Ethical Considerations for Living in Temporary Shelters (i.e., camps) Following a Natural Disaster

Document Type : RESEARCH PAPER


1 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran

2 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

4 Cancer Research Center, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

5 Department of Health in Emergency and Disaster, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

6 Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran

7 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran


Background: Some disasters, such as earthquake and flood make the majority of affected people homeless. The
accommodation of these people in temporary shelters and camps requires some specific ethical issues. The aim of the
present study was to discuss ethical issues regarding living in camps following natural disasters.
Methods: This study is conducted utilizinga qualitative content analysis approach. The required data were collected
from four Focus Group Discussions (FGDs). Subsequently, 11 in-depth interviews were completed using the individuals
who had the experience of receiving care following natural disasters and continued until data saturation. Data were
analyzed using Graham content analysis method.
Results: According to the results obtained from affected people’s views, the most important ethical issues that are not
considered important in temporary shelters and camps include:1) the violation of privacy,2) the shortage of basic needs
(e.g., food, water, and sanitation) and type and quality of services rendered,3) lack of attention to cultural and religious
views of the affected people, 4) cause of evacuation, 5)lack of co-operation among disaster managers, 6)respecting the
properties of the affected people, 7)conditions and geographic location of camps, 8)property care, and 9)communitybased
Conclusion: Without paying attention to ethical issues, living in temporary shelters (i.e., camps) violates the dignity of
affected people and then the affected people will not have appropriate cooperation with the managers. All these issues
expose them to more harm than before.
Level of evidence: VI


