Human Settlements Discussion Paper – Climate Change 2


d) Adapting to impacts and losses, and rebuilding to reduce future risks

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d) Adapting to impacts and losses, and rebuilding to reduce future risks
Although the reconstruction process is a precious opportunity for addressing both short term concerns and longer term development issues, it can often just replace old problems with new ones. There tends to be little understanding of how reconstruction affects children, or how it could potentially be turned to better advantage in providing social as well as physical benefits. Although new housing, for instance, may be a vast improvement over conditions in emergency camps and transitional shelter, it can fail to meet the needs of both younger and older children in some critical ways. The issues that arise may be relevant not only for reconstructed settlements following major disasters, but also for much smaller scale reconstruction, and for upgrading undertaken to reduce risks from potential climate-related extremes.
“Rebuilding” of course means lives as well as infrastructure, housing and neighbourhood space. The need for attention to livelihoods is well recognized. But social capital generally can use support especially in situations where people have been displaced and resettled. Active involvement and collaboration in the creation of physical conditions that are truly responsive to social needs can go a long way in supporting these critical aspects of people’s lives.

Rebuilding with children’s health and safety in mind

The creation of new or reconstructed settlements or neighbourhoods can be a good opportunity for addressing the basic infrastructure that is so critical not only to protection from future weather events, but also to children’s health. Piped water supplies to houses, in-house latrines, adequate drainage systems can all be more economically installed at this stage. There are many practical precedents for low cost infrastructure installed with community involvement in cooperation with local government.233 Even when there are not the resources for in-house solutions, local involvement in designing community-level solutions can result in a huge improvement over a lack of such infrastructure, or the often inadequate and unmaintained municipal provision.234

Safety is also a major concern, and a neighbourhood designed and built with children in mind will make this a priority, ensuring that play and mobility are possible without risk. A major concern in this regard is the circulation routes through a community. In existing poor urban settlements, the narrowness and poor quality of many streets and alleys may actually serve as protective factors for children, making street play relatively safe. But reconstruction (or upgrading) efforts may include ensuring that streets are wide and durable enough to allow traffic to pass through easily – an important consideration especially for emergency access in case of fire or illness. At the same time, if vehicles can move through at even moderate speed, children will be more limited in their ability to move around freely and safely. In completely rebuilt areas, a distinction between access roads and a circulation network of small, safe pedestrian lanes can encourage social interaction and child mobility, instead of inhibiting it, as well as increasing the amount of common community space. This holds true whether it applies to high rise buildings or smaller units. Figure 4 is drawn to reflect surroundings less dense than is common in most urban areas, but the principle remains the same. In upgraded areas, wherever streets are improved and paved, it makes sense to include speed bumps or other devices to slow traffic, so that children’s play is safe and pedestrian needs take priority. Sidewalks are also an important component of children’s safe mobility. Reaching school, for instance, or running errands will be far safer if children do not have to walk in traffic. Adequate planning of common space can also help to ensure safe places for children to play. This will be discussed further below. The following section also stresses the importance of household modifications that ensure the protection of young children from injury and poisoning.

Figure 3: Different circulation patterns affect safety and mobility for children







Source: Sketch by Selim Iltus, from Bartlett and Iltus (2007) Making Space for Children, Chennai: Save the Children
Rebuilding in ways that strengthen family and community

Location: The location of rebuilt settlements has implications for livelihoods as well as for access to such amenities as schools, markets and health facilities, with implications for both households and the children in them. In Tamil Nadu after the tsunami, many large resettlement areas remained empty after they were completed, in part because of their location. People in the town of Nagapattinam, for instance, refused to move 2 kilometers away to a site which separated them from jobs and other supports, even though this meant staying in their hot, crowded, run down emergency barracks. Genuine consultation in advance of such major decisions, and throughout the rebuilding process, far from being a factor that slows down the process, is the only approach likely to ensure its practicality and efficiency.

