability in conflict and their consideration in response. Emerging policies and guidelines but a lack of recognition and awareness, including by disability specialised organisations. Not meeting the diverse needs of people with intellectual disabilities compounds the negative impacts of conflict.

Quality: Tier 3

Relevant finding: Attitudinal change needed. Responders should adopt social model, twin track approach, and recognise the diversity of disability.

HIS 8. Staff and capacity for inclusive humanitarian assistance

10. Disability

10.1 Disaster relief and crisis intervention with Deaf communities: lessons learned from the Japanese Deaf community

Author: Takamaya K

Sector: Communications

Year: 2017

Region: Japan

Context: Earthquake

Overview: Describes challenges and interventions post-earthquake for Deaf people. Deaf communities and professionals mobilised quickly to conduct needs assessments. Communication barriers, including with responders, led to some Deaf people sheltering in cars or damaged homes. Lack of data sharing hampered response.

Quality: Tier 2

Relevant findings: Despite relaxing of data protection laws in emergencies, government reluctant to share data on Deaf people with Deaf associations.

10.2 Preparedness Training Programs for Working with Deaf and Hard of Hearing Communities and Older Adults: Lessons Learned from Key Informants and Literature Assessments

Author: Kamau P W, Ivey S L, Griese S E, et al

Sector: Communications

Year: 2017

Region: USA

Context: General

Overview: Reviews trainings to emergency personnel to assist Deaf people and older people. Need collaborative design of trainings and protocols. Also, to provide trainings to care staff and home carers. Responders need audience specific communication skills.

Quality: Tier 2

Relevant learning: Increase availability of affordable trainings with collaborations between Deaf people, older people, and response agencies.

10.3 Responding to the deaf in disasters: establishing the need for systematic training for state-level emergency management agencies and community organizations

Author: Engelman A, Ivey S L, Tseng W, et al

Sector: Communications

Year: 2013

Region: USA

Context: General

Overview: Training gaps for responders on how to include and work with Deaf people in emergencies. Also, Deaf organisations not prepared or trained to support response. Increased effectiveness and improved communication by responders who received training reported.

Quality: Tier 1

Relevant finding: Training with Deaf people improves the cultural competence and effectiveness of responders.

10.4 Intersecting sexual and reproductive health and disability in humanitarian settings: risks, needs, and capacities of refugees with disabilities in Kenya, Nepal, and Uganda

Author: Tanabe M, Nagujjah Y, Rimal N

Sector: Health

Year: 2015

Region: Nepal, Kenya, Uganda

Sector: Conflict

Overview: Explores access to sexual and reproductive health (SRH) services among refugees with disabilities. Varying levels of awareness of SRH. Barriers to accessing services included negative attitudes of service providers, transportation, and inaccessible facilities. High risk of sexual violence reported. Marital status determines how pregnant women treated.

Quality: Tier 1

Relevant finding: SRH service providers need training to improve service delivery to people with disability.

10.5 ‘I see that it is possible’ building capacity for disability inclusion in gender-based violence programming in humanitarian settings (G)

Author: Pearce E

Sector: Protection

Year: 2015

Region: Burundi, Ethiopia, Jordan, Northern Caucasus, Russian Federation

Context: Conflict

Overview: Negative attitudes and discrimination by GBV service providers, family, and community members are frequent barriers to access. Also limited transportation and lack of appropriate communication by service providers.

Quality: Tier 1

Relevant finding: Reflective learning changes GBV practitioners’ attitudes to people with disability.

10.6 Educating first responders to provide emergency services to individuals with disabilities

Author: Wolf-Fordham S B, Twyman J S, Hamad C D

Sector: General

Year: 2014

Region: USA

Context: General

Overview: Evaluates an online program on disability inclusive emergency planning and response. Uses a scenario based learning simulation, including disaster impacts, appropriate interactions and communications, evacuation and planning.

Quality: Tier 1

Relevant finding: Online role-play simulations are viable for training responders on disability inclusion.

11. Older age

11.1 Preparedness Training Programs for Working with Deaf and Hard of Hearing Communities and Older Adults: Lessons Learned from Key Informants and Literature Assessments

Author: Kamau P W, Ivey S L, Griese S E, et al

Sector: Communications

Year: 2017

Region: USA

Context: General

Overview: Reviews trainings to emergency personnel to assist Deaf people and older people. Need collaborative design of trainings and protocols. Also, to provide trainings to care staff and home carers. Responders need audience specific communication skills.

