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Satisfaction with the humanitarian response to the 2010 Pakistan floods: a call for increased accountability to beneficiaries
  1. Thomas Kirsch1,
  2. Muhammad Ahmed Siddiqui2,
  3. Paul Clayton Perrin3,
  4. W Courtland Robinson3,
  5. Lauren M Sauer1,
  6. 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}


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.

  • Pakistan
  • flood
  • disaster
  • disaster response
  • impact
  • displacement
  • economic recovery
  • psychological conditions
  • quality assurance
  • pre-hospital
  • mental health
  • management
  • quality assurance

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  • 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.