Assessing Needs After the Super Typhoon: Results from a Random Household Survey in Samar, Leyte, Cebu, Iloilo, Capiz, Aklan, and Palawan

Assessing Needs After the Super Typhoon: Results From a Random Household Survey in Samar, Leyte, Cebu, Iloilo, Capiz, Aklan, and Palawan

December 2013

Athena Kolbe1, Marie Puccio2, Marvin Bautista3, Erika Childs4, Leah James5, Robert Muggah6, Juan Masipag7, and Almathe Jean8

Summary

A research team conducted a post-disaster assessment in the Philippines within weeks of a Typhoon Haiyan (Yolanda). The household survey involved a random sample of 4,366 households (covering a total of 20,524 individuals and a response rate of 83.2%) in Samar, Leyte, Cebu, Iloilo, Capiz, Aklan, and Palawan. The study assessed access to remittances, damage to property, food security, access to water, attitudes toward service providers and victimization. It found pronounced differences in vulnerability between urban and rural households. For example, half of all households experienced hunger following the natural disaster, with urban households more than 8.97 times more likely to be food secure than rural households. Moreover, urban households were more likely to receive remittances than rural households, and those receiving support were 4.72 times more likely to be food secure. And notwithstanding widespread reports of looting, just 10% reported looting – with rural residents more affected than their urban counterparts. The survey sheds light on the early needs and risks confronting survivors and can inform recovery efforts.

1 University of Michigan, Ann Arbor (USA) and Enstiti Travay Sosyal ak Syans Sosyal (Haiti). 2 University of Michigan, Ann Arbor and Enstiti Travay Sosyal ak Syans Sosyal. 3 Enstiti Travay Sosyal ak Syans Sosyal (Haiti) and Association for Social Development (Philippines). 4 Enstiti Travay Sosyal ak Syans Sosyal. 5 Natural Hazards Center at the Institute for Behavioral Science, University of Colorado, Boulder (USA) and Enstiti Travay Sosyal ak Syans Sosyal. 6 Igarapé Institute (Brazil) and SecDev Group (Canada). 7 Association for Social Development (Philippines). 8 Enstiti Travay Sosyal ak Syans Sosyal.

Introduction

In early November Typhoon Haiyan (Yolanda) struck Southeast Asia, with especially damaging consequences for the Philippines. It was one of the deadliest typhoons ever recorded, killing almost 6,000 people in the country. Just three weeks earlier, on October 15, a 7.2 magnitude earthquake shook the island province of Central Visayas killing 195 and injuring 651, with another 300,000 people displaced.9 Shortly after the earthquake a team of researchers associated with the Igarapé Institute and the Enstiti Travay Sosyal ak Syans Sosyal (Institute of Social Work and Social Science) traveled to Central Visayas with the intention of implementing a peer-led trauma intervention for adults with children in the area impacted by the earthquake. The intervention, Relief for the Spirit, had been previously administered in internal displacement camps in post- earthquake Haiti.

Coincidentally, the team was already on the ground when the Super Typhoon hit the Philippines. As a result, it was possible to temporarily redirect resources to administer a rapid household survey assessing post-disaster needs in mid-November 2013. A total 4,366 households with a total of 20,524 individuals were included in the study. The response rate for this survey was 83.2%. This report, which presents the initial findings of that survey, was prepared by a team of Filipino, Haitian, US and Canadian researchers. The study focuses on a wide range of issues including food security, access to water, medical concerns, psychological problems, attitudes toward service providers, and crime. This initial report was prepared specifically to support the recovery and reconstruction activities of the Philippines government together with multilateral and bilateral donors and non-governmental organizations working on post-disaster needs.

