Research conducted by Global Disaster Medicine - Health Needs and Response
A disaster is defined by a lack of resources: a lack of staff, lack of skill, lack of material and lack of time. Our research concerns the challenge of how we, despite the lack of resources, can provide optimal health care, as well as construct and manage the best functioning health care system.
Needs assessments in disasters
The intention behind needs assessment in disasters is to systematically assume the type of needs to allow optimal planning for relief in order to maximise the use of resources. Needs assessments are time sensitive and rely on rapid estimates of severity and population affected as well as systematic information on the pre-disaster vulnerability tin the affected area. Our research into needs assessment in disasters has generated two PhD thesis and remains a feature of the research we do.
We continue to develop methods for timely needs assessments taking into account the changing nature of conflicts and natural disasters, and have created and tested a model to estimate and compare the severity of disasters. Our research currently focuses on predicting the severity of disasters and health care needs.
The impact of armed conflicts and other crises on health demand and utilisation
Societies at Risk - Anticipating the Impact of Armed Conflict, is an inter-disciplinary research project that looks at the impact of armed conflict as a hazard, exposure and vulnerability. It seeks to provide a comprehensive, multidisciplinary and forward-looking assessment that may provide well-informed decision-making and anticipatory action. The aim is to develop a comprehensive risk-based framework for empirically assessing the expected impact of armed conflict on human development
Anneli Eriksson has led research on the understanding of the impact of armed conflict on health, as part of the project. We have conducted qualitative studies where we seek to understand how people manage health care needs during armed conflicts. In doing so, interviews have been conducted in Sweden with persons who have been affected by conflict, and focus group discussions have been held in Ukraine and Lebanon. We have also conducted literature reviews, and conducted cohort studies to investigate if there are any correlations between conflict intensity and health outcome at regional level in two contemporary armed conflicts. In two studies, we also looked at health effects on a country level, in relation to conflict intensity and vulnerability.
We are also conducting research on civilian prehospital care in armed conflict and how such systems can be strengthened and further developed, which is the focus of Wessam El Ghoul's doctoral studies. Since, existing literature is largely limited to military prehospital care or to settings unaffected by conflict, there is a significant evidence gap regarding the effectiveness of prehospital care for civilians in war zones. At present, we are collecting and analyzing data from ongoing conflicts in Ukraine and Gaza.
Similar to the question of impact of armed conflict, we also study the impact of other form of crises on health service demands and utilisation. In particular, we study the effects of floods and other forms of extreme weather. Moreover, we look at how health systems can be strengthened to cope with crises.
Dell Saulnier is co-leading a work package in a REACH project on assessing the impact of floods and extreme heat on maternal and child healthcare utilisaiton and coverage, focused on Brazil and Zambia. The aim is to better understand the characteristics that make this system vulnerable to floods and heat, as well as the characteristics that make it resilient.
Health systems resilience and performance
Here our research focuses primarily on identifying characteristics and behaviours that generate and sustain resilience capacity. This includes looking at decision-making structures, knowledge sharing, trust and interdependence. Furthermore, we explore issues of power in resilience and in the outcomes of resilience interventions, as well as identifying the thresholds between the three main resilience capacities for different kinds of crises.
Our work within this field includes a project that looks at discerning the role of the private sector in creating health system resilience, through a case study in Zambia. This project is funded by the Swedish Research Council. It focuses particularly on the role of for-profit and not-for-profit private sector actors in resilience, such as information sharing between sectors, trust and legitimacy, and organisational resilience. The aims are to:
- Identify weaknesses and challenges in the process of sharing COVID-19 test information between public and private facilities in Zambia for use in diseases surveillance and monitoring
- Understand the population’s perceptions of trust in private sector health services compared to public services during the COVID-19 pandemic
Dell Saulnier is also the co-supervisor of a doctoral research project, funded Forte, that looks at health systems resilience in managing the COVID-19 pandemic and what lessons can be drawn from regional preparedness plans in Sweden.
