Research conducted by the Centre for Research on Health Care in Disasters
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 services. On this page we present our current research. At the moment we conduct research in four areas: moral stress, needs assessment, management of conflict injuries and health system resilience.
Professor Johan von Schreeb is in overall charge of the research conducted.
Our most recent publications:
This is a selection of a few of our most recent publications.
- Märit Halmin, Ghada Abou Mourad, Adam Ghneim, Alissar Rady, Tim Baker, Johan Von Schreeb. Development of a quality assurance tool for intensive care units in Lebanon during the COVID-19 pandemic. International Journal for Quality in Health Care, Volume 34, Issue 2, 2022
Martina E. Gustavsson, Niklas Juth, Filip K. Arnberg, Johan von Schreeb. Dealing with difficult choices: a qualitative study of experiences and consequences of moral challenges among disaster healthcare responders. Conflict and Health volume 16, Article number: 24 2022
Maria Palmqvist, Johan Von Schreeb, Andreas Älgå. Autotransfusion in low-resource settings: a scoping review. BMJ Open 2022;12:e056018
Needs assessments in disasters
To plan relief activities following a disaster the following needs assessment information is needed: The context in which the disaster struck? What was the socioeconomic situation before the disaster? What resources are available and how was the pre-disaster situation for the population?
Our previous research findings highlight the lack of a “system” among disaster response agencies to make use of needs assessment data. Relief is sent based on “experience” and “feeling” rather than on objective needs assessment. Our focus has changed towards developing methods and approaches of estimating needs and risk following disasters, rather than how to collect the data on ground. We have created and tested a model to estimate and compare the severity of disasters, and our work now focuses on predicting the severity of disasters using the model of indicators we developed earlier.
- To map existing models of severity assessment models used in complex disasters and earthquakes
- To evaluate the extent to which the mapped severity models can estimate the number of people affected and killed by earthquakes and floods
- Based the first objectives, to define a model for estimating the severity and level of needs in different types of disasters
- Moreover, to explore contextual and conceptual aspects of needs assessments and how their results may influence the international humanitarian health assistance response in disaster situations
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, health care 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 as they do not sufficiently capture the complexity of disasters and the pressure responders are working under.
Our research aims to better understand what determinants are crucial to moral stress and what can be done to prevent illness and suffering.
- To identify and categorise moral challenges in disaster response
- To explore how and to what extent these challenges affect wellbeing among responders
- To systematically develop education materials to prepare responders
- To assess the extent that a preparatory education improves the preparedness and the capacity of responders to handle moral stress
Societies at risk
Armed conflict is human development in reverse. The full scale of conflicts’ impacts remains unknown, and fragmentation of research into multiple academic fields limits our understanding, that is why we are part of the Societies at Risk project.
Societies at risk - anticipating the impact of armed conflict, is an inter-disciplinary research project that looks at the impact of armed conflict as an hazard, exposure and vulnerability. It considers the macro and micro effects on economies, health, water security, political institutions, human rights, gender equality and forced migration.
The Centre for Research on Health Care in Disasters forms part of the project along with Uppsala University, Universitat Autònoma de Barcelona, the International Security and Development Center (ISDC), Stockholm University, Johns Hopkins University, University of Pittsburgh, and V-Dem at University of Gothenburg. The project seeks to provide a a comprehensive, multidisciplinary and forward-looking assessment that may provide for a 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
The Centre for Research on the Health Care in Disasters will contribute to the cross-cutting themes and to the work package on health impacts of armed conflict.
- To assess the impact of armed conflict on a population of a given combination of hazard, exposure, and vulnerability across a set of outcome metrics, such as mortality, malnutrition, and economic growth, explicitly taking how these effects interact and reinforce each other into account.
- To estimate the hazard of conflict by applying the insights of research on the causes of war.
- To research the extent to which populations are exposed to conflict as a function of distance to it in terms of time and space.
- To assess the vulnerability of exposed populations to adverse impacts, conflict and climate-related and natural disasters.
- To formulate scenario simulations and cost-benefit analyses based on the results of the research. This will make use of a forward-looking, live, risk-assessment system that will produce regularly updated evaluations of expected impacts globally across locations.
- To produce free-standing estimates of conflict exposure and an index of vulnerability to shocks.
Management of conflict injuries:
Local negative pressure therapy for gunshot and explosion wounds
Wounds caused by gunshots and explosions often have difficulty healing because of extensive tissue damage and contamination. Current management practices are based on experience treating military personnel, but these skills may not necessarily be transferable to a civilian context. Research is needed to enable evidence-based management of traumatic injuries and evaluate the use of new therapies.
Our research concerns local negative pressure therapy, which is a relatively new technology that primarily aims to reduce infections and shorten healing time. We performed a randomised controlled study in close vicinity to active conflicts to evaluate if the Vaccum Assisted Closure (VAC) treatment improved wound healing and reduced infection complications of limb injuries. The results of this study showed no significant benefit, which provides support for evidence-based management of patients with traumatic injuries. More studies regarding improved management of conflict injuries are underway.
- To assess pre-hospital trauma mortality in conflict situations and examine to what extent it is possible to reduce this
- To evaluate the efficacy and safety of local negative pressure treatment of explosion and gunshot wounds
Epidemiology of conflict-related trauma in contemporary armed conflicts
Armed conflicts constitute a significant public health problem, and the advent of asymmetric warfare tactics creates unique and new challenges to health care organisations providing trauma care in conflicts.
Our retrospective studies analyse the epidemiology of presentations to civilian hospital close to ongoing conflicts in Afghanistan and Iraq and assess different aspects of their management.
Health system resilience:
Towards health systems resilience to extreme weather events: managing health needs during floods in Cambodia
Extreme weather events like floods are expected to become more common as climate change continues, putting health at risk. Knowledge on what health needs is expected after such events is needed for health systems to be able to provide health services. Resilient health systems have the capacity to maintain their functions and change when experiencing events like floods which enables them to continue delivering essential health services.
Our research aims to assess the effects of flooding on health and the capacity of the public health system to manage health needs during floods in Cambodia, with a view to identifying capacities that foster health systems resilience to extreme weather events.