A selection of the key findings observes that:

• More than half of all households experienced hunger after the typhoon. Urban households were 8.97 times more likely to be food secure than rural households in the weeks after the typhoon;

• A quarter of all urban households and almost one in five of all rural households reporting remittances in the 12 months prior to the typhoon;

• Remittance support, especially when sent from family members abroad, was a protective factor with respect to food security. Those receiving remittances or cash transfers after the typhoon were 4.72 times more likely to be food secure than other households;

• More than 85% of respondents claimed to have had access to water after the typhoon, though water sources previously considered safe to drink appear to have been rapidly contaminated.

• Children were 1.22 times more likely than adults to experience diarrhea and 2.43 times more likely to have fever in the weeks immediately following the typhoon;

9 See UN Office for the Coordination of Human Affairs, (October 25, 2013) accessed online at http://reliefweb.int/report/philippines/bohol-earthquake-action-plan-october- 2013.

• Though gender-based violence outside the household was less frequently reported than in other post-disaster environments, physical and emotional abuse by intimate partners was a concern with 11.3% of all women saying they had been physically abused since the typhoon;

• More than 70.3% of households reported some damage to their home with families in rural areas 2.7 times more likely to say that their home was completely destroyed or damaged beyond what they could afford to repair;

• Just 10.9% of survey respondents claimed that something was stolen or taken from their home without permission after the storm, with rural residents claiming to be hardest hit. The average value of items taken was 1016 PHP (approximately USD $23);

• Of the 18% of households who interacted or attempted to interact with municipal or other government employees while seeking assistance, 9.1% gave or were pressured to give, a bribe to receive support.

• Sexual assault and harassment appear to be lower than reported in other post- disaster environments. None of the survey respondents reported being subjected to a sexual assault or attempted sexual assault during the evacuation process or in the weeks after Yolanda;

• The greatest risk factors for intimate partner violence included being forced to relocate living places multiple times, living in a crowded environment, being from a rural area, and experiencing hunger. Staying with relatives, engaging in daily prayer, and having a male partner who was attempting to work were associated with lower rates of such victimization;

• An overlooked need during and after disasters relates to female reproductive and hygiene care. Few women stated that they had access to feminine hygiene supplies and most women who were sexually active stated that they did not have access to birth control; and

• Nearly half of all respondents (46.3%) surpassed the criteria for registering posttraumatic stress disorder (PTSD). Women were more likely than men to have been categorized as suffering from PTSD.

Methodology

The household survey was rapidly organized in the weeks between the October earthquake and the November typhoon. Surveys were conducted in Samar, Leyte, Cebu, Iloilo, Capiz, Aklan, and Palawan during an eleven day period beginning November 14, 2013 and concluding November 25, 2013. A research team consisting of 42 university- educated men and women were recruited to administer the survey. All team members received intensive training in October 2013 with a short follow-up training (12 hours) in

November 2013. A total 4,366 households with a total of 20,524 individuals were included in the study. The response rate for this survey was 83.2%.10

A multi-stage approach was deployed in order to identify households and main respondents throughout Samar, Leyte, Cebu, Iloilo, Capiz, Aklan, and Palawan. First, a list of the barangays in each of these provinces and the estimated population figures (based on the 2010 census) was obtained from the National Statistics Office. Using proportion to population size (PPS) sampling, a representative number of barangays in the selected areas were randomly surveyed. A list of random GPS locations was generated within each barangay with the number of GPS points created relative to the population of the barangay.

For each location, after the GPS locations were identified, interviewers identified all households within a 10m radius including those homes which were destroyed or abandoned after the disaster. A household was randomly selected from within this 10 mile radius: the probability of choosing a household was (1/number) of households within 10m. Thus for items related to the household as a whole, the weight used was the inverse, i.e. the number of households within 10m.11 In cases where the selected household had relocated to a shelter or another location and could be located with assistance from neighbors, they were interviewed. In ten percent of cases (n=548), the missing household could not be found and another household was randomly chosen to replace it using the aforementioned process.

