Now, we're going to discuss the planning cycle and how it starts with the basic assessment. Here's some words from the sphere standards and it says the priority needs of a disaster affected population are identified through a systematic assessment of the context, the risks to life with dignity, the capacity of an affected population and relevant authorities to respond, planning will identify the minimum assistance levels. So what our emphasis here is a systematic assessment. When we see a disaster is easy to go in and look at water and sanitation needs if we're engineers, and if we're public health people, we'll go in and look at what are the clinical needs, if we're nutritionists will look at what that nutrition needs. But here we want to emphasize a systematic approach to the assessment. So we're doing a comprehensive picture of what's going on. Here we have a photograph of a study that we did a few years ago in Central Iraq with large numbers of people that had been displaced by conflict Al Anbar province and they're coming into Central Iraq, and they have many needs and we're trying to do this in a comprehensive manner. So we identify all the needs and not just the ones that we feel comfortable addressing. The initial assessment starts usually in a day or two after a disaster strikes. Most people who have the capacity to the assessment are not on the scene. So it takes a while to begin this assessment. Here we have to balance the need for speed to understand what the population's needs are with a sensitivity for the major health issues to have some idea of what we should be looking for in this particular disaster. The purpose of assessment is to identify problems, and the reason we want to identify the problems is so we can set the priorities, mobilize the resources needed, and implement the appropriate services. Already, we're getting into some difficult areas when we talk about setting priorities, because in disasters, there are never enough resources to go around to meet all the needs, so it's important to set our priorities. So in addition to the specific health needs or other types of needs like water and sanitation, we have to understand what the context is, what the resources of a population would be to support the recovery process, we have to understand how things might change. Is this the rainy season and then soon going to be dry? Is this an area where there's a lot of instability already and things may get worse? Do we have issues about tensions between various ethnic groups? Do we have additional populations that are likely to come in this area? So understanding the context is critically important. Then we have an opportunity to come back later on. Once we do our initial assessment, then this will raise a lot of questions and it will answer a few questions, but it'll raise many more. This is an opportunity to come back in a week or two or a few days later and look at some of these other issues in detail. The time for assessments never goes away in disasters, we'll have to go back on a repeated basis to see how people are adjusting to their situations, what needs have been satisfied, and what new needs are created. A classic example would be a nutritional assessment. If we find a situation where there's a lot of malnutrition, we want to come back and see how well we have met the needs of the population for improved nutrition. There are other situations like a recovery process for shelter. How well have we assisted depopulation in rebuilding their shelters, and are there areas that we need to put additional resources and additional emphasis on. There are many cookbooks and many checklists out there, and the reason there's so many is none of them are really satisfactory, we're always trying to make one, that's a bit better. One of the major problems is being able to grasp the context. There's no one size fits all checklist. There's some that are very useful, some that are more comprehensive. But often, we find that key information in a particular environment is not collected or and unfortunately this is frequent, the information that is collected is not analyzed or even if its analyzed, it may not be fed into the planning process. Sometimes the information collected is not representative. In fact, this is often the case. We don't have a good sampling frame in many situation, so we may not know where people live and how to create a good assessment that represents all the populations. A while back, we conducted a survey in Mosul, immediately after ISIS had been ousted from Mosul. There most of the city had been destroyed. So we didn't know to the nearest 100,000 people, how many people were living in the city and where they were living, nobody knew this. So the risk of collecting non-representative sampling is really a problem here. We have issues of denominators. So how many people are living there? We don't know. How can we create ratios, and age, and sex distribution when we're not doing as comprehensive and representative sampling. This is always a risk that we have to face. Sometimes we know we're not going to get this information, so we have to approximate it in the best way that we can, and then when the picture becomes a bit clear, then we can go back and collect a bit more in the way of denominators, and some of the more detailed representative sampling. One of our problems is that we may collect the information that's needed initially, but then we don't go back and follow up to see how people have adjusted to the situation. A personal example again is from our research a while back with Mosul. We found how people were coping, we found what their health needs were and what wasn't being met. But then we went back a year later and repeated the same study to see how people were adjusting to the circumstances they were currently living in, many of the health facilities being demolished, many of the utilities not working. How do they adjust to this and how can we help this community in strengthening its response to the recovery process. There are a number of formal checklists out here, many of them are very good. There's one called the Multi-Sector Initial Rapid Assessment, MIRA. This is produced by the Inter-Agency Standing Committee. Then there's a set of guidelines from the Red Cross movement. These are all excellent, and these are things that can help us to understand what's happened, how did things get the way they are, what's likely to happen next, how may things develop, and if we don't see this information and the guidelines, then we add this in ourselves because this is important information to have. In this next slide, we have an example from the Standing Committees Initial Rapid Assessment form, and there there's an opportunity to