tag:theconversation.com,2011:/fr/topics/hurricane-matthew-32086/articlesHurricane Matthew – The Conversation2023-02-10T17:01:52Ztag:theconversation.com,2011:article/1996372023-02-10T17:01:52Z2023-02-10T17:01:52ZBahamas songbird is under threat of extinction – but preserving old pine forests will help save it<p>The <a href="https://en.wikipedia.org/wiki/Bahama_warbler">Bahama warbler</a>, a small songbird found exclusively on Grand Bahama and Abaco, two islands in the north-east <a href="https://en.wikipedia.org/wiki/Lucayan_Archipelago#/media/File:Map_of_the_Caribbean-Lucayan_Archipelago.png">Bahama archipelago</a> only “became” a species in 2010. But due to its <a href="https://academic.oup.com/auk/article/127/4/932/5148703">limited range</a> and increasingly <a href="https://www.researchgate.net/profile/John-Lloyd-15/publication/228394066_Taxonomy_and_population_size_of_the_Bahama_Nuthatch/links/0912f50d45df51b40d000000/Taxonomy-and-population-size-of-the-Bahama-Nuthatch.pdf">fragmented habitat</a>, the warbler was immediately treated as a species of conservation concern.</p>
<p>In 2016, these islands were devastated by a category five storm called <a href="https://www.nhc.noaa.gov/data/tcr/AL142016_Matthew.pdf">Hurricane Matthew</a>. Storms of this strength pose a serious threat to the Bahamas’s unique <a href="https://theconversation.com/hurricane-dorian-was-also-a-catastrophe-for-the-bahamas-unique-birds-123493">birdlife</a>. So as conservation biologists, we wanted to determine how well the warbler had fared.</p>
<p>In 2018, our University of East Anglia Masters’ students, David Pereira and Matthew Gardner, spent three months <a href="https://www.cambridge.org/core/journals/bird-conservation-international/article/abs/distribution-and-habitat-requirements-of-the-bahama-warbler-setophaga-flavescens-on-grand-bahama-in-2018/2068B09FA0293A394DCF7A80F2F04376">researching</a> birds on Grand Bahama island. They chose Grand Bahama because this island was the sole home of another newly recognised species, the <a href="https://www.researchgate.net/profile/William-Hayes-9/publication/238112811_Grand_Bahama's_Brown-headed_Nuthatch_A_Distinct_and_Endangered_Species/links/02e7e52c27788d6b43000000/Grand-Bahamas-Brown-headed-Nuthatch-A-Distinct-and-Endangered-Species.pdf">Bahama nuthatch</a>. Both species are tied closely to the native Caribbean pine forests that cover (or covered) the islands.</p>
<p>Matthew and David played a recording of the nuthatch’s call in order to attract and observe it. They covered all of the island this way and measured habitats everywhere to work out what particular characteristics are preferred by the two species. The fieldwork went well for the warbler, but much less so for the nuthatch. </p>
<h2>Preferred habitat</h2>
<p>The Lucayan estates, an area in the middle of the island where there are the most remaining pine trees, proved to be the best place for both birds. They recorded 233 warblers there and 94 further east. But at the island’s west and east extremities, where the pines were smallest and their condition poor, they found none. They only recorded a nuthatch on six separate occasions.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/509424/original/file-20230210-14-kicqoq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Grand Bahama's pine forests." src="https://images.theconversation.com/files/509424/original/file-20230210-14-kicqoq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/509424/original/file-20230210-14-kicqoq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509424/original/file-20230210-14-kicqoq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509424/original/file-20230210-14-kicqoq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509424/original/file-20230210-14-kicqoq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509424/original/file-20230210-14-kicqoq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509424/original/file-20230210-14-kicqoq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Daniel Pereira carrying out fieldwork in Grand Bahama’s pine forests.</span>
<span class="attribution"><span class="source">Matthew Gardner</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>On analysing their data, Matthew and David found that the warbler was most likely to be encountered in areas of forest where fewer pines had lost their needles. Pine trees losing their needles is a sign of environmental stress and is induced by wind damage and saltwater penetration. The warbler also lived where <a href="https://en.wikipedia.org/wiki/Thrinax_radiata">thatch palms</a>, a small tree but the largest beneath the forest canopy, were taller.</p>
<p>The warbler forages among pine needles, on thatch palms, and also on tree bark. So naturally, bigger pines and palms will have larger areas in which the species can forage.</p>
<p>Areas that had suffered a degree of burning were also favoured by the Bahama warbler. Pinewoods in the Americas tend to burn every few years. This often occurs when lightning strikes following a period of drought.</p>
<p>Yet these fires are usually “cool”, meaning they affect tree bark and surrounding undergrowth, but rarely the canopy. The larger pine trees and thatch palms survive these fires well.</p>
<p>Bark that has been damaged by fire cracks and lifts. This offers a niche habitat for insects to hide in and breed, meaning there are probably more insects per foraging patch in these areas than elsewhere on the island. This is how David explains the warbler’s use of areas where fires have created such conditions.</p>
<h2>Species under threat</h2>
<figure class="align-center ">
<img alt="A satellite image of a large hurricane in the Caribbean Sea" src="https://images.theconversation.com/files/509410/original/file-20230210-27-rcvo7i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509410/original/file-20230210-27-rcvo7i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509410/original/file-20230210-27-rcvo7i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509410/original/file-20230210-27-rcvo7i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509410/original/file-20230210-27-rcvo7i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509410/original/file-20230210-27-rcvo7i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509410/original/file-20230210-27-rcvo7i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hurricane Dorian in the Caribbean Sea on its way to US mainland in August 2019.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hurricane-dorian-carribean-sea-on-way-1492317566">lavizzara/Shutterstock</a></span>
</figcaption>
</figure>
<p>But a year after the survey, another category five storm completely obliterated Grand Bahama’s forests with winds of up to 185 mph. This storm, called <a href="https://www.nhc.noaa.gov/data/tcr/AL052019_Dorian.pdf">Hurricane Dorian</a>, was one of the most powerful hurricanes ever to make landfall on the Bahama’s and inflicted <a href="https://nypost.com/2019/11/16/damaged-caused-by-hurricane-dorian-totals-3-4b-in-the-bahamas/">US$3.4 (£2.8) billion</a> in damage.</p>
<p>Since the hurricane, there have been no reports of Bahama warblers or nuthatch on Grand Bahama. The <a href="https://www.newscientist.com/article/2215361-hurricane-dorian-may-have-made-a-species-of-bird-go-extinct/">Bahama nuthatch</a> may now be extinct. But birders have more recently reported sightings of the warbler on the neighbouring island of Abaco. We predict that the warbler now only survives there.</p>
<p>Our research may help to conserve the remaining Bahama warbler populations on Abaco. Ensuring habitats include large old pines and tall thatch palms, preferably managed for fire, will be crucial to ensuring the species’ survival.</p>
<p>But climate models show that global warming is <a href="https://www.nature.com/articles/s41467-022-34321-6">increasing</a> hurricane frequency and raising the probability that tropical storms grow into intense, damaging hurricanes in just a few hours. Other <a href="https://www.nature.com/articles/ngeo779">research</a>, carried out in 2010, indicates that tropical storms may become stronger and 2–11% more intense by 2100.</p>
<p>Abaco’s pine forest habitats could be affected by these more intense hurricanes in the future. Surveying the Abaco population of Bahama Warblers is now a matter of urgency to determine the species’ status on the island.</p>
<p>What this sad episode tells us is that conservationists will have to move warblers to other pine islands to establish reserve populations in case the next hurricane makes landfall on Abaco. This has saved other island bird species in the past.</p>
<p>In 2011, 59 <a href="https://www.researchgate.net/profile/David-Wright-60/publication/264309452_Translocation_of_the_Seychelles_warbler_Acrocephalus_sechellensis_to_establish_a_new_population_on_Denis_Island_Seychelles/links/53d7d7da0cf2631430bfc5b6/Translocation-of-the-Seychelles-warbler-Acrocephalus-sechellensis-to-establish-a-new-population-on-Denis-Island-Seychelles.pdf">Seychelles warblers</a> were captured on Cousin Island and released on Frégate Island. By 2013, the population of the Seychelles warbler on Frégate had increased to 80 individuals including 38 of the original birds. However, this method is expensive as it must be determined whether the new region is a suitable host for the new species and would require significant funding and support in the Bahamas.</p>
<p>But time must not be wasted as the threat of extinction to the Bahama Warbler grows with each passing hurricane season. We must now try to secure the most threatened species from extinction.</p><img src="https://counter.theconversation.com/content/199637/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Bahama warbler favours large pine trees and palms, fieldwork shows.Diana Bell, Professor of Conservation Biology, University of East AngliaNigel Collar, Honorary Professor of Biological Sciences, University of East AngliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1226982019-08-30T12:15:19Z2019-08-30T12:15:19ZHow do hospitals know what to do when hurricanes approach?<figure><img src="https://images.theconversation.com/files/290212/original/file-20190829-106524-1lvp7g3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">This file photo shows a building at the Bay Medical Center Sacred Heart hospital damaged from Hurricane Michael in Panama City, Fla. in Oct. 11, 2018.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Hurricane-Michael-Hospitals/3136f6b58cbf464dbc88a15091b8754f/42/0">David Goldman/AP Photo</a></span></figcaption></figure><p>We all expect hospitals to be open and operating when we need them, but extreme weather events like hurricanes are a strain on resources and pose significant challenges for hospitals. </p>
<p>Closing a hospital is an extreme action, but several <a href="https://www.statnews.com/2017/09/09/irma-hospital-evacuations-rundown/">hospitals in Florida, Georgia and South Carolina</a> did just that before the arrival of Hurricane Irma in 2017. </p>
<p>With <a href="http://www.fha.org/facts.html">more than 300 hospitals</a> and a higher share of older adults than any other state, emergency plans for Florida’s hospitals were a critical issue facing emergency planners during those storms. This is true now as well as Hurricane Dorian approaches the state.</p>
<p>As a professor of urban planning, I have studied emergency planning and evacuation and also co-authored an extensive report on how hospitals coped with the aftermath of <a href="https://mceer.buffalo.edu/publications/bulletin/06/20-01/02katrinasem.asp">Hurricane Katrina</a> and <a href="https://mceer.buffalo.edu/publications/Reconnaissance/08-SP07/08-SP07.pdf">Hurricane Gustav</a>. Hospitals plan for catastrophic events, but there are always lessons to be learned. </p>
<p>Hospitals try to stay open and to care for patients already hospitalized and for those who suffer injury or illness from a storm. Here’s how they do it. </p>
<h2>Planning is paramount</h2>
<p>Each hospital is required to have an emergency plan, usually approved by the hospital’s accrediting body. A hospital director and emergency leadership team are responsible for implementing the disaster plan.</p>
<p>A hospital typically convenes a top leadership team and activates the hospital’s Incident Command Center (ICC). Team members coordinate with weather experts, local governments, local law enforcement, ambulance companies and first responders, and communicate with patients and their families. </p>
<p>One of the most difficult decisions facing a hospital’s leadership team as it prepares to face a storm is the decision to evacuate some or all of the hospital’s patients.</p>
<p>Before a storm, a decision would be made to “shelter in place” (prepare the hospital and all patients and staff to “batten down the hatches” and remain in the hospital) or perform a full-scale evacuation, as did several hospitals in the <a href="https://www.statnews.com/2017/09/09/irma-hospital-evacuations-rundown/">Florida Keys, Miami, Tampa and Jacksonville</a> as Irma approached. In that case, patients would be moved to other facilities. This is rare, however, as the risk to patients and costs in time and money are very high. </p>
<p>In some cases, a hospital will transfer certain patients at very high risk should a power outage occur, as a Savannah hospital decided to do in <a href="https://www.statnews.com/2017/09/09/irma-hospital-evacuations-rundown/">transferring newborns from its neonatal unit</a> to hospitals in Atlanta.</p>
<p>Hurricanes can be classified as an expected event, unlike other extreme events that happen spontaneously and without warning, like earthquakes. When a hurricane is predicted, plans are focused on the “zero hour,” or when the hurricane is predicted to make landfall. Major milestones in the emergency plan are performed according to a predetermined schedule in the hours and days leading up to the zero hour.</p>
<p>Hospital staff prepare the hospital to weather a storm. Supplies and equipment must be moved to higher floors in case of flooding. Security must be on hand because of the threat of vandals and looters. At the same time, patients must be continually cared for.</p>
<p>On the patient side, patients who can be discharged from a hospital before a disaster strikes are discharged. New patients are not admitted. Elective surgeries are canceled. Pregnant women and patients who need specialized care, such as the babies in Savannah, may be transferred to facilities out of harm’s way. But transferring a patient is a decision made with great care, as any transfer could produce shocks that put patients in grave danger.</p>
<h2>Preparing for the worst</h2>
<p>The medical staff of doctors, nurses and technicians are typically divided into an “A team,” who would be in place in the hospital when the disaster strikes, and a “B team,” who would be on standby to report to the hospital after the disaster and relieve the A team. Sometimes, the B team is already at the hospital and goes into action to relieve the A team as necessary. </p>
<p>There is no difference in ability between the A and B teams; they are merely called A and B to distinguish between the two groups. That said, staff members with disaster experience are prized employees. </p>
<p>Depending on hospital policy, hospital staff members may be allowed to bring family members and even pets with them to the hospital, since past experience has shown that this practice increases the likelihood they will report to work in the face of the disaster and not flee and abandon their jobs. During <a href="https://www.urban.org/sites/default/files/publication/50896/411348-Hospitals-in-Hurricane-Katrina.PDF">Hurricane Katrina</a>, some hospital staff evacuated New Orleans when they were expected at work, and hospital administrators have since better communicated emergency plans to reassure all staffers that their safety is of prime importance.</p>
<h2>Dealing with the chaos after a storm</h2>
<p>Hospitals also face important decisions about patient care after a storm. To evacuate after a disaster and face aftermath conditions, such as <a href="http://www.history.com/topics/hurricane-katrina">unprecedented flooding in New Orleans</a> following Hurricane Katrina, could be more challenging than evacuating before a disaster. Dangerous hospital evacuations were performed in New Orleans after Hurricane Katrina. If extreme flooding occurs, emergency plans must take into account the fact the surface transportation might not be available.</p>
<p>In the aftermath of a disaster, hospitals may suffer power loss. Emergency plans call for backup power and other contingency systems. Uninterrupted power is critical, since some patients may be connected to lifesaving equipment. </p>
