Disasters are heart-wrenching. The scale of the distress and suffering can be hard to bear even when you're just watching snug and safe in your unaffected lounge room.
Those images send us rushing to donate in droves. That generosity can add up to hundreds of millions of dollars for a massive disaster.
Let's pause right there. Is emotional donating to a specific-incident relief fund always a good idea? Is it the best thing to do?
The answer may be counter-intuitive, but it's clear: no. GiveWell points out that "emergency aid is one of the worst uses of donations, despite being one of the most emotionally compelling."
Why? By the time donations are processed, the agency can have far too much money that can only be spent on a kind of relief that's no longer needed. And it's short-sighted.
Some agencies - like Médicins sans Frontières - have asked donors to put the money to other use (and given it back when people say no). But that's not typical. GiveWell recommends that you be proactive about choosing a trustworthy agency you will donate to before the next disaster, then don't restrict the use of the money. And why not donate regularly?
What is the best use of money? That brings us to the science around minimizing harm from disasters - and the end of easy answers.
There has been a very sharp increase in disasters. As Will Durant (1885-1981) put it, "Civilization exists by geological consent, subject to change without notice." Overpopulation, getting desperate and moving into less-than-ideal areas, clustering along the coast - all these contribute, along with climate change.
David Bressan, geologist and Scientific American blogger, explains that living in cities means "people lose awareness of natural hazards." Scars on the land remind people of the world's instability. But we smooth them over and cancel them out in cities. We can forget that minimizing the risks is critical - including solid infrastructure that can make communities more resilient in the face of disasters that can't be prevented.
Floods remain the biggest disaster risk, worsened by de-forestation, urbanization, population growth and climate change. They were responsible for 6.8 million deaths in the 20th century, affecting at least 2,821,895,005 people between 1980 and 2009. Another 61 million were affected by earthquakes in that time. You'd expect us to be investing heavily in the science of risk reduction and harm minimization, wouldn't you?
And then there's what all those first responders should do when they get there. They want to do more good than harm, but we can't take it for granted that experience alone is enough. I've blogged before on the controversy of psychological care after trauma, a typical example of how much more we have to learn about helping people in crisis.
But the scientists and international agencies gathered together at Evidence Aid meetings agree that we're falling far short on the science needed for disaster response. Responders don't have easy access to reliable enough information, and we aren't getting adequate overviews of what primary studies are needed. How best to respond to mass casualty events is only "an emerging area" of science. A major workload also faces another organization, the Collaboration for Environmental Evidence.
Finding and building on systematic reviews and meta-analyses in the area of disaster preparedness and response is Evidence Aid's mission. Last week, Claire Allen and Bonnix Kayabu from Evidence Aid presented the results of their priority-setting exercise at the international meeting of the Cochrane Collaboration in Quebec. The director, Professor Mike Clarke, held down the fort in Belfast.
They're deep in the process of writing summaries of 100 systematic reviews - to join the 100 they've already done. They've identified 30 priority topics needing systematic reviews. And they've just scratched the surface of what needs to be done.
Outstanding people, great mission - but a big problem. Evidence Aid was recently awarded the second "Unorthodox Prize" for being an extraordinary philanthropic opportunity that unfortunately "falls outside the traditional issue categories of most funders."
What it means in the field when knowledge isn't fit for purpose was made clear in a presentation by Professor Mike Ardagh at last year's Cochrane meeting. He talked about the challenges his hospital faced after the earthquake in Christchurch in 2011, and the limitations of the readily accessible body of knowledge on crush injury syndrome.
Potassium is released from the crushed area into other parts of the body, including the kidneys and the heart, where it becomes life-threatening. Faced with such a large number of crush injuries, they initially treated people with hyperkalemia (high potassium) in the way they usually did when people with renal conditions had the problem - including using drugs that move the potassium back into the cells. But it didn't work, said Ardagh: "it wasn't much use when the muscles were all squashed."
As the Unorthodox Prize-givers stress, the lasting impacts of disasters fall disproportionately on the world's poor. Evidence Aid "could have a big and sustained positive impact." And maybe our donations could be used more rationally.
The Cochrane Collaboration published an anniversary collection of methods articles about systematic reviews here.
Declaration of interest: Although I've never been involved with Evidence Aid, I have worked with Claire Allen and Mike Clarke extensively in the past.
The trends in natural disasters infographic comes from the GRID-Arendal Centre, United Nations Environment Programme (UNEP) (by Emmanuelle Bournay, UNEP/GRID-Arendal).
Woodcut of the “great and terrible” Rhine flood, Germany, newspaper in 1651 (Klaegliche und erbarmlich newe Zeitung), is from the Bavarian State Library, (Signatur Einbl. II, 22).
The thoughts Hilda Bastian expresses here at Absolutely Maybe are personal, and do not necessarily reflect the views of the National Institutes of Health or the U.S. Department of Health and Human Services.