Main Subjects

1. Guha-Sapir D, HoyoisP, Below R. Annual disaster
statistical review 2015: the numbers and trends.
Centre for Research on the Epidemiology of Disasters
(CRED).Available at:URL:
2015-numbers-and-trends; 2017.
2. Zandian E, Rimaz S, HolakouieNaieni K, Nedjat S,
Naderimagham S, Larijani B, et al. Economic effects
of 1978 Tabas Earthquake (Iran).Arch Iran Med.
2016; 19(6):409-13.
3. Social and Public Policy Issues following the Bam,
Iran, Earthquake. EERI special earthquake report.
Available at:URL:
Iran_Bam_Insert2_Aug04.pdf; 2004.
4. Mahdi T, Mahdi A. Reconstruction and retrofitting of
buildings after recent earthquakes in Iran. Proc Eng.
2013; 54(1):127-39.
5. Berberian M. Tabas-e-golshan (Iran) catastrophic
earthquake of 16 September 1978; a preliminary
field report. Disasters. 1978; 2(4):207-19.
6. Nia MS, Nafissi N, Moharamzad Y. Survey of Bam
earthquake survivors’ opinions on medical and
health systems services. Prehosp Disaster Med.
7. von Schreeb J, Riddez L, Samnegård H, Rosling H.
Foreign field hospitals in the recent sudden-onset
disasters in Iran, Haiti, Indonesia, and Pakistan.
Prehosp Disaster Med. 2008; 23(2):144-51.
8. Watson JT, Gayer M, Connolly MA. Epidemics after
natural disasters. Emerg Infect Dis. 2007; 13(1):1-5.
9. Tanaka H, Iwai A, Oda J, Kuwagata Y, Matsuoka
T, Shimazu T, et al. Overview of evacuation and
transport of patients following the 1995 Hanshin-
Awaji earthquake. J Emerg Med. 1998;16(3):439-44.
10. Willoughby M, Kipsaina C, Ferrah N, Blau S, Bugeja L,
Ranson D, et al. Mortality in nursing homes following
emergency evacuation: a systematic review. J Am
Med Dir Assoc. 2017;18(8):664-70.
11. Akabayashi A, Hayashi Y. Mandatory evacuation of
residents during the Fukushima nuclear disaster:
an ethical analysis. J Public Health (Oxf). 2012;
12. Kawano T, Nishiyama K, Morita H, Yamamura O,
Hiraide A, Hasegawa K. Association between shelter
crowding and incidence of sleep disturbance among
disaster evacuees: a retrospective medical chart
review study. BMJ Open. 2016;6(1):e009711.
13. Kawano T, Tsugawa Y, Nishiyama K, Morita H,
Yamamura O, Hasegawa K. Shelter crowding
and increased incidence of acute respiratory
infection in evacuees following the Great Eastern
Japan Earthquake and tsunami. Epidemiol Infect.
14. Jhung MA, Shehab N, Rohr-Allegrini C, Pollock DA,
Sanchez R, Guerra F, et al. Chronic disease and
disasters medication demands of Hurricane Katrina evacuees. Am J Prev Med. 2007;33(3):207-10.
15. Newnham EA, Balsari S, Lam RP, Kashyap S, Pham P,
Chan EY, et al. Self-efficacy and barriers to disaster
evacuation in Hong Kong. Int J Public Health.
16. Hsieh HF, Shannon SE. Three approaches to
qualitative content analysis. Qual Health Res.2005;
17. Khankeh H, Ranjbar M, Khorasani-Zavareh D,
Zargham-Boroujeni A, Johansson E. Challenges
in conducting qualitative research in health: a
conceptual paper. Iran J Nurs Midwifery Res.
18. Graneheim UH, Lundman B. Qualitative content
analysis in nursing research: concepts, procedures
and measures to achieve trustworthiness. Nurse
Educ Today. 2004; 24(2):105-12.
19. Beck CT. Qualitative research: the evaluation of its
credibility, fittingness, and auditability. West J Nurs
Res. 1993; 15(2):263-6.
20. Lincoln YS. Emerging criteria for quality in
qualitative and interpretive research. Qualit Inquiry.
21. The Sphere Project. Humanitarian charter and
minimum standards in humanitarian response.
3rded.Rugby: Practical Action Publishing; 2011.
22. Fairchild AL, Colgrove J, Jones MM. The challenge of
mandatory evacuation: providing for and deciding
for. Health Aff (Millwood). 2006; 25(4):958-67.
23. KathleenGeale S. The ethics of disaster management.
Dis PrevManagInt J. 2012;21(4):445-62.
24. Centers for Disease Control and Prevention (CDC).
Assessment of health-related needs after tsunami
and earthquake--three districts, Aceh Province,
Indonesia, July-August 2005. MMWR Morb Mortal
Wkly Rep. 2006; 55(4):93-7.
25. Zhang W, Ohira T, Abe M,Kamiya K, Yamashita S,
Yasumura S, et al. Evacuation after the Great East
Japan Earthquake was associated with poor dietary
intake: The Fukushima Health Management Survey. J
Epidemiol. 2017;27(1):14-23.
26. Ebner DK, Ohsawa M, Igari K, Harada KJ, Koizumi
A.Lifestyle-related diseases following the evacuation
after the Fukushima Daiichi nuclear power plant
accident: a retrospective study of Kawauchi
Village with long-term follow-up. BMJ Open. 2016;
27. Khazai B, Hausler E. Intermediate shelters in
bam and permanent shelter reconstruction in
villages following the 2003 Bam, Iran, Earthquake.
Earthquake Spectra. 2005; 21(S1):487-511.
28. Rashid SF, Michaud S. Female adolescents and
their sexuality: notions of honour, shame, purity
and pollution during the floods. Disasters. 2000;
29. Akabayashi A. Must I stay? -- the obligations of 
physicians in proximity to the Fukushima Nuclear
Power Plant. Camb Q Healthc Ethics. 2012;21(3):
30. Protecting persons affected by natural disasters,
IASC Operational Guidelines on Human Rights
and Natural Disasters. Brookings-Bern Project on
Internal Displacement. Available at: URL: https://
internal-displacement/; 2012.
31. Zahari RK, Ariffin RN. Community-based disaster
management in Kuala Lumpur. J ASIAN Behav Stud.
32. Chen LC, Liu YC, Chan KC. Integrated communitybased
disaster management program in Taiwan:
a case study of Shang-An village. Natural Hazards.
2006; 37(1):209-23.
33. OzgeKaradag C, KerimHakan A. Ethical dilemmas
in disaster medicine. Iran Red Crescent Med J.
34. Baker MS. Creating order from chaos: part II:
tactical planning for mass casualty and disaster
response at definitive care facilities. Mil Med.
35. Larkin GL. Unwitting partners in death-the ethics of
teamwork in disaster management. Virtual Mentor.
2010; 12(6):495-501.