When natural disasters happen: do more good than harm! By Shobha Shukla and Bobby Ramakant

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Whenever natural disasters and humanitarian crises occur, enormous amount of resources are spent on relief and aid services, albeit without knowing whether they will do more good than harm. At a pre-conference symposium organized by Evidence Aid, before 22nd Cochrane Colloquium opens in Hyderabad, India, the message was clear from those with experience in disaster management activities: despite best intentions, lot of interventions are happening without strong evidence that they actually do more good than harm.
Dr Prasanta Mahapatra who superannuated from Indian Administration Services (IAS) as a senior bureaucrat and now represents Institute of Health Systems, Hyderabad, India said: “When faced with any emergency people have a need to do something. Inaction is not an option. Passivity is not an option. People want public health authorities to do something and expect them to know what to do and do what they ought to do. People care about what works rather than what ought to work.”
When disaster strikes, do authorities know what works and what does not, while planning relief and aid interventions? Evidence suggests otherwise.
For instance, one of the belief is: “Dispatchers will hear of the disaster and send response units to the scene.” But reality is often otherwise: “emergency response units, both local and distant, will often self-dispatch!”
Another belief is: “trained emergency personnel will carry out field search and rescue” but often the reality is: “most initial search and rescue is carried out by the survivors themselves.”
Likewise a common belief is: “trained personnel will triage and refer to hospitals, if needed” but reality is often different: “Casualties are likely to bypass onsite triage and go directly to hospitals.”
Another belief is “casualties will be transported to hospitals by ambulance” but often the reality is: “most casualties arrive by a variety of means (private cars, taxis, police, walk, etc)”.
Another much subscribed belief is “casualties will be distributed among hospitals appropriately” but reality is: “most casualties are transported to the closest or most familiar hospitals.”
Planning can make a difference only if it is backed by evidence and other contextual information. “We need to generate original research in India on various aspects of disaster medicine and healthcare. Systematic reviews are important and have their own roles but we need original research too. Most disasters arise from either chaotic dynamic systems or choatic processes” said Dr Mahapatra.
Pointing out conflicting research priorities, he questioned “Why is there more research on earthquake than on flood disasters in India?” Research needs to be done on locally compelling challenges that require evidence to inform programming.
Dr Prathap Tharyan, Director of South Asian Cochrane Centre and Network, housed in Christian Medical College (CMC) Vellore and a co-chair of 22nd Cochrane Colloquium said: “When in 2004 earthquake-triggered Indian ocean tsunami had occurred on 26th December 2004, one of the places most severely affected in India was Nagappatinam in Tamil Nadu, about 500 km away from CMC Vellore. The administration did a fantastic job in mobilising support, but the scale of disaster was very large. Acute stress reactions were common such as acute grief reactions, insomnia, etc. Almost all the people affected by the tsunami were suffering from some form of psychological trauma.”
One of the interventions that is not evidence based was: single session de-briefing. Evidence indicates that single session individual debriefing neither prevented the onset of post-trauma stress disorder (PTSD) nor reduced psychological distress. “Well-meaning but misdirected and sometimes harmful interventions could be prevented if those making decisions about the nature of responses have access to reliable and up-to-date evidence” said Dr Tharyan. Coping mechanisms also exist at individual and community levels that enhance resilience in the face of adversity.
Decision makers need to know what interventions, actions and strategies will work and which do not work, which of them remain unproven and which no matter how well-meaning might be harmful! Undoubtedly decision makers need access to reliable information which might help them take relevant and best possible decisions while responding to disasters. Systematic reviews seek to avoid undue emphasis on single studies, identify all relevant research and appraise its quality, make best use of research already done and maximise the power of the conclusions.
Evidence-based and locally relevant responses to natural disasters and humanitarian crises will save lives, reduce morbidity and enable people and communities to recover more quickly and efficiently.

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