Within the household, one adult was randomly selected from all the adults in the household. The interviewer recorded the total number of adults in the household and chose the one with the most recent birthday (at the date of the interview) to be the main respondent. Consequently, the probability of selection of an individual, given that his/her household had been chosen, was 1/number of adults in household. The overall probability of selecting an individual given a GPS location was the product of the probability of choosing a household and the probability of choosing an individual within the household. The weight for items related to the individual was the inverse of this product, which is equivalent to the product of the number of households within 10m and the number of adults in the household.

10 5249 households were selected for the study. Of these 548 had left their homes and could not be located even with assistance from neighbors, local authorities and social media. In 16 homes, despite visiting four different times at various times of the day, only children were present and an adult could not be located to respond to the survey. An additional 319 households (6.1%) declined to participate in the study. 11 When a GPS location was not within 10m of a household so defined, another location was used. One household was randomly chosen to participate. The numbers of households within 20m of each location were recorded for later use in determining the probability of selecting the household and determining the sampling weight.

Demographics

The demographics of the study population reflected the diversity of the Philippines as a whole. The mean age of respondents was 26.5 years (SD: 7.3 years) while the mean age of all household members was 22.6 years (SD: 9.8 years). There were slightly more males than females in the participating households. And youth under age 15 made up 34.3% (n=7030) of the individuals in participating households (see Table 1).

Table 1. Individual-Level Demographics Urban Rural All (n=7157) (n=13367) (n=20524) Female 49.2% 48.8% 48.9% (3522) (6523) (10045) Male 50.8% 51.2% 51.1% (3635) (6844) (10479) Under age 5 9.2% 12.0% 11.0% (658) (1606) (2264) Aged 60 or older 6.0% 8.0% 7.3% (429) (1069) (1498) Disabled including old age-related 6.1% 9.0% 8.0% functional impairment (pre-disaster) (436) (1203) (1639)

Nearly 40% of the surveyed households, 1,704 (comprising 7,157 individuals), were from urban areas. Female-headed households were more common among participating households than across the Philippines in general with 42.6% of rural households and 46.5% of urban households led by women whereas the World Bank reported in 2008 that 16.6% of households across the country are headed by women.12

Table 2. Household-Level Demographics Urban Rural (n=2662) All (n=1704) (n=4366) Female-headed 46.5% 42.6% 44.2% (793) (1135) (1928) Mean household size 4.2 5.0 4.7 (SD: 1.3) (SD: 1.8) (SD: 1.6) Participates in religious services at 21.9% 47.0% 37.2% least monthly (374) (1251) (1625) Had improved water source pre- 94.0% 89.7% 91.4% disaster (1601) (2388) (3989) Received remittances from abroad 26.0% 18.0% 21.1% in the 12 months prior to the (443) (479) (922) typhoon

12 It is not clear if this figure refers to households headed by single women or households where a woman is one of the heads of the household. In our study, we defined “female headed” as households where one or more of the heads of household were female. This figure includes households headed by a man and a woman where the woman is also a head of household responsible for making financial decisions on behalf of the entire household. See World Bank (2008) http://data.worldbank.org/indicator/SP.HOU.FEMA.ZS?page=1.

Received remittances or cash 18.5% 3.7% 9.5% transfers since the typhoon (316) (99) (415)

Households frequently reported receiving remittances from abroad with a quarter of all urban households and nearly a fifth of all rural households reporting remittances in the 12 months prior to the typhoon. Households in areas impacted by the October 2013 Bohol earthquake were slightly more likely to report remittances in the 12 months prior to the typhoon than households in other surveyed areas (see Table 2).

Food Security

Food security was measured according to guidelines designed by the US Department of Agriculture (USDA) in 2000. Households were surveyed using an 18-item instrument consisting of multiple indicator questions aimed at capturing and distinguishing the full range of severity of food insecurity. This instrument has been shown to be stable, robust, reliable measure of food security among US households.

