Humanitarian aid organizations continue response efforts, but those on the ground say it will be a long-term effort to recovery. Data scientists and information managers have used data analysis to track mobility patterns, understand current needs, map damage to buildings and health infrastructure, and effectively share information.

Crisis Ready, a collaboration between Direct Relief and the Harvard Data Science Initiative, hosted Data in Crisis: Responding to the Earthquakes in Turkey and Syria at Harvard on March 3 with over 200 online participants and many others in person.

The nearly two-hour conversation centered on how crisis response organizations have used novel data sources and methods to support Turkey and Syria. The presenters shared their organization’s response models, how to make ethical and effective use of data, and key takeaways from the disaster so far. While open data has helped to determine where people are going and their current needs, scientists say they still expect a drastic undercount of the displaced population as first responders and families continue to look for residents.

The in-person and Zoom event included internationally known speakers: Dr. Andrew Schroeder, Vice President of Research and Analysis at Direct Relief and Co-Director of CrisisReady; Dr. Caroline Buckee, Co-Director of CrisisReady and Professor of Epidemiology at Harvard University; Dr. Abdulfatah Elshaar, Chairman of the Syrian Medical Society and Internal Medicine Physician at Sturdy Memorial Hospital; Ozge Acar, Technical Coordinator at NeedsMap Social Cooperative; Dr. Samer Attar, a medical volunteer at the Syrian American Medical Society and orthopedist at Northwestern Memorial Hospital; Nathaniel Raymond, lecturer at Yale University in the Humanitarian Research Lab; and Can Unen of OpenStreetMap (HOTOSM).

Schroeder opened the event and shared that over 217,000 structures have been destroyed or deemed unsafe, including 520,000 housing units. Across the globe, digital volunteers have mapped buildings and their degree of damage in the earthquake area. Unen from HOTOSM explained to meeting viewers how precision mapping and open information sharing with international response agencies have been beneficial to saving lives.

With millions displaced, medical supports remain the top reported need: antibiotics, access to chronic disease medications, acute trauma support for search and rescue, and support for the displaced staff of medical organizations.

Attar, who volunteered as a surgeon in Syria, said being on the ground changes one’s perspective. There were limited resources that required doctors to make critical triage decisions. He said that they treated two to three patients on the same bed or even on the floor–most of whom had body parts that had been crushed by shattered buildings.

The surgeon said it was a sobering experience and one where he felt like his contributions were “barely making a dent.” Attar said that doctors performed dozens of surgeries per day, but many more people still need critical medical care.

“There wasn’t a lot of heavy machinery, so we would find people digging through the rubble trying to find relatives, or whoever they could find, using their hands or whatever they could find to dig them out,” Attar said.

Dr. Elshaar, also from SAMS, shared that the situation in Syria is one of the worst humanitarian crises in history, given the dire circumstances of Covid-19, the Russian and Ukraine war, the spread of cholera in Syria, and now the earthquake. He shared that hospitals and clinics have been targeted over the past 12 years of civil war in the country, making access to care more difficult.

The SAMS doctor shared an assessment of immediate needs: wound care, amputations and prosthetics, and medication for diabetes, hypertension, cancer, maternal/pediatric health, cholera treatment, and mental health trauma.

Though the situation in Turkey remains dire, access to data is increasing. Mobility data from Data for Good at Meta, analyzed by organizations like CrisisReady, show that population density is shifting away from highly impacted areas in Syria and Turkey. Survivors of the earthquakes are moving to less impacted areas of the country, including large cities like Ankara and Istanbul and rural areas with less damage. However, it’s unclear what housing will be available to them long term. Many are staying in a range of temporary and ad hoc shelters.

Dr. Buckee shared that institutional challenges are often greater than data challenges for epidemiologists trying to model the spread of infectious diseases like cholera and arboviruses.

She shared that having preexisting partnerships before disaster responses is key and that following simple models during a disaster will reap success in determining which populations are at risk, where displaced people may relocate, and identifying the medium to the long-term impact of infectious and non-communicable diseases. The simpler the models, the better for quick and efficient decision-making.

Some said they use social media to track movement, but real-time information gaps persist.

Social media also plays a key role in mapping the landscape of needs at scale. Projects on digital platforms like NeedsMap are at the center of efforts to report where individuals may need food, shelter, and medical care. They can also highlight where the capacity exists to meet those needs.

While helpful, Raymond reminded the crowd that information must be treated with high degrees of care for both individual privacy and community protection. Data can make an enormous impact on disaster response, but the responsibility exists to ensure that vulnerable populations aren’t exposed to further risk.

Dr. Andrew Schroeder contributed to this story.

The post Follow the Data: CrisisReady Shares Emergency Response Models for Turkey-Syria Earthquakes appeared first on Direct Relief.

CrisisReady participants have been analyzing and sharing data to identify communities most vulnerable to health risks from the massive wildfires that have burned large parts of California in each of the last several years. In addition to the direct risk to life and property, these risks include lost power to life-sustaining medical equipment; lost access to medicine and medical services; smoke inhalation hazards; heightened disease transmission risk in temporary shelters; and psychological impacts of displaced and disrupted lives.

CrisisReady is a collaborative project between Direct Relief and researchers at Harvard School of Public Health, Harvard Medical School, Stanford University, and a network of researchers in epidemiology, public health and disasters. The collaboration evolved from the Covid-19 Mobility Data Network, a volunteer research network of 100+ scientists from around the world that formed in early 2020 to collect and analyze population movement data, helping local and national governments reduce Covid-19 transmission through social distancing policies.

Nearly 95% of California is currently in severe drought, according to the National Integrated Drought Information System. “The fuel is there for serious events that can have enormous adverse consequences,” said Andrew Schroeder, Vice President of Research and Analysis at Direct Relief.

While wildfire is a natural part of the California landscape, the massive wildfires of recent years have brought new threats to public safety, including more frequent and more severe fire-related electrical power outages, and the increasingly frequent encroachment of wildfires into heavily populated urban and suburban areas. Within a few weeks in October 2019, the Saddleridge Fire came within five miles of more than 200,000 households, while the Getty Fire came within five miles of 190,000 homes, said Mathew Kiang, an instructor in the Department of Epidemiology and Population Health at Stanford University School of Medicine.