<p>In southern states, where most hurricanes in the U.S. first hit land, air conditioning is vital to patient comfort. Therefore, hospitals in states such as Florida, Georgia and South Carolina must have a plan to ensure air conditioning, when possible. </p>
<p>Hospitals must also be prepared to be self-sufficient in the event that responders cannot reach them. Plenty of food, water and medicine must be on hand. Emergency supplies are always on hand in hospitals, but hospitals order even more if the threat of an extreme event is real, as was the case with Irma.</p>
<h2>Lessons from previous extreme events</h2>
<p>Any time a disaster occurs and a hospital’s ICC is activated, there are lessons to be learned. Hospitals’ experiences in Hurricane Katrina, Hurricane Sandy and other extreme events brought some of those lessons to the forefront.</p>
<p>First, it is especially important to construct resilient building systems, such as electrical, gas, water and sewers. Emergency planners should plan for a backup system to activate should a main system fail. For example, backup generators, which typically had been placed on first-floor or basement maintenance rooms, are now often placed on higher floors after they were wiped out in previous hurricanes and floods. Many hospitals also have their own wells on site (or wells that can be used in emergency).</p>
<p>Second, hospitals must plan to be self-sufficient, in a worst-case scenario for up to a month. Hospitals should be prepared with greater quantities and fuel and critical supplies. Agreements with partners made in advance of disasters can open up channels for faster delivery of supplies.</p>
<p>When disaster strikes, protecting lives is a top priority, and hospital staffers are surely some of the bravest people working to save lives. </p>
<p>Hospital communities should take comfort in their preparation of a disaster plan, and then execute it with adaptability and flexibility. Advanced planning for extreme events allows hospital staff to focus on what they do best – compassionate patient care – when a disaster strikes.</p><img src="https://counter.theconversation.com/content/122698/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel Baldwin Hess does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even in areas predicted to take direct hits from hurricanes and other storms, hospitals must do all they can to stay open. It isn’t an easy task, but preparation and practice help.Daniel Baldwin Hess, Professor, Department of Urban and Regional Planning, University at BuffaloLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1086522019-01-25T11:54:01Z2019-01-25T11:54:01ZIn Haiti, climate aid comes with strings attached<figure><img src="https://images.theconversation.com/files/255428/original/file-20190124-196241-1klsjw3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Haiti had not yet recovered from its devastating 2010 earthquake when it was hit hard by Hurricane Matthew in 2016. It is one of the world's most vulnerable nations to climate change.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Haiti-Hurricane-Matthew/3c9cbaf824854ceb9ed5b34ef298b0b0/56/0">AP Photo/Rebecca Blackwell</a></span></figcaption></figure><p>Perhaps <a href="https://www.theguardian.com/world/2016/oct/04/why-is-haiti-vulnerable-to-natural-hazards-and-disasters">no people</a> know better than Haitians just how dangerous, destructive and destabilizing climate change can be. </p>
<p>Haiti – which had not yet recovered from a massive 2010 earthquake when <a href="https://theconversation.com/caring-for-haitian-women-after-hurricane-matthew-what-we-learned-from-the-2010-earthquake-66799">Hurricane Matthew</a> killed perhaps a thousand people and caused a cholera outbreak in 2016 – is one of the world’s <a href="https://reliefweb.int/report/world/climate-change-vulnerability-index-2017">most vulnerable countries</a> to climate change. </p>
<p>Scientists say extreme weather events like hurricanes, floods and droughts will become worse as the planet warms. <a href="http://www.undp.org/content/undp/en/home/presscenter/pressreleases/2017/09/18/small-island-nations-at-the-frontline-of-climate-action-.html">Island nations</a> are expected to be among the hardest hit by those and other impacts of a changing climate, like shoreline erosion.</p>
<p>For poor island countries like Haiti, <a href="https://www.oxfam.org/sites/www.oxfam.org/files/rr-climate-change-resilience-haiti-260314-en.pdf">studies show</a>, the economic costs, infrastructural damage and loss of human life <a href="https://www.germanwatch.org/sites/germanwatch.org/files/Global%20Climate%20Risk%20Index%202019_2.pdf">is already overwhelming</a>. And scientists expect it will only get worse.</p>
<p>To help Haiti address this pending crisis, international donors have stepped in with funding for climate action. The problem with that system, as I found in a <a href="http://environment.harvard.edu/events/2018-11-05-173000-2018-11-05-184500/addressing-climate-change-haiti-are-current-actions">recent analysis of international climate aid in Haiti</a>, is that the money may not be going where it’s most needed.</p>
<h2>Extreme vulnerability</h2>
<p>Though Haiti’s greenhouse gas emissions amount cumulatively to <a href="https://www.climatelinks.org/sites/default/files/asset/document/Haiti%20Fact%20Sheet%20-%20rev%2010%2008%2016_Final.pdf">less than 0.03 percent of global carbon emissions</a>, it is a full participant in <a href="https://unfccc.int/news/haiti-submits-its-climate-action-plan-ahead-of-2015-paris-agreement">the 2015 Paris climate agreement</a> and has committed to reduce its greenhouse gas emission by 5 percent by 2030.</p>
<p>To meet that goal, Haitian officials say, the Caribbean country must switch 1 million traditional light bulbs for more efficient LED bulbs, grow 137,500 hectares of new forest and shift 47 percent of its electricity generation to renewable sources. Those are just a few objectives in Haiti’s <a href="https://www4.unfccc.int/sites/submissions/INDC/Published%20Documents/Haiti/1/CPDN_Republique%20d'Haiti.pdf">2015-2030 climate plan</a>.</p>
<p>It needs help to meet them. </p>
<p>Haiti is among the poorest countries in the Western Hemisphere. Nearly 60 percent of the population lives on less than US$2.41 per day, according to <a href="http://www.worldbank.org/en/country/haiti/overview">the country’s 2012 household survey</a>, the most recent poverty data available. </p>
<p>More than <a href="https://www.cfr.org/backgrounder/haitis-troubled-path-development">20 percent of its national budget</a> is funded by loans from the World Bank and the International Monetary Fund – a setup that gives international lenders an unusual level of control <a href="https://theconversation.com/haitis-deadly-riots-fueled-by-anger-over-decades-of-austerity-and-foreign-interference-100209">over Haiti’s government expenditures</a>. </p>
<p>The same is true of <a href="https://www.oxfam.org/sites/www.oxfam.org/files/rr-climate-change-resilience-haiti-260314-en.pdf">Haiti’s climate mitigation efforts</a>. The majority of the money behind its 15-year plan to finance climate mitigation and adaptation activities – from disaster preparation and renewable energy development to increasing food security – also comes from international donors.</p>
<p>The crowdsourced nature of Haiti’s climate budget can make it hard to determine just how much money Haiti has to spend – and what, exactly, the government can spend it on. </p>
<p>So, last year, I worked with the Climate Policy Lab at the Fletcher School at Tufts University to analyze Haiti’s climate budget. </p>
<h2>A hodgepodge of climate funding</h2>
<p>In an unpublished 2018 study, we found that the World Bank and Inter-American Development Bank are the two biggest donors to Haiti’s $1.1 billion climate fund. Switzerland is also a major financier, having given the Caribbean nation $64.4 million since 2009, as is Japan, which has given $14.8 million to help fund Haiti’s climate efforts.</p>
<p>Most of this $1.1 billion comes in the form of grants, not loans – it’s free money. And, in a country with a gross domestic product of $8 billion, $1.1 billion for climate mitigation is a substantial sum of money. </p>
<p>However, as <a href="http://environment.harvard.edu/events/2018-11-05-173000-2018-11-05-184500/addressing-climate-change-haiti-are-current-actions">my recent analysis of the Tufts climate study shows</a>, the bulk of the money appears to be misallocated. </p>
<p>Numerous international donors, each of which has set its own climate objectives, fund climate action in the country. The result, I found in my analysis, is that Haiti’s climate budget is a mashup of donor priorities that puts too much money behind certain initiatives while underfunding other environmental needs. </p>
<p>Fully 70 percent of Haiti’s $1.1 billion climate budget – $773 million – is earmarked for making energy production more sustainable in Haiti. This involves improving hydroelectric power and increasing solar usage, among other energy upgrades. </p>
<p>Renewable energy may have seemed like a sensible priority for the World Bank and other individual donors. But, put together, this is a disproportionately high investment for a country with <a href="https://www.iied.org/qa-haiti-aims-for-31-co2-emission-reduction-2030">such low carbon emissions</a>, my analysis shows. My research suggests the money could be better used to connect more Haitians to the energy grid. Currently, just <a href="https://www.bu.edu/ise/files/2018/03/FINAL-Haiti-Electricity-Report-March-2018.pdf">20 percent of Haitians</a> – most of them in Port-au-Prince – have semi-reliable electricity. Power is a necessity after any disaster. </p>
<p>Reforestation projects are also notably absent in Haiti’s climate budget. </p>
<p>Haiti is the Caribbean’s <a href="https://earther.gizmodo.com/has-haiti-lost-nearly-all-of-its-forest-its-complicate-1830108360">most deforested nation</a>. <a href="https://www.sciencedirect.com/science/article/pii/S0303243414000300">Seventy percent of forests</a> on the island have disappeared since the late 1980s. It desperately needs reforestation projects to <a href="https://psmag.com/environment/haiti-is-set-to-lose-its-forests-in-twenty-years">reduce flooding, coastal erosion and water pollution</a> and prevent mudslides. </p>
<p>Yet in my analysis of the total $116 million in donor funds earmarked for watershed management and soil conservation, I found barely a mention of reforestation. </p>
<h2>Mismatch between perception and reality</h2>
<p>Other areas of Haiti’s climate change plan are somewhat better funded but, to my mind, misguided. </p>
<p>Take disaster risk reduction, for example. Of the $269 million earmarked for reducing disaster risk in Haiti, most funds are set aside for rebuilding after disasters. </p>
<p>That may seem sensible in a country prone to earthquakes, flooding and hurricanes, but research shows that <a href="https://www.unenvironment.org/news-and-stories/press-release/new-research-lays-out-how-deliver-investment-sustainable">sustainable construction</a> – not merely rebuilding – better prepares a country for disasters and other long-term effects of climate change. Planning saves time, energy, money and human life.</p>
<p>Haiti’s international donors have set aside little money for ensuring that new highways, buildings and other critical infrastructure in Haiti are constructed in a resilient, climate-ready manner – before the next big disaster happens. </p>
<h2>Addressing the power imbalance</h2>
<p>This kind of mismatch between local needs and donor priorities is a common hazard of internationally funded budgets. </p>
<p>Donors call the shots about how their money is spent from afar. Often they don’t have enough on-the-ground information to be making such important executive decisions. </p>
<p>In interviews, local Haitian officials <a href="http://environment.harvard.edu/events/2018-11-05-173000-2018-11-05-184500/addressing-climate-change-haiti-are-current-actions">told me</a> that the municipal agencies that actually engage with people and communities have little say over how they may spend climate funds or which environmental projects are implemented.</p>
<p>In Haiti, this problem is not limited to climate funding – <a href="https://journals.openedition.org/poldev/1625">it’s a hazard of running a national government</a> on the largess of other countries.</p>
<p>Last year, the International Fund for Agricultural Development, a United Nations donor agency, <a href="https://www.ifad.org/documents/38714170/39150184/Enabling+the+rural+poor+to+overcome+poverty+in+Haiti.pdf/1572827b-a187-4635-a706-46a0daaabf88">announced a community-based strategy</a> to building climate resilience in Haitian agriculture by partnering with local organizations and agencies. </p>
<p>“This community-based approach <a href="https://webapps.ifad.org/members/lapse-of-time/docs/english/EB-2018-LOT-P-5-Rev-1.pdf?attach=1">will support Haitians working together</a> to enhance their economic potential, resilience and coping strategies when faced with climatic and economic shocks,” a 2018 report said.</p>
<p>My climate research in Haiti supports this assessment.</p>
<p>If international donors allow Haitian
authorities more control over funding, working more closely with local community organizations, they would not only help address its most important needs, the strategy would be cost-effective. Money channeled to where Haiti most needs it is money well spent.</p><img src="https://counter.theconversation.com/content/108652/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Keston K. Perry is a former postdoctoral scholar at the Center for International Environment and Resource Policy, Fletcher School, Tufts University.</span></em></p>Haiti is extremely vulnerable to climate change. It is also very poor. International donors have stepped in to help the country fund climate mitigation, but is the money going where it’s most needed?Keston K. Perry, Postdoctoral researcher, SOAS, University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/861932018-01-25T11:39:01Z2018-01-25T11:39:01ZWhy climate change is worsening public health problems<figure><img src="https://images.theconversation.com/files/202891/original/file-20180122-182968-19hqzwv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People collect water piped in from a mountain creek in Utuado, Puerto Rico on Oct. 14, 2017, in the aftermath of Hurricane Maria. Hundreds of thousands of Puerto Ricans were still without running water. </span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Puerto-Rico-Environmental-Crisis/8caf29f0169c47fb8a4f96c3b9da51fb/175/0">AP Photo/Ramon Espinosa</a></span></figcaption></figure><p>Around the world, the health care debate often revolves around access. </p>
<p>Dr. Tedros Adhanom Ghebreyesus, head of the World Health Organization, recently announced: “All roads lead to universal health coverage.” Discussions for how to translate this vision into a road map for action is central to the agenda of the <a href="http://apps.who.int/gb/ebwha/pdf_files/EB142/B142_13-en.pdf">WHO’s executive board</a> meeting this week in Geneva. </p>
<p>Yet focusing on access is not enough. The imperative for access must be paired with a frank acknowledgment that climate change is making communities around the world more vulnerable to ill health. A <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32464-9/fulltext?elsca1=tlpr">2017 commission of The Lancet</a>, a leading health research journal, tracked the effects of climate change on health and found evidence of harms “far worse that previously understood.”</p>
<p>Even as we move to close the access gap, a string of natural disasters in late 2017, including successive hurricanes and widespread forest fires, threaten to widen the vulnerability gap.</p>
<p>As a global health professional (Sosin) and a cultural anthropologist (Kivland), we have witnessed how the global exchange of health technology, expertise and aid has contributed to dramatic gains in the delivery of health care in Haiti and other settings, especially around infectious diseases. Yet climate change threatens to undermine the health gains in vulnerable communities across the globe. </p>
<p>As firsthand witnesses to sharp health disparities globally, we argue that world leaders need to insist that any health care strategy must address the social and environmental vulnerabilities driving poor health in the first place.</p>
<h2>The health burden of climate change</h2>