Figure 1. Measuring Food Security Post-Typhoon n=4,366) Food Security Measured by the USDA Scale (n=4366)

Food secure 1046 1515 24% 35% Insecure without hunger 2518 Insecure with moderate hunger 58% 802 1003 Insecure with severe hunger 18% 23%

The instrument was adapted in accordance with established protocols to measure experiences since the typhoon. Affirmative responses to the 18-item measure were summed and then categorized according to food insecurity severity per USDA guidelines. Categories consist of: food insecure with severe hunger, food insecure with moderate hunger, food insecure without hunger, and food secure.

More than half of all households experienced hunger after the typhoon (see Figure 1). Urban households were more likely to report food security with 40.1% (n=683) scoring as “food secure” on the USDA Food Security Scale. Urban households were 8.97 times (95% CI: 7.45-10.79) more likely to be food secure than rural households in the weeks after the typhoon. Rural households were significantly more likely than urban households to report losing food stored for later consumption and/or animals used for food or sale during or after the typhoon (see Table 3).

Table 3. Food Security in Urban and Rural Barangays Urban (n=1704) Rural (n=2662) All (n=4366) Food-secure 40.1% (683) 4.5% (119) 18.4% (802) Food-insecure without 31.3% (533) 19.3% (513) 24.0% hunger (1046) Food-insecure with 17.2% (293) 46.0% (1222) 34.7% moderate hunger (1515) Food insecure with severe 11.4% (195) 30.4% (808) 23.0% hunger (1003)

Common sources of energy used for cooking food included agricultural residues, fuel wood, charcoal, and gas/kerosene. Most households (78.5%) stated that they had enough cooking fuel for at least 24 hours though shortages of gas and kerosene in some areas were forcing households to revert to other types of cooking fuel. Households in the rural areas were most likely to report that they had access to all of the cooking fuel they needed. Rural households were less likely to report using gas or kerosene as their primary source of cooking fuel. Nearly all households reported access to at least one storage container with a closed lid for storing and protecting food.

Remittances have shown to be a protective factor following a disaster as a way to increase food security for affected households.13 Economic conditions in the Philippines are heavily influenced by remittances, with nearly 10% of the country's GDP coming from this monetary source.14 The number of personal remittances from Filipinos working overseas has continually grown throughout 2013, yielding an average of US $2 billion dollars a month - a 6.6 percent increase from the previous year.15

Receiving remittances from abroad or money from others was strongly related to food security. Though only ten percent of households had received remittances or cash transfers since the typhoon, many more reported that they expected to receive such funds. In many areas banks and stores where electronically transferred funds could be received were hampered by electrical, internet and phone outages as well as a shortage of actual cash to distribute. Excessive wait times and long lines were reported in all geographic areas.

For those households who did receive funds, it was clear that receiving any amount of money from others, especially family members abroad, was a protective factor in regards to food security (see Table 4). Households who received remittances or cash

13 See Kolbe, A., Puccio, M., & Muggah, R. (2012). After the storm: Haiti's coming food crisis. Strategic Note, 6, 1-12. Rio de Janeiro: Igarape Institute.

14 See Borgne, E. (2009, April 7). Remittances and the Philippines' economy: the elephant in the room. World Bank. Retrieved from http://blogs.worldbank.org/eastasiapacific/remittances-and-the-philippines- economy-the-elephant-in-the-room

15 See Sentral, B. and Pilipinas, N. (2013). Personal remittances break US $2.0 billion mark for sixth consecutive month in September 2013; reach US $18 billion in January- September. Retrieved from http://www.bsp.gov.ph/publications/media.asp?id=3305

7 transfers after the typhoon were 4.72 times (CI: 4.25-5.26) more likely to be food secure than other households. Only 9.4% (n=39) of households receiving remittances or cash transfers after the typhoon experienced hunger compared to 61.35% (n=2424) of households not receiving remittances or cash transfers after the typhoon.

