Refugee settlements are highly exposed to extreme weather conditions.

Involuntary displacement from conflict and other causes leads to clustering of refugees and internally displaced people, often in long-term settlements. Within refugee-hosting countries, refugee settlements are frequently located in isolated and remote areas, characterized by poor-quality land and harsh climatic conditions. Yet, the exposure of refugee settlements to climatic events is underresearched. In this article, we study the exposure of the 20 largest refugee settlements worldwide to extreme variations in climatic conditions. The analysis integrates exposure of camp locations compared to the national trends for both slow- and rapid-onset events and includes descriptive statistics, signal-to-noise analyses, and trend analyses. Our findings show that most refugee settlements included face relatively high exposure to slow-onset events, including high temperatures (for settlements in Kenya, Ethiopia, Rwanda, Sudan, and Uganda), low temperatures (in the case of Jordan and Pakistan), and low levels of rainfall (in Ethiopia, Rwanda, Kenya, and Uganda) compared to national averages. Our findings for rapid-onset events-heatwaves, coldwaves, and extreme rainfall-are less conclusive compared to country trends, although we find relatively high exposure to extreme rainfall in Cox's Bazar, Bangladesh. Our analyses confirm that refugee populations are exposed to extreme weather conditions postdisplacement, which, in combination with their sociopolitical exclusion, poses a threat to well-being and increased marginalization. Our findings call for an inclusive and integrated approach, including refugees and their host communities, in designing climate adaptation and sustainable development policies, in order to promote equitable sustainable development pathways in refugee-hosting countries.

A resilience view on health system resilience: a scoping review of empirical studies and reviews.

BACKGROUND: Prompted by recent shocks and stresses to health systems globally, various studies have emerged on health system resilience. Our aim is to describe how health system resilience is operationalised within empirical studies and previous reviews. We compare these to the core conceptualisations and characteristics of resilience in a broader set of domains (specifically, engineering, socio-ecological, organisational and community resilience concepts), and trace the different schools, concepts and applications of resilience across the health literature. METHODS: We searched the Pubmed database for concepts related to 'resilience' and 'health systems'. Two separate analyses were conducted for included studies: a total of n = 87 empirical studies on health system resilience were characterised according to part of health systems covered, type of threat, resilience phase, resilience paradigm, and approaches to building resilience; and a total of n = 30 reviews received full-text review and characterised according to type of review, resilience concepts identified in the review, and theoretical framework or underlying resilience conceptualisation. RESULTS: The intersection of health and resilience clearly has gained importance in the academic discourse with most papers published since 2018 in a variety of journals and in response to external threats, or in reference to more frequent hospital crisis management. Most studies focus on either resilience of health systems generally (and thereby responding to an external shock or stress), or on resilience within hospitals (and thereby to regular shocks and operations). Less attention has been given to community-based and primary care, whether formal or informal. While most publications do not make the research paradigm explicit, 'resilience engineering' is the most prominent one, followed by 'community resilience' and 'organisational resilience'. The social-ecological systems roots of resilience find the least application, confirming our findings of the limited application of the concept of transformation in the health resilience literature. CONCLUSIONS: Our review shows that the field is fragmented, especially in the use of resilience paradigms and approaches from non-health resilience domains, and the health system settings in which these are used. This fragmentation and siloed approach can be problematic given the connections within and between the complex and adaptive health systems, ranging from community actors to local, regional, or national public health organisations to secondary care. Without a comprehensive definition and framework that captures these interdependencies, operationalising, measuring and improving resilience remains challenging.

Measuring social resilience in cities: An exploratory spatio-temporal analysis of activity routines in urban spaces during Covid-19.

Covid-19 has dramatically changed life in cities across the globe. What remains uncertain is how national policies and appeals to comply with suggested rules translate to changes in the behaviour of citizens in urban areas. This lack of local knowledge leaves urban policy makers and planners with few clues as to the determinants of social resilience in cities during protracted crises like a pandemic. Methods are required to measure the capacity of people to conduct routine activities without risking exposure to a prevalent disease, particularly for those most vulnerable during a health crisis. By spanning the fields of urban resilience, human geography, mobility studies and the behavioural sciences, this study explores how to measure social resilience in cities during a protracted crisis. Using a public participation GIS online platform, we observe changes in citizen behaviour within urban spaces during the Covid-19 pandemic. Inhabitants from three districts of a Dutch city mapped their activity routines during the lockdown period and during the year before the pandemic. Spatio-temporal analysis reveals changes in the clustering of activities into what we describe as 'activity bubbles'. We reflect on the influence of the urban space on these changes and assess the contribution of this exploratory research methodology for gaining insights into behavioural change. Implications for urban planning and resilience theory are discussed.