<p>Climate scientists argue that global warming is exacerbating extreme weather events. And natural disasters are often the source of health crises, particularly in fragile settings. Consider the case of Puerto Rico. The official death toll of the storm was estimated at 64; however, later reports have estimated that the disruption of health care services contributed to <a href="https://www.nytimes.com/interactive/2017/12/08/us/puerto-rico-hurricane-maria-death-toll.html">upwards of 1,052 deaths</a> on the island. </p>
<p>Lagging recovery efforts have exposed how natural disasters deepen the relationship between socio-economic inequality and health disparity. In Puerto Rico, <a href="https://www.puertoricoreport.com/how-mississippi-is-catching-up-and-puerto-rico-is-not/#.WfNWfEyZNE5">where poverty rates are double those of the poorest continental state</a>, <a href="http://www.miamiherald.com/news/weather/hurricane/article175955031.html">people already struggling with illnesses such as diabetes and kidney disease</a> have seen their conditions worsen as the long-crumbling health care system is overwhelmed with patients and neglected by the mainland government.</p>
<p>The <a href="https://theconversation.com/flooding-from-hurricane-harvey-causes-a-host-of-public-health-concerns-83134">health impacts of the storms </a>may persist even beyond the restoration of health services.</p>
<p>Hurricane Harvey exposed the toxic afterlife of disastrous storms. <a href="https://www.nytimes.com/interactive/2017/09/08/us/houston-hurricane-harvey-harzardous-chemicals.html?_r=0">Storm damage to 40 industrial sites</a> released chemical toxins linked to cellular damage, cancer and other long-term health problems. As <a href="http://www.thelancet.com/commissions/pollution-and-health">The Lancet’s Commission on Pollution and Health</a> found, air, water and soil pollution is now the leading environmental cause of death and disability, accounting for more than 9 million deaths annually. These numbers will only grow in the face of climate-induced disasters.</p>
<p>Restoring health care systems is vital for these communities, but it will merely treat the symptoms and not the causes of post-disaster illness. We believe that policymakers must address the link between environmental and health crises.</p>
<h2>Haiti as case study</h2>
<p>We have learned this lesson from our work in Haiti. Once a death sentence in rural Haiti, today HIV is largely controlled thanks to widespread access to antiretroviral therapy. The prevalence of the disease in pregnant women fell from <a href="http://www.nbcnews.com/id/31755066/ns/health-aids/t/haiti-surprise-good-news-about-aids/#.WfNXOEyZNE5">6 percent to just over 2 percent </a> in the 10-year period from 1993 to 2003. Likewise, vaccines against cholera, introduced in 2015,<a href="https://www.scientificamerican.com/article/vaccine-haiti-cholera/">have proven to be up to 90 percent effective against the disease</a>.</p>
<p>However, even as vaccine coverage continues to grow, the population remains at risk for cholera and other emergent threats. Only 58 percent of the population has access to safe water and only 28 percent has access to <a href="https://www.globalwaters.org/WhereWeWork/LAC/Haiti">basic sanitation</a>. These conditions worsen in the wake of natural disasters. <a href="https://www.nytimes.com/2016/10/15/world/americas/cholera-haiti-hurricane-matthew.html">Hurricane Mathew in 2016</a> triggered spikes in cholera and other waterborne diseases, especially diarrhea, <a href="http://www.who.int/mediacentre/factsheets/fs330/en/">the second leading cause of death among children</a>.</p>
<p>Hitting the one region of Haiti that had not yet been denuded of trees and vegetation, Hurricane Matthew seemed to complete the destruction of the country’s food systems. </p>
<p>Since the late 1980s, the erosion of waterways, loss of habitats and destruction of agricultural land have fueled the importation of cheap, processed foods. Rice and pasta have replaced a diet once rich in fruits, vegetables and whole grains. The high-sugar, low-nutrition foods contribute to the dual health burdens of obesity and under-nutrition. </p>
<p>These trends are ongoing, but they are <a href="https://health2016.globalchange.gov/">exacerbated by the disastrous shocks of extreme weather events</a>, which are made more likely by climate change. As Hurricane Matthew came ashore, it decimated fishing villages and tore through farming communities, killing livestock, uprooting crops and denuding backyard fruit trees. The United Nations estimated that <a href="https://www.washingtonpost.com/world/the_americas/a-month-after-hurricane-matthew-800000-haitians-urgently-need-food/2016/11/03/382cb2a6-9f74-11e6-8864-6f892cad0865_story.html?utm_term=.854ada106f6d">800,000</a> people suffered food shortages. </p>
<h2>Closing the vulnerability gap</h2>
<p>Haiti is often cast as behind the global curve. But as a reflection of the dangerous intersection of climate change, poverty and ill health, it is in fact predictive of what is to come in the rest of the world. Haiti teaches us that our own health is not bound up simply in the present decisions we make about health care systems but rather more broadly situated in the changing natural environment.</p>
<p>Closing the access gap has been a long battle and the gains cannot be underestimated. Yet the challenge ahead is even more daunting. Whereas increasing access has centered on extending health care technologies to underserved populations, closing the vulnerability gap will require approaches that extend beyond the health sector and national borders.</p>
<p>In the past year, the health care debate in the U.S. has centered on attempts to limit or expand access to care. Meanwhile, the Trump administration has left the Paris climate accord and unraveled environmental protections for national and transnational corporations – with little resistance from health advocates. We believe that leaders must recognize that environmental policy is health policy. Rollbacks of environmental regulations will cause far greater consequences on health, in the U.S. and globally, than any health care bill. </p>
<p>Fixing health care systems while we undermine the environmental conditions for health are a textbook example of what Haitians describe as “lave men, swiyè atè"—washing your hands but drying them in the dirt.</p><img src="https://counter.theconversation.com/content/86193/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Climate change threatens to widen the health gap between the haves and have-nots. Here’s why addressing environmental issues that drive poor health is a starting point.Chelsey Kivland, Professor of Anthropology, Dartmouth CollegeAnne Sosin, Global Health Initiative Program Manager, Dartmouth CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/836942017-09-11T00:26:41Z2017-09-11T00:26:41ZCholera fears rise following Atlantic hurricanes: Are we making any progress?<p>As hurricanes barrel through some of the most impoverished communities in the Western Hemisphere, and as floods ravage <a href="http://www.aljazeera.com/news/2017/08/floods-kill-dozens-central-southern-yemen-170830134822650.html">Yemen,</a> <a href="http://www.aljazeera.com/news/2017/08/400-killed-sierra-leone-floods-170818103301675.html">Sierra Leone</a>, <a href="http://www.express.co.uk/news/world/847710/monsoon-kills-1200-india-nepal-bangladesh-hurricane-harvey">Bangladesh and India</a>, now is the time to rethink and prioritize cholera epidemic prevention and response.</p>
<p>In the aftermath of Hurricane Matthew in 2016, a surge of cholera in Haiti increased the <a href="https://www.nytimes.com/2016/10/15/world/americas/cholera-haiti-hurricane-matthew.html?mcubz=0">death toll from the disease</a>. Officials in Haiti this week are already urging people to <a href="https://www.nytimes.com/2017/09/07/us/destruction-caribbean-irma-florida.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=a-lede-package-region&region=top-news&WT.nav=top-news">add bleach to their drinking water</a> to prevent the spread of cholera in the aftermath of Irma. </p>
<p>I am a medical anthropologist, and I’ve worked for over a decade in parts of the Horn of Africa regularly affected by outbreaks of cholera and other infectious diseases. I am concerned about cholera in the Caribbean in the aftermath of Irma and other hurricanes on the horizon. But there is some good news – if we take action. </p>
<h2>Rare in wealthy nations, but too common in impoverished ones</h2>
<p>Cholera is an infamous scourge, particularly in impoverished, flooded and war-torn areas. It causes a severe form of <a href="https://www.cdc.gov/cholera/illness.html">diarrhea</a> and can quickly lead to death if left untreated. </p>
<p>In books detailing its <a href="https://books.google.com/books?id=8R3NrzE8veEC&dq=The+Ghost+Map:+The+Story+of+London%27s+Most+Terrifying+Epidemic--and+How+It+Changed+Science,+Cities,+and+the+Modern+World&source=gbs_navlinks_s">historical</a> and <a href="https://books.google.com/books?id=oiAOYIwRarQC&dq=cholera+briggs&source=gbs_navlinks_s">social significance</a> and in recent media reports from <a href="http://www.reuters.com/article/us-yemen-cholera-sanitation-idUSKBN1AC1W9?il=0">Yemen</a>, <a href="http://www.huffingtonpost.com/entry/concerning-cholera-in-sudan-an-open-letter-to-dr-tedros_us_59789554e4b0c6616f7ce68d">Sudan</a> and <a href="http://www.nation.co.ke/counties/nairobi/Cholera-outbreak-in-Nairobi-worries-residents/1954174-4024430-1s8o3a/index.html">Kenya</a>, cholera is depicted as a symbol of savagery, state failure and filth. However, these portrayals and the sensationalism of cholera in our popular culture and news media obscure the fact that today, with concerted efforts, we can actually prevent, detect and stop its emergence and spread.</p>
<p>Cholera is caused by the ingestion of the bacterium <a href="https://www.cdc.gov/cholera/index.html"><em>Vibrio cholerae</em></a>, which is often present in water or food that is contaminated with fecal matter. Cholera outbreaks occur when water pipes or sewage systems fail or do not exist at all, and where cholera already exists in the environment. </p>
<p>Epidemic outbreaks of cholera typically happen in impoverished countries also affected by conflict or disasters: Today this includes <a href="http://www.who.int/hac/crises/ssd/sitreps/south-sudan-cholera-update-30june2017.pdf?ua=1">South Sudan</a>, <a href="http://www.southsudannewsagency.com/index.php/2017/06/25/cholera-epidemic-sudan-now-reaches-darfur-rainy-season-begins-earnest-implications-terrifying/">Sudan</a>, <a href="http://reliefweb.int/report/haiti/epidemiological-update-cholera-4-may-2017">Haiti</a>, <a href="http://www.who.int/csr/don/21-july-2017-cholera-kenya/en/">Kenya</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455997/">all the countries in the Horn of Africa</a>, <a href="http://www.reuters.com/article/us-yemen-cholera-sanitation-idUSKBN1AC1W9?il=0">Yemen</a> and the <a href="http://www.who.int/wer/2016/wer9123.pdf?ua=1">Democratic Republic of Congo</a>. In 2010 United Nations peacekeepers <a href="http://www.fbrhaiti.org/uploads/1/6/3/3/16331678/haitis_cholera_4.1.12.pdf">reintroduced cholera to Haiti</a> during the disaster response there, subsequently <a href="http://www.ajtmh.org/docserver/fulltext/10.4269/ajtmh.17-0582/tpmd170582.pdf?expires=1504644867&id=id&accname=guest&checksum=3A8E2851A0ED8C75C2FFCD9E89028CB6">killing over 10,000 people</a>. And in just the last four months in Yemen, about <a href="http://reliefweb.int/sites/reliefweb.int/files/resources/Yemen_daily_epi_update_20170725.pdf">2,000 cholera deaths</a> have been reported. Most of the people who die of cholera today are children. </p>
<p><a href="https://www.cdc.gov/cholera/illness.html">Symptoms of cholera</a> typically begin anywhere from two to five days after infection, but patients who are already malnourished or sick with other ailments can actually die within hours. Cholera is far more deadly than other diarrheal diseases, and it is not simply caused by people failing to properly wash their hands. It is a highly pathogenic, frightening, fast-moving, killer bacterium that can spread like wildfire in crisis-affected communities.</p>
<h2>A case of denial?</h2>
<p>To make matters worse, in recent years, due to the stigma of cholera and fears of its potential <a href="http://www.who.int/bulletin/volumes/90/3/11-093427/en/">effects</a> on tourism and trade, public health authorities in several countries have euphemistically classified suspected cholera cases as “acute watery diarrhea” or “AWD.” For example, this year, in the weeks preceding the election of the new director general of the World Health Organization, accusations surfaced that Dr. Tedros Adhanom Ghebreyesus, then a leading candidate for the position, repeatedly <a href="https://www.nytimes.com/2017/05/13/health/candidate-who-director-general-ethiopia-cholera-outbreaks.html">covered up</a> cholera outbreaks in his home country. By not providing laboratory tests for suspected cholera cases, public health officials in Ethiopia and elsewhere have effectively hidden its emergence and spread.</p>
<p>But there is good news: Cholera is now more easily detectable, preventable and controllable than ever before.</p>
<p>Even in areas without adequate or functioning laboratories, a new <a href="http://onlinelibrary.wiley.com/doi/10.1111/tmi.12252/full">Crystal VC dipstick rapid test</a> can <a href="http://www.ajtmh.org/content/journals/10.4269/ajtmh.15-0496">enable disease surveillance and provide early warning</a> that an outbreak of cholera is unfolding. These rapid diagnostic tests were designed specifically for use in resource-constrained environments and humanitarian emergencies.</p>
<p>Plus, killed oral cholera vaccines (kOCVs) are now a <a href="http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30359-6/fulltext">proven tool</a> for cholera prevention and control. Thanks to the vaccines’ efficacy and herd immunity, only two doses of kOCVs have an average of 76 percent effectiveness in outbreak situations, and can provide protection for at least three years, if not longer. Even just one dose of a kOCV can provide <a href="http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30359-6/fulltext">short-term protection</a>, making it a practical option in outbreaks in which a rapid reduction in short-term risk is needed.</p>
<p>With these new and inexpensive technologies, we as a global health community should now work to realize the potential for cholera early interventions and outbreak prevention – even before floods, hurricanes, wars and other crises unfold. The World Health Organization has led the way in developing <a href="http://www.who.int/cholera/surveillance/en/">surveillance</a> mechanisms and <a href="http://www.who.int/cholera/kit/en/">ready-to-go kits</a> for first responders, but more must be done.</p>
<p>There are still far too few investments in infrastructure projects in the places at highest risk of cholera outbreaks. Cholera provides undeniable evidence of people’s longstanding – not just sudden – lack of clean water and sanitation facilities. Refugee camps and makeshift shelters are rarely only temporary habitations; people usually end up living there for years if not decades. </p>
<p>And WHO’s kits – while incredibly useful for aid workers – are designed to last for only the first month of a response. Cholera outbreaks will never cease if we focus only on technological fixes and temporary humanitarian solutions, and ignore the structural inequities that result in contaminated water sources and outbreaks of infectious diseases. </p>
<p>Cholera was a <a href="https://www.cdc.gov/cholera/usa/index.html">problem until the 19th century</a> in impoverished and flood-prone parts of the southern United States. How was it finally <a href="https://www.cdc.gov/cholera/usa/index.html">eliminated</a> in the places now ravaged by hurricanes Harvey and Irma? Only through hefty investments in water and sewage treatment systems. </p>
<h2>Solutions are available</h2>
<p>In the wake of the 2014 Ebola response and after much reflection, the WHO is attempting to cast itself as an organization that can prevent and identify outbreaks of disease as well as coordinate global epidemic responses. But the international community cannot simply wait for the next Ebola outbreak or ignore the existence of <em>Vibrio cholerae</em> in the world’s most vulnerable and disaster-affected communities.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/185306/original/file-20170908-32266-1yh69iq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/185306/original/file-20170908-32266-1yh69iq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/185306/original/file-20170908-32266-1yh69iq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/185306/original/file-20170908-32266-1yh69iq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/185306/original/file-20170908-32266-1yh69iq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/185306/original/file-20170908-32266-1yh69iq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/185306/original/file-20170908-32266-1yh69iq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A child plays in a seaside slum in Port-Au-Prince, Haiti, hours before Hurricane Irma brought flooding to the north of the island.</span>