Table 4. Food Security of Households Receiving Remittances or Cash Transfers Received (n=415) Did Not Receive All (n=3951) (n=4366) Food-secure 64.1% (266) 13.6% (536) 18.4% (802) Food-insecure without 26.5% (110) 23.7% (936) 24.0% hunger (1046) Food-insecure with 6.5% (27) 37.7% (1488) 34.7% moderate hunger (1515) Food insecure with severe 2.9% (12) 25.1% (991) 23.0% hunger (1003)

Water and Water-Borne Illnesses

More than 85% (n=3721) of respondents said they had access to water after the typhoon. However, water sources which were previously safe to drink appear to have been, in all surveyed areas, contaminated during or immediately after the typhoon. The symptoms of water-borne illnesses were frequently reported (see Table 6).16 Few households (5.7%) reported using tablets or other means to purify water before drinking it. Nearly all households (92.3%) reported having access to a place to store water after the storm, although households in the rural areas were more likely to use uncovered buckets to store water.

Table 6. Individuals with symptoms of possible water-borne illness Adults aged 15+ Children under All (n=20524) (n=13494) 15 (n=7030) Diarrhea 44.0 53.5 47.3 (5939) (3762) (9701) Vomiting and/or Nausea 6.1 27.1 13.3 (821) (1905) (2726) Stomach Pain and/or 11.8 31.6 18.4 Cramping (1592) (2224) (3786) Fatigue 45.1 37.0 42.3 (6087) (2601) (8688) Dehydration 16.7 14.2 15.8 (2254) (996) (3250)

16 The primary respondent was asked if they or any of the other household members had experienced any illness since the typhoon. This was an open-ended question and symptoms were recorded for each individual in the household and later translated and coded for analysis. These figures can be seen a conservative estimate as it is likely that medical problems could have been underreported in cases where the primary respondent was not aware of the illnesses or symptoms experienced by other household members.

Muscle aches or pains 19.0 12.1 16.6 (2552) (850) (3402) Fever 10.3 25.0 15.3 (1390) (1758) (3148)

Children were particularly vulnerable to illness and to medical problems which could be related to water-borne illness after the storm. Children were 1.22 times (CI: 1.18-1.25) more likely than adults to experience diarrhea in the weeks immediately following the typhoon. They were also 2.43 times (CI: 2.28-2.59) more likely than adults to have a fever and 2.68 times (CI: 2.53-2.84) more likely than adults to experience stomach pain or cramping.

Housing and Property Issues

The vast majority (70.3%) of households reported some damage to their home. The type and severity of damage varied and only 18 households had been visited by an engineer or building professional to assess the safety of their home and the extent of damages at the time of the survey.17 Families in rural areas were 2.7 times more likely to say that they thought their home was completely destroyed or damaged beyond what they could afford to repair.

Nearly 100% of respondents said that there was storm debris left on their property or blocking access to their home. At the time of the survey only 12.5% of the households said the debris had been removed completely though most households had already begun the process of removing some debris. Households stated that they were assisted in debris removal by family members and friends (65.5%), neighbors (51.9%), religious organizations and local voluntary groups (12.1%), the local government or government employees including police and soldiers (8.8%), charities and NGOs from the Philippines (7.2%), and foreign NGOs and charities (1.1%).

When asked to name their top priority for post-disaster assistance, 39.2% of urban dwellers and 20.8% of rural households said that housing was the area where resources should be directed. Some of the suggestions from those who prioritized housing were: rebuilding and repair of existing structures (55.8%), relocating displaced families to safer housing (21.7%), helping families make their homes safer for future disasters (20.3%), and reimbursing households through a cash pay-out to those whose property was damaged or destroyed (12.4%).

In addition to damaged housing, personal and household property was also lost or damaged in the storm or lost in the immediate aftermath as families relocated and some homes were broken in by non-households members foraging for food and supplies. (See table 7).

News reports after the typhoon reported widespread looting in storm effected areas. Survey respondents were asked if anything was stolen or taken from their home without permission in after the storm and 476 (10.9%) responded in the affirmative. Rural

17 Data was collected by the enumerators on the type of visible damage to the home however this has not yet been coded and thus is not presented in this initial report of findings.