Women’s ownership: It has frequently been noted that women are more likely to make children’s concerns a priority than men are. Jayaraj, in a discussion of rebuilding experiences in Andra Pradesh following on cyclones and other disasters over recent decades, notes that in the rebuilding process, when issues related to women are adequately addressed, children’s needs are far more likely to be taken care of. She stresses the importance of registering new house sites in women’s names, or, when houses are being repaired or rebuilt in situ, ensuring that ownership by men be converted to joint ownership as a condition of the subsidized construction of permanent housing. She also stresses that there be at least 50 percent representation of women in all decision-making bodies, and that measures be taken to support and sustain women’s leadership. 235

Layout: Often new housing in less dense urban areas is placed in a grid pattern on land leveled and stripped of vegetation – an arrangement that is efficient for engineers, but that fails to make optimal use of space from a social perspective. Housing that is clustered to reflect and support social ties can encourage local interaction and mutual support (at the same time that it allows better for children’s play (Figure 4).
Figure 4: Different ways to use the same space: traditional grid layout

versus more positive open space








Source: Sketch by Selim Iltus, from Bartlett and Iltus (2007) Making Space for Children, Chennai: Save the Children
Priorities in this regard can be very locally specific however. In a participatory site design process in Delhi, for instance, young girls objected to a courtyard arrangement for new housing, arguing in favor of a street layout, which would leave them less likely to be cornered by drunken men.236

In more dense urban areas, high rise housing is the most practical response, but it has long been recognized in a number of settings (primarily in high income countries) to raise significant issues especially for younger children and their caregivers.237 Anecdotal evidence from low income countries points to the same concerns.238 Efforts must be made in these cases to consider internal layouts that promote social interaction as well as making it easier for caregivers to allow small children out of their apartments for play.239 Outdoor space can also be arranged, even around high rise housing, in ways that maximize safety and opportunity for children who are old enough not to need at adult in the vicinity.

Housing: Minor adaptations to housing design, whether in apartments or free-standing units, can also make a considerable difference to family dynamics and to caregivers feeling better control over their capacity to deal adequately with their children’s needs. It is often assumed, for instance, that one or two-room living is adequate for those with low-incomes. Conversations with numerous families however, both in the context of disaster rebuilding and other rehousing efforts make it clear that privacy is an issue that is too seldom addressed, and that an extra partition wall, even in a small housing unit, can relieve tensions within households. Other adaptations eagerly sought by caregivers include adequate shelving to keep possessions up off the floor as well as such hazardous items as medicines, pesticides and kerosene out of the reach of small children.240
Another consideration especially in newly planned areas is ensuring space flexible enough to allow for small enterprises, both home-based and within the neighbourhood, making it easier to earn without going long distances. It is also important to consider the role of common space in allowing for social interaction and community meetings. An excellent example of shared community space, unlikely as it may seem, is the community toilets built by poor urban slum dwellers and grassroots women’s cooperatives in India (See Box 9)


Box 10: Community toilets as common space

In Indian cities, what little provision there is for sanitation in slum settlements has usually taken the form of public toilet blocks. These are most often shoddily constructed buildings with no provision for maintenance or repair. The toilets frequently become blocked and unusable, and so the open area round about is used for defecation and often for dumping garbage. The area becomes a health hazard even at the best of times, especially for small children, but during heavy rains the waste can be spread around even more widely.

When the women of the grassroots collective, Mahila Milan, started building their own community toilets in the l990s with the support of the Mumbai-based NGO SPARC, they focused on better quality construction, with large tanks to store sufficient water for regular maintenance and handwashing. They also built special children’s toilets, with smaller squat plates, handles for holding onto and a lot of natural light. Young children are generally afraid of the dark and of falling into the large openings of adult latrines. Waiting in line for long periods is also difficult for them, and they often get pushed out of the way by adults in a rush. These pleasant cheerful toilets encouraged them not to defecate in the open as they almost always did before. The privacy and security concerns of women and older girls were taken into account as well by providing separate toilets with separate entrances. Small fees, charged to families for the use of these spaces, helped to cover maintenance costs of the toilets.