Quality: Tier 2

Relevant learning: Increase availability of affordable trainings with collaborations between Deaf people, older people, and response agencies.

11.2 Safeguarding older adults with dementia, depression, and delirium in a temporary disaster shelter

Author: Holle C L, Turnquist M A, Rudolph J L

Sector: Shelter

Year: 2018

Region: USA

Context: General

Overview: Information on dementia, depression, and delirium among older people in shelters. While beyond the scope of health volunteers to diagnose these conditions, it is important they are aware of these conditions and can refer people as needed. Provides a checklist for use by shelter workers.

Quality: Tier 2

Relevant finding: Capacity of shelter staff determines whether older adults need to transfer to higher level health care or not.

HIS 9. Managing resources for inclusive humanitarian assistance

12 Disability

12.1 Enabling the disabled: media use and communication needs of people with disability during and after the Sichuan earthquake in China

Author: Fu K W, White, J, Chan Y Y, Zhou L, et al

Sector: Communications

Year: 2010

Region: China

Context: Earthquake

Overview: Media use by people with disability post-earthquake. High demand for information. TV and fixed line phone use dropped. Radio, mobile phone, and newspaper use increased. Little use of Internet. Face to face communication important. Peer-to-peer mobile network established pre-disaster reported effective.

Quality: Tier 1

Relevant finding: Need to prioritise end-to-end restoration of mobile communication infrastructure post-disaster, including battery charging facilities for users.

12.2 Conflict and mental health: the experiences of people living with mental illness and disability amidst ongoing conflict.

Author: Joseph J, Soletti A B, Basumatary K

Sector: Health

Year: 2017

Region: India

Context: Conflict

Overview: Examines approaches to mental health and psychosocial support in conflict affected indigenous communities. Highlights a lack of mental health support system and mistrust in outsider interventions due to strong traditional beliefs.

Quality: Tier 2

Relevant finding: Local support mechanisms and informal care systems may provide a foundation for support in absence of formal support services.

12.3 Feeding support team for the frail, disabled, or elderly people during the early phase of a disaster

Author: Maeda K, Shamoto H, Furuya S

Sector: Health

Year: 2017

Region: Japan

Context: Earthquake

Overview: Identified poor oral hygiene, inactivity, malnutrition, appetite loss, eating problems, and swallowing problems among people with disabilities and older adults in shelters. Feeding support by multidisciplinary team in shelters can improve health outcomes immediately after earthquake.

Quality: Tier 3

Relevant finding: Deployment of multidisciplinary disaster feeding support teams improves health and well-being in shelters.

12.4 How did rehabilitation professionals act when faced with the Great East Japan earthquake and disaster? Descriptive epidemiology of disability and an interim report of the relief activities of the ten rehabilitation-related organizations.

Author: Liu M, Kohzuki M, Hamamura A, et al

Sector: Health

Year: 2012

Region: Japan

Context: Earthquake

Overview: Collaboration of rehabilitation related organisations initiated post-earthquake. The organisations were poorly prepared for response, but successfully collaborated. Contributing factors included, establishing institutional coordination mechanisms with costs shared, briefings to teams prior to dispatch, 1-week dispatch period for teams with handover, daily remote support to teams.

Quality: Tier 1

Relevant finding: Collaborative efforts and resource sharing facilitated management of resources for more effective response.

12.5 Safety needs of people with disability during earthquakes

Author: Aryankhesal A, Pakjouei S, Kamali M

Sector: Shelter

Year: 2017

Region: Iran

Context: Earthquake

Overview: Considerations for earthquake resistant construction of shelter. Compliance with building codes essential. Also, safe room setting, ease of evacuation, and adaptation of WASH facilities.

Quality: Tier 1

Relevant finding: Compliance with building regulations needed alongside considerations of internal layout of, and egress from, shelters.

13. Older age

13.1 Feeding support team for the frail, disabled, or elderly people during the early phase of a disaster

Author: Maeda K, Shamoto H, Furuya S

Sector: Health

Year 2013

Region: Japan

Context: Earthquake

Overview: Identified poor oral hygiene, inactivity, malnutrition, appetite loss, eating problems, and swallowing problems among people with disabilities and older adults in shelters. Feeding support by multidisciplinary team in shelters can improve health outcomes immediately after earthquake.

Quality: Tier 3

Relevant finding: Deployment of multidisciplinary disaster feeding support teams improves health and well-being in shelters.