Power outages, including intentional Public Safety Power Shutoffs (PSPS) to reduce the risk of wildfires caused by downed power lines, have become far more common in California. In 2019 there were nearly 1,100 power outages of at least eight hours, covering over 111 million household-days across 56 of the state’s 58 counties, and 149 24-hour power outages across 45 counties accounting for 8 million household days, Kiang said. Potentially deadly risks from power outages include carbon monoxide poisoning, gastrointestinal illness, heart attack, injury, mental health impacts, renal disease and temperature-related illness. The neighboring Riverside, Orange and San Bernardino Counties in Southern California all have large numbers of households relying on durable medical equipment and have experienced frequent, long power outages, Kiang said.

Researchers with CrisisReady are also looking at how smoke and particulate matter generated by these massive wildfires has affected the health of the people nearby and downwind of the fires. Other research directions include incorporating hospitalization and mobility data to better understand where people go during fires or immediately after fires, their medical needs, and a better accounting of resources including shelters, hospitals and long-term care facilities.

CrisisReady is building open source, web-based tools to help communities meet surges in demand for health resources. Named the “Health System Resilience Mapper,” the tools will help communities, response agencies, healthcare systems, and aid agencies optimize their health care service capabilities in preparation for increased demand during and after natural disasters.

Disasters often simultaneously cause an immediate spike in demand for urgent health services and a reduction in existing capacity to provide those services. For example, a fire that causes injuries and also damages the area hospital requires alternatives to be identified for both fire victims and persons who were relying on care at that facility. Similarly, when a disaster or potential disaster prompts mass evacuations from one area, the areas to which evacuees flee can experience immediate surges in demand for health services that evacuees bring with them.

To date, no U.S. health care system can predict the demand for these services after a disaster. Data on health care utilization, environmental threats and population mobility exists in silos across many institutions, but CrisisReady’s Health System Resilience Mapper will combine, for the first time, these data streams to provide real-time actionable information for decision-makers working to protect populations affected by disasters.

“The escalating number and scale of wildfires is putting disproportionate pressure on the most vulnerable communities in California,” Schroeder said. “In order to build health systems that adapt equitably and respond effectively to those pressures, it is vital to have much better data before events happen.”

The Health System Resilience Mapper will let public health agencies run simulations to anticipate demand surges for healthcare when a fire breaks, as well as provide real-time decision support tools that help predict the level of the humanitarian aid needed in a specific region after a crisis has hit.

“Interdisciplinary, cross-sector teams can greatly improve disaster response by bringing together different kinds of data and building the tools we need to support health systems in advance of a crisis,” said Harvard’s co-leads for CrisisReady, Caroline Buckee, Associate Professor of Epidemiology at the Harvard T.H. Chan School of Public Health, and Satchit Balsari, Assistant Professor of Emergency Medicine at Harvard Medical School. “The data we need to more effectively help disaster-affected communities exist already, but they need to be in the right place at the right time—and they need to be analyzed appropriately—to support decision makers during a crisis.”

“As a long-time California resident, I’ve seen the increasingly devastating effects of wildfires, first-hand: countless homes and neighborhoods destroyed, small businesses forced to close their doors and irreversible damage to our environment,” said Jacquelline Fuller, President of Google.org. “But what we often don’t see are the secondary effects these natural disasters have on the lives of thousands of people with complex medical care needs who face the risk of infrastructure disruption, interrupted care, and forced displacement. As wildfires continue to grow in intensity and severity throughout the U.S., particularly in California, Google.org’s grant will help enable the critical work Direct Relief and Harvard University are doing to help communities better prepare, protect, and serve those in need the next time our home state is faced with a disaster.”

The post CrisisReady Researchers Probe Health Risks from California Wildfire Season appeared first on Direct Relief.

This post was authored by Dr. Jennifer Chan – Northwestern University, with support from Lauren Bateman and Kate Bruni. This work is part of the User Feedback Project for the Covid-19 Mobility Data Network, which has been generously supported by the Institute for Global Health at Northwestern University.

The interactive dashboard can be found here, although it is not currently being updated.

Syracuse is a modest sized city of just over 140,000 people in upstate New York. It sits within the heart of the Finger Lakes region, not far from Lake Ontario. Although far from the worst hit areas of New York state by COVID-19, Syracuse saw alarming increases in cases and deaths during the initial wave of the pandemic. Daily cases in Onondaga County, where Syracuse is located, hit their daily peak of 145 on the 19th of May, with nearly 5,000 total cases and over 200 deaths recorded as of October 13, 2020.

The city of Syracuse, like many others around the United States, sought to use digital mobility data as part of their means to implement, monitor and adjust physical distancing policies in order to mitigate the spread of COVID-19. A small data team within the city government took it upon themselves, with support from the COVID-19 Mobility Data Network, to learn how to analyze digital mobility data in order to inform public health decision-making, and in the process made significant advances in data applications for the control of Covid-19 in their area.

The use of mobility data by the city of Syracuse from March through June, 2020, is an example of a multi-member collaboration between Harvard researchers in the COVID-19 Mobility Data Network and a city-level data team, which was tasked with responsibilities in public health analysis despite not itself sitting within the department of health.

Facebook mobility data was integrated into broader situational awareness efforts including an interactive dashboard that was made available to the mayor and others. Different users and decision-makers viewed mobility data trends after social distancing measures during phases of reopening, holidays, and spring temperature changes.

“I think it’s (mobility data) pushing the decision makers to think about things in ways that we haven’t thought about before.” – Neha Majety

The all-woman data team worked closely with Nishant Kishore, a PhD student affiliated with the Center for Communicable Disease Dynamics at Harvard University.

The Syracuse team learned about the COVID-19 Mobility Data Network and Facebook mobility data through their chief data officer as well as a group call with other cities in the United States. Virtual conversations followed between Nishant and the team, where they discussed both the potential added value of mobility data and its limitations for COVID-19 response activities. The data team was working to support the mayor’s interests in seeing how people were responding to the executive orders to stay at home.