The toilet blocks were intentionally built in central locations, not isolated on the periphery of the settlement as the old municipal toilets had been. This helped to ensure that the sites were informally monitored and kept clean. In some cases, where there was sufficient space, a community hall was built adjoining the toilets; in others, a meeting space was created on a terrace on top. Sometimes this space was also used as a child care centre. Although this linking of toilets and community space may seem a strange solution, in fact it works very well. In dense settlements, this may be the only available meeting place. The social interaction that takes place here begins to transform the way people relate to the toilets. Instead of seeing the toilet block as a humiliating, filthy place to be avoided as much as possible, people are proud of it and want to keep it clean. For older children in particular, the chance to have this basic human function treated with dignity and acceptance is an important component of their own self-respect. This change in attitude is supported by the celebration of a toilet festival as each block opens, where the contribution of all can be acknowledged – both people from government agencies and from communities. The management committees gradually formalize the maintenance and management of the toilets which, in turn, helps to develop formal structures within the community.

Source: Sundar Burra, Sheela Patel and Thomas Kerr (2003) Community-designed, built and managed toilet blocks in Indian cities, Environment and Urbanization 2003; 15; 11-32




Considering children’s routines and activities

The quality of common space is also critical to children’s needs. In most resettlement areas, the emphasis is on housing units and infrastructure, with little attention to the importance of common space. Shared space and facilities in any neighbourhood can help to make up for limitations in housing and can contribute to creating the kind of safe vital local environments that make a huge difference to the social needs of growing children. Solutions may involve formal recreational facilities or space for community meetings and gatherings, or just places where people can sit and talk while children play. Whatever the scale and the level of formality, any space that encourages positive social interaction will make it easier for children to engage in the world outside of home – a need which increases the older they get. A neighbourhood that provides varied opportunities within secure local space allows children to test and develop their competence in all kinds of important ways, and to feel a sense of belonging within a community.

When space is allocated for common use, it will ideally be as central as possible, as with the Mumbai toilet blocks described above, or scattered throughout a community. Too often, if this kind of space is thought about at all, it tends to be given a peripheral location. Larger recreational facilities, like space for cricket or football, may be more reasonably placed towards the edge of things. But space for social interaction and play for small children works much better if there are small informal pockets here and there, easily accessible to all, rather than a formal fenced playground at the edge of things.

Vegetation is a factor often overlooked in both resettlement efforts and upgrading. Robust research from poor urban neighbourhoods in the USA has shown that children are significantly more likely to engage in creative play when they have access to pleasant green surroundings; they also interact better with adults, and have even been found do better in school. (Adults, at the same time, have been found more likely to spend time outdoors when there are trees and vegetation, more likely to get to know their neighbours, less likely to experience domestic violence, and better able to cope with life problems. 241 While this research comes from the west, qualitative research from a number of countries, several in low income countries and communities in the South, highlights the emphasis children give to the importance of trees and pleasant outdoor environments.242 Anecdotal evidence from post-tsunami areas points in the same direction. After the tsunami, the landscape was devastated and stripped bare of vegetation in many places. While adult priorities were shelter and livelihoods, children spoke repeatedly of their desire for trees and shade. In one community, where replacement housing was slowly going up on a typically barren desolate stretch of land, children asked if they could start a nursery so that there would be something to plant when the construction was over.243 (By the same token, children in areas prone to crime or violence will also frequently point to the need for trimming back vegetation in places that are known to be unsafe and installing adequate lighting.)244

Children’s active involvement in planning – along with adults

Adequate responses to construction and upgrading require a close understanding of local realities and this has long been acknowledged to come most fruitfully from those who are affected. The values of community participation, and even more of community driven processes, are well established. People are the experts in their own lives. Where solutions are called for that affect children’s lives, or that can draw productively on their knowledge, the same principle applies. (See Box 10)




Box 11: Children bring their perspective to tough decisions on a practical house design
Serious flooding in the last few years in Tamil Nadu, India, has displaced even more people than the tsunami did – and especially the extremely poor dalit (untouchable caste) communities who live in mud shacks in the low lying land that no one else wants. Save the Children secured the funds to build flood-proof housing in eight dalit villages, and decided to work in partnership with these communities to come up with the best solutions. Most of the available resources would have to go to a solid foundations that would withstand flooding and get the houses up off the ground. Other than that, the tentative plan was for a one roomed house, 11’x 17’, with a tiled roof.

