Martina Valente

Background: Temperatures are rising due to anthropogenic climate change, increasing the frequency, duration and magnitude of extreme heat events. Heatwaves remain the deadliest hazards in Australia, with Victoria experiencing a disproportionate number of heat-related deaths. Despite heat plans implemented following the 2009 Black Saturday bushfires, statewide health risk assessments for heatwaves are yet to be developed. Current research focuses on quantitative assessments of mortality and emergency presentations, with no systematic analysis of health system vulnerability. Aims: To assess emergency department vulnerability using a modified World Health Organization (WHO) tool and qualitative analysis, identify gaps in hospital preparedness, and inform heat-related health systems policy and resilience strengthening. Method: A convergent, parallel mixed-methods approach investigated vulnerability across four metropolitan hospitals, comprising a 72-question checklist covering five domains delivered to emergency management teams, and 21 key-stakeholder interviews with emergency department staff ranging from clinicians to emergency managers. Results: Vulnerabilities exist across all categories, with the largest proportion affecting water, sanitation and hygiene (WASH), healthcare waste facilities, and patient and workforce capacity. Interviewees identified measures to enhance resilience, including increasing public awareness, improving emergency preparedness protocols, cooling infrastructure, training and surge capacity. Conclusion: While emergency departments are equipped to handle sudden mass casualty events, slow-onset disasters like heatwaves present unique challenges that current plans do not adequately address. Victorian health systems are vulnerable to heatwaves and require systematic coordinated responses, robust policy and effective surge capability to manage future extreme temperature events.

Decision-making in humanitarian crises is rarely based on evidence and often constrained by uncertainty. Humanitarian health organizations such as the International Committee of the Red Cross (ICRC) operate in conflict settings, characterized by multi-layered, complex crises. Understanding how their decision-making processes influence the continuity of humanitarian health operations can provide insight to inform the development of resilience-oriented interventions in these contexts. We conducted a qualitative case study on the ICRC health operations in Lebanon, with the objective of exploring the elements shaping decision-making and understanding how different organizational factors influenced absorptive, adaptive, and transformative capacities in response to disruptive events in a hospital programme. Twenty semi-structured interviews were conducted with ICRC decision makers. Data were analysed through qualitative content analysis. Three themes emerged, describing how decisions were shaped by people and the trust they were able to develop in internal and external relationships; political considerations often overriding public health priorities; and unresolved tensions around the institutional identity and mandate. Resilience capacities were sustained by different factors. Absorptive capacities were primarily sustained by the availability of material resources, as well as operational contingency plans allowing for flexibility in their allocation. Adaptive capacities were strengthened by cohesive social networks among committed team members. Transformative capacities were limited, promoted by the ability to innovate while at the same time constrained by a rigid organizational culture. Our findings suggest that health governance and local leadership need to be strengthened to enable transformative capacities within humanitarian organizations. Through this, accountability and legitimacy can be enhanced, especially amid growing critiques and dramatically contracting funding.

Introduction: Emergency, critical and operative (ECO) services are essential pillars of a resilient healthcare system and are integral to achieving universal health coverage, especially in post-conflict low- and middle-income countries like Afghanistan. The objective of this study is to evaluate the capacity, safety and availability of ECO services, and to understand their integration relation with barriers, facilitators and system level factors contributing to the delay to receive ECO care in nine Afghan provinces. Methods: This study used a concurrent mixed-methods approach with explanatory data analysis and interpretation. Quantitative data were obtained from adapted WHO Harmonized Health Facility Assessment and WHO Surgical Assessment Tool, complemented by qualitative interviews with hospital directors, surgeons and gynaecologists from 11 Ministry of Public Health-led facilities including maternal, district, provincial and regional hospitals across nine provinces. The dimensions of staff, supplies, infrastructure, safety protocols, training, and surgical and obstetric/gynaecological capacity were assessed. Interviews explored providers’ perspectives on accessibility, referral systems, training and gendered barriers to care. Results: Data revealed significant gaps in workforce, safety, emergency protocols, anaesthesia staff, resuscitation equipment and diagnostic tools. No facility met the WHO benchmark for essential surgical services. The 11 interviews confirmed systemic fragmentation, lack of communication across facilities, informal referrals, frequent supply shortages and restricted access to care for women, exacerbated by social and cultural norms. Staff often worked without pay, and training was irregular. Conclusions: Afghan ECO care is fragmented and staffing and structural limitations and socio-political factors contribute to fatal delays. Leveraging existing processes such as the non-governmental organisation networks—especially amid critical underfunding for international agencies—may offer pragmatic low-cost strategies to strengthen ECO services in the Afghan post-conflict context, while future work should focus on people-centred needs assessment.

Flood-induced disasters are increasing in frequency and severity, with high-income countries (HICs) facing growing health, social, and operational challenges, particularly in managing and protecting vulnerable populations that are disproportionately affected. This scoping review, conducted in accordance with PRISMA-ScR guidelines, examined how vulnerability is defined, addressed, and operationalized in evacuation management during flood-induced disasters in HICs. A systematic search identified 98 peer-reviewed studies published between 2014 and 2025. The analysis revealed critical gaps and inconsistencies in how vulnerability is conceptualized and applied in evacuation contexts. Several groups–including single-parent households, caregivers, individuals with mental health conditions, undocumented workers, and those facing linguistic or educational barriers–remain underrepresented, while others, such as informal caregivers, religious minorities, and victims of domestic abuse, are not addressed at all. The review also identified substantial variation in national approaches to vulnerability mapping and management, with most countries relying on fragmented and inconsistently integrated practices. Evidence linking vulnerability assessment to evacuation planning and sheltering decisions remains limited. Research on Flexible Surge Capacity and the use of Alternative Care Facilities for vulnerability-informed evacuation remains scarce, particularly regarding non-medical facilities as community-based hubs for rapid assessment and triage. Furthermore, few studies addressed continuity across the disaster timeline, linking pre-disaster vulnerability assessment, rapid needs assessment, and long-term recovery support. This review advances understanding of how vulnerability can be more effectively embedded in evacuation management, providing empirically grounded and comparative insights to inform inclusive, intersectional, and operational flood-induced disaster management strategies in HICs.