In terms of research on health systems performance, we are currently leading a project that looks at the casual relationship between social health insurance (SHI) and financial protection, service utilisation and health outcomes, which focuses on Cambodia and is funded by the Swedish Research Council. The aims are to:
- Understand how, why and under what circumstances SHI schemes influence primary health care-related health outcomes in low- and middle-income countries
- Determine the effect of the Cambodian SHI reform on primary health care service utilisation and financial protection among scheme members
- Assess the impact of the Cambodian SHI reform on the primary health care-related health outcomes of scheme members
- Explore demand- (scheme members) and supply-side (primary health care system actors) perceptions of how the Cambodian SHI scheme influences financial protection and service utilisation for primary health care services
- Understand the pathways to impact of the Cambodian SHI scheme on primary health care-related health outcomes
Systems thinking for health systems
Our methods research focuses on systems thinking for health systems, which is an approach to help understand the complexity of problems within the health system, by looking at them holistically, viewing them as interconnected, and understanding the relationships and interactions between system stakeholders and parts. Dell Saulnier was a founder of the European region of the Systems Thinking Accelerator (SYSTAC) network that promotes systems thinking for health systems.
Emergency Medical Teams (EMTs)
Emergency Medical Teams (EMTs) are teams of health care professionals that provide direct clinical care to people affected by emergencies and disasters and support local health systems. It is an initiative within the World Health Organization (WHO) and our research group leader, Johan von Schreeb, was part of setting it up following the chaotic international response to the 2010 Haiti earthquake. He co-authored the first version of the “Blue Book” (Classification and Standards for Foreign Medical Teams in Sudden Onset Disasters) and has significantly contributed to developing the EMT-initiative. He also co-authored the 2021 version of the Blue Book as well as the Red Book (A Guidance Document for Medical Teams Responding to Health Emergencies in Armed Conflicts and Other Insecure Environments)
We continuously conduct operational research on EMTs, by collecting and analysing data from disasters where EMTs (both national and international) have been deployed and assess their contribution, and to what extent they are integrated into the health system in the affected area.
In addition to research, members of our group also work as mentors for agencies striving to get EMT-classified, we are part of verification missions and contribute to trainings and awareness sessions in countries that are signing up to become an EMT. These aspects are described further on our policy and expertise-page.
Moral stress and ethical challenges in disasters
The resource scarcity that defines disasters brings with it moral challenges beyond those in normal healthcare settings. In disaster response situations, healthcare staff will be in new, often threatening, situations where they will need to make difficult decisions to prioritise among overwhelming needs. Available professional ethical guidelines are of limited use, since they do not sufficiently capture the complexity of disasters, and the pressure responders are working under.
Our research on this topic aims to better understand what determinants are crucial to moral stress and what can be done to prevent illness and suffering. In early 2024, Martina Gustavsson, defended her PhD titled Moral conflicts in health crises : Swedish health care workers’ experiences and management of moral stress, within this topic. She remains affiliated to our group and continues to conduct research in this field.
Prioritising and quality assessment of intensive care in disasters, crises and resource-limited contexts
In a disaster or crisis, regardless of what has caused it, the number of patients in need of intensive care often increases. In spite of a scale up of the care, a situation could arise where the number of patients exceed the available care and prioritising must be made. Methods for quality assessment of intensive care is also often not adapted to disasters, crises or resource-limited context.
We conduct operational research in this field with the aim of understanding and improving prioritisation and quality assessment of intensive care in crisis. Related to prioritisation, we have conducted a pilot study on attitudes to prioritising patients to intensive care among medical students and plan to develop this into a larger project that will study attitudes among the general population.
In terms of quality assessment of intensive care in disasters or low-resource settings, we have previously developed and implemented tools to assess the quality of care of critically ill patients during the COVID-19-pandemic in Lebanon and we are currently preparing for a larger project to develop a quality assessment tool to be used in intensive care in resource-limited settings.
Previous research projects
During our over twenty years of research, we have covered several topics within the field of disaster medicine and been involved in multiple research projects.
These include, most recently:
- Undernutrition and breast-feeding in humanitarian settings. Within our group, we have extensive collective experience of both working with, researching and teaching on the topic of malnutrition, undernutrition and breast-feeding in humanitarian setting. The latter was explored in Nieves Amat Camacho’s PhD thesis, titled Feeding in Crisis - Exploring the Provision of Breastfeeding Support during Humanitarian Emergencies.
- Assessment of the levels of independence and ability to conduct day-to-day activities after injury for patients in humanitarian setting, within which Bérangére Gohy defended her PhD thesis, Independence in activities after injury in humanitarian settings: assessment, change over time and associated factors in 2023.
- Management of conflict injuries - Local negative pressure therapy for gunshot and explosion wounds, within which Andreas Älgå defended his PhD thesis, Wounds of war: surgical care for conflict-related injuries among civilians in resource-limited settings in 2019.
For questions regarding our research
Johan von Schreeb
Research group leaderResearch group leader Johan von Schreeb, Professor of Global Disaster Medicine, has overall responsibility for the group’s research