A group of children and adults in one village raised reservations about the plan, however. “It makes no sense for us to have a tile roof,” pointed out a 12 year old boy. “We have cyclones here, and things fly around. Tiles can get smashed easily by falling coconuts. And we have no money, so we’ll never be able to replace the broken tiles. We’ll just have to cover the damage with palm thatch, and then we’ll be right back to leaking roofs again.” People agreed that a flat reinforced concrete roof would fit their needs better. It would provide a place to escape to during especially high floods, like those of the last few years, and somewhere to stay and keep belongings safe until the waters receded. (In some villages, it took a month last year for the waters to recede, and people spent the time camped on a road nearby.)

A flat roof had been considered earlier by Save the Children. But it would cost about 80 percent more, for both the extra materials and for the stronger foundation to carry the extra weight. The women in the group decided they would be willing to compromise with a much smaller flat-roofed house to reduce the costs. But when they drew up a full scale floor plan with chalk, they were taken aback by how small their houses would actually have to be to fit the budget. They decided they needed to think about this a little longer, but that they would probably go for the tiled roof plan. A the children who were present pleaded with them. One boy agreed that the smaller house would be “too small to breathe in,” but all the others were adamant – it would be much better, they felt, to have a smaller house if it meant they would be safe from rushing flood water. They recalled how fast the last flood had risen, and how frightened they were of being washed away by the chin-high waters. “What if it came at night next time?” they asked. The women, sitting and listening nearby, nodded their heads in recognition of the children’s fears, and decided to negotiate further with the organization, and to determine what they would need to find for added funds in order to have the security of a flat roof, and still allow for a house a little bit larger than 10’ x10’.
Source: author’s field visit, Feb 2007.

Unfortunately, involving even adults in the aftermath of disaster is surprisingly rare, as already discussed. Despite the established value of this approach, there is a tendency is to see it as inefficient in the context of emergency rebuilding measures. The centralized, top-down nature of post-disaster reconstruction, along with the pressure to provide immediate responses (in part because of donor time frames) generally gets in the way of a more process-driven, integrated approach. Ironically, the “quick, efficient” approach is often not that quick; nor does it result in solutions that people are happy with. Involving children may in fact be more acceptable, in part because it is not seen as serious enough to pose any kind of threat to the status quo. The standard approach within child focused organizations is to conduct child participation projects as separate events for children, giving them a chance to identify local issues that concern them, and sometimes to take action. These projects are valued for their capacity to educate children in active citizenship, and to give them a chance to articulate their ideas. But they too seldom become embedded into wider community initiatives.245 As a result they can be quite short lived, ending when the support organization leaves. When children's concerns are dealt with outside the context of more general community aspirations and efforts, they may remain split off from the very processes and people that should sustain them. For instance, children's concerns about drainage or waste removal are unlikely to result in more than a few clean up days if they do not become incorporated into wider community efforts to negotiate a solution. When adults are also engaged in identifying and debating the issues, the results are more likely to put down roots, and a serious engagement with local authorities is more likely to follow. Karen Malone of the Growing Up in Cities network, which has worked in many countries to provide children and young people with ways to address the local issues that affect them, has noted that child or youth-specific projects are generally taken less seriously by local governments than projects that involve the entire community.246 Roger Hart, with his “ladder” of children’s participation, also places children’s work alongside adults at a higher level than projects where children make decisions in isolation. 247

This shared process can also change the way adults see their children. Many adults are surprised by the thoughtful perspective and practical common sense that children can bring to a discussion of local concerns. When adults and children are part of a joint process, an interest in children’s and young people’s views can become a routine part of the local decision making culture.248
This is not to suggest that children and young people should not have their own projects and aspirations, or negotiate with local authorities on behalf of their own specific interests, which may not always be part of a wider community effort. Nor does it mean that a short lived project is by definition without value. Louise Chawla, long involved with the Growing Up in Cities program, has this to say about the way this network operates:

As the project moves into a site, it is meant to be used as a tool to help community leaders and government agencies understand the issues that young people face and to see ways to integrate young people into community development as constructive, insightful partners. If institutions see ways to include the methods that they learn into ongoing operations, that is great. But if the project is just used to help solve a particular problem, that is okay too. What we hope it will leave behind is a new configuration of better, more equal relationships between adults and young people, and a public that sees young people in a more accurate and more hopeful light—as partners in collaborative processes to create more livable cities for everyone.249

The implications for local efforts to adapt to climate change are clear.


