Emerg Med J doi:10.1136/emermed-2012-201226
  • Original article

Satisfaction with the humanitarian response to the 2010 Pakistan floods: a call for increased accountability to beneficiaries

  1. Shannon Doocy3
  1. 1Department of Emergency Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  2. 2Aman Foundation, Karachi, Korangi, Pakistan
  3. 3Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Thomas Kirsch, Department of Emergency Medicine, The Johns Hopkins School of Medicine, 5801 Smith Ave, Davis 200, Baltimore, MD 21209, USA; tkirsch1{at}
  1. Contributors All authors were involved in some form in the conception and design of the study, as well as the interpretation of data and review of the manuscript. In addition, TK served as the lead investigator for the study, and MAS was the primary individual responsible for performing the data analysis.

  • Accepted 27 June 2012
  • Published Online First 9 August 2012


Objective Ascertain recipients' level of satisfaction with humanitarian response efforts.

Design A multi-stage, 80×20 cluster sample randomized survey (1800 households) with probability proportional to size of households affected by the 2010 Indus river floods in Pakistan. The floods affected over 18 million households and led to more than 8 billion USD in response dollars.

Results Less than 20% of respondents reported being satisfied with response, though a small increase in satisfaction levels was observed over the three time periods of interest. Within the first month, receipt of hygiene items, food and household items was most strongly predictive of overall satisfaction. At 6 months, positive receipt of medicines was also highly predictive of satisfaction. The proportion of households reporting unmet needs remained elevated throughout the 6-month period following the floods and varied from 50% to 80%. Needs were best met between 1 and 3 months postflood, when response was at its peak. Unmet needs were the greatest at 6 months, when response was being phased down.

Conclusions Access-limiting issues were rarely captured during routine monitoring and evaluation efforts and seem to be a significant predictor in dissatisfaction with relief efforts, at least in the case of Pakistan, another argument in favor of independent, population-based surveys of this kind. There is also need to better identify and serve those not residing in camps. Direct surveys of the affected population can be used operationally to assess ongoing needs, more appropriately redirect humanitarian resources, and ultimately, judge the overall quality of a humanitarian response.


  • All authors had full access to all the data in the study, and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This study was funded by the Johnson and Johnson Foundation, with supplemental funds provided by the Center for Refugee and Disaster Response at the Johns Hopkins Bloomberg School of Public Health. The Johnson and Johnson Foundation had no role in the study design, the collection, analysis or interpretation of data, in the writing of the report or the decision to submit the article for publication. The researchers functioned entirely independently from the primary funder.

  • Competing interests None.

  • Patient consent Because no personal medical record information was collected, the patient consent form was not necessary. The study did, however, obtain full verbal consent prior to all surveys, in accordance with IRB ethical regulations.

  • Ethics approval This study was approved for human subjects research by the IRB (case #3311) of Johns Hopkins Bloomberg School of Public Health. Participants gave informed consent before taking part.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Free sample
This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of EMJ.
View free sample issue >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.


Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

Navigate This Article