From warning messages to preparedness behavior: The role of risk perception and information interaction in the Covid-19 pandemic.

During infectious disease outbreaks, early warning is crucial to prevent and control the further spread of the disease. While the different waves of the Covid-19 pandemic have demonstrated the need for continued compliance, little is known about the impact of warning messages and risk perception on individual behavior in public health emergencies. To address this gap, this paper uses data from the second wave of Covid-19 in China to analyse how warning information influences preventive behavior through four categories risk perception and information interaction. Drawing on the protective action decision model (PADM) and the social amplification of risk framework (SARF), risk warning information (content, channel, and type), risk perception (threat perception, hazard- and resource-related preparedness behavior perception and stakeholder perception), information interaction, and preparedness behavior intention are integrated into a comprehensive model. To test our model, we run a survey with 724 residents in Northern China. The results show that hazard-related preparedness behavior perception and stakeholder perception act as mediators between warning and preventive action. Stakeholder perception had much stronger mediating effects than the hazard-related attributes. In addition, information interaction is effective in increasing all categories risk perception, stimulating public response, while functioning as a mediator for warning. The risk warning information content, channel, and type are identified as key drivers of risk perception. The research found that information channel was more related to different risk perception than other characteristics. Overall, these associations in our model explain core mechanisms behind compliance and allow policy-makers to gain new insights into preventive risk communication in public health emergencies.

On the Interplay of Data and Cognitive Bias in Crisis Information Management: An Exploratory Study on Epidemic Response.

Humanitarian crises, such as the 2014 West Africa Ebola epidemic, challenge information management and thereby threaten the digital resilience of the responding organizations. Crisis information management (CIM) is characterised by the urgency to respond despite the uncertainty of the situation. Coupled with high stakes, limited resources and a high cognitive load, crises are prone to induce biases in the data and the cognitive processes of analysts and decision-makers. When biases remain undetected and untreated in CIM, they may lead to decisions based on biased information, increasing the risk of an inefficient response. Literature suggests that crisis response needs to address the initial uncertainty and possible biases by adapting to new and better information as it becomes available. However, we know little about whether adaptive approaches mitigate the interplay of data and cognitive biases. We investigated this question in an exploratory, three-stage experiment on epidemic response. Our participants were experienced practitioners in the fields of crisis decision-making and information analysis. We found that analysts fail to successfully debias data, even when biases are detected, and that this failure can be attributed to undervaluing debiasing efforts in favor of rapid results. This failure leads to the development of biased information products that are conveyed to decision-makers, who consequently make decisions based on biased information. Confirmation bias reinforces the reliance on conclusions reached with biased data, leading to a vicious cycle, in which biased assumptions remain uncorrected. We suggest mindful debiasing as a possible counter-strategy against these bias effects in CIM.

Epidemiological modelling in refugee and internally displaced people settlements: challenges and ways forward.

The spread of infectious diseases such as COVID-19 presents many challenges to healthcare systems and infrastructures across the world, exacerbating inequalities and leaving the world's most vulnerable populations at risk. Epidemiological modelling is vital to guiding evidence-informed or data-driven decision making. In forced displacement contexts, and in particular refugee and internally displaced people (IDP) settlements, it meets several challenges including data availability and quality, the applicability of existing models to those contexts, the accurate modelling of cultural differences or specificities of those operational settings, the communication of results and uncertainties, as well as the alignment of strategic goals between diverse partners in complex situations. In this paper, we systematically review the limited epidemiological modelling work applied to refugee and IDP settlements so far, and discuss challenges and identify lessons learnt from the process. With the likelihood of disease outbreaks expected to increase in the future as more people are displaced due to conflict and climate change, we call for the development of more approaches and models specifically designed to include the unique features and populations of refugee and IDP settlements. To strengthen collaboration between the modelling and the humanitarian public health communities, we propose a roadmap to encourage the development of systems and frameworks to share needs, build tools and coordinate responses in an efficient and scalable manner, both for this pandemic and for future outbreaks.