IV. CONCLUSION

There are many vulnerable populations in the context of climate change – the poor, the elderly, pregnant women, those in particular locations. Children are not unique in this sense. However, they constitute an extremely large percentage of those who are most vulnerable, and the implications, especially for the youngest children, can be long term. If speculation about the impacts of climate change fails to take into account the particular vulnerabilities (as well as capacities) of children at different ages, measures for prevention and adaptation may prove to be inadequate in critical ways, and may even result in additional stresses for young minds and bodies.

Addressing these concerns for children may appear to be an unrealistic burden, adding unduly to the need for time and resources in the face of so many other compelling priorities. Fortunately, this is not a zero sum game. As stressed in this paper, there are strong synergies between what children need and the adaptations required to reduce or respond to more general risks. The most useful measures to protect children’s health are also fundamental in reducing risks from potential disasters – like adequate drainage, waste removal, proper sanitation. Supporting adults so that they are better able to address their children’s needs also leaves them better equipped to work collaboratively on reducing risks, preparing for disasters, and rebuilding their lives after a crisis. Ensuring that children continue to have opportunities to play, learn, and to take an active role in finding solutions will prepare them to be the citizens we need to continue addressing theproblems faced by their communities and by the planet. It has generally been found that neighbourhoods and cities that work better for children tend to work better for everyone, and this principle undoubtedly applies as well to the adaptations that are being called for by climate change.



1 See, for instance, Save the Children (2007) Legacy of Disasters: The Impact of Climate Change on Children, Save the Children UK, London; UNICEF (2007) Climate Change and Children, United Nations Children’s Fund: New York; Waterston, T (2006) Climate change – the greatest crisis for children?, Journal of Tropical Pediatrics 52(6) 383-385

2 Confalonieri, U, B Menne, R Akhtar , K Ebi,.,M Hauengue, RS Kovats, B Revich, and A Woodward, (2007) Human Health, in Parry, ML, OF Canziani, JP Palutikof, PJ van der Linden and CE Hanson (eds) Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, Cambridge University Press, Cambridge UK pp 391-431


3 Adger, W N, S Agrawala, MMQ Mirza, C Conde, K O’Brien, J Pulhin, R Pulwarty, B Smit and K Takahashi (2007) “Assessment of adaptation practices, options, constraints and capacity”, in Parry, ML, OF Canziani, JP Palutikof, PJ van der Linden and CE Hanson (eds) Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, Cambridge University Press, Cambridge, UK, 717-743.

4 Epstein, Paul R, Sarah Meginness, John Rich, Roger Swartz, Jean McGuire, John Auerbach (2003) Urban Indicators of Climate Change, Center for Health and the Global Environment, Harvard Medical School, The Boston Public Health Commission, 19

5 Douglas, Ian, Kurshid Alam, MaryAnne Maghenda, Yasmin Mcdonnell, Louise McLean and Jack Campbell (2008) “Unjust waters: climate change, flooding and the urban poor in Africa”, Environment and Urbanization 20 (1) in press; Satterthwaite, David, Saleemul Huq, Mark Pelling, Hannah Reid and Patricia Romero-Lankao (2007)Adapting to Climate Change in Urban Areas: The Possibilities and Constraints in Low- and Middle-income Nations, London: International Institute for Environment and Development

6 In most countries children, legally, are those under 18, although this varies. The Convention on the Rights of the Child is most generally applied to those under 18. Children over 14 are often referred to as youth or young people. On the other hand, the term youth can apply to those up to 25 or older in some places. This paper sets no firm boundaries in this regard. Most of the material here focuses primarily on younger children, although adolescents or young people are also discussed where relevant.