9 residents were more likely to report that items had been taken than urban residents. Commonly taken items included food, clothing, shoes, blankets, water, cooking or kitchen items, and tools. The average value of items taken was 1016 PHP (approximately USD $23) and in nearly all cases the respond reported that other valuable items in the home were visible but were not taken.18

Table 7. Lost or Damaged Property Percentage of Households (n=4366) Important papers or identification cards such as birth certificates, 21.1% passport, driver’s license, Health Insurance card, bank credit cards, (922) vaccination book, bank account book, educational records, or land deeds Pictures, mementos and other items of sentimental value 44.1% (1924) Clothing 63.0% (2752) School books, school uniforms, other school related items 22.7% (993) Things needed to care for a baby or small child such as a crib, toddler 8.4% chair, diapers, etc. (365) Food we stored for future use 70.5% (3077) Food we had for current or immediate use 74.6% (3256) Drinking water 67.4% (2944) Work tools including fishing equipment if used by income earner 53.4% (2330) Household tools or items such as cooking pots, blankets, etc. 47.7% (2081) Method of transportation owned by our household such as bike, boat, 19.8% motorcycle, etc. (864) Seeds, fertilizer, farming equipment, seedlings, plants, fruit tree(s) 59.1% (2581) Animal(s) used for food or sale such as chickens, etc. 45.9% (2003) Valuable household items such as a television, laptop, stereo, karaoke 45.6% machine, washing machine, etc. (1991)

Respondents were also asked if they themselves had taken things that did not belong to them after the typhoon. A total of 312 (7.2%) respondents admitted to foraging or stealing from others after the typhoon. Most said they took these items from neighbors (70.2%) or local businesses (26.6%). The items respondents most commonly reported taking were food/water, clothing, medications or first aid supplies, and household items.

18 Eight respondents reported that a note was left behind promising to repay the family, replace or return the items, or giving an explanation for why the individual had been forced to steal from the family.

Confidence in Police and State Institutions

Respondents in urban areas were somewhat positive about their interactions with the government and their confidence in state institutions after the typhoon (see Figures 2 and 3) while rural residents were less positive. Both urban and rural residents expressed concerns that government assistance was needed to reestablish local industry and transportation and that such assistance was slower in coming than was expected. Rural residents in particular cited the lack of transportation as a serious problem. In some areas roads were washed out and in others, boats typically used for transportation were lost or damaged.

Nearly 80% (n=2109) of rural residents said they felt isolated and did not have access to goods and supplies, government services, or information because of the lack of transportation. Urban residents were 3.8 times more likely than rural residents to report interaction with state actors including police, soldiers and civil servants in the weeks following Yolanda. Interactions with police and soldiers were positive overall with few reports of harassment or abusive behavior towards citizens.

Figure 2. How has the government been doing at _____ since Yolanda? (Asked of urban residents, n=1704)

100% 90% 80% 70% 60% Very Badly 50% 40% Somewhat Badly 30% 20% Okay 10% 0% Good Very Good

Disturbingly, of the 784 (18.0%) households who interacted or attempted to interact with municipal or other government employees in search of assistance after the typhoon, 71 (9.1%) gave or were pressured to give, a bribe to receive help. This appears to be an ongoing problem in the country. A 2013 report from Transparency International indicates that though bribes were less frequently reported in the Philippines than in neighboring countries, 12% of people paid at least one bribe to a public service official in the span of a year.19 The study covered experiences with eight

19 See Transparency International (2013). Corruption climate in the Philippines. Retrieved from http://www.transparency-ph.org/wp- content/uploads/2013/07/Philippine-Global-Corruption-Barometer-Report1.pdf.

