IntroductionEnabling health care facilities to deal with impairments or outages of water supply and sewage systems is essential and particularly important in the face of growing risk levels due to climate change and natural hazards. Yet, comprehensive assessments of the existing preparedness and response measures, both in theory and practice, are lacking. The objective of this review is to assess water supply and wastewater management in health care facilities in emergency settings and low-resource contexts. It thereby is a first step toward knowledge transfer across different world regions and/or contexts.MethodA systematic review was performed to identify published articles on the subject using online MEDLINE and Web of Science. The initial searches yielded a total of 1,845 records. Two independent reviewers screened identified records using selection criteria. A total of 39 relevant studies were identified. Descriptive analyses were used to summarize evidence of included studies.ResultsOverall, water supply was far more discussed than wastewater management. Studies on emergency preparedness identified back-up water storage tank, additional pipelines, and underground wells as key sources to supply health care facilities with water during an emergency. In emergency response, bottled of water, followed by in-situ back-up water storage tanks previously installed as part of disaster preparedness measures, and tanker trucks to complete were most used. Questions on how to improve existing technologies, their uptake, but also the supplementation by alternative measures remain unanswered. Only few guidelines and tools on emergency preparedness were identified, while multiple studies formulated theoretical recommendations to guide preparedness. Recovery planning was rarely discussed, despite many studies mentioning the importance of the reconstruction and restoration phases. Literature focus on recovery is mostly on technical aspects, while organizational ones are largely absent. Despite their key role for preparedness and response, citizens and patients' perspectives are hugely underrepresented. This fits into the bigger picture as communication, awareness raising and actor cooperation in general is addressed comparatively little.DiscussionCombining organizational and technical aspects, and intersecting theory and practice will be necessary to address existing gaps. Improving both, preparedness and response, is key to maintaining public health and providing primary care.
In July 2021, the Rhine-Meuse region straddling Belgium, Germany and the Netherlands was affected by devastating floods that have led to the loss of more than 240 lives and damage worth billions of Euros. The event was closely watched by regional agencies that had to organize response and recovery, and also received noticeable global attention. Diverse sets of responses and reflections accumulated among researchers, local and regional governments, local and international media, development organizations, public offices and citizen groups, wherein links to climate change and gaps in our preparedness for unexpected, extreme events were a common element of the discourse. In response to the floods, and in recognition of the cross-border effects of climate change, the United Nations University institutes in Belgium (UNU-CRIS), Germany (UNU-EHS) and the Netherlands (UNU-MERIT) have launched the “UNU Climate Resilience Initiative” with the aim to share knowledge, shape policy and drive action – and ultimately shift the focus from risk to proactive adaptation, innovation and transformation. Within the context of this initiative, researchers from the three institutes have conducted research in the flood affected areas and organized the two-day “Flood Knowledge Summit 2022: From Risks to Resilience”, which took place from 7 to 8 July 2022 in Maastricht, the Netherlands. Complementing existing national initiatives and efforts in the three countries, the event aimed to connect different actors – including affected citizens, first responders, authorities, researchers and civil society – from the region, the European Union (EU) and the Global South to share experiences, engage in dialogue and facilitate learning regarding how to strengthen climate resilience for all. This summit served to map various efforts to understand the data, information, governance and knowledge gaps at national, subnational and regional levels in order to address growing risks of climate change, including how to adapt to not only climate-induced extreme events like floods but also other hazard events, and created a regional momentum to support multidimensional efforts towards building resilience. Drawing on our research and outcomes of the Flood Knowledge Summit 2022, the UNU Climate Resilience Initiative has identified five key areas in which further research and action is needed to tackle climate risks and facilitate pathways towards climate resilience.
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