Adverse impact of international NGOs during and after the Bam earthquake: Health system’s consumers’ points of view


  • Seyed Hesam Seyedin, PhD
  • Mohammad Reza Aflatoonian, MPH
  • James Ryan, OStJ, MCh, FRCS, DMCC, FFAEM



international NGO, disaster relief, Bam earthquake, health policy, response


Background: On December 26, 2003, an earthquake occurred in the city of Bam in Iran which completely destroyed the city. National and international responses to the calamity were quick and considerable and nongovernmental organizations (NGOs) from all over the world conducted extensive emergency assistance, fulfilling a crucial role during the emergency.The present study discusses some difficulties and problems which originated from the activities of international NGOs during their response to the Bam earthquake.
Methods: A qualitative study using semistructured interview technique was conducted with nineteen public health and therapeutic affairs managers who were directly responsible for response and recovery in Bam. Analysis of the data was carried out by the framework analysis technique and supported by qualitative research software, the Atlas.ti.
Results: The study found that although international NGOs did their best to help people in the region, they also had some adverse impacts on the community in the disaster affected areas. The problems originated from lack of knowledge of cultural issues, inefficient timing for the delivery of funds and services, uneven goods delivery, and poor communication with local people and authorities.
Conclusions: The study’s findings could have implications for the international aid organizations including the United Nations (UN). Some activities such as roles and responsibilities of the NGOs; networking; and coordination and education of the NGOs could serve as the cornerstone for improvement of their efforts during disasters.

Author Biographies

Seyed Hesam Seyedin, PhD

Assistant Professor, School of Health Services and Information Management, Iran University of Medical Sciences, Tehran. Iran.

Mohammad Reza Aflatoonian, MPH

Academic Member, HSR and Leishmaniasis, Kerman University of Medical Sciences, Kerman, Iran.

James Ryan, OStJ, MCh, FRCS, DMCC, FFAEM

Emeritus Professor at the Centre for Conflict and Catatsrophe Medicine at St George’s University of London, United Kingdom; International Professor of Surgery at USUHS, Bethesda, Maryland.


Emami MJ, Tavakoli AR, Alemzadeh H, et al.: Strategies in evaluation and management of Bam earthquake victims. Prehosp Disaster Med. 2005; 20(5): 327-330.

Seyedin SH: Iranian disaster management system—Needs to eliminate weakness and problems. 13th Multidisciplinary Iranian Researchers Conference in Europe, Leeds, UK, 2005.

Zarocostas J: WHO praises Bam response, but warns of disease. Lancet. 2004; 363(9404): 218.

Moszynski P: Cold is the main health threat after the Bam earthquake. BMJ. 2004; 328(7431): 66.

Akbari ME, Farshadi AA, Asadi-Lari M: The devastation of Bam: An overview of health issues 1 month after the earthquake. Public Health. 2004; 118: 403-408.

Okano K, Atsumi T: The situation of local Iranian NGOs and their role in the recovery and the reconstruction of Bam. Bulletin of the Earthquake Research Institute, University of Tokyo. 2004; 79: 171-177.

WHO Regional Office for the Eastern Mediterranean: Health sector response to the Bam earthquake: Lessons learnt.WHO, 2005.

Seyedin SH, Ryan J, Keshtgar M: Why do countries respond to disasters very late? 16th World Conference on Disaster Management, Toronto, Canada, June 18, 2006.

Tashakkori A: Mixed Methodology: Combining Qualitative and Quantitative Approaches. Thousand Oaks, CA: Sage Publications, 1998.

Gobo G: Sampling, representativeness and generalizability. In Seale C, Gobo G, Gabrium GF, et al. (eds.): Qualitative Research Practice. London: Sage, 2004: 435-456.

Lacey A, Luff D: Trent Focus for Research and Development in Primary Care: An Introduction to Qualitative Analysis. Sheffield University, Trent Focus, 2001: 34.

Ritchie J, Spencer L: Qualitative data analysis for applied policy research. In Bryman A, Burgess R (eds.): Analyzing Qualitative Data. London and New York: Routledge, 1994: 173-194.

Lewis J, Ritchie J: Generalizing from qualitative research. In Rithchie J, Lewis J (eds.): Qualitative Research Practice: A Guide for Social Science Students and Researchers. London: Sage, 2003: 263-286.

Haynes BE, Freeman C, Rubin JL, et al.: Medical response to catastrophic events: California’s planning and the Loma Prieta earthquake. Ann Emerg Med. 1992; 21(4): 368-374.

Seyedin SH, Ryan J: Crisis management system efficiency of health organizations. J Med Safety. 2008; 2(1):1-6.

Seyedin SH, Ryan J: Approach of health organizations to crisis management system. International Forum of Crisis Management for Infectious Disease, Union of Risk Management for Preventive Medicine (URMPM),Tokyo, Japan, November 17, 2007.

Al-Shehri MM: Preparation for Disaster Management in Saudi Arabia. Swansea: University of Wales, 1996.

Ryan J: ABC of conflict and disaster—Conflict recovery and intervening in hospitals. BMJ. 2005; 331(7511): 278-280.

Jacob PK: Modeling disaster response planning. J Urban Planning Dev. 2000; 126(1): 26-33.

Crippen D: The World Trade Center attack—Similarities to the 1988 earthquake in Armenia: Time to teach the public life-supporting first aid? Crit Care. 2001; 5(6): 312-314.

Mattox K: The World Trade Center attack disaster preparedness: Health care is ready, but is the bureaucracy? Crit Care. 2001; 5(6): 323-325.

Ferrer RR, Ramirez M, Sauser K, et al.: Emergency drills and exercises in healthcare organizations: Assessment of pediatric population involvement using after-action reports. Am J Disaster Med. 2009; 4(1): 23-32.

Bremer R: Policy development in disaster preparedness and management: Lessons learned from the January 2001 earthquake in Gujarat, India. Prehosp Disaster Med. 2003; 18(4): 372-384.

Seyedin SH: Health System Effectiveness and Efficiency for Disasters and Conflicts [PhD Thesis], London: University College London (UCL), 2008.



How to Cite

Seyedin, PhD, S. H., M. R. Aflatoonian, MPH, and J. Ryan, OStJ, MCh, FRCS, DMCC, FFAEM. “Adverse Impact of International NGOs During and After the Bam Earthquake: Health system’s consumers’ Points of View”. American Journal of Disaster Medicine, vol. 4, no. 3, May 2009, pp. 173-9, doi:10.5055/ajdm.2009.0026.