11 agencies (Registry and Permit Service, Police, Education System, Utilities, Land Services, Tax, Medical and Health Services, and the Judicial System). (See Table 8)

Figure 3. How has the government been doing at _____ since Yolanda? (Asked of rural residents, n=2662)

Table 8. Agreement with public opinion statements about state institutions Please tell me if you strongly agree (1), agree somewhat (2), Mean SD disagree somewhat (3), or strongly disagree (4) with the following statements: The government is obliged to prepare adequate facilities for 1.9 0.3 evacuation in every community in the event of a disaster. The government did a good job at making sure everyone had 3.1 1.7 access to adequate evacuation facilities for Typhoon Yolanda. The government thinks about people like me when making 2.6 0.8 decisions regarding disaster management and relief. I am confident that my community will receive the help we 3.0 0.6 need from the government in order to rebuild. The government took care to assure that vulnerable people 2.5 1.2 including those with disabilities and elderly people were properly cared for during and after Yolanda. I need to pay a bribe to get the help I need from the 2.9 1.3 government. I need to know someone or have a friend or relative on the 2.8 1.5 inside in order to get the services and help I need from the government. The government is making sure that post-disaster aid is 2.8 0.6 distributed fairly. I saw the police mistreat people during/after Yolanda. 3.5 0.4 I saw soldiers mistreat people during/after Yolanda. 3.2 0.5

Women’s Issues

Data was gathered on a variety of issues which may be of particular concern to women including family violence, sexual assault and harassment, women’s health needs, parenting, and childcare. Female respondents were asked a series of questions using a tablet based data entry program in which their responses were not visible to the enumerator to decrease bias in the data collection process. Data regarding intimate partner violence was included as this is often related to poor health outcomes in other areas which are of concern in a post-disaster environment.20

Table 9. Women’s Concerns Regarding Children and Personal Issues (n=2094) Lack of childcare is hampering my ability to care for household 19.7% (414) members, meet our basic needs, and find resources Our family is experiencing a lot more conflict and we are arguing more 32.8% (686) now than we did before Yolanda I’m concerned because I don’t have access to the feminine hygeine 87.8% (1839) products I need I’m concerned because I don’t have access to birth control medication 47.9% (1002) or other types of contraception As a women I feel safe in the place where I’m staying right now. 84.8% (1776) The children in my household are safe in the place where we are staying 82.0% (1717) right now; I’m not afraid that someone is going to mistreat them or molest them. Violence against women has increased since Yolanda. 8.6% (181) Since Yolanda, I experienced being harassed or intimidated sexually by 1.3% (27) a man.

Sexual assault and harassment were lower than reported in other post-disaster environments. None of the survey respondents reported being subjected to a sexual assault or attempted sexual assault during the evacuation process or in the weeks after Yolanda. There were some reports of sexual harassment in government established evacuation centers and informal evacuation locations (including churches, local homes which were more sturdy than those in the surrounding neighborhood, and schools). Encouragingly, female respondents reported that others in the vicinity were quick to come to their aid and to stop the harassment or shame the harasser (see Table 9).

One overlooked need during and after disasters relates to female reproductive and hygiene care. Few women stated that they had access to feminine hygeine supplies and most women who were sexually active stated that they did not have access to birth control (see Table 9). Nearly half of all women aged 15-49 in the Philipines use contraception.21 The lack of access to birth control was a signficant concern for women who were taking medication to prevent pregnancy, reduce cramping with menstration, or to regulate their cycle. Female children and young adults (through aged 20) were 1.66 times more likely than female adults (aged 21 or older) to lack feminine hygeine

20 Black, M. C. (2011). Intimate partner violence and adverse health consequences: Implications for clinicians. American Journal of Lifestyle Medicine, 5(5), 428-439 21 World Bank (2013). Contraceptive prevalence (% of women ages 15-49). Retrieved December 10, 2013, from http://data.worldbank.org/indicator/SP.DYN.CONU.ZSWebpage

13 supplies. Additionally, nearly a quarter of mentstrating women (23.6%) stated that their menstral cycle was distrupted, late, unusually short, or that they experienced another type of disturbing change regarding menstration in the weeks after Yolanda.