7 See for instance Jennifer Kirschke and Willem van Vliet’s discussion of the energy and resourcefulness shown by many children in the wake of Hurricane Katrina, in contrast to the picture portrayed by the media: Kirschke, J and W van Vliet (2005) “ ‘How Can They Look So Happy?’ Reconstructing the Place of Children after Hurricane Katrina: Images and Reflections”, Children, Youth and Environments 15 (2) 378-391

8 Walker, Susan, Theodore D Wachs, Julie Meeks Gardner, Betsy Lozoff , Gail A Wasserman, Ernesto Pollitt, Julie A Carter, and the International Child Development Steering Group (2007) “Child development: risk factors for adverse outcomes in developing countries”, The Lancet, 369:145-157

9 See for instance Van den Poel, E, O O’Donnell, E Van Doorslaer (2007) “Are urban children really healthier?”, Evidence from 47 developing countries, Social Science and Medicine 65: 1986-2003

10 In Nairobi, for example, figures for 2002 show mortality rates of 62 per thousand for children under five, as compared to 113 per thousand for Kenya’s rural areas. But within the city’s informal settlements, this rate rises to 151 per thousand, and in the Embakasi slum, to 254 per thousand – four times as high as for the city as a whole. APHRC (2002), Population and Health Dynamics in Nairobi’s Informal Settlements, African Population and Health Research Center, Nairobi.

11 A recent case study of rickshaw pullers in Dhaka, for instance, shows that the adult children of these first generation migrants were scarcely better educated than their fathers – 55 percent had never attended school at all, and only a small number were functionally literate. School attendance rates generally in Dhaka are only 58 percent, as compared to 73 percent for villages Begum, Sharifa and Binayak Sen (2005)” Pulling rickshaws in the city of Dhaka: a way out of poverty?”, Environment and Urbanization, 17:. 11 - 25.


12 UN–Habitat (2003), The Challenge of Slums: Global Report on Human Settlements 2003, Earthscan Publications, London.

13 McGranahan, Gordon, Deborah Balk and Bridget Anderson (2007), "The rising tide: assessing the risks of climate change and human settlements in low-elevation coastal zones", Environment and Urbanization, Vol. 19, No. 1, pages 17–37.

14 Parry, ML, OF Canziani, JP Palutikof, PJ van der Linden and CE Hanson (eds) Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, Cambridge University Press, Cambridge, UK;, Satterthwaite, David, Saleemul Huq, Mark Pelling, Hannah Reid and Patricia Romero-Lankao (2007)Adapting to Climate Change in Urban Areas: The Possibilities and Constraints in Low- and Middle-income Nations, London: International Institute for Environment and Development

15 Diagne, Khady (2007) “Governance and natural disasters: addressing flooding in Saint Louis, Senegal”, Environment and Urbanization 19(2): 552-562

16 Bronfenbrenner, U (1979). The Ecology of Human Development: Experiments by Nature and Design. Cambridge, Mass., Harvard University Press

17 Engle, P, S Castle and P Menon (1996) “Child development: vulnerability and resilience”, Social Science and Medicine, 43(5) 621-635


18 Moser, Caroline ON (1998) “The asset vulnerability framework: Reassessing urban poverty reduction strategies”, World Development 26 (1) 1-19

19 See for instance, Evans, Gary W and Kimberley English (2002) “The environment of poverty: multiple

stress exposure, psychophysiological stress, and socioemotional adjustment”, Child



Development 73 (4) 1238-1248. See also Werner, E and R Smith (1992) Overcoming the Odds: High Risk Children from Birth to Adulthood, Ithaca, NY and London: Cornell University Press for classic research exploring resilience longitudinally in a cohort of children in Hawaai.

20 According to the Convention on the Rights of the Child, children have rights not only to provision and protection, but to active participation. They have the right, for instance, to express their opinions in matters that concern them, and to have these opinions weighed when decisions are made, in accordance with their age, maturity and understanding of the situation (Article 12); the right to freedom of thought and conscience, subject to the guidance of parents or other guardians; the right to seek, obtain and impart information, and to have access to informational material not deemed harmful to their well-being (Article 17), the right to associate with others and to assemble freely (Article 15).

21 Gibson, EJ and AD Pick (2000), An Ecological Approach to Perceptual Learning and Development, New York: Oxford University Press.

22 A well known overview of children’s capacities in this regard is Hart, R. (1997) Children's Participation: The Theory and Practice of Involving Young Citizens in Community Development and Environmental Care, London, Earthscan/UNICEF. For a few recent examples of children’s active involvement, see Chatterjee, Sudeshna. (2007) “Children’s role in humanizing forced evictions and resettlements in Delhi”, Children, Youth and Environments 17 (1): 198-221; Awuor, George and James Njuguna (2007) “The Mathare Youth Sports Association (MYSA) ShootBack Project”, Children, Youth and Environments 17(3): 227-235.