Objectives: The overall objective of this study is to shed light on the disaster preparedness status of geriatric patients visiting tertiary hospitals in Istanbul while assessing the relationship between frailty scores, self-efficacy, and independence among geriatric patients. Methods: This prospective cross-sectional study was conducted in the Emergency Medicine Departments of 2 tertiary centers in Istanbul. In the survey, health and frailty status, demographics, and earthquake preparedness and planning were assessed. The Clinical Frailty Scale (CFS), Tilburg Frailty Indicator (TFI), and PRISMA-7 score were administered. Contingency tables were constructed to examine the associations between frailty categories and categorical outcomes related to disaster preparedness, self-efficacy, and independence. Results: A small portion (5.4%) of patients had received earthquake preparedness training. Regarding emergency preparedness, 32.4% had easy access to a list of emergency contacts, and 32.1% knew the location of the emergency kit. A relationship was found between the presence of an earthquake preparedness kit and the CFS and TFI (PP<0.005). Conclusions: Inadequate disaster preparedness, characterized by low self-efficacy and high external dependence, are influenced by frailty. Enhancing disaster preparedness requires identifying and supporting frail individuals.

Objectives: To assess the current state of knowledge and perceptions towards heatwaves of emergency department (ED) health care workers in Singapore and investigate potential strategies and solutions to improve the knowledge and readiness. Methods: A qualitative study conducted in Khoo Teck Puat Hospital in Singapore, using semi-structured, face-to-face interviews with an open-ended interview guide on emergency physicians and registered nurses of various lengths of work experience actively working in the ED. Thematic analysis was employed involving memo-writing, coding, and theme-development with constant comparison. Results: Six themes— (1) Knowledge and understanding of Extreme Weather Events, (2) Knowledge and risk-assessment of Heatwaves, (3) Impressions of increased vulnerability to heatwaves, (4) Preventive measures for acute heat related illness, (5) Heatwave impact on the emergency department, and (6) Potential strategies and solutions—emerged and were presented in an interactive framework. Overall, it emerged that there is basic foundational knowledge, with more education and training required, especially targeting the knowledge gaps identified. There is also a need to increase awareness of heatwaves and their impact on health, and to develop comprehensive extreme heat response plans. Conclusions: The findings provide a framework for emergency departments to guide their preparations for inevitable heatwaves and their associated health impacts.

Background/Objectives: Non-Communicable Diseases (NCDs) place an excessive strain on health systems in disaster-affected settings and may lead to a parallel public health emergency lasting months or years after a disaster. Although NCDs are increasingly recognized as a major challenge in disasters and humanitarian emergencies, a dedicated and standardized response plan is missing, as well as a shortage of evidence-based guidelines for NCD management in theses contexts. Over the years, Emergency Medical Teams (EMTs) have traditionally been deployed to manage acute conditions such as trauma and infectious diseases that quickly impact health systems. However, greater attention is needed to address acute exacerbation of NCDs and to ensure continuity of care for people with chronic health needs in disasters and emergencies. Methods: We conducted a scoping review exploring the EMTs’ management of chronic NCDs during disasters and humanitarian emergencies, in order to identify the strategies adopted, the challenges faced, and the recommendations provided to address this health problem. The online databases PubMed, Scopus, and EBSCO were searched to identify relevant papers. Results: After screening the papers against the eligibility criteria, 17 publications were retrieved. Five different areas of intervention concerning EMTs and NCDs management were identified: (i) EMTs pre-departure preparation, operational time, and length of stay; (ii) EMTs staff composition and training; (iii) EMTs logistics; (iv) EMTs integration with local health services; (v) EMTs clinical data record. Conclusions: The findings emerging from this study showed that NCDs significantly impact disaster response in different settings, underlining the need to implement a range of EMTs activities to guarantee assistance for chronic health needs. In view of strengthening the ability of health systems to cope with the NCDs’ burden, the EMTs’ initiatives should be considered as a bridge between the support provided during the acute phase of an emergency and the continuation of care ensured by the system in its early recovery phase.

In 2008, the World Health Organization launched the Mental Health Gap Action Program (mhGAP) to scale up mental health care in non-specialized health care settings. Studies have demonstrated the benefits of mhGAP implementation while highlighting the need for better contextual adaptation and ongoing support. The challenge of integrating mental health into primary care is particularly noticeable in fragile and conflict-affected settings, where the need for such services is greater and health systems are often disrupted. A literature search was conducted on PubMed, PsycINFO, Scopus, and Web of Science to identify relevant peer-reviewed studies addressing the effectiveness of mhGAP in fragile and conflict-affected settings. Information was collected on study characteristics and design, impact of mhGAP, and main operational challenges. After full-text review, 10 articles met the inclusion criteria, reporting the impact of mhGAP on primary care personnel, on service user outcomes and in health systems. Studies reported post-training improvements in knowledge, mainly on epilepsy and psychosis. However, gaps remained in skills related to conducting mental state examinations, assessing suicide risk, and strengthening psychosocial support. The evidence was inconclusive regarding the impact of mhGAP on improving access to mental health care at the primary level. Several implementation challenges were identified, including an overemphasis on short-term knowledge transfer and the lack of structured supervision following mhGAP training.