“Our mayor is very adamant about us making data driven decisions, as a government, as a whole. And being able to remind him that there are different, obscure ways of addressing that data and supporting our populations (is important).” – Amanda Darcangelo

After two calls, the team decided to use Facebook population data given the delayed baseline period and subsequent lack of movement data. Nishant created a template showing population changes as a proxy for movement at the census tract level, as well as population changes during different times of day. The situation reports were shared in PDF format and frequently reviewed by the data team and chief data officer. Joanna Bailey, the data team’s GIS expert, soon had access to geographic shapefiles, enabling them to adapt and determine how best to use the data to fit their needs.

Mobility on Easter Sunday and Changes in Temperature

The Syracuse team integrated the Facebook data into a broader situational awareness dashboard for the county. They were interested in visualizing the trends in case data in relation to spikes in mobility. The purpose of the dashboard was to correlate spikes in mobility to weather pattern trends.

At the team’s request, Joanna Bailey received comma-separated-values (CSV) files of anonymized aggregated data so they could continue to monitor changes and analyze the data in combination with other data including temperature, COVID-19 symptom emergency call locations, and the number of COVID-19 cases and tests. During Easter weekend they anticipated that there would be increased movement during that time due to family gatherings and warmer weather.

Their analysis confirmed that there was a spike in movement during the holiday weekend. The structured data files enabled Joanna and Jennifer Glass, the data intern, to create maps that the team believed provided an easier way for them to monitor changes and work with other datasets to see potential relationships between movement near business areas during reopening phases as a potential proxy for rates of economic recovery.

Envisioning Use Cases and Collaborations

Like many other collaborative teams in the mobility network, groups working within government agencies envisioned that the mobility data would help them better understand the impact of social distancing policies during the early phases of the pandemic. What many groups learned over time was that iterations and adaptations with the mobility data were crucial in aligning it with their specific needs.

“I also feel like this is kind of giving us the opportunity to look deeper into the different parameters that govern the society… You know, it kind of pushes us into more diverse tracks of thought. So I think it’s helping us in a lot of ways.” – Neha Majety

More often than not, defining those needs with an often unfamiliar data source takes time – a journey of learning between all groups involved. The Syracuse collaboration “kicked off” in the first week of April with PDF situation reports, and evolved over time to maps created internally by the Syracuse data team and eventually an online dashboard. Using the Facebook population data as a proxy for movement data helped the data team in Syracuse support the broader needs of the government during the response to COVID-19.

“It’s definitely made our leadership reassess what using data means… [for example] here are some people who are mobile, and here are tracks in which we may have more mobile people but we don’t know because they don’t have internet.” – Amanda Darcangelo

While some of the outcomes included an evolution of maps, data products, and insights over time, the use of Facebook data had meaningful influence on how the data team envisioned the role of data generally in the crisis, including perceptions of how it can play a meaningful role in the ongoing digital transformation within their organization.

The post Digital Mobility Data, Physical Distancing, and COVID-19 in Syracuse appeared first on Direct Relief.

This post was authored by Andrew Schroeder, Nishant Kishore, Navin Vembar, and Caleb Dresser.

Key points:

• The area of displacement from Calcasieu post-Laura stretched in all directions from the epicenter, principally to Orleans Parish and Baton Rouge in the east, and to Houston in the West.
• Rates of return to Calcasieu have been relatively slow, with only ⅓ of displaced persons having returned 25 days post-storm.
• Displacement and return have been disproportionately gendered, with greater numbers of women being displaced and also returning at higher rates than men.
• Shelter usage patterns show significantly lower utilization after Laura in the past.

The 2020 hurricane season has been unusually active, with 23 named storms as of September 24th, six greater than the previous annual record set in 2005. As Hurricane Sally arrived on the Gulf Coast across the Florida panhandle and into Mississippi and Alabama, people once again had to evacuate at-risk locations and seek safety from the storm in the midst of a pandemic. Hurricane Laura landed in Louisiana and Texas less than three weeks previously, and some evacuees from that storm were still staying in temporary shelters, hotels, and other types of short-term housing. The succession of events and their potential geographic overlap raised serious concerns about safe evacuation and long term displacement. Risks remain high for similar events throughout the rest of this year, making reflection and learning from the recent past a particular imperative now.

Where Did People Go?

Data from Facebook and Camber Systems highlights patterns of movement as people moved to shelter from the hurricanes that landed on the Gulf Coast in the early part of September.

First, we can see the estimated change in the population of devices from Facebook data. The difference in densities between counties can be seen by comparing the percentage change of the population with an estimated absolute change extrapolated using the American Community Survey (ACS) data from the US Census.

Cameron Parish, in the southwest corner of the state, is highlighted red in both pictures, indicating a significant percentage change of people as well as a significant absolute change. But just south, Jefferson Parish, is not red in absolute change, as it has a far lower density of people.

The overall pattern of dispersal from Calcasieu Parish in the face of Laura is shown in the below animation. Calcasieu Parish is useful to focus on given that it hosts the city of Lake Charles, which bore the brunt of the storm.

According to reports from the Red Cross over 8,000 homes were destroyed or badly damaged, the majority located in the Lake Charles area. Throughout the region, the locations with the greatest reduction in population as of September 7th (the last date of Facebook mobility data available)ranged from Harris County, TX on the highest end through the following set of cities across southern Louisiana.

Gender and Displacement

According to long-term displacement data from Facebook, population displacement from Calcasieu Parish has been gender skewed to a degree that demands further investigation. Although the overall Facebook data sample appears to be skewed towards women, with the user base in the region, those with location services enabled, being composed of 56.2% women, the proportion of persons displaced from Calcasieu Parish was tilted to an even greater degree towards women. Whereas 55.1% of all displaced persons in the region were female, according to Facebook, as of September 10th, 2020 that number rose to 63.3% for women from Calcasieu, a difference of 8.2%.

