Lee Christopher, Doocy Shannon, Deli Anwar, Kirsch Thomas, Weiss William, Robinson Courtland
Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
BMC Public Health. 2014 Nov 17;14:1168. doi: 10.1186/1471-2458-14-1168.
There exists little agreement on the choice of indicators to be used to assess the impact of humanitarian assistance. The 2004 Indian Ocean tsunami led to significant mortality and displacement in Aceh Province, Indonesia, as well as a nearly unprecedented humanitarian response. Six years after the disaster we conducted an impact assessment of humanitarian services rendered in Aceh using a comprehensive set of rights-based indicators and sought to determine modifiable predictors of improved outcomes in disaster-affected households.
A sample of 597 returned and non-returned households in Banda Aceh and Meulaboh was selected using a multistage stratified cluster survey design. We employed principle components analysis and the Framework on Durable Solutions for Internally Displaced Persons to develop a comprehensive and rights-based approach to humanitarian impact measurement using multivariate regression models.
The attainment of durable solutions was equivalent in both returned households 100.1 [CI] 97.63-102.5) and households that integrated elsewhere (99.37 [CI] 95.43-103.3, P = 0.781). Standard of living as well as education and health facility satisfaction increased significantly whereas monthly income decreased after the tsunami, from 2585241 IDR ([CI] 2357202-2813279 IDR) to 2038963 ([CI] 1786627-2291298 IDR, P < 0.001). Shelter (P = 0.007) and legal assistance (P < 0.001) were both significantly associated with positive durable solutions outcomes, whereas prolonged displacement duration was significantly associated with poorer outcomes (P < 0.001). Livelihood assistance received after one year was associated with higher odds of increasing or maintaining pre-tsunami income levels (OR = 3.02, P = 0.008), whereas livelihood assistance received within one year was associated with lower odds of attaining pre-tsunami income (OR = 0.52, P = 0.010).
We find that after adjusting for pre-tsunami conditions and tsunami-related damages, the impact of sectoral responses can be assessed. The duration of displacement was the strongest negative predictive factor for the attainment of durable solutions, suggesting that measures to reduce displacement time may be effective in mitigating the long-term effects of disaster on households. The durable solutions framework is a novel and effective impact measurement tool and can be used to identify factors amenable to intervention and inform future disaster recovery efforts.
在用于评估人道主义援助影响的指标选择上,几乎没有达成共识。2004年印度洋海啸在印度尼西亚亚齐省造成了重大人员伤亡和流离失所,同时也引发了近乎史无前例的人道主义救援行动。灾难发生六年后,我们使用一套全面的基于权利的指标,对亚齐提供的人道主义服务进行了影响评估,并试图确定受灾家庭改善结果的可改变预测因素。
采用多阶段分层整群抽样调查设计,在班达亚齐和默拉博选取了597户回迁和未回迁家庭作为样本。我们运用主成分分析和国内流离失所者持久解决框架,通过多元回归模型制定了一种全面且基于权利的人道主义影响衡量方法。
回迁家庭(100.1 [可信区间] 97.63 - 102.5)和在其他地方融入的家庭(99.37 [可信区间] 95.43 - 103.3,P = 0.781)在实现持久解决方面相当。海啸过后,生活水平以及对教育和卫生设施的满意度显著提高,而月收入从2585241印尼盾([可信区间] 2357202 - 2813279印尼盾)降至2038963印尼盾([可信区间] 1786627 - 2291298印尼盾,P < 0.001)。住房(P = 0.007)和法律援助(P < 0.001)均与积极的持久解决结果显著相关,而流离失所时间延长与较差结果显著相关(P < 0.001)。一年后获得的生计援助与提高或维持海啸前收入水平的较高几率相关(比值比 = 3.02,P = 0.008),而一年内获得的生计援助与达到海啸前收入的较低几率相关(比值比 = 0.52,P = 0.010)。
我们发现,在对海啸前状况和与海啸相关的损害进行调整后,可以评估部门应对措施的影响。流离失所时间是实现持久解决的最强负面预测因素,这表明减少流离失所时间的措施可能有效减轻灾难对家庭的长期影响。持久解决框架是一种新颖且有效的影响衡量工具,可用于识别适合干预的因素,并为未来的灾难恢复工作提供参考。