23 Prüss-Üstün, A and C Corvalán (2006) Preventing Disease through Healthy Environments. Towards an Estimate of the Environmental Burden of Disease. World Health Organization: Geneva,

24 World Health Organization. Health and environment in sustainable development: 5 years after the Earth summit [press release]. Available at: http://www.who.int/archives/inf-pr-1997/en/pr97-47. html.

25Prüss-Üstün, A and C Corvalán (2006) Preventing Disease through Healthy Environments. Towards an Estimate of the Environmental Burden of Disease. World Health Organization: Geneva, page 66

26 Nishikiori , N, T Abe, DGM Costa, S D Dharmaratne, O Kunii and K Moji (2006) “Who died as a result of the tsunami? – Risk factors of mortality among internally displaced persons in Sri Lanka: a retrospective cohort analysis”, BMC Public Health 6: 7

27 Jonkman, SN and I Kelman (2005) An analysis of the causes and circumstances of flood disaster deaths, Disasters 29(1) 75-97

28 Gagnon EB, MB Aboutanos A K Malhotra , D Dompkowski, TM Duane ,RR Ivatury (2005)” In the wake of Hurricane Isabel: a prospective study of postevent trauma and injury control strategies”, The American Surgeon 71(3):194-7.


29 Pradhan, Elizabeth Kimbrough, Keith P. West, Joanne Katz, Steven C LeClerq, Subarna K Khatry, and Sharada Ram Shrestha (2007) “Risk of flood-related mortality in Nepal”, Disasters 31(1) 57-70

30 Nishikiori , N, T Abe, DGM Costa, SD Dharmaratne, O Kunii and K Moji (2006) “Who died as a result of the tsunami? – Risk factors of mortality among internally displaced persons in Sri Lanka: a retrospective cohort analysis”, BMC Public Health 6: 7.



28


29


30



31 Although it is recommended by the Sphere standards that emergencies be defined relative to a local baseline mortality rate, when this baseline is unknown, it is common for a standard rate to be used. For crude mortality, this is 1/10,000/day; for under five mortality, it is 2/10,000/day. Sphere Project (2004) Humanitarian Charter and Minimum Standards in Disaster Response www.sphereproject.org/


32 Renzaho, A (2007)”Mortality rates, prevalence of malnutrition, and prevalence of lost pregnancies among the drought-ravaged population of Tete province, Mozambique”, Prehospital and Disaster Medicine 22(1) 26-34.

33 United Nations Children’s Fund (2007) The State of the World’s Children, UNICEF: New York

34 www.who.int/entity/ceh/indictators/0_14disasterareas.pdf, downloaded October 15 2007


35 Confalonieri, U, B Menne, R Akhtar , K Ebi,.,M Hauengue, RS Kovats, B Revich, and A Woodward, (2007) Human Health, in Parry, ML, OF Canziani, JP Palutikof, PJ van der Linden and CE Hanson (eds) Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, Cambridge University Press, Cambridge UK

36 Murray, C J and A D Lopez (1996). The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020, Harvard University Press, Boston.

37 Shi, A(2000), How Access to Urban Potable Water and Sewerage Connections affects Child Mortality,

Development Research Group, World Bank, Washington DC.



38 Cairncross, S (1990), “Water supply and the urban poor” in Hardoy, J, S Cairncross and

D Satterthwaite (editors), The Poor Die Young: Housing and Health in Third World Cities, Earthscan,



London.

39 Victoria, C G, PG Smith, JP Vaughan, and LC Noble (1988) “Water supply, sanitation and housing in relation to the risk of infant mortality from diarrhoea”, International Journal of Epidemiology 17(3): 651-654; Curtis, V, B Kanki, T Mertens, E Traore, I Diallo, F Tall and S Cousens (1995). “Potties, pits and pipes: explaining hygiene behaviour in Burkino Faso”, Social Science and Medicine 41(3): 383-393.