The proportion of returnees was also skewed towards greater proportions of women. As of September 20th 33% of the population displaced from Calcasieu had returned. However the rate for women was much higher at 37% as compared with 28% for men. The rate of return has also increased steadily for women relative to men over the past 10 days. These gender differences in rates of return potentially indicate greater challenges for women with longer term displacement.

Reasons for the gender disparities in displacement are likely due to underlying social vulnerabilities in the area. For example, the rate of households headed by a single parent in Calcasieu is more than three times greater for women as compared to men, with 10.5% of family households being headed by a single female parent as opposed to 2.8% for men. These types of gendered household disparities tend to reflect underlying income differences as well.

Shelter Utilization

Historically, the American Red Cross and community partners have provided shelter for tens of thousands of people during major hurricanes. This year, however, the ongoing COVID-19 pandemic has fundamentally altered the process of evacuation and sheltering. Response agencies are now operating smaller shelters, conducting COVID-19 screening, and working to house evacuees in hotels, where they can self-isolate, rather than in mass shelters. Many evacuees have been also choosing to avoid shelters altogether, in some cases choosing to sleep in vehicles instead.

While past hurricanes in the region have resulted in many thousands of people staying in shelters at the height of a storm, usage numbers peaked at a few hundred per night following Hurricane Laura and quickly downtrended. Most of the people who would have been expected to use shelters during a major storm chose not to do so during and after Hurricane Laura. Based on this, it seemed likely that evacuees from Hurricane Sally would also use shelters far less than they would have been expected to in years past.

Epidemiological modeling shows that hurricane evacuations can impact the spread of COVID-19 as evacuees are displaced from their homes. In seeing the spread of people away from the hurricanes and that people had yet to return home from Laura before Sally hit, the long-term impact of transmission from evacuees needs to be studied. The information here, especially that showing where people went – and then stayed – is important for future planning. There are nearly impossible tradeoffs to be made here, given that evacuation from hurricanes is necessary – but, appropriate shelter planning can potentially reduce the spread of COVID-19 across counties.

The post Displacement, Gender Disparities, and Shelter Utilization after Hurricane Laura appeared first on Direct Relief.

According to the most recent reports from the Ministry of Health and the World Health Organization, three districts in the province of Cabo Delgado (Pemba, Mecufi and Metuge) have seen outbreaks of cholera since Cyclone Kenneth made landfall.

The coastal city of Pemba is the center of these outbreaks, with 108 total cases, followed by Metuge with 19, and Mecufi with 10.New cases are being detected regularly, with the most recent reporting, on May 9, recording one of the highest total case loads since the storm.

In addition to patient treatment with antibiotics and rehydration, Mozambique’s second mass cholera vaccination campaign of the year is scheduled for the end of this week.According to the most recent epidemiological bulletin, “Over 516,000 doses of the Oral Cholera Vaccine (OCV) were received by the authorities and health partners in Pemba on 12 May, for the vaccination campaign scheduled to start on 16 May.” The previous cholera vaccination campaign in Beira saw over 900,000 individuals vaccinated across three districts in the path of Cyclone Idai.

The 516,000 doses, administered in single-dose format to maximize the reach of the current supply, covers a considerable swath of the population in Cabo Delgado. However, health authorities remain vigilant to any potential changes in the geography of case detections, which might alter calculations of the total at-risk population and the scope and focus areas for vaccines.

Epidemiologists at Harvard School of Public Health, with whom Direct Relief, Nethope, Facebook’s Data for Good team, and the Northwestern University School of Medicine have been collaborating since the aftermath of Cyclone Idai, have updated their model to understand how the emergence of cholera cases may spread using a very simple gravity model, in order to make it better suited to possible tactical planning efforts for cholera vaccination. More detail about the model and its methodology can be found here.

Case counts for new cholera detections can be input variably. The model combines cases with a gravity model (simulated population movement based on population estimates from before the flood), flood extent, previous cholera incidence and El Nino sensitivity measures, to rank surrounding areas with respect to risk of cholera emerging there. As new case totals are updated, the probability of future outbreak areas may change in significant ways, alerting health authorities to the need for revised planning estimates. The model uses district boundaries for population. Therefore, new case detections recorded at the sub-district level need to be combined into district-level totals for estimation.

Members of the health cluster, including the World Health Organization and the Mozambique Ministry of Health, have been briefed on the details and functionality of this model. Documentation is in the process of being translated to Portuguese to ensure that local actors are fully informed. As the campaign is rolled out over the coming weeks, and new information becomes available, additional modeling efforts can be adapted and revised to reflect improved understanding of the outbreaks.

Click here to explore the model.

The post Predicting the Spread of Cholera in Mozambique as Case Count Rises appeared first on Direct Relief.

Just six weeks after Cyclone Idai devastated the country and sparked a cholera outbreak that has so far resulted in over 6,300 cases and 8 deaths – despite a successful mass vaccination campaign that reached 900,000 people in four districts – Cyclone Kenneth threatens a repeat of those events in an area that, in many ways, is just as large, complex and vulnerable to disaster.

Cholera has not yet emerged as an active threat in the area likely to be most affected by Cyclone Kenneth. However, particularly in the wake of recent events in Beira after Cyclone Idai, it is clearly a risk. Flood waters and high winds lead to the loss of homes, displacement of population, damaged health infrastructure and, perhaps most seriously from the standpoint of waterborne diseases, damaged sanitation systems which can quickly spread the bacteria which cause cholera.

Can we already know enough precisely about the factors which may lead to cholera outbreaks, including the combination of those factors which may specifically exist in northern Mozambique, in order to focus attention, prioritize key geographic areas and possibly begin planning now for the scale, form and location of health emergency response which may be required?

Modeling Cholera Risk for the Aftermath of Cyclone Kenneth

To help identify the areas in Mozambique at greatest risk from the storm and its aftermath, a team of researchers led by Dr. Caroline Buckee, Dr. Ayesha Mahmud and Rebecca Kahn from Harvard University School of Public Health, in collaboration with Direct Relief, Nethope Crisis Informatics, Facebook Data for Good and Jen Chan from Northwestern University School of Medicine, developed an initial model-based estimation of likely cholera in the region.^1,2

The model highlights several key areas primarily in the Cabo Delgado province, as well as areas of Tete, Zambezia and Sofala provinces, at the highest risk for potential cholera outbreaks following Cyclone Kenneth. Collectively, the five districts considered by the results of this model to be most at risk represent a population of nearly 1.2 million people.