13.2 Special needs hurricane shelters and the ageing population: development of a methodology and a case study application

Author: Horner M W, Ozguven E E, Marcelin J M, et al

Sector: Shelter

Year: 2018

Region: USA

Context: General

Overview: Use of spatial modelling to optimise shelter locations. Included minimising transport costs and maximising site accessibility. Shelter placement needs to be considered alongside further factors including access to essential services and public safety.

Quality: Tier 1

Relevant finding: Geographic information system based modelling has potential to assist in shelter placement.

13.3 Benefits of managing the capacity of special needs shelters with cross-county collaboration: case study in Florida

Author: Alisan O, Kocatepe, A, Tuydes-Yaman H, et al

Sector: Shelter

Year: 2017

Region: USA

Context: Tropical Storm

Overview: Uses geographic information system data and demand scenarios to optimise shelter allocation for older populations. Enhanced collaboration across counties can reduce the need for adding new shelters.

Quality: Tier 1

Relevant finding: Increased efficiency from managing shelter resources and allocations across administrative boundaries.

13.4 Physical performance deterioration of temporary housing residents after the Great East Japan Earthquake

Author: Ishii T, Ochi S, Tsubokura M, et al

Sector: Shelter

Year: 2015

Region: Japan

Context: Earthquake

Overview: Ability to stand, grip strength and functional mobility among temporary housing residents deteriorated compared to those remaining in their own homes. Temporary housing was away from services, such as shops and restaurants. Improved health monitoring of temporary housing residents needed.

Quality: Tier 1

Relevant finding: Locating temporary housing near to community facilities can maintain mobility and functioning of older people.

13.5 Catastrophic events and older adults

Author: Cloyd E, Dyer C B

Sector: Shelter

Year: 2010

Region: USA

Context: General

Overview: Outlines specific needs of older people and key considerations for shelter health workers. Recommends separate shelter areas for older people, involvement of gerontologists, and triage on arrival at shelter to establish who needs personal assistance.

Quality: Tier 3

Relevant finding: Availability of skilled human resources plus adaptations needed for age appropriate shelters.

13.6 Ageing in remote and cyclone-prone communities: geography, policy, and disaster relief

Author: Astill S

Sector: General

Year: 2016

Region: Australia

Context: Tropical Storm

Overview: Finds variations in policies between local councils and an overreliance on in-situ care facilities by emergency managers. Response efforts contributed to negative longer-term economic impacts and outmigration. This led to a lack of family support for older people who remained.

Quality: Tier 1

Relevant finding: Emergency management policies should consider and account for local community capacities and gaps.

Section B. Distribution of articles

Figure 1. Articles by year of publication

Most articles (n= 46) on the inclusion of people with disability in humanitarian response have been published since 2015.

The overall number of articles identified on the inclusion of older people in humanitarian response (n =28) was less than for disability. There has been an increase in publications in the last couple of years.

Figure 2. Articles by region the research was conducted in

[picture]

Most disability articles (19) were either global or addressed multiple countries. Most disability articles with a single country focus were from research in the USA (10) and Japan (5). Little research was identified in other countries. Most articles focusing on individual countries were from Asia (8).

Most older age publications were from the USA (9) followed by articles with a global or multiple country focus (7). Most of the remaining studies were from Japan (4) and other Asian countries (4).

Figure 3. Articles by humanitarian context

[picture]

Most disability articles were general without a focus on a specific humanitarian context (18). The majority of the remaining articles focused on natural hazard disasters (16) with most of these focusing on earthquake response (13). Eleven articles focused on conflict. One article focused on responding to a chemical contamination event. Only one article focused on a slow onset disaster (drought).

Most older age articles were general (9). Four articles addressed conflict and the remainder natural hazard disasters (15) with most focusing on earthquakes (5) and tropical storms (5). Three articles focused on drought.

Figure 4. Article type by HIS

Key

HIS 1 data, HIS2 access, HIS 3 resilience, HIS 4 participation, HIS 5 feedback mechanisms, HIS 6 coordination, HIS 7 organisational learning, HIS 8 staff and capacity, HIS 9 managing resources.

Across the HIS, most of the identified disability articles were from peer reviewed journals (35 out of 46).

Most older age articles addressed HIS 2 (access) and most of these were from grey literature (9 out of 15). All remaining articles for older age (13) under the other HIS were from peer reviewed journals (n = 28).