40 Adger, Neil, Pramod Aggarwal, Shardul Agrawala et al. (2007), Climate Change 2007: Impacts, Adaptation and Vulnerability: Summary for Policy Makers, Working Group II Contribution to the Intergovernmental Panel on Climate Change; Fourth Assessment Report, IPCC Secretariat, WHO AND UNEP, Geneva, subsequently published in Parry, Martin, Osvaldo Canziani, Jean Palutikof, Paul van der Linden and Clair Hanson (editors) Climate Change 2007: Impacts, Adaptation and Vulnerability, Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, Cambridge University Press, Cambridge and New York, page 8.

41 Ibid., page 8.

42 Wilbanks, Tom and Patricia Romero Lankao with Manzhu Bao, Frans Berkhout, Sandy Cairncross, Jean-Paul Ceron, Manmohan Kapshe, Robert Muir-Wood and Ricardo Zapata-Marti (2007), “Chapter 7: Industry, Settlement and Society”, in Parry, Martin, Osvaldo Canziani, Jean Palutikof, Paul van der Linden and Clair Hanson (editors) Climate Change 2007: Impacts, Adaptation and Vulnerability, Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, Cambridge University Press, Cambridge and New York, pages 357-390.

43 Rhode, TE (1999) “Integrating urban and agriculture water management in southern Morocco”, Arid

Lands News Letter, 45, quoted in Wilbanks, Romero Lankao et al. (2007), op. cit.

44 Dunne, E F, H Angoran-Benie, A Kamelan-Tano, TS Sibailly, BB Monga, et al. (2001), “Is drinking water in Abidjan, Côte d’Ivoire, safe for infant formula?”, Journal of Acquired Immune Deficiency Syndrome 28(4): 393–398.


45 Hashizume M, B Armstrong , S Hajat , Y Wagatsuma , AS Faruque , Y Hayashi , et al. (2007), “Association between climate variability and hospital visits for non-cholera diarrhoea in Bangladesh: effects and vulnerable groups,” International Journal of Epidemiology. In press

46 Moraes LR, Cancio JA, Cairncross S, Huttly S (2003) “Impact of drainage and sewerage on diarrhea in poor urban areas in Salvador, Brazil”, Transactions of the Royal Society of Tropical Medicine and Hygiene

97(2): 153-8



47 Prado, MS, A Strina, M L Barreto , A M Oliviera-Assis, L M Paz  and S Cairncross (2003) “Risk factors for infection with Giardia duodenalis in pre-school children in the city of Salvador, Brazil”, Epidemiology and Infection 131: 899-906

48 Heller, L, EA Colosimo, CM de Figueiredo Antunes (2003) Environmental sanitation conditions and health impact: a case control study, Revista de Sociedade Brasileira de Medicina Tropical 36(1) 41-51

49 Douglas, Ian, Kurshid Alam, MaryAnne Maghenda, Yasmin Mcdonnell, Louise McLean and Jack Campbell (2008) “Unjust waters: climate change, flooding and the urban poor in Africa”, Environment and Urbanization 20 (1) in press


50 Douglas, Ian, Kurshid Alam, MaryAnne Maghenda, Yasmin Mcdonnell, Louise McLean and Jack Campbell (2008) “Unjust waters: climate change, flooding and the urban poor in Africa”, Environment and Urbanization 20 (1) in press

51 Checkley W, L Epstein, R Gilman et al (2000) “Effect of El Nino and ambient temperature on hospital admissions for diarrhoeal disease in Peruvian children”, Lancet, 355: 442-450

52 Bunyavanich, Supinda, Christopher P. Landrigan, Anthony J. McMichael, Paul R. Epstein (2003)The impact of climate change on child health”, Ambulatory Pediatrics 3:44-52

53 Ligon, B L (2006)”Infectious diseases that pose specific challenges after natural disasters: a review”, Seminars in Pediatric Infectious Diseases, 17(1), 36-45

54 Confalonieri, U, B Menne, R Akhtar , K Ebi,.,M Hauengue, RS Kovats, B Revich, and A Woodward, (2007) Human Health, in Parry, ML, OF Canziani, JP Palutikof, PJ van der Linden and CE Hanson (eds) Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, Cambridge University Press, Cambridge UK pp 391-431.

55 Kovats, RS and Rais Akhtar (2008) “Climate, climate change and human health in Asian cities”, Environment and Urbanization 20(1) in press

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