rate in red, yellow or green what the circumstances are for the population for a specific situation. We also have illustrated on this slide something known as the FOG, and this comes from USAID. It's called the Field Operations Guide. This is an amazing collection of information. For instance, do you need to know how many kilos a camel can carry? Which is interestingly enough, 250 kilos, but a donkey can only carry a 100 kilos. Do you need to know how many meters of runway space a loaded C-130 Hercules aircraft requires with a load of food in cold weather? Well, it's all there in this handbook. So you don't need to commit this to your brain, it's all there when you need. Then, there's another approach to things, and that's looking at systematic assessment using flow diagrams to determine whether specific gaps are there and whether they're being filled, and to determine whether something actually needs to be done about this situation or whether this is likely to take care of itself, as many problems are likely to do in emergency situations. Further, in the problem analysis, we need to have an emphasis to look beyond the symptoms. There are a lot of symptoms at the surface of things, but underneath these things are root causes. Some of these may represent vulnerabilities in the society that had been there for a long period of time. These need to be addressed and not just focusing on specific symptoms. Because we're looking at this from a public health aspect, we're going to emphasize the importance of data to help define the problems. Do we need more data, and if so, how much more data do we need to be clear about the situation and what kind of response is required? Then, in the problem analysis, we need to avoid assigning blames or solutions while the problem is still being defined. Sometimes we can come to a quick conclusion that may not really represent the depth of the problem because we have not taken the time to fully understand this problem. Now, when we're finished with our analysis of the population's needs, then we should be able to produce a problem statement. This says what the problem actually is and what are the specific needs that the population has. So this problem statement to a disaster plan is like a research statement is to a research project. It tells us really what we're going to do, gives us a clear explanation of what's happened. We need to be able to, in our problem analysis, check the current circumstances against some standards, or as we often say, benchmarks. So what are these population needs now compared to what their population needs were before or similar population? So is this a severe situation or maybe not? Maybe this is a usual situation. But it can help us to set our priorities, and it can help us to decide where we should put our resources when we're guiding our response, or if we're guiding our recovery process, or helps us decide what should go into our plan for prevention or preparedness. Again, we're back to the Sphere Standards. These help us specifically with the technical standards. But they're also increasingly a good guide for the process. Are we doing things in the right way? Some time ago, it was realized that just putting the services into place was not enough. We've seen this with a number of recent disasters as well. It's easy to quickly put into place access to services, but then when we turn around and look at the quality of services, they're not as good as they should be. So now we have a new humanitarian standard that looks at quality and accountability, trying to address some of these deficits in quality. So here's an example of some of the technical standards that we might see in the Sphere Standards. So for living space, their standard is excluding the cooking area and bathing area, every person should have 3.5 square meters of space in whatever dwelling or shelter they are living. In cold climates or urban climates where internal cooking space and bathing or sanitation is required, then the space is more per square meter per person. Then, there's a standard for internal floor to ceiling height. The highest point should be at least two meters, or if you're in a hot climate, a bit more space. Another example more aligned with the health services are the number of community health workers that we need per 1,000 people. We also have a standard on the percentage of births that are attended by skilled personnel. There is a standard on the number of personnel that are necessary for 10,000 people. Then, there are standards on process. Everybody who's carrying out health activities have received specific training in the appropriate protocols and in the case management. Then, we have to think about how do we assess what are the biggest threats? There's some criteria that we can use. There could be situations of high case fatality rates. There could be situations where we have high volume of things and high R sub zero value. This means how infectious a particular infection is or we can look at the prevalence or the high potential for future problems. So I've done a little two-by-two table here. We can see in this table that there's some boxes that have high severity of disease, some boxes that have high volume, and where we have a situation with high volume and high severity, this should be a priority area for us. These are tough choices. What are the consequences of doing A but not B? What is the maximum good that can be achieved with the resources we have, and how would we apply utilitarian ethical values which say, the maximum good for the maximum number of people? Then, we have to think about what are the alternatives. There may be several alternatives. We have to do some serious thinking before we select one alternative over another. We have to think also can the community strengthen its own coping strategies? Sometimes communities are traumatized, and initially, they're unable to do this. We also have to think, will the problems resolve quickly, and are there some short-term approaches we can use or are there some long-term approaches that need to have our emphasis? If we do short-term approaches, let's be sure they don't get in the way of doing some long-term resolution of problems. Then, we have to think about the alternatives of maybe other organizations who have better skills than we do to address these issues. We can think also of using a priority matrix. If you haven't thought about this, look up a priority matrix and think how we might use this weighing the various solutions that we need to think about. From all of this process of evaluating how we need to address things, we can select the optimum plan or the optimum intervention that would be appropriate for the needs generated by a specific disaster.