Figure 5. Quality assessment tiers of articles by HIS

Key

HIS 1 data, HIS2 access, HIS 3 resilience, HIS 4 participation, HIS 5 feedback mechanisms, HIS 6 coordination, HIS 7 organisational learning, HIS 8 staff and capacity, HIS 9 managing resources.

Quality marker tiers from 1 (higher) to 3 (lower).

Differences in the quality of disability articles were found across all HIS. While most disability articles fell under HIS 2 (access), the majority were of lower quality (Tier 3 = 8).

The quality of older age articles scored higher overall with most being in Tier 1. Only two articles under HIS 2 (access) and two under HIS 9 (managing resources) were in Tier 3.

Section C. List of guidelines

Recent years have seen an increase in the number of guidelines on the inclusion of people with disability and older people in humanitarian response. Examples of these guidelines are listed below.

In terms of the evidence base outlined in these annexes and supplementary report, the majority of guidelines listed below do not substantially reference existing literature. Exceptions include the guidelines authored by Akerkar and Bhardwaj, 2018 and Hutton, 2008. Generally, the guidelines refer to case studies and internal resources alongside frameworks, reports, and standards. Some guidelines, such as the IASC 2019 guidelines, have been produced in consultation with people with disability.

General principles of disability inclusion described in the guidelines are also present in the reviewed literature. For example, use of the Washington Group questions, engagement with OPDs, and applying universal design principles.

Akerkar S, Bhardwaj R. 2018. Good practice guide: embedding inclusion of older people and people with disabilities in humanitarian policy and practice. Age and Disability Consortium (ADCAP). 1-60. https://reliefweb.int/sites/reliefweb.int/files/resources/Good%20Practice%20Guide%20ADCAP.pdf

Cordero R P, Mitra G, Tucker M. 2017. Guidance: including children with disabilities in humanitarian action- general. UNICEF. http://training.unicef.org/disability/emergencies/downloads/UNICEF_General_Guidance_English.pdf

Cordero R P, Mitra G, Tucker M. 2017. Guidance: including children with disabilities in humanitarian action- nutrition. UNICEF. http://training.unicef.org/disability/emergencies/downloads/UNICEF_Nutrition_English.pdf

Cordero R P, Mitra G, Tucker M. 2017. Guidance: including children with disabilities in humanitarian action- health and HIV/AIDS. UNICEF. http://training.unicef.org/disability/emergencies/downloads/UNICEF_Health_English.pdf

Cordero R P, Mitra G, Tucker M. 2017. Guidance: including children with disabilities in humanitarian action- child protection. UNICEF. http://training.unicef.org/disability/emergencies/downloads/UNICEF_Child_Protection_English.pdf

Cordero R P, Mitra G, Tucker M. 2017. Guidance: including children with disabilities in humanitarian action- education. UNICEF. http://training.unicef.org/disability/emergencies/downloads/UNICEF_Education_English.pdf

European Civil Protection and Humanitarian Aid Operations. 2019. DG ECHO Operational Guidance: the inclusion of persons with disabilities in EU-funded humanitarian aid operations. European Commission. https://reliefweb.int/sites/reliefweb.int/files/resources/2019-ECHO-Disability-Inclusion-Guidance-Note_EN.pdf

Hartog J. 2014. Disaster resilience in an ageing world: how to make policies and programmes inclusive of older people. HelpAge International. https://www.unisdr.org/2014/iddr/documents/DisasterResilienceAgeingWorld.pdf

HelpAge. 2003. Older people in disasters and humanitarian crises: guidelines for best practice. HelpAge International. https://www.helpage.org/silo/files/older-people-in-disasters-and-humanitairan-crises-guidelines-for-best-practice.pdf

Hutton D. 2008. Older people in emergencies: considerations for action and policy development. World Health Organization. https://www.who.int/ageing/publications/Hutton_report_small.pdf?ua=1

IASC. 2019. Guidelines: inclusion of persons with disabilities in humanitarian action. Inter-Agency Standing Committee. https://interagencystandingcommittee.org/iasc-task-team-inclusion-persons-disabilities-humanitarian-action/documents/iasc-guidelines

Lange K, Mitra G, Wood G. 2019. Guidance on strengthening disability inclusion in humanitarian response plans. Department for International Development (DFID). https://reliefweb.int/report/world/guidance-strengthening-disability-inclusion-humanitarian-response-plans

World Bank. 2017. Including persons with disabilities in water sector operations - a guidance note. World Bank Group. https://openknowledge.worldbank.org/handle/10986/27542