Key factors included in this spatial disease-risk model include the previous cholera incidence for this area, estimated severity of flood impacts, and the likelihood of increased cholera incidence during El Nino years. Previous cholera incidence was based on modeled estimates derived from cholera outbreak data and ecological data from Lessler et al. on cholera hotspot detection for Africa, published in The Lancet in 2018.³ Flooding impact estimates were based on the most recent weather information available, with the highest severity in the northernmost districts. Sensitivity to the effects of El Nino was based on work from Moore et al published by the Proceedings of the National Academy of Sciences (PNAS) in 2017.⁴

Details of the Cholera Risk Model

Risk scores for each variable were scaled between 0 and 1, and maps were produced which show both the averaged effect for all variables and the individual impact of each variable in isolation. For Cyclone Kenneth, the projected overall cholera risk is an average of the flooding index, El Niño sensitivity index and previous cholera incidence.

Additional model outputs have also been produced for the Beira area in central Mozambique which is the location of the current cholera outbreak. In addition to the factors which have been identified for the Cyclone Kenneth area, the Beira model includes a “gravity model” which estimates the likelihood of population movement from the area where most infected individuals are located out to areas where those individuals may travel. The gravity (diffusion) model assumes that travel from Beira occurs based on the population size of Beira, the population size of the receiving district and the geodesic distance between Beira and the receiving district according to the formula:

The goal of this additional model output for Beira is to determine the likelihood that despite what appears to be the containment of the current outbreak, the disease may move along with travelers who leave that region and arrive elsewhere in the country. The “gravity model” simulates human movement, in the absence of detailed mobility data, and has been used previously in epidemiological models (for example, in Xia et al in the American Naturalist in 2004).⁵ High resolution population data was deployed from Facebook.⁶

Focusing Attention and Planning on Emerging Health Risks

As additional flooding and cholera case data becomes available, in the event of actual cholera outbreaks, these models can and will be updated to reflect changing predictions based on new information and new circumstances.

Direct Relief, Nethope and colleague organizations involved in health emergency response activities in Mozambique and other potentially affected countries will be continuing to pay close attention to any signs that communities may be seeing outbreaks of cholera in the days and weeks to come, as southern Africa copes with what is already the most serious sequence of storm-based disaster impacts for this region in recorded history. The modeling work performed by our colleagues at Harvard is an extraordinarily valuable guide to the risks which may still lie in the future. Additional modeling analysis is also in the works for areas of southern Malawi which have already been affected by Cyclone Idai and which lie in the inland path of Cyclone Kenneth.

The data, code and methodology which drives these models will be posted in the coming days to GitHub so that other researchers and interested parties may use these models, reproduce their results, and help us to improve our collective focus on and response to the enormous set of health risks faced by communities in Mozambique and elsewhere.

External Resources:

1. The R-Shiny web application containing output of the cholera risk model
2. Cyclone Kenneth Cholera Modeled Maps
3. Lessler et al, “Mapping the Burden of Cholera in Sub-Saharan Africa and Implications for Control: An Analysis of Data Across Geographic Scales,” The Lancet, vol. 31, issue 10133, May 12, 2018
4. Moore et al, “El Nino and the Shifting Geography of Cholera in Africa,” Proceedings of the National Academy of Sciences of the United States of America, 114 (17) 4436-4441, April 10, 2017
5. Xia et al, “Measles Metapopulation Dynamics: A Gravity Model for Epidemiological Coupling and Dynamics,” The American Naturalist, vol. 164, no. 2, August 2004
6. High-resolution population data set from Facebook
7. GitHub Repository: Cholera and Mozambique

The post If Cyclone Kenneth Leads to Cholera in Mozambique, Who Is Most at Risk? appeared first on Direct Relief.

Like many individuals and institutions, humanitarian organizations are also contending with these at-times-bewildering shifts in perception, policy and technology.

Rather than simply celebrating social media uncritically or disengaging from it given certain dystopian fears, it may be possible to find a more productive engagement with social media as a force for good. Humanitarian organizations can use these services in striking new ways, by focusing on what can be learned from the data being produced at greater-than-ever scale and speed.

Direct Relief, for instance, not only delivers messages through its social channels; it also derives insight from social media data sources to inform its understanding and advance its core mission of strengthening the health and well-being of people in situations of crisis and poverty. By drawing analytically upon these novel sources of data for good, Direct Relief and others have begun to see the outlines of an alternate future for how social media – treated ethically and responsibly – may play a more realistic and hopeful role in humanitarian operations.

The Best (and Worst) of Times for Social Media

To see what’s possible in the future, it’s useful to understand more about the recent past.

Social media has existed for about 15 years. For most of that time, the platforms which marked its rise, including Facebook, Twitter and similar services, emphasized scaling personal communications and expanding new forms of marketing. The business model popularized by Google, and then later by Facebook, of monetizing user data to create targeted advertising, has been ascendant within and beyond the technology sector for the better part of two decades. Harvard professor emeritus Shoshana Zuboff goes so far as to describe it in her book, “The Age of Surveillance Capitalism,” as an emergent economic system where profitability has been re-founded upon pervasive, commercially-focused monitoring by networks of apps, databases and mobile devices.

During the first decade of social media’s rise, the creation of these new forms of digital interaction and commerce were viewed with near-utopian reverence. That sentiment shifted dramatically in recent years. Election hacking and Black Mirror-style social rating systems, among other things, have taken some of the proverbial bloom off the social media rose.

One of the key answers to this best-of-times/worst-of-times dilemma for social media in the humanitarian space has been for companies to create “data for good” programs. Rather than just using the tools on their own, “data for good” programs promote structured access by analysts to the core data resources. Through data sharing and protection agreements, companies with valuable private data can enable its use at enormous scale and frequency to conduct analysis and guide programs for the public benefit.