<span class="attribution"><a class="source" href="http://pictures.reuters.com/Package/2C0BF1SSS3ETN#/SearchResult&ALID=2C0BF1SSS3ETN&VBID=2C0BX42PO7BP&POPUPPN=5&POPUPIID=2C0BF1SSCSTAF">AP Photo/Dieu Nalio Chery</a></span>
</figcaption>
</figure>
<p>This is the chance for the WHO to fulfill this mission and make right <a href="https://www.nytimes.com/2017/06/26/world/americas/cholera-haiti-united-nations-peacekeepers-yemen.html?mcubz=3">mistakes of the past</a>. Cholera has been eliminated from disaster-affected Texas and Florida. The same can happen elsewhere too. Thousands of lives are at stake. </p>
<p>The WHO and its partners should lead a vigorous appeal to donors and humanitarian organizations working in several locations – in the paths of Atlantic hurricanes, in flooded regions of South Asia, and in war-torn parts of the Middle East and Africa – where cholera still kills and the risk of an outbreak is high. The new director of the WHO, Dr. Tedros, is perfectly positioned to counter <a href="https://www.nytimes.com/2017/05/13/health/candidate-who-director-general-ethiopia-cholera-outbreaks.html?mcubz=3">his recent detractors</a> and demonstrate his capacity for swift action by mounting the WHO’s first coordinated, multi-country cholera epidemic response.</p><img src="https://counter.theconversation.com/content/83694/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Carruth does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Surviving a hurricane in poor countries such as Haiti is no guarantee of surviving the secondary problem of cholera.Lauren Carruth, Assistant Professor, School of International Service, American University School of International ServiceLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/789792017-07-31T02:29:15Z2017-07-31T02:29:15ZBridges and roads as important to your health as what’s in your medicine cabinet<figure><img src="https://images.theconversation.com/files/179638/original/file-20170725-12396-6g8rh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The water tower in Flint, Michigan, where lead-contaminated water led to a health crisis in 2014. </span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Flint-Water/9cb8d7235f904f18b52141d9249281cf/2/0">AP Photo/Carlos Osorio</a></span></figcaption></figure><p>Two seemingly unrelated national policy debates are afoot, and we can’t adequately address one unless we address the other.</p>
<p>Health care reform has been the hottest topic. What to do about America’s aging infrastructure has been less animated but may be more pressing.</p>
<p>Yet even as cracks in America’s health system and infrastructure expand, political divides between parties and within parties have stalled efforts to develop policies and implement solutions. Problematically, debates over health care reform and infrastructure projects remain separate. </p>
<p>As a professor of architecture who also studies health equity – the establishment of systems, laws and environments that promote fair access to health care – I believe we have reason to be concerned.</p>
<p>What if a solution to bridging both the political and sectoral divides between health care and infrastructure was, literally, a bridge? Sure, bridges are core elements of infrastructure, but what do bridges have to do with health care?</p>
<p>As it turns out, a lot.</p>
<h2>Abroad, substandard infrastructure kills</h2>
<p>We have seen the negative effects of poor infrastructure most in poverty-stricken countries.</p>
<p>In October 2016, Haiti saw the importance of bridges. Still reeling from the devastating 2010 earthquakes, the poorest country in the Americas was struck by Hurricane Matthew.</p>
<p>Torrential rains led to contaminated food and water supplies, and, subsequently, a cholera outbreak. They also washed out the bridge over the <a href="http://www.haitilibre.com/en/news-18821-haiti-flash-the-bridge-ladigue-collapses-situation-west-pap.html">River La Digue</a>. The collapse broke a link in the primary highway connecting the capital of Port-au-Prince to the southern peninsula of Haiti, the area worst hit by Matthew. </p>
<p>Without road access, medical supplies, water and food rations, community-education programs, and equipment to repair water and sanitation systems could not be delivered. Disease spread further.</p>
<p>Disasters are not the only situations where fractures in infrastructure impact health.</p>
<p>In Uganda – a country with a high prevalence of preventable and treatable illnesses, such as respiratory infections – the <a href="https://www.buffalo.edu/globalhealthequity/articles-and-reflections.host.html/content/shared/www/globalhealthequity/articles-and-reflections/last-mile--a-matter-of-life-and-death.detail.html">“last mile” of the supply chain</a> is a matter of life and death. While effective, low-cost treatments exist, the leading causes of childhood mortality include pneumonia, malaria and diarrheal diseases.</p>
<p>As in the U.S., rural children in Uganda are at a greater risk of death than those living in cities. In fact, children living in the rural northeast region of Karamoja <a href="https://dhsprogram.com/pubs/pdf/FR264/FR264.pdf">die at more than double</a> the rate of children living in the capital region of Kampala. The health literacy of parents is one factor; access to health facilities is another. </p>
<h2>Improving infrastructure, improving health</h2>
<p>New research from the University at Buffalo reveals something more striking about the <a href="https://www.buffalo.edu/globalhealthequity/articles-and-reflections.host.html/content/shared/www/globalhealthequity/articles-and-reflections/last-mile--a-matter-of-life-and-death.detail.html">role of supply chains</a>: Many preventable deaths are occurring simply because local clinics and kiosks ran out of supplies. </p>
<p>“In some districts,” according to Biplab Bhattacharya, a Ph.D. student on the team, “only 50 percent of health facilities have regular supplies of ACTs,” a primary treatment for malaria, “and many were vulnerable to stock-outs between deliveries.” </p>
<p>Li Lin, the lead researcher, also noted that retailers who struggle to keep adequate supplies of inexpensive yet lifesaving over-the-counter therapies, like oral rehydration solutions for children with acute diarrhea. </p>
<p>This research comes from a rather unexpected partnership between scholars in industrial and systems engineering who worked with partners in the Clinton Health Access Initiative and the Ministry of Health in Uganda. The work illustrates the value of nontraditional partnerships in identifying problems and finding solutions. </p>
<p>Future public health efforts in Uganda, therefore, may focus not on the development of vaccines or treatments but on infrastructure, such as information management systems, which can predict stock-outs before they happen, and improved roads, which can enable faster delivery of supplies.</p>
<h2>US vulnerable, too</h2>
<p>While robust technologies shore up <a href="http://www.smithsonianmag.com/history/when-america-invested-infrastructure-these-beautiful-landmarks-were-result-180953570/">America’s supply chains</a>, including the delivery of medications and other health supplies, other areas of infrastructure are not only deteriorating but also do not address imminent, or recurring, public health threats. I fear that America is slowly returning to its status in the early 19th century as a developing nation. </p>
<p>In the late 1800s and early 1900s, cities throughout the U.S. eradicated the spread of waterborne diseases, such as typhoid, by investing in <a href="http://americanhistory.oxfordre.com/view/10.1093/acrefore/9780199329175.001.0001/acrefore-9780199329175-e-141">water and sanitation improvements</a>.</p>
<p>However, as the Flint water crisis of 2014 illustrated, <a href="http://www.npr.org/2017/06/14/532902398/michigan-health-chief-charged-with-involuntary-manslaughter-for-flint-water-cris">America’s infrastructure</a> presents one of the greatest threats to the health of Americans. Michael Beach, associate director for healthy water at the Centers for Disease Control and Prevention, stresses that “the U.S. commitment to bring safe water and sanitation to the country,” in the 19th and 20th centuries, “was a great first step, but we can’t let our guard down; germs adapt.”</p>
<p>Beach adds that outdated infrastructure has contributed to an estimated <a href="http://www.medscape.com/viewarticle/772712">240,000 water main breaks</a> each year, and, if not upgraded can “expose users to sewage, pathogens, and other contaminants.”</p>
<p>According to the 2017 <a href="https://www.infrastructurereportcard.org/cat-item/bridges/">Infrastructure Report Card</a>, the average U.S. bridge is 43 years old and there are, on average, 188 million trips each day across structurally deficient American bridges. With each passing car and each passing day, these bridges become more life-threatening.</p>
<p>According to the World Bank, approximately <a href="http://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-with-other-countries">17 percent of the U.S. GDP</a> goes to health care spending, more than any other country. By contrast, <a href="https://www.enotrans.org/article/70-year-trend-federal-infrastructure-spending/">spending on transportation infrastructure</a> amounts to less than 0.4 percent of the country’s GDP. Moreover, during the past decade, <a href="https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html">health spending has grown</a>, while infrastructure spending has constricted despite the need for upgrades. </p>
<p>While political debates often tie public works projects to economic development and health care policies to human health, infrastructure and health care intersect. Both have economic and health implications. Civic infrastructures – including the seemingly unrelated sectors of energy, transportation and housing – are as important to the health care toolkit as vaccines, hospital beds and surgical units.</p>
<p>For example, over half a million children under the age of five die every year worldwide due to <a href="http://www.who.int/mediacentre/news/releases/2017/pollution-child-death/en/">air pollution</a>. <a href="http://www.euro.who.int/en/data-and-evidence/evidence-informed-policy-making/publications/hen-summaries-of-network-members-reports/what-are-the-effects-on-health-of-transport-related-air-pollution">Transportation-related smog</a> is one contributor, which is why cities with the best transportation systems often have a lower incidence of respiratory diseases. Investments in transit not only improve convenience and access but also reduce governments’, and individuals’, burden of treating otherwise preventable diseases.</p>
<p>Of course, infrastructure spending is not immune to political roadblocks. Questions regarding how to resource a plan, which projects to prioritize and how to award contracts present challenges. New approaches to funding might be legislation on improving health infrastructure, <a href="http://www.uniteforsight.org/health-workers-course/module1">like the construction and renovation of rural hospitals</a>, or the development and purchase of medical technologies for specialized urban health centers, or the training of community-based health professionals who can work across sectors.</p>
<p>We might then build outward, ensuring better transportation to these hospitals, stronger paths of communication from major health centers and the integration of neighborhood services across health, education and transportation sectors. We could also shore up rural hospitals, structurally and financially, as, according to the <a href="http://www.ivantageindex.com/2017-rural-relevance-study/">Chartis Center for Rural Health</a>, 80 have closed across the U.S. since 2010. This is despite higher levels of patient satisfaction than their urban counterparts.</p>
<p>Moving the health care debate to a discussion on infrastructure might accomplish two vital needs. It might advance the health care debate by both walking away from the current gridlock and approaching the destination from a fresh perspective. It might also advance public health by making America’s highways, neighborhoods and water systems safer, mediating the risks of health care and bridge collapses.</p><img src="https://counter.theconversation.com/content/78979/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Korydon Smith does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Congressional inability to devise a health care plan for the US is not the only impediment to good health care. Contaminated water pipes and old bridges are also roadblocks.Korydon Smith, Professor of Architecture and Associate Director of Global Health Equity, University at BuffaloLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/685672016-11-14T11:16:39Z2016-11-14T11:16:39ZWorld set for hottest year on record: World Meteorological Organization<figure><img src="https://images.theconversation.com/files/145504/original/image-20161111-21844-hjgv8o.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Flooding on the Niemur River near Moulamein, Australia, October 22, 2016.</span> <span class="attribution"><span class="source">Blair Trewin</span>, <span class="license">Author provided</span></span></figcaption></figure><p>2016 is set to be the world’s hottest year on record. According to the <a href="http://public.wmo.int/en/media/press-release/provisional-wmo-statement-status-of-global-climate-2016">World Meteorological Organization’s preliminary statement</a> on the global climate for 2016, global temperatures for January to September were 0.88°C above the long-term (1961-90) average, 0.11°C above the record set last year, and about 1.2°C above pre-industrial levels.</p>
<p>While the year is not yet over, the final weeks of 2016 would need to be the coldest of the 21st century for 2016’s final number to drop below last year’s. </p>
<p>Record-setting temperatures in 2016 came as no real surprise. Global temperatures continue to rise at a rate of 0.10-0.15°C per decade, and over the five years from 2011 to 2015 they averaged 0.59°C above the 1961-1990 average. </p>
<p>Giving temperatures a further boost this year was the very strong El Niño event of 2015−16. As we saw in 1998, global temperatures in years where the year starts with a strong El Niño are typically 0.1-0.2°C warmer than the years either side of them, and 2016 is following the same script.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/145505/original/image-20161111-25052-ross6u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/145505/original/image-20161111-25052-ross6u.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145505/original/image-20161111-25052-ross6u.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145505/original/image-20161111-25052-ross6u.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145505/original/image-20161111-25052-ross6u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=494&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145505/original/image-20161111-25052-ross6u.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=494&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145505/original/image-20161111-25052-ross6u.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=494&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Global temperature anomalies (difference from 1961-90 average) for 1950 to 2016, showing strong El Niño and La Niña years, and years when climate was affected by volcanoes.</span>
<span class="attribution"><span class="source">World Meteorological Organization</span></span>
</figcaption>
</figure>
<h2>Almost everywhere was warm</h2>
<p>Warmth covered almost the entire world in 2016, but was most significant in high latitudes of the Northern Hemisphere. Some parts of the Russian Arctic have been a remarkable 6-7°C above average for the year, while Alaska is having its warmest year on record by more than a degree. </p>
<p>Almost the whole Northern Hemisphere north of the tropics has been at least 1°C above average. North America and Asia are both having their warmest year on record, with Africa, Europe and Oceania close to record levels. The only significant land areas which are having a cooler-than-normal year are northern and central Argentina, and parts of southern Western Australia. </p>