Table 10. Intimate Partner Violence (IPV) Before and After Yolanda (n=2094) Experienced physical abuse by an intimate partner in the 12 months 14.6% (306) prior to Yolanda Experienced physical abuse by an intimate partner since Yolanda 11.3% (237)

Percentage of those who experienced physical abuse by an intimate 77.5% (237) partner before Yoland who also experienced experienced physical abuse by an intimate partner after Yolanda Experienced emotional abuse22 by an intimate partner since Yolanda 18.8% (394) Percentage of those who experienced physical abuse by an intimate 82.0% (251) partner in the 12 months prior to Yolanda who also experienced emotional abuse by an intimate partner after Yolanda.

Information about gender-based violence inclidng a domenstic violence screening instrument was used with all female respondents. Nearly 15% indiciated that they had been subjected to physical abuse by an intimate partner in the previous year.23 These physical altercations most commonly occurred during arguments or disputes; the most common topic of dispute reported by female respondents was regarding parenting. Women who reported Intimate Partner Violence (IPV) during the previous year were significantly more likely to report an incident of physical abuse after Yolanda. The greatest risk factors for IPV were being forced to relocate living places multiple times, living in a crowded environment, being from a rural area, and experiencing hunger. Staying with relatives, engaging in daily prayer, and having a male partner who was attempting to work were associated with lower rates of IPV among women who reported previous incidents of victimization.

22 Specifically, female respondents were asked if their intimate partner had: “acted very angry toward you in a way that seemed dangerous; told you that you were a loser, a failure, or not good enough; called you names; insulted, humiliated, or made fun of you in front of others; tried to keep you from seeing or talking to your family or friends; made decisions for you that should have been yours to make, such as the clothes you wear, things you eat, or the friends you have; kept track of you by demanding to know where you were and what you were doing; made threats to physically harm you; threatened to hurt him- or herself or commit suicide when he or she was upset with you; threatened to hurt a pet or threatened to take a pet away from you; threatened to hurt someone you love; hurt someone you love; threatened to take your children away from you; kept you from leaving the house when you wanted to go; kept you from having money for your own use; or destroyed something that was important to you?” 23 Specifically women were asked if any of the following had been done to them by an intimate partner: “Slapped you? Pushed or shoved you? Hit you with a fist or something hard? Kicked you? Hurt you by pulling your hair? Slammed you against something? Tried to hurt you by choking or suffocating you? Beaten you? Burned you on purpose? Or, used a knife or gun on you?”

Mental Health

A variety of mental health measures were applied in the survey. Results from the Harvard Trauma Questionnaire (HTQ), a instrument for Posttraumatic Stress Disorder (PTSD) are particularly notable. The HTQ is a widely-used clincial instrument created by the Harvard Program in Refugee Trauma which assesses trauma symptoms originally based on the DSM-III-R.24 The checklist-style questionnaire was later revised to reflect all 16 of the PTSD symptoms in DSM-IV. This instrument was designed for international use, initially being tested and used in Vietnam, Cambodia and Laos. The questionnaire is designed to be used by mental health and medical practitioners.25

Figure 4. Posttraumatic Stress Disorder Amongst Respondents

11, 0%

2023, 46% Has PTSD 2332, 54% Limited PTSD symptoms

No symptoms reported

Nearly half of all respondents (46.3%; n=2023) surpassed the HTQ cut-off score for PTSD (a score of 2.5 or greater). Women were more likely than men to score above 2.5 (and thus be categorized has having PTSD) than men. Rural residents and residents of areas impacted by the October 2013 Bohol Earthquake were also more likely to exhibit symptoms of PTSD than other residents. Food insecurity was highly correlated with increased symptoms of PTSD; the greater the food insecurity the household experienced as measured by the USDA Scale, the higher the respondent scored on the HTQ (See Figure 4).

24 Harvard Program in Refugee Trauma. (2011). HPRT Questionnaire. Retrieved from http://hprt-cambridge.org/screening