Direct Relief now engages in several corporate “data for good” efforts, from social media to location intelligence to news publication and healthcare. These different services, on their own and in combination, are opening new possibilities for answering timeless questions about people and communities in crisis, their needs, and changes over time, especially during emergencies.

The Thomas Fire & Facebook Disaster Maps

Direct Relief’s first experience with social media data for humanitarian use was a trial by fire.

In December 2017, the hills above Santa Barbara, where Direct Relief is headquartered, were an inferno. The Thomas Fire, at that time the largest in California’s history, tore through neighboring Ventura County and carved its way north at an astounding rate. The air, right down to the shores of the Pacific Ocean, was a choking cloud of smoke, filled with particulate pollution. Direct Relief responds to many such wildfire events each year, but this one was different because of the scale, and its proximity to its headquarters.

In collaboration with the Santa Barbara and Ventura County Public Health Departments, Direct Relief staff fanned out to distribute thousands of N-95 masks for protection from the smoke.

Where should these masks be distributed for maximum effect? The fire was dynamic, changing literally with the winds. How could staff know where people would be at different times, and how many masks they might need?

A few weeks earlier, Nethope.org hosted a webinar for a new product from Facebook’s Data for Good team called “Disaster Maps.” Facebook’s user base is massive and spread out in dense patterns over virtually the entire planet. If people opt into a setting called location history on their mobile phones, Facebook is able to anonymize and aggregate this data at a neighborhood level and determine how, when and where populations move. Using these aggregated insights, Facebook can create maps of astonishing clarity about the dynamics of entire populations, in real time.

Facebook Disaster Maps are comprised of aggregated user locations within grid squares that are 600 meters on a side and are updated daily. The implications of these data for humanitarian aid are profound.

With access to such maps, which Facebook provides for free to organizations like Direct Relief that sign data-sharing agreements, questions about where and when to maximize things like N-95 mask distribution could start to be answered in new ways. Evacuation patterns could be analyzed to understand the degree to which people were evacuating their neighborhoods or staying behind. The ebb and flow of population density around planned distribution sites or health centers could be tracked throughout the day. The smoke plume pouring off the hills could be overlaid on that movement pattern to determine how many people were in areas of heightened respiratory risk.

Before too long, Direct Relief was making maps routinely from the Facebook data. Daily briefings filled with news of populations in motion. Connections emerged between these mobile clusters of people and information about pre-existing social vulnerabilities, which led to more detailed assessments of areas in need. The town of Montecito was hit in January 2018 with deadly mudslides. Within hours, Facebook disaster maps revealed the residents’ movements, or lack thereof, in the affected area. Questions could be posed empirically of how those numbers lined up with official evacuation zones.

Social Media as an Operational Humanitarian Platform

When the emergencies of late 2017 and early 2018 finally subsided, a threshold had been crossed. Instead of making do with hypothetical assumptions about how people should behave during emergencies, humanitarian agencies like Direct Relief could base their actions on how people actually behave.

With each passing event, more can be learned about how to respond effectively and anticipate the needs of people in crisis, but it’s not enough for it to reside at the 30,000-foot analyst view. For data like Disaster Maps to be truly impactful, it must get to the operational levels of humanitarian response. For Direct Relief, that means figuring out new ways to get data, and, more importantly, interpretations of that data, into the hands of people best placed to use it. By April and May 2018, workshops had been hosted with non-profit primary health centers in Texas to help them prepare for the upcoming hurricane season. The workshops demonstrated how Facebook Disaster Maps might have helped during Hurricane Harvey, had the tool been available at the time.

Simple insights from social media data could be revelatory in the right context. During Hurricane Harvey, the outlying areas of Houston saw elevated population levels for days. In contrast to news about overcrowded shelters downtown, the health centers in retrospect saw their broader lived realities reflected in the Facebook data. Resources were often needed most in the suburban and exurban zones, far from the city center. The same pattern played out later in the year with Hurricane Florence in the Carolinas and Hurricane Michael in Florida, where enormous pockets of need aligned with areas of high social vulnerability, in outlying areas, and away from the urban cores.

Part of the operational dimension of social media for humanitarian aid lies in linking new analytical capacities with the coordination capacity of the more familiar elements of the platforms. In the case of Facebook, Direct Relief piloted the use of groups to encourage coordination among health centers as well as a venue for distributing Disaster Maps. Through Facebook Groups, positive feedback loops emerged, helping guide analytical insights to those on the front lines of crisis while learning from them about the ground-level realities of events and the impacts of their actions.

Facebook Community Help, a service of Facebook Crisis Response that allows individuals to post their needs during an emergency and others to post their ability to meet those needs, also points the way towards a new humanitarian future where the services we’re using to communicate resemble price signaling marketplaces. The demand for and supply of assistance can become increasingly precise and knowable even under the most chaotic conditions. Direct Relief secured the ability of primary health centers to post information into Community Help as institutions rather than individuals, which means that in upcoming emergencies real-time maps of need, supply, and response activity might be feasible.

Learning from Facebook Data for Good

Privacy concerns for all these new developments need to be kept front and center, given the recent cascade of revelations around privacy failures. How do humanitarian actors use granular information about populations in crises without jeopardizing them even more through the release of information which might be used to target or take advantage of them? Here too, the Data for Good team at Facebook arguably marks out a kind of best practice in the field. In order to access Disaster Maps or the underlying datasets of Community Help, Direct Relief agrees to stringent data protection protocols. Strong limits are placed on access, even blocking the use of APIs, to prevent unplanned or unwanted release of information. Companies that deal in private data could take more than one lesson in proper information management from the standards and trade-offs governing Facebook Data for Good.

Towards the end of 2018, after engaging with Facebook Data for Good for the better part of the year, Direct Relief began seeing an uptick in conversations with businesses about how their core datasets could likewise become useful during humanitarian response. Financial services, location intelligence, news media, healthcare and many other sectors began posing interesting questions about the terms, conditions and use cases that might transform their data assets into social goods for communities experiencing disasters.