<p>The warmth did not just happen on land; ocean temperatures were also at record high levels in many parts of the world, and <a href="https://theconversation.com/au/topics/2016-coral-bleaching-event-26991">many tropical coral reefs were affected by bleaching</a>, including the Great Barrier Reef off Australia.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/145508/original/image-20161111-25052-ip7u3q.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/145508/original/image-20161111-25052-ip7u3q.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=427&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145508/original/image-20161111-25052-ip7u3q.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=427&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145508/original/image-20161111-25052-ip7u3q.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=427&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145508/original/image-20161111-25052-ip7u3q.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=537&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145508/original/image-20161111-25052-ip7u3q.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=537&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145508/original/image-20161111-25052-ip7u3q.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=537&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Global temperatures for January to September 2016.</span>
<span class="attribution"><span class="source">UK Meteorological Office Hadley Centre</span></span>
</figcaption>
</figure>
<p>Greenhouse gas levels continued to rise this year. After global carbon dioxide concentrations reached 400 parts per million for the first time in 2015, they reached new record levels during 2016 at both Mauna Loa in Hawaii and Cape Grim in Australia. </p>
<p>On the positive side, the Antarctic ozone hole in 2016 was one of the smallest of the last decade; while there is not yet a clear downward trend in its size, it is at least not growing any more. </p>
<p>Global sea levels continue to show a consistent upward trend, although they have temporarily levelled off in the last few months after rising steeply during the El Niño. </p>
<h2>Droughts and flooding rains</h2>
<p>El Niño was over by May 2016 – but many of its effects are still ongoing. </p>
<p>Worst affected was southern Africa, which gets most of its rain during the Southern Hemisphere summer. Rainfall over most of the region was well below average in both 2014-15 and 2015-16. </p>
<p>With two successive years of drought, many parts are suffering badly with crop failures and food shortages. With the next harvests due early in 2017, the next couple of months will be crucial in prospects for recovery. </p>
<p>Drought is also strengthening its grip in parts of eastern Africa, especially Kenya and Somalia, and continues in parts of Brazil. </p>
<p>On the positive side, the end of El Niño saw the breaking of droughts in some other parts of the world. Good mid-year rains made their presence felt in places as diverse as northwest South America and the Caribbean, northern Ethiopia, India, Vietnam, some islands of the western tropical Pacific, and eastern Australia, all of which had been suffering from drought at the start of the year. </p>
<p>The world has also had its share of floods during 2016. The Yangtze River basin in China had its wettest April to July period this century, with rainfall more than 30% above average. Destructive flooding affected many parts of the region, with more than 300 deaths and billions of dollars in damage. </p>
<p>Europe was hard hit by flooding in early June, with Paris having its worst floods for more than 30 years. </p>
<p>In western Africa, the Niger River reached its highest levels for more than 50 years in places, although the wet conditions also had many benefits for the chronically drought-affected Sahel, and eastern Australia also had numerous floods from June onwards as drought turned to heavy rain. </p>
<p>Tropical cyclones are among nature’s most destructive phenomena, and 2016 was no exception. The worst weather related natural disaster of 2016 was <a href="https://theconversation.com/au/topics/hurricane-matthew-32086">Hurricane Matthew</a>. Matthew reached category five intensity south of Haiti, the strongest Atlantic storm since 2007. It hit Haiti as a category 4 hurricane, causing at least 546 deaths, with 1.4 million people needing humanitarian assistance. The hurricane then went on to cause major damage in Cuba, the Bahamas and the United States.</p>
<p>Other destructive tropical cyclones in 2016 included Typhoon Lionrock, responsible for flooding in the Democratic People’s Republic of Korea which claimed at least 133 lives, and Cyclone Winston, which killed 44 people and caused an estimated US$1.4 billion damage in Fiji’s worst recorded natural disaster. </p>
<p>Arctic sea ice extent was well-below average all year. It reached a minimum in September of 4.14 million square kilometres, the equal second smallest on record, and a very slow autumn freeze-up so far means that its extent is now the lowest on record for this time of year.</p>
<p>In the Antarctic, sea ice extent was fairly close to normal through the first part of the year but has also dropped well below normal over the last couple of months, as the summer melt has started unusually early. </p>
<p>It remains to be seen what impact the summer of 2016 has had on the mountain glaciers of the Northern Hemisphere. </p>
<p>While 2016 has been an exceptional year by current standards, the long-term warming trends mean there will be more years like it to come. <a href="https://theconversation.com/2015s-record-breaking-temperatures-will-be-normal-by-2030-its-time-to-adapt-68224">Recent research</a> has shown that global average temperatures which are record-breaking now are likely to become the norm within the next couple of decades.</p><img src="https://counter.theconversation.com/content/68567/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Blair Trewin is a staff member of the Australian Bureau of Meteorology.
The World Meteorological Organization is the United Nations' specialized agency on the state and behaviour of the Earth's atmosphere, its interaction with the land and oceans, the weather and climate it produces and the resulting distribution of water resources. 191 countries and territories are members. </span></em></p>The final weeks of 2016 would need to be the coldest of the 21st century to avoid it becoming the hottest year.Blair Trewin, Lead author, 2016 WMO Global Statement on the Status of the Global Climate, World Meteorological OrganizationLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/667992016-10-24T06:41:23Z2016-10-24T06:41:23ZCaring for Haitian women after Hurricane Matthew – what we learned from the 2010 earthquake<p>Haiti is still reeling from the damage wrought by Hurricane Matthew. The UN has estimated that <a href="http://www.un.org/apps/news/story.asp?NewsID=55311#.WAeH0JN97aY">750,000 people have been affected</a> by the Category 4 storm that devastated the country’s southern regions on October 4.
It’s believed there are <a href="http://www.wsj.com/articles/haitis-death-toll-from-hurricane-matthew-climbs-more-people-in-shelters-1476115790">175,000 people without shelter</a>; there are also reports of those who have lost their homes <a href="http://www.nytimes.com/2016/10/18/world/americas/haiti-hurricane-matthew-caves.html?_r=0">taking shelter in caves</a>.</p>
<p>The recovery is already underway, and a significant part of that effort will focus on women, who are always at <a href="https://theconversation.com/conflicts-expose-women-to-violence-but-the-arab-world-is-finding-ways-to-fight-back-65807">greatest risk in emergency situations</a>. </p>
<p>The conditions following the hurricane remind us of <a href="http://link.springer.com/article/10.1007/s00038-016-0895-8">our work in Haiti</a> from 2011 to 2013. We visited the country as part of a research team studying gender-based violence against internally displaced women following the 2010 earthquake. </p>
<h2>Violence against women in Haiti</h2>
<p>We interviewed 200 displaced women living in tent cities and camps following the earthquake. We found that experiences of gender-based violence were extremely high for these women, both before and after the earthquake – 71% had experienced violence before and 75% experienced violence in its aftermath. </p>
<p>These figures presented two surprises: first, we found that gender-based violence prior to the earthquake was considerably higher than was previously thought. Second, there was no significant difference in prevalence before or after the earthquake. </p>
<p>In other words, violence against women is common in Haiti regardless of the situation. Our studies showed that the perpetrators were primarily intimate partners, not strangers capitalising on a chaotic and lawless time for the country – as was <a href="http://link.springer.com/article/10.1007/s00038-016-0895-8">reported anecdotally</a> in the aftermath of the earthquake. </p>
<p>Instead, it was the same intimate partners and ex-partners who abused women both before and after the disaster. </p>
<h2>Why is violence against women so common?</h2>
<p>The high proportion of women who reported abuse may be related to the low levels of education we found among our sample: 11% of the women we interviewed had never attended school, 38% reported education up to eighth grade level; 43% had not reached high school. In all, only 3.8% were high school graduates. </p>
<p>We also found a 90% rate of unemployment. Both employment status and education level have been found to be associated with <a href="http://www.who.int/reproductivehealth/publications/violence/24159358X/en/">intimate partner violence</a> globally. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/26361648">Higher rates</a> of violence against women are also associated with women having lower status within society, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/26361648">rigid masculinity norms</a> about male-female relationships.</p>
<p>Although the majority of the women in this study – in both the abused and non-abused groups – did not express a personal tolerance for abuse, there were still higher percentages of women who did so than in other regions, <a href="http://www.ncbi.nlm.nih.gov/pubmed/27641740">for example</a> the Virgin Islands and the US. </p>
<p>The women in the Haiti sample indicated tolerance for abuse at the following rates: female infidelity (35% of abused women to 23% of non-abused); female disobedience (33% to 22%); belief that it is important for a man to show his wife or girlfriend that he is the boss (62% to 55%).</p>
<h2>Symptoms among abuse victims</h2>
<p>We found high rates of post-traumatic stress disorder (PTSD) among victims of intimate partner violence. This finding has been reported in <a href="https://www.ncbi.nlm.nih.gov/pubmed/21676510">numerous other studies globally</a>, but this was the first time it was reported in Haiti. </p>
<p>Although some instances of PTSD may have been a result of the earthquake, we found symptoms significantly more frequently among abused women, and they were more severe. In these cases, the trauma related directly to the severity and frequency of intimate partner violence, rather than the earthquake. </p>
<p>Perceived physical health was low for all women in this sample, but abused women perceived their mental and physical health to be worse than non-abused women, both before and after the 2010 earthquake. </p>
<p>Abused women suffered depression, chronic stress, suicidal behaviour, central nervous system symptoms, face and head injuries, traumatic brain injuries, and gastrointestinal and gynaecological problems. These symptoms have also been associated with abuse in <a href="http://www.ncbi.nlm.nih.gov/pubmed/27641740">other studies</a>.</p>
<h2>What we can do</h2>
<p>In a situation where women who are already suffering violence at the hands of their partners are affected by a natural disaster, what should we do?</p>
<p>Collaborating with our Haitian partners, we put together a programme to protect women left homeless after the 2010 earthquake from violence. KOFAVIV, the <a href="http://www.ijdh.org/2006/03/archive/kofaviv-commission-of-women-victims-for-victims/">Commission of Women Victims for Victims</a>, provided clinics and shelter for women, and assisted us in implementing a very successful safety intervention programme for a group of women who had experienced intimate partner violence and abuse. Our results will be published in a forthcoming study.</p>
<p>We collected data on 68 adult Haitian women, monitoring their health before, during and after our intervention. These women had participated in our initial survey and indicated interest in participating in a follow-up safety education and training program. </p>
<p>The women participated in three small group sessions over a three-week period. Discussions helped them recognise types of violence and abuse, understand how and why it happens, and to know that they did not cause it. They learned how to stay safe in a violent or abusive relationship including how to stay safe while still living in camps or temporary housing. </p>
<p>Each woman was helped to develop a safety plan. They learned about the health consequences of abuse and its effects on children, as well as the recovery process and resources available for help. </p>
<p>For women who had taken part in the programme, we found statistically significant decreases in PTSD, depression and the amount of violence they experienced three months later. We also observed a significant increase in physical quality of life after the intervention. Sadly, there was no statistically significant increase in mental quality of life.</p>
<p>The intervention also helped prevent further violence. Before, 73.5% of the women reported emotional or physical abuse; only 10.3% reported abuse after three months. Similarly, 41.2% reported sexual abuse before the intervention; this fell to 10.3%.</p>
<p>Short-term interventions may benefit not only women, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3908534/">but also their children</a>, who may have symptoms of traumatic stress, often from witnessing domestic violence. </p>
<h2>Helping women after Hurricane Matthew</h2>
<p>After this latest disaster, it is essential for health-care providers to foster trust, confidence, respect and healing during relief programmes in Haiti. Plans to address gender-based violence should be integrated into <a href="http://www.who.int/violence_injury_prevention/violence/status_report/2014/en/">humanitarian and emergency relief guidelines</a>.</p>
<p>Balanced health care for women after natural disasters should include sensitivity to the abusive and traumatic experiences that many have already suffered, including attention to privacy and security during sensitive examinations and treatments.</p>
<p>Effective communication between aid groups, and resource sharing could improve health care for abused women after Hurricane Matthew. One of the reasons our intervention was so successful after the earthquake was that it was implemented by trusted Haitian personnel in a supportive environment. A similar approach will be needed following Haiti’s latest natural disaster.</p>
<p><em>The authors would like to acknowledge the contributions of Annie Lewis-O'Conner, Elizabeth Sloand, Cheryl Killion, Nancy Glass, Nicole Cesar Muller, Gloria Callwood, Mona Hassan and Faye Gary.</em></p><img src="https://counter.theconversation.com/content/66799/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacquelyn Campbell is a member of the Board of Directors of Futures without Violence and the National Health Collaborative on Violence and Abuse.</span></em></p><p class="fine-print"><em><span>Doris Campbell and Hossein Yarandi do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Women already face high levels of violence in Haiti. But natural disasters can provide a good opportunity to intervene.Doris Campbell, Consultant Research Professor, Principal Investigator, and Co-Administrative Core Director, Caribbean Exploratory NIMHD Research Center, University of the Virgin IslandsHossein Yarandi, Professor of Health Economics, Wayne State UniversityJacquelyn Campbell, Professor of Nursing, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/581232016-10-13T12:30:41Z2016-10-13T12:30:41ZWhat Hurricane Matthew’s path through Haiti and the US tells us about global inequality<p>Hurricane Matthew, the Atlantic’s first Category 5 storm in almost a decade, slammed into Haiti on October 4. Strong winds left a path of death and destruction through the island, with at least 1,000 people already confirmed dead and more than 2m of the island’s 10m population affected. Now there are warnings of <a href="http://www.bbc.co.uk/news/world-latin-america-37616068">famine and cholera</a>.</p>