Each company requires an answer that’s distinctive to their corporate culture and the content of their data. Taken together though, these private datasets, which track money, health and the whereabouts of large-scale populations on a near-constant basis, and which in many ways now hold the highest value for humanitarian response, may find their way into a new common operational picture, at once public and private. When and if they do, humanitarian actors need to make sure that picture is governed by reasonable standards of privacy and effective information management, of the sort marked out in part by the Facebook Data for Good team.

To the surprise of the world, which at the close of 2018 seemed practically consumed by newfound fears of social media, and a repudiation of the earlier utopian impulses, perhaps the true legacy of Facebook’s Data for Good initiative might be to illuminate a third path. It’s possible that with the right guidance, ethics and emphasis on localized results, efforts like Disaster Maps will form a bridge between the private data which increasingly governs public life and the social good, which can be engaged through careful collaborative action.

Future social media users may be so fortunate one day to re-think these tools in their entirety from such a hopeful point of view.

The post “Data for Good” and the New Humanitarian Future appeared first on Direct Relief.

The event is called the Global Humanitarian Policy Forum. This year, under the banner of “interoperability” (the ability of making systems and organizations work together) and humanitarian action, Direct Relief was invited to participate.

While a surprising succession of speakers criticized the term “interoperability” as unwieldy and nondescript, throughout the proceedings a clever and subtle shift of emphasis could be heard in the endless debates over data sharing and humanitarian effectiveness.

Rather than hewing to the path of negotiated inter-agency settlements (almost inevitably a political minefield), this year’s Forum zeroed-in on interoperability as an informational problem. Questions that arose included:

• How can software mediate institutional interests in data security and competition?
• To what degree is humanitarian coordination as such really a software problem more than a political problem?
• What sorts of informational standards, from newcomers like Humanitarian eXchange Language (HXL) to standbys like Common Alerting Protocol (CAP) and Open Geospatial Consortium (OGC), best allow software to play a greater and more helpful role in humanitarian coordination?
• Can the shift to a more self-consciously informational set of problems in humanitarian space help to improve the relevance and positive impact of actors in the global humanitarian system amid a set of tectonic geopolitical shifts? (These shifts range from rapidly increasing wealth in emerging market countries, to new assertions of sovereignty and regional priority throughout the global south, to a startling set of post-financial-crisis shifts in the impact of private capital, the dissemination of mobile networked technologies and the potentially diminishing willingness of states to fund humanitarian action).

As the conversation shifted to more intimate group discussions by the second day, we heard compelling claims that humanitarian agencies may need to shift away from “innovation” per se as an organizing paradigm for humanitarian investment, in favor of pragmatic interests in “absorptive capacity” and appropriate technologies.

For more than a decade, NGOs have been funded to produce a huge array of pilot technology and data projects, the vast majority of which have had no impact whatsoever upon humanitarian operations. Representatives from the Harvard Humanitarian Initiative in particular emphasized that the humanitarian sector as a whole has been producing far more projects than can ever be meaningfully deployed in practice, leading to a classic risk of speculative crash and backlash.

Likewise, sacred cows of innovation funding, such as the imperative to take new technologies “to scale” as a demonstration of success, came under criticism for neglecting to think seriously about scale in ways that differ from private technology investments and which respect the multiplicity of spatial scales which define the problems that require humanitarian action.

As the Forum came to a close, OCHA marked out a series of new events over the next two years which will carry forward this discussion of coordination as an informational problem. Direct Relief, and through us our partners, will continue to be in the midst of this dialogue.

The post Reflections on the 2014 UN Global Humanitarian Policy Forum appeared first on Direct Relief.

The effects of Ebola extend well beyond those infected. The side effect is depriving people of basic human needs. These grants will enable the people of West Africa to quickly receive essential care and supplies they need to get through this crisis. – Paul G. Allen

With Mr. Allen’s support, Direct Relief will focus on the following near-term priorities to meet the urgent needs of frontline health providers:

• Restock and reopen 100 health centers staffed by 1,500 health workers by providing kits containing a stock of essential items. The contents of these kits were developed by Harvard-trained doctors working in Liberia and approved by the Ministry of Health to set the standard for ensuring a safe and well-functioning health facility.
• Ensure safe births by providing 267 Midwife Kits to Liberia and Sierra Leone – enough for 13,350 deliveries. In Sierra Leone alone, pre- and post-natal care visits are down 28 percent, and delivery with a skilled birth attendant is down 16%. Estimates show that maternal mortality may rise to 15 percent as a result of the Ebola crisis.
• Equip 47 Ebola treatment facilities in Liberia and Sierra Leone. Direct Relief will pre-package the supplies per facility to ensure efficient in-country receiving and immediate delivery. This will help remove bottlenecks and enable more rapid and direct transportation of materials to the centers caring for patients with Ebola.

This support from Mr. Allen is essential to Direct Relief’s collaborative efforts to meet the vastly expanded, urgent need for critical supplies necessary to contain, treat those sickened by the virus, and address the outbreak’s shattering ripple effects on the broader health system. – Thomas Tighe, CEO of Direct Relief.

To date, Direct Relief has sent 140 tons of medical materials valued at $6.98 million (wholesale) via airlifts and ocean freight containers.

Mr. Allen’s Contributions to Date:

From the early days of the outbreak, Mr. Allen and the Paul G. Allen Family Foundation have focused on finding, funding and coordinating strategic solutions that address the most critical needs and can be deployed quickly. To date, Mr. Allen has committed funding towards implementing the following solutions:

• A contribution to the American Red Cross to fund equipment, volunteers and educational materials in Guinea, Sierra Leone and Liberia. (August 2014)
• A matching grant to Global Giving, which more than 700 donors doubled in only four days. Ten groups received funding to distribute sanitation supplies, conduct training sessions and produce public service announcements. (August 2014)
• A partnership with UNICEF to airlift 50,000 protection kits into Liberia. (September 2014)
• A partnership with Airlink to execute a continuous air bridge to deliver critically needed medical protective gear and pharmaceuticals. (September 2014)
• A grant to the CDC Foundation to establish CDC emergency operations centers in the most-affected countries, Guinea, Liberia and Sierra Leone. These centers are helping to develop a systematic response with improved data management and communication systems for disease and patient contact tracing, which will ultimately help to detect and stop the disease from spreading. (September 2014)
• Funding to Medical Teams International (MTI) to help provide infrastructure, housing and transportation needs for MTI’s staff in Liberia. (September 2014)
• A partnership with Doctors Without Borders/Médecins Sans Frontieres to support their existing Ebola emergency programs in Guinea, Liberia and Sierra Leone. (September 2014)
• A grant to BBC Media Action to support education and communications programs in the affected countries aimed at increasing public knowledge and awareness, supporting the government in responding to the crisis and instilling safer health practices among local audiences. (October 2014)
• The establishment of the Ebola Medevac Fund to fund and develop two Medevac containment units that can be used to safely evacuate medical professionals from West Africa. (October 2014)
• A partnership with University of Massachusetts Medical School to help provide training, medical workers, and lab equipment for relief efforts in Liberia. (October 2014)
• A grant to AmeriCares, to provide additional supplies and services to under-resourced clinics to improve the county health system in Grand Bassa County in Liberia. (October 2014)
• A grant to Action Against Hunger to provide food for isolated patients, construct water kiosks and hand washing stations, improve Ebola prevention awareness, and train community health volunteers. (October 2014)
• A $1 million grant to Direct Relief to support the continued delivery by Direct Relief of medical supplies and logistical support on the ground in Ebola-affected West African nations. To date, Direct Relief has sent 140 tons of medical materials via airlifts and ocean freight containers. (October 2014)

The post Ebola Response: Paul G. Allen Family Foundation Grants $1 Million to Direct Relief appeared first on Direct Relief.

A Harvard physician and medical anthropologist as well as subject of the Pulitzer Prize-winning book, Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World, Farmer is the founding director of Partners in Health (PIH), an international charity that has worked with Direct Relief since 2008.

Over the last six years, Direct Relief has provided PIH with more than $12 million in medical aid, much of which has helped provide life-saving health care to people in Haiti.

“It’s easy to say ‘I’m against poverty,’ but linking that notion to engagement is more difficult. The link between sentiment and ideals and actually serving others is the difference—PIH can’t do that without “stuff” and that’s how we got connected with you [Direct Relief].”

Farmer shared with the crowd a personal story to illustrate disparities in health care around the world. While he was in residency for medical school, he was hit by a car and wasn’t able to walk for six months. Though a hardship, he recognized that unlike many others living in poverty, he didn’t have to worry about his family, livelihood, or about not being able to walk again.

The experience further solidified his view that all people deserve to have the same care that he had, regardless of the difficulty involved.

“Thank you to Direct Relief for taking so seriously this grand idea of providing the same standard of care, no matter of circumstance. This coming together in partnership is what matters and helps people most,” he said.

He told the audience that despite the challenges, he was encouraged by their involvement in global efforts to help impoverished people access quality health care.

“Effectiveness and compassion [in a program] are very difficult to measure, but it’s those difficult-to-measure things that bring people to a warehouse on a Sunday afternoon—people who care and have compassion for others.”

The post Dr. Paul Farmer of Partners in Health Visits Headquarters appeared first on Direct Relief.

The Harvard-educated medical doctor has worked with Partners in Health for 14 years and currently serves as Deputy Chief of Mission to Haiti. During a visit to the West Coast, he informed the group of the $16 million facility funded through donations and grants set to be completed at the end of July.

“This is the most ambitious project we have ever done in 25 years,” he said of the institution that will provide modern health services to underprivileged Haitians and serve as a hub to coordinate and run community health networks.

The 320-bed teaching hospital set on 14 acres of land in the town of Mirebalais, 40 miles northeast of capital Port-au-Price, will likely take Direct Relief’s work in Haiti in a new direction.

“They’re the best. We want to work with the best. We will reach out and try to find a way to support this hospital,” said Brett Williams, director of international programs at Direct Relief.

A partner with Direct Relief International prior to the devastating magnitude 7.0 earthquake that struck the island nation Jan. 12, 2010, Mr. Williams said cooperation has only grown closer since the disaster that left many of Haiti’s hospitals in ruins.

“On a regular basis, we share inventory we have with their entire network,” he said. “I view the partnership getting stronger and stronger.”

Partners in Health founders set root in Haiti in 1985 when they established a small two-room clinic in Cange, according to their website. Two years later, the organization was officially founded and though they now work in 12 different countries, Haiti remains their largest and most developed program.

Dr. Walton said Partners in Health does not specialize in disaster relief, but was forced to start work in the unfamiliar setting after the earthquake due to their long history in the country. With the epidemic outbreak of cholera last fall, their work has taken on an even larger role.

“There is such an unmet need,” he said. “We get flooded with patients.”

Dr. Walton praised Direct Relief for its hurricane pre-positioning in Haiti as well as its post-earthquake and post-cholera response. “I have always found Direct Relief to be an unbelievable partner,” he said.

He said he views the hospital, which will eventually be turned over to the Haitian Ministry of Health, as a way for the group to continue giving access to health care and medical training to rural Haiti. Their work in the country relies on community health workers and has always been focused in clinics outside of Port-au-Prince.

Dr. Walton said their trained health workers provide directly observed therapy, meaning they disburse medications to recipients and make sure it is consumed. They hope to introduce maternal health care training to their community health workers in the future.

Dr. Walton doesn’t see the hospital center as detracting from their work with community health workers, “It will only enhance our community projects,” he said, adding that it has lecture hall facilities for education and can be a referral institution for cases community health workers are not trained to handle.

The group hopes that eventually the project will be completely run by Haitians, who will be selected and then paired with trained physicians to learn the technology that has never been present in the country.

He said the hospital will be solar powered and host the country’s only publicly accessible computed tomography (CT) scan. Other advances include an oxygen generator and waste water treatment plant.

The post David Walton of Partners in Health visits Direct Relief appeared first on Direct Relief.