<p>Haitians, however, are no strangers to disaster. A 2010 earthquake left at least 100,000 dead and a subsequent cholera outbreak affected many more. Flooding in 2004 also killed thousands. And those are just the major events that make it into the global media. For most people in Haiti, so-called “natural disasters” are a recurrent theme in their lives.</p>
<p>In the US, however, it’s a different story. Hurricane Matthew reached Florida two days later and ran along the coast to North and South Carolina, killing <a href="https://www.theguardian.com/world/2016/oct/11/hurricane-matthew-death-toll-shooting-north-carolina-florida-georgia">at least 33</a>. Though the storm slowed as it made its way across the Caribbean, the difference in death numbers is not coincidental: natural disasters remain disproportionately a hazard of the poor.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/141251/original/image-20161011-12027-wa3ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/141251/original/image-20161011-12027-wa3ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/141251/original/image-20161011-12027-wa3ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=241&fit=crop&dpr=1 600w, https://images.theconversation.com/files/141251/original/image-20161011-12027-wa3ri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=241&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/141251/original/image-20161011-12027-wa3ri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=241&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/141251/original/image-20161011-12027-wa3ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=303&fit=crop&dpr=1 754w, https://images.theconversation.com/files/141251/original/image-20161011-12027-wa3ri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=303&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/141251/original/image-20161011-12027-wa3ri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=303&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Flooding damaged the town of Kill Devil Hills, North Carolina, but there were no casualties.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/chrisrehak/29943745290/">Chris Rehak</a></span>
</figcaption>
</figure>
<p>Globally, the number of deaths from disasters is <a href="http://www.emdat.be/database">falling</a>. However, they still have the most debilitating effects in developing countries, where population growth, the burgeoning of shanty towns and land degradation all add to the risk. </p>
<p>Disaster statistics in the developed world tell a completely different story, in which the number of fatalities proportional to the total population has <a href="http://www.emdat.be/database">declined dramatically</a> in recent decades. There, building and zoning codes are typically well-enforced, structures are retrofitted to withstand hazards, emergency services are better equipped, and early warning systems have become increasingly sophisticated. All this has reduced human losses, even if the cost in material terms increased <a href="http://library.uniteddiversity.coop/More_Books_and_Reports/State_of_the_World/State_of_the_World_2001.pdf">at least eightfold</a> in the last four decades of the 20th century.</p>
<p>Natural disasters have come to mean two very different types of events depending on where you are in the world. British prime minister Benjamin Disraeli famously spoke of “<a href="http://www.victorianweb.org/authors/disraeli/diniejko3.html">two nations</a>” who are “as ignorant of each other’s habits, thoughts, and feelings, as if they were dwellers in different zones, or inhabitants of different planets”. Disraeli was talking about Victorian Britain, but the same might be said about the “two worlds” that have come to separate people in the developed and developing countries in terms of wealth, life expectancy and exposure to risk. For one, disaster is now principally about economic loss, and for the other it remains primarily about loss of life.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/141248/original/image-20161011-12013-1gqv876.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/141248/original/image-20161011-12013-1gqv876.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/141248/original/image-20161011-12013-1gqv876.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=783&fit=crop&dpr=1 600w, https://images.theconversation.com/files/141248/original/image-20161011-12013-1gqv876.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=783&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/141248/original/image-20161011-12013-1gqv876.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=783&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/141248/original/image-20161011-12013-1gqv876.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=984&fit=crop&dpr=1 754w, https://images.theconversation.com/files/141248/original/image-20161011-12013-1gqv876.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=984&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/141248/original/image-20161011-12013-1gqv876.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=984&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Matthew moves from poor world to rich world, October 7.</span>
<span class="attribution"><span class="source">NASA</span></span>
</figcaption>
</figure>
<h2>Two worlds</h2>
<p>The root of this separation lies in the way disasters are perceived. In the developed world, disasters are viewed as abnormal events, a temporary disruption in everyday lives and where a return to “normality” is confidently expected. On October 9, for instance, two days after the storm peaked in Florida, the state’s governor announced the national guard would help schools reopen <a href="http://www.ibtimes.co.uk/national-guard-prepare-florida-schools-reopening-wake-hurricane-matthew-1585546">as quickly as possible</a>. </p>
<p>In the developing world, disasters are seen as normal everyday events that people have had to learn to live with. So normal, in fact, that society and culture are partly the product of <a href="https://books.google.co.uk/books/about/Cultures_of_Disaster.html?id=5O8qU49LIzQC&redir_esc=y">adapting to their frequent occurrence</a>. </p>
<p>This fault line also extends to the nature of the state. The developed world is governed by strong states that “nationalise” disasters, disempower their citizens and absolve them of responsibility for their own personal safety. The state in developing countries, however, is fundamentally weaker without the institutional and infrastructural capacity to provide for the needs of its citizens. As a result, communities are stronger, made more self-reliant through neglect and default. Trust is at the local level, expressed in terms of families, friends and neighbourhoods. </p>
<p>For the inhabitants of one world, disasters have become primarily a state affair; for the inhabitants of the other, they are a community concern.</p>
<p>In the developed world, disaster mitigation is primarily a matter of science and technology and the numerical modelling of risk. However, for those in the developing world, <a href="https://www.unisdr.org/who-we-are/international-strategy-for-disaster-reduction">disaster preparedness</a> is generally about people: educating, training and organising them; relying on them to take care of themselves, because the state does not possess the resources for technological solutions.</p>
<h2>Different sets of priorities</h2>
<p>Developed countries are increasingly concerned with protecting property and sensitive structures like costly skyscrapers or nuclear power plants. Disaster is largely calculated in property damage – “<a href="http://www.usatoday.com/story/weather/2016/10/08/hurricane-matthew-economic-damage-cost-6-billion/91783304/">Hurricane Matthew economic damage nears $6 billion</a>”.</p>
<p>While the material damage inflicted on developing countries can be immense in relative terms, disaster is still measured in lost lives. Governments remain primarily concerned with saving people. Priorities, therefore, are often at odds: Western advice is frequently regarded as impractical or irrelevant by many in developing countries. </p>
<p>Moreover, much Western-funded reconstruction and aid is tied to a set of externally imposed guidelines frequently espousing neoliberal values that can make matters worse by channelling scarce resources into inappropriate projects. This “<a href="http://portal.unesco.org/culture/en/files/37745/12197591975Concept_paper_Indigenous_Peoples__Development_with_Identity.pdf/Concept%2Bpaper%2BIndigenous%2BPeoples%2B%2BDevelopment%2Bwith%2BIdentity.pdf">development aggression</a>” leaves people more exposed to risk by ignoring community needs and treating local people mainly as passive recipients or as a profit-making resource.</p>
<p>As a result of differences in both what disasters mean and the way to tackle them, the <a href="http://www.sciencedirect.com/science/article/pii/S2212420915000059">communitarian and organisational skills</a> of people in developing countries are often unfairly dismissed and ignored. The emphasis on low-cost, low-tech solutions that stress living with risk and encouraging self-reliance is regarded by professionals in developed countries as a response to the absence of state services rather than as the bedrock of what makes communities resilient. </p>
<p>Such attitudes make for an uncertain future as climate change and population growth affect both the magnitude and frequency of extreme events. Disraeli’s two “nations” have become “two worlds”. As disasters like Hurricane Matthew become more commonplace, all of us may be forced to rely less on state services and costly defences and more on ourselves and our neighbours.</p><img src="https://counter.theconversation.com/content/58123/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Greg Bankoff receives funding from NERC, ESRC, AHRC & Australian Research Council. </span></em></p>Natural disasters remain disproportionately a hazard for the world’s poor.Greg Bankoff, Professor of Modern History, University of HullLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/667852016-10-13T06:11:16Z2016-10-13T06:11:16ZHow to help Haitians recover from the mental trauma of Hurricane Matthew<p>Hurricane Matthew has left <a href="http://www.nytimes.com/interactive/2016/10/10/world/americas/haiti-hurricane-matthew-aftermath-destruction-maps-photos.html">hundreds dead in Haiti</a>. Winds of <a href="http://www.nhc.noaa.gov/archive/2016/al14/al142016.public.015.shtml">more than 200km per hour</a> have totally devastated cities and towns across the southern peninsula of the tiny nation. </p>
<p>For me, pictures showing the levels of destruction in the south of the country immediately recall the earthquake of January 12 2010. </p>
<p>This has also been the observation of many of my colleagues – psychologists, social workers, humanitarians and professors at the State University of Haiti – who have visited the ruined cities of the South, Grand’Anse and Nippes regions. Aerial pictures show the cities of <a href="http://www.nytimes.com/2016/10/11/world/americas/jeremie-haiti-hurricane-matthew.html?_r=0">Jérémie</a>, <a href="http://www.cbc.ca/news/world/hurricane-matthew-haiti-canadian-teacher-1.3798081">Dame Marie</a>, <a href="http://www.cbc.ca/news/world/hurricane-matthew-cbc-in-haiti-slow-aid-1.3800390">Les Cayes</a>, <a href="http://www.npr.org/sections/goatsandsoda/2016/10/11/497474873/a-census-of-destruction-in-haiti">Port Salut</a> and others in a state of total devastation. </p>
<p>Hurricane Matthew has once again exhibited the vulnerability of the modern world’s first black republic to natural disasters. </p>
<h2>Post-traumatic stress</h2>
<p>Natural disasters don’t just have physical consequences. When people have been directly exposed to an event in which others have died, and in which they were afraid for their own lives, we can <a href="http://www.ptsd.va.gov/professional/trauma/disaster-terrorism/traumatic-effects-disasters.asp">expect them to develop</a> severe post-traumatic stress and symptoms of depression. </p>
<p>In survivors, we also observe recurrent nightmares, psychological distress, trouble concentrating or making decisions, learning difficulties, depressive and anxiety symptoms, and social dysfunction. Research into the earthquake of 2010 showed all of these <a href="https://www.ncbi.nlm.nih.gov/pubmed/23124841">traumatic consequences</a>. </p>
<p>Survivors of natural disasters <a href="http://www.apa.org/topics/disasters/">also report</a> physical symptoms such as nausea, headaches and chest pain. </p>
<p><a href="https://www.researchgate.net/publication/262816970_Long-term_outcomes_among_child_and_adolescent_survivors_of_the_2010_Haitian_earthquake">Studies</a> in the aftermath of the January 2010 earthquake found that two years later, <a href="https://www.researchgate.net/publication/261218255_Assessment_of_prevalence_and_determinants_of_posttraumatic_stress_disorder_and_depression_symptoms_in_adults_survivors_of_earthquake_in_Haiti_after_30_months">more than a third</a> of children, adolescents, and adults showed severe symptoms of post-traumatic stress disorder. Almost half of the children and adolescents and more than a quarter of the adults also showed severe symptoms of depression. </p>
<p>We know that time cannot heal injuries associated with traumatic events, and psychological support programs must be created to support survivors. Mental health professionals can work to build therapeutic resilience among survivors without forcing people to talk about the event.</p>
<h2>Lessons from 2010</h2>
<p>Since the 2010 earthquake, international NGOs have invested heavily in providing psychological support to survivors. But <a href="https://www.researchgate.net/publication/281462954_An_Empiricist_Approach_of_Assessing_Psychological_Status_of_Clients_Undergoing_Psychotherapy_Applying_the_Trauma_Screening_Questionnaire">our studies</a> show that these programmes have not been effective, and were often actually culturally inappropriate. </p>
<p>The programmes began at a time when survivors were not necessarily ready to talk about the event because there was no physical, social and cultural infrastructure in the country. Everything had collapsed. </p>
<p>In circumstances like these, we must first recreate an acceptable living environment. As psychologist Alessandra Pigni has <a href="https://www.irinnews.org/fr/node/255289">written</a>, “You can’t give people peace of mind if they don’t have a home.” </p>
<p>Only after rebuilding can people express their pain and make sense of what has happened to them. This also explains why after natural disasters, <a href="http://www.jhsph.edu/research/centers-and-institutes/center-for-refugee-and-disaster-response/publications_tools/publications/_CRDR_ICRC_Public_Health_Guide_Book/Chapter_5_Emergency_Mental_Health_and_Psychosocial_support.pdf">few people go to see psychologists</a> installed by NGOs in relief camps, and why the results of emergency social support might not be totally effective. </p>
<p><a href="https://www.researchgate.net/publication/259409029_P1-97_Long-Term_Effects_of_a_Flood_on_the_Psychosocial_Health_of_Victims">Long-term studies</a> among populations affected by natural disasters, and the testimonies we have received on the ground in Haiti, have shown that people most need psychological support two years after the event, when normal life has resumed. Sadly, by then NGOs and psychologists are far, far away. </p>
<p>So how can make sure that we do not repeat the same mistakes of 2010 this time around? There are some key lessons to guide us.</p>
<h2>Starting with schools</h2>
<p>Schools, with all the important people they contain – teachers, student peers and support staff – can be excellent points of first aid. In Haiti, there are fewer than <a href="http://www.who.int/mental_health/who_aims_country_reports/who_aims_report_haiti_fr.pdf">200 graduate psychologists</a> and 30 psychiatrists, for a population of more than ten million people. So it is essential to support existing help systems, such as families and schools.</p>
<p>Training teachers to support children when they go back to school is crucial. Teachers should be given the tools to identify the pain of children, help them with breathing and relaxation exercises, and guide them to relevant services. </p>
<p>Recovery programmes should ensure that all children go back to school, and give special consideration to orphans. The Haitian school is a complex space where humour, sharing, solidarity, generosity, altruism and empathy can come together as what psychologists call “<a href="https://www.researchgate.net/publication/262877209_ECOLE_ET_RESILIENCE_CHEZ_LES_ENFANTS_ET_ADOLESCENTS_DANS_L'HAITI_POSTSEISME">multifactorial factors of resilience</a>” in the face of traumatic events. </p>
<p>In the long term, art programmes should be implemented in the school curriculum, as artistic creation <a href="http://eds.b.ebscohost.com/abstract?site=eds&scope=site&jrnl=10885870&AN=102975761&h=hJdwzDWvz69Sy1GmqJXcKzZsg06AKaj9HAHj0aFDOxp95a7zugKdttCLpPA7xGp4fXZuOxqX4jZLhZMZiCHz1A%3d%3d&crl=f&crawlloc=cf%3az%2f0723729285&crawllib=RD201501.LIB&resultLocal=ErrCrlNoResults&resultNs=Ehost&crlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d10885870%26AN%3d102975761">has been shown</a> to be a protective factor for psychological resilience.</p>
<h2>Facilitate the grieving process</h2>
<p>One of the greatest disasters following the 2010 earthquake was the way the dead were dealt with. Funeral rituals were not respected and the grieving process was not properly facilitated. Almost seven years later, there is still <a href="https://www.researchgate.net/publication/277556252_The_Stone_That_Mourns_Its_Victims_Haiti_Still_Recovering_From_Its_Injuries_and_Traumas_5_Years_After_the_2010_Earthquake">no official list</a> of the deceased. </p>
<p>One of the most important things the government of Haiti should ensure is to have a complete list of the dead and missing. With this list, each city could build a monument to victims, inscribed with all of their names.</p>
<p>In the absence of a personal tomb, this monument will serve as a cemetery where families can come to remember lost ones when the need arises. Considering the role and the importance of the dead in <a href="https://www.researchgate.net/publication/259087128_Evenement_sismique_et_seismes_du_monde_interne_le_cas_d'un_preadolescent_Haitien">Haitian culture</a>, this will facilitate the grieving process for survivors. </p>
<h2>Long-term counselling centres</h2>
<p>After rebuilding, a time will come when survivors need psychological support for their traumatic experiences resulting from Hurricane Matthew. For now, counselling units should be set up for those who have lost family members. These cannot be short-term centres; it is crucial to implement long-term programmes that last at least two years. </p>
<p>If ongoing field missions are not feasible, temporary, recurrent counselling missions that last several weeks could be set up periodically in the worst-affected areas. Haiti should consider setting up mobile humanitarian psychiatry clinics staffed by Haitian professionals. </p>
<p>Where local care is not possible, survivors with special needs should be followed up via long-distance phone calls on a regular basis. These programs must be implemented by Haitian Creole-speaking professionals who are knowledgeable of Haitian culture. </p>
<h2>Planning for the future</h2>
<p>The recovery process from the severe psychological injuries caused by Hurricane Matthew must accompany the physical reconstruction of devastated cities. The Haitian government must immediately take measures to deal with the deaths – this is a part of proper care for survivors. </p>
<p>In the short term, psychological support should rely on existing social structures such as schools and churches. </p>
<p>For the long term, psychological counselling centres should be set up, and they should be appropriate to Haitian culture. </p>
<p>We should never forget one key recommendationfrom Johns Hopkins University’s emergency mental health guide: “community-based mental health care is the <a href="http://www.jhsph.edu/research/centers-and-institutes/center-for-refugee-and-disaster-response/publications_tools/publications/_CRDR_ICRC_Public_Health_Guide_Book/Chapter_5_Emergency_Mental_Health_and_Psychosocial_support.pdf">best solution</a>”. The aftermath of Hurricane Matthew may be tragically similar to that of the 2010 earthquake, but our response doesn’t have to be.</p><img src="https://counter.theconversation.com/content/66785/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jude Mary Cénat does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Haiti has been struck by natural disasters before. Here’s what we learned about helping victims.Jude Mary Cénat, Lecturer; Postdoctoral Fellow, Université du Québec à Montréal (UQAM)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/668112016-10-11T14:06:33Z2016-10-11T14:06:33ZHurricane Matthew: Haiti faces yet another challenge to ‘build back better’<p>Hundreds of people are now known to have died when Hurricane Matthew hit Haiti with 145 mile-per-hour winds on October 1. The poorest country in Matthew’s path, Haiti was also the <a href="http://www.bbc.co.uk/news/world-latin-america-37596222">hardest hit</a>. Poor coastal communities have been devastated; villagers have lost their crops, their animals and their homes. A combination of poverty, hazardous and insecure housing and weak governance left Haitians vulnerable to the elements.</p>
<p>Worse still, this comes six years after the devastating earthquake of 2010, which killed <a href="http://news.bbc.co.uk/1/hi/8510900.stm">around 230,000 people</a>. The earthquake’s epicentre was close to the densely populated capital, Port-au-Prince, which already suffered from poor building regulations and widespread poverty. Millions of homes were destroyed, and as recently as April 2016, <a href="http://www.telegraph.co.uk/news/2016/10/07/hurricane-matthew-florida-lashed-by-monster-storm/">62,590</a> people were reportedly still living in temporary camps. </p>
<p>The poor response to the 2010 disaster means the damage wrought by Matthew will be all the harder to repair. Haiti and the outside organisations helping it have sorely failed to “<a href="http://practicalaction.org/build-back-better">build back better</a>” since the earthquake – and while some of the reasons are logistical, others come down to serious failings on the part of outside “helpers”.</p>
<p>There has been plenty of consternation about the way funds meant to help the country have been spent. Housing remains a particular problem; in 2015, a report claimed that the American Red Cross had only managed to convert donations of half a billion dollars into <a href="http://www.nbcnews.com/news/investigations/what-does-haiti-have-show-13-billion-earthquake-aid-n281661">six permanent housing units</a>. </p>
<p>The Red Cross has attempted to <a href="http://www.huffingtonpost.com/2015/06/04/red-cross-haiti-report_n_7511080.html">set the record straight</a> on the scale and effectiveness of its interventions, but the organisation’s reputation in Haiti has <a href="http://www.independent.co.uk/news/world/americas/haitians-urging-people-not-give-money-american-red-cross-how-to-help-hurricane-matthew-aid-cholera-a7352681.html">struggled since</a>. </p>
<p>It’s clear that problems with land tenure, red tape, administrative costs, language barriers, utilities and governmental and contractual transparency all but thwarted NGO efforts to improve the situation. And discouragingly, these problems are not unique to the Haitian disaster. Similar issues have plagued the Eastern Visayas region of the Philippines ever since it was hit by Typhoon Yolanda in November 2013. </p>
<h2>Getting it right</h2>
<p>Many survivors there are still living in temporary housing or in perilous conditions in shanty coastal communities. Those that have moved to permanent housing have little or no access to drinkable water, and there are few opportunities to secure a livelihood. As with the Haitan earthquake, millions of dollars in <a href="http://www.rappler.com/nation/43310-yolanda-international-community">international aid</a> were pledged in the aftermath of Yolanda, although <a href="https://openspending.org/faith?_view=default">official figures</a> show that the amount received was somewhat less than originally announced.</p>
<p>In the immediate aftermath of both Yolanda and the Haitian earthquake, aid agencies faced the twin problems of getting relief goods to those in critical need and ensuring that these goods were distributed fairly. As I and my fellow researchers found during our project <a href="https://www.nottingham.ac.uk/iaps/research/projects/poverty-alleviation-in-the-wake-of-typhoon-yolanda.aspx">Poverty Alleviation in the Wake of Typhoon Yolanda</a>, communities spontaneously supported each other in the aftermath of Yolanda, but as soon as relief goods arrived, tensions developed over the equity of distribution. Who gets what in the aftermath of a disaster is a perennial problem.</p>
<p>The problem for relief workers in Haiti now will be to co-ordinate the immediate distribution of relief goods. But claims to be building back better either socially or materially are not credible until the poorest of the poor have safe housing and a reasonable standard of living. </p>
<p>The problem for both Haiti and the Philippines is that even before the 2010 earthquake and Typhoon Yolanda, people were living in entrenched poverty. The economies of both disaster-ravaged areas were largely dependent on agriculture. For both industrial manufacturing is limited and infrastructure is underdeveloped. It is unrealistic to expect disaster relief to solve socio-economic problems that were decades, if not centuries, in the making.</p>
<h2>Ineptitude and incompetence</h2>
<p>On another note, the response to Hurricane Matthew may yet have another set of unexpected consequences. If it goes seriously wrong, it could be a serious political liability for Hillary Clinton’s presidential campaign.</p>
<p>The <a href="https://theconversation.com/at-the-core-of-hillary-clintons-image-problem-is-the-familys-foundation-62737">Bill, Hillary and Chelsea Clinton Foundation</a>, as it’s now called, was at the forefront of “building back better” for Haiti after the 2010 earthquake. Millions of <a href="http://africasacountry.com/2015/07/hillary-haiti/">dollars</a> were channelled through the foundation, and Hillary Clinton is on record as describing the Haitian relief efforts as a “<a href="http://www.politico.com/magazine/story/2015/05/clinton-foundation-haiti-117368">road test</a>” that would act as a model for relief and development efforts. </p>
<p>But NGOs’ response to Haiti’s crises have come in for plenty of criticism. Some critics have <a href="http://foreignpolicynews.org/2015/09/23/disaster-capitalism-outsourcing-violence-and-exploitation/">derided</a> so-called “<a href="https://www.theguardian.com/books/2015/nov/27/disaster-capitalism-antony-loewenstein-review">disaster capitalism</a>” – the phenomenon by which huge quantities of money funnelled into post-disaster reconstruction somehow never manage to improve the lives of the people their funders are meant to help.</p>
<p>Chelsea Clinton, meanwhile, wrote her parents a <a href="https://foia.state.gov/searchapp/DOCUMENTS/HRCEmail_August_Web/IPS-0120/DOC_0C05774208/C05774208.pdf">now-notorious account</a> of the ineptitude and negligence that marked the international response to the earthquake. Referring to the chaotic and uncoordinated UN and NGO efforts she saw on a fact-finding visit to Haiti, she wrote: “To say I was profoundly disturbed by what I saw – and didn’t see – would be an understatement. The incompetence is mind numbing.” </p>
<h2>The long haul</h2>
<p>In the aftermath of this latest disaster, <a href="https://donate.oxfam.org.uk/emergency/hurricane-matthew?pscid=ps_ggl_emergencies_hurricane_matthew_2016_generic&gclid=CO2a8tP-yM8CFcQp0wod3wECyw&gclsrc=aw.ds&dclid=COL6_NP-yM8CFeahUQodRDsIrg">Oxfam</a>, the <a href="http://www.redcross.org.uk/Donate-Now/Make-a-single-donation/Hurricane-Matthew-Appeal/Hurricane-Matthew-Appeal-Search?gclid=CKLAmf3-yM8CFcQV0wodX68AkQ">Red Cross</a> and <a href="https://www.clintonfoundation.org/blog/2016/10/04/members-clinton-foundation-community-respond-hurricane-matthew-ways-support">The Clinton Foundation</a> have already launched emergency appeals for donations for Matthew’s victims. But unless international aid focuses on those that need it most and sets a higher bar for success than bare subsistence, the residents of Haiti’s vulnerable coastal communities will remain permanently exposed to the ravages of “natural” disasters. </p>
<p>Aid agencies should also stay attached to poor communities for the long haul. If they don’t, rehabilitation projects become “orphaned” and vulnerable communities slip back into destitution. This is obviously a significant challenge to aid agencies and the resources they have at their disposal, and there’s always another headline-making disaster that needs immediate money and attention.</p>
<p>Above all, we need to remember that earthquakes and hurricanes may be natural, but the scale of their impact is man-made. To genuinely build back better, the international community needs to take a much harder look at why the rich stay rich and the poor get poorer. That would demand a fundamental reallocation of wealth and power. </p>
<p>Until that happens, poor people and nations will be forever vulnerable and the rich will always be appeasing their conscience with international aid. At the very least, we can but hope that Matthew will prompt a reassessment of what building back better actually means.</p><img src="https://counter.theconversation.com/content/66811/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Pauline Eadie receives funding from the ESRC/DFID for the project ‘Poverty Alleviation in the Wake of Typhoon Yolanda’. ESRC reference ES/M008932/1. You can follow this project on Facebook as Project_Yolanda and Twitter @Project_Yolanda. </span></em></p>Six years after a catastrophic earthquake, Haiti has to recover from yet another disaster. Getting it right will be a herculean task.Pauline Eadie, University Lecturer in International Relations, University of NottinghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/667662016-10-11T05:02:00Z2016-10-11T05:02:00ZHurricane Matthew is just the latest unnatural disaster to strike Haiti<p>At least <a href="http://www.abc.net.au/news/2016-10-10/hurricane-matthew-makes-its-exit-to-sea/7917250">1,000 people were killed</a> when Hurricane Matthew battered the Tiburon peninsula in Haiti last week, destroying houses and displacing tens of thousands. </p>
<p>A humanitarian crisis <a href="http://www.aljazeera.com/news/2016/10/horrors-left-hurricane-matthew-clear-haiti-161008094813244.html">is now unfolding</a> for the survivors, with the Pan American Health Organization <a href="http://www.scientificamerican.com/article/u-n-expecting-cholera-upsurge-in-haiti/">warning</a> of a likely cholera surge in the country due to severely damaged water supply and sanitation systems. </p>
<p>Several other Caribbean island states have been affected, including the Dominican Republic, Jamaica, Barbados, Saint Vincent and the Grenadines, and Cuba, as well as the <a href="http://www.abc.net.au/news/2016-10-10/hurricane-matthew-makes-its-exit-to-sea/7917250">United States</a>.</p>
<p>In 2011, one of us (Jason) led a team to Haiti’s capital Port-au-Prince to contribute to the reconstruction effort after the devastating 2010 earthquake. The team worked particularly on the provision of housing. </p>
<p>In all interactions, the team encountered a local community that was honourable, industrious and kind. This perception is confirmed by those who have spent <a href="https://www.theguardian.com/commentisfree/2016/oct/06/hurricane-matthew-haiti-aid-long-term-economic-investment">time on the ground</a> after Hurricane Matthew.</p>
<p>But, as is common in the <a href="https://commons.trincoll.edu/disasterarchipelago/?page_id=1034">media and institutional narrative following disasters</a>, prejudices and preconceptions abound. Following the earthquake, the Haitians were <a href="http://news.bbc.co.uk/2/hi/8502616.stm">portrayed</a> as weak, dependent, corrupt and lawless victims. The international community intervened, amid a global outpouring of grief, support and solidarity. </p>
<p>Five years later, destruction and suffering in Haiti is again making headlines. Why is history repeating itself?</p>
<h2>Unnatural disasters</h2>
<p>According to the <a href="http://www.preventionweb.net/files/45462_backgoundpaperonterminologyaugust20.pdf">United Nations Office for Disaster Risk Reduction</a>, disaster risk is a function of hazard, exposure and vulnerability. It is normally expressed as the likelihood of deaths, injury or loss of infrastructure for a specific period of time. This suggests that disasters are the product of the human condition.</p>
<p>But other experts <a href="http://naturalhazardscience.oxfordre.com/view/10.1093/acrefore/9780199389407.001.0001/acrefore-9780199389407-e-25">describe</a> disasters as “manifestations of unresolved development problems”. Therefore, disasters are not a natural phenomenon. Humans play a central role. As a result, a natural hazard such as Hurricane Matthew impacts each country in its path differently.</p>
<p>Countries, regions, people groups and individuals are distinctly affected by hazards, mostly based on pre-existing vulnerability. While most scholars agree that there are particular vulnerabilities for specific hazards, some <a href="http://naturalhazardscience.oxfordre.com/view/10.1093/acrefore/9780199389407.001.0001/acrefore-9780199389407-e-25">argue</a> for “a generalised vulnerability that affects the poorest of the poor and most marginal in all parts of the world”.</p>
<p>In Haiti, many aspects of risk and vulnerability <a href="http://www.irdrinternational.org/wp-content/uploads/2016/01/FORIN-2-29022016.pdf">have very deep roots</a> in colonial history. The structural injustice existing in society has been compounded by recent trends in international economics. These have worked to exacerbate widespread vulnerability and exposure.</p>
<h2>The status quo has failed Haiti</h2>
<p>The earthquake in 2010 resulted in 222,750 deaths, 300,000 injuries, 1.5 million displaced people, and more than 3 million affected in total. Most of the built environment in Port-au-Prince was destroyed, as well as its basic services and infrastructure.</p>
<p>In August 2010 the United Nations <a href="https://www.theguardian.com/world/2016/aug/18/un-public-admission-haiti-cholera-outbreak">tacitly admitted blame</a> for the cholera outbreak that occurred after the earthquake. However, <a href="https://theconversation.com/five-years-after-haiti-quake-a-new-setback-for-cholera-victims-36149">it later invoked absolute immunity</a>. </p>
<p>Cholera has claimed <a href="http://www.scientificamerican.com/article/u-n-expecting-cholera-upsurge-in-haiti/">more than 9,000 lives</a> and infected more than 720,000 people in Haiti since 2010. And the failure to contain and eradicate the disease has manifested into the current crisis, with a <a href="http://www.aljazeera.com/news/2016/10/hurricane-matthew-haiti-battles-cholera-outbreak-161009042525983.html">surge of infections</a> in the areas hit hardest by Hurricane Matthew due to poor water and sanitation.</p>
<p>Little of the <a href="http://www.npr.org/sections/goatsandsoda/2015/01/12/376138864/5-years-after-haiti-s-earthquake-why-aren-t-things-better">US$13.5 billion pledged</a> by the international community after the earthquake <a href="http://cepr.net/blogs/haiti-relief-and-reconstruction-watch/haiti-by-the-numbers-four-years-later">ever made it</a> to Haiti’s people or into its economy. <a href="https://www.theguardian.com/global-development/poverty-matters/2013/jan/14/haiti-earthquake-where-did-money-go">Most of it (94%)</a> went to private contractors, donor nations’ own civilian and military entities, international non-government organisations, and UN agencies.</p>
<p>Investigations have revealed that the actors of <a href="https://www.theguardian.com/commentisfree/2014/feb/05/haiti-the-neoliberal-model-imposed-on-the-country-is-failing-its-citizens">predatory capitalism</a> rushed to secure quick and easy profits in the wake of calamity. This has helped to prevent any serious effort to address disaster risk by <a href="http://www.poverties.org/blog/poverty-in-haiti">sidelining local stakeholders</a>. </p>
<p>Under the guise of goodwill and solidarity, the United States has officially supported what journalist Antony Loewenstein <a href="https://www.versobooks.com/books/1985-disaster-capitalism">calls</a> “the latest incarnation of a tired model that failed to deliver long-lasting benefits to locals, but instead delivered cheap labour to multinationals”.</p>
<p>No argument for skills development and employment opportunities can really excuse <a href="https://www.theguardian.com/commentisfree/2014/feb/05/haiti-the-neoliberal-model-imposed-on-the-country-is-failing-its-citizens">abusive labour practices</a>. In Haiti, these simply reinforced underlying vulnerability and made a mockery of the commitment to “build back better”. In reality, the United States’ interests have been <a href="http://www.slate.com/articles/news_and_politics/politics/2016/09/the_truth_about_the_clintons_and_haiti.html">protected and served</a> in Haiti for a century.</p>
<h2>Reducing disaster risk in an age of uncertainty</h2>
<p>Put simply, we are creating new risk faster than we are dealing with the existing risk. James Lewis and Ilan Kelman <a href="http://currents.plos.org/disasters/article/the-good-the-bad-and-the-ugly-disaster-risk-reduction-drr-versus-disaster-risk-creation-drc/">warn</a> that:</p>
<blockquote>
<p>…without tackling all vulnerability drivers – that are the roots of [disaster risk creation] – the conditions of [disaster risk creation] will continue to prevail over attempts at [disaster risk reduction].</p>
</blockquote>
<p>We continue to demand conformity to orthodox ways of thinking about economics, development, governance and society that have locked us into destructive pathways. Disaster risk is socially-constructed and we must propose solutions that do not ignore <a href="http://www.irdrinternational.org/wp-content/uploads/2016/01/FORIN-2-29022016.pdf">root causes</a>. This means providing empowerment and autonomy to communities which live in at-risk areas, including access to resources, education, livelihoods, and health.</p>
<p>Jocelyn McCalla, of the National Coalition for Haitian Rights, <a href="https://www.theguardian.com/commentisfree/2016/oct/06/hurricane-matthew-haiti-aid-long-term-economic-investment">asserts</a> that:</p>
<blockquote>
<p>Hurricane Matthew has disrupted the expected course of events. We should not seek to put Haiti back on course. We need to change course altogether, use disruption to identify another course of action in consultation with Haitians. </p>
</blockquote>
<p>We know that development, imposed by external forces that exploit the local labour force is not in the interest of the marginalised. A failure to respect human rights, local needs, the environment and human-environment relations simply creates disaster risk.</p>
<p>A shift towards truly transparent, democratic and participative practices is necessary. We must acknowledge the role of corporations, governments, NGOs and even United Nations agencies both in creating new risk and preventing the reduction of existing risk. Otherwise our well-meaning efforts to help Haiti now and in the future will leave us asking the same questions when disaster next strikes.</p><img src="https://counter.theconversation.com/content/66766/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jason von Meding receives funding from the Australian Department of Foreign Affairs and Trade. </span></em></p><p class="fine-print"><em><span>Giuseppe Forino receives funding from University of Newcastle. </span></em></p>At least 1,000 people perished when Hurricane Matthew battered Haiti last week, destroying houses and displacing tens of thousandsJason von Meding, Senior Lecturer in Construction Management and Disaster Risk Reduction, University of NewcastleGiuseppe Forino, PhD candidate Disaster Management, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/666642016-10-07T18:00:24Z2016-10-07T18:00:24ZWhen catastrophe strikes, who foots the bill?<p>Hurricane Matthew <a href="http://www.chicagotribune.com/news/nationworld/ct-hurricane-matthew-florida-20161007-story.html">has slammed into the Florida coast</a> after hammering Haiti. Close to 2 million people were asked to evacuate to escape its winds and rain. </p>
<p>While any loss of life will be the biggest concern, the hurricane is expected to cause extensive damage to buildings and infrastructure, leaving Floridians saddled with heavy losses – some insured and some not. </p>
<p>For a category 4 storm in this area – as it was deemed at one point – the <a href="http://www.bloombergquint.com/markets/2016/10/05/hurricane-matthew-is-a-15-billion-threat-headed-to-florida">economic disruption</a> is expected to cost anywhere from $5 billion to $15 billion, according to Bloomberg. The storm was later downgraded to category 3.</p>
<p>Real estate analytics firm CoreLogic <a href="http://www.corelogic.com/about-us/news/media-advisory-hurricane-matthew.aspx">estimates</a> that more than 954,000 homes in Florida are at risk of surge damage from a Category 4 storm, with another million at risk in South Carolina, North Carolina and Georgia. </p>
<p>So who’s going to pay for it? </p>
<h2>First lines of defense</h2>
<p>One consequence of climate change is that <a href="https://cdn.americanprogress.org/wp-content/uploads/2016/09/21081429/CostsOfClimate.pdf">extreme weather events</a> are occurring more often with the potential to cause catastrophic damage more frequently. According to the <a href="http://www3.weforum.org/docs/Media/TheGlobalRisksReport2016.pdf">2016 Global Risks Report of the World Economic Forum</a>, extreme weather events rank second as the most likely threat to global stability going forward. And my research on the safety and soundness of financial institutions suggests this trend may also threaten the stability of the insurance industry. </p>
<p>The first line of defense to deal with the costs are the insurance companies operating in Florida, which will be busy in coming weeks and months assessing and paying the insurance policy claims of the insured home and business owners. </p>
<p>But most of Florida’s property insurers <a href="http://www.businesswire.com/news/home/20160526006307/en/Fitch-Florida-Specialist-Insurers-Largely-Untested-Hurricanes">are relatively new</a> because the market went through a fundamental restructuring after Hurricane Wilma in 2005, transitioning from large national insurers to smaller ones focused almost exclusively on the state. Wilma caused $12.3 billion in insured losses (in 2015 dollars), <a href="http://www.tampabay.com/news/business/banking/hurricane-matthew-has-the-florida-insurance-industry-bracing-for-its/2296864">ranking it fifth</a> among the most costly U.S. hurricanes. </p>
<p>This has made the next line of defense, reinsurers, much more important. </p>
<p>Insurance companies buy backup policies with reinsurers to reduce their exposure to insurance claims that require potentially large payouts in extreme weather events. This allows firms to reduce their liability on individual claims and achieve a reduced overall risk exposure from greater diversification. </p>
<p>The costs of all these policies are rising, though, as the historical and mathematical models used to price the policies factor in the more recent and more severe storms. </p>
<p>If weather-related events in the future do turn out to be more costly for insurers than in the past, historical data and traditional policy pricing models may not support equity valuations in this industry sufficiently to keep the firms financially stable. In other words, the firms may not have enough financial firepower to cover future calamities. </p>
<p>So, while insurers, reinsurers and their regulators try to develop better models and tools to manage climate and other catastrophic risks, global financial markets have provided some relief. </p>
<h2>Cat bonds to the rescue</h2>
<p>The issuance of catastrophe (aka “cat”) bonds has become an important source of funding for the insurance industry and an effective tool for shifting some of the largest risks to capital market investors. </p>
<p>Essentially, cat bonds are like most debt securities in that the issuer (in this case an insurer or reinsurer) gets access to financing (held in escrow) from investors in exchange for regular coupon payments and the eventual return of principal. The difference with this type of debt is that if a loss greater than a pre-specified amount occurs as a result of a hurricane or earthquake, the issuer is allowed to delay or skip interest and/or principal payments, while the bondholders incur losses that can be substantial. </p>
<p>Yet, in a near-zero interest rate environment, investors have largely benefited from the higher yields associated with catastrophe bonds. And <a href="http://www.naic.org/cipr_topics/topic_insurance_linked_securities.htm">few cat bonds</a> have suffered losses as a result of hurricane or earthquake, making them (so far) very rewarding for their holders. </p>
<p>And those attractive returns have increased the demand for these bonds and boosted issuance of the debt. Currently, there are about <a href="http://www.wsj.com/articles/hurricane-matthew-to-test-catastrophe-bond-market-1475791599">$12 billion worth of catastrophe bonds</a> with at least some exposure to Florida storms. That’s a little over half of all $22 billion cat bonds outstanding. (Only $5.55 billion of the debt was outstanding in 2005.)</p>
<p>But these bonds <a href="http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2140653">are not entirely immune</a> to financial crises or natural catastrophes. And some argue that the good times could end as the Florida market <a href="http://www.tampabay.com/blogs/the-buzz-florida-politics/as-hurricane-matthew-nears-a-reminder-that-insurance-market-is-untested/2296854">is heavily reliant</a> on reinsurance and also cat bonds, which means pension plans and other holders of the debt <a href="http://www.wsj.com/articles/hurricane-matthew-to-test-catastrophe-bond-market-1475791599">could face substantial losses</a> in case of extreme damage. </p>
<h2>Flooding losses</h2>
<p>These types of insurance <a href="https://www.allianz.com/en/press/news/financials/stock_bonds/news_2007-04-10.html/">typically</a> only cover wind-related damage from hurricanes. Yet such storms are also associated with extensive flooding. That’s covered by a different type of insurance altogether. </p>
<p>The National Flood Insurance Program (NFIP) administered by the Federal Emergency Management Agency (FEMA) works with several insurance companies to provide flood insurance to individuals and businesses in communities that have joined NFIP and adhere to sound floodplain management standards. </p>
<p>This is an example of a public-private partnership <a href="http://ascelibrary.org/doi/abs/10.1061/(ASCE)NH.1527-6996.0000201">that could be extended</a> to help protect against other extreme threats. The recent flood in Louisiana, for example, <a href="http://www.claimsjournal.com/news/southcentral/2016/09/09/273375.htm">is estimated</a> to have caused economic losses in the range of $10 billion to $15 billion. </p>
<p>FEMA has limited resources available to help the uninsured who often face daunting financial losses. According to the <a href="https://www.americanprogress.org/issues/green/report/2016/09/22/144386/the-costs-of-climate-inaction/">Center for American Progress</a>, FEMA provided about $67 billion in financial assistance to communities and individuals, or about $200 per U.S. resident, from 2005 to 2015. </p>
<h2>No insurance, no problem?</h2>
<p>But who pays when there’s no insurance? In the recent Louisiana flooding, for example, a <a href="http://www.claimsjournal.com/news/southcentral/2016/09/09/273375.htm">model suggested</a> 80 percent of damaged homes didn’t have flood insurance. </p>
<p>In Florida’s case, Citizens Property Insurance covers homeowners who cannot find insurance on the open market. This state-run company has reportedly spent a decade <a href="http://www.tampabay.com/news/business/banking/hurricane-matthew-has-the-florida-insurance-industry-bracing-for-its/2296864">increasing its reserves</a> and reducing the number of policies it covers. </p>
<p>Its $7.5 billion surplus, access to the Florida Hurricane Catastrophe Fund and reinsurance backup should help it handle a 1-in-100 year storm without having to levy new assessments on property owners, according to Citizens. </p>
<h2>More extremes lie ahead</h2>
<p>Extreme weather is expensive for insurance companies and their reinsurers, communities, taxpayers and also, potentially, capital market investors. </p>
<p>And it’s only getting more expensive as climate change increases the frequency of storms and their severity. </p>
<p>While more can be done to improve risk pricing and risk management, climate change mitigation is critical for our ability to continue to survive and recover from the catastrophes that lie ahead.</p><img src="https://counter.theconversation.com/content/66664/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carolin Schellhorn does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even though Hurricane Matthew has been downgraded to category 3, it’s expected to cause substantial damage to Florida and other states in the region. The question is, who pays.Carolin Schellhorn, Assistant Professor of Finance, St. Joseph's UniversityLicensed as Creative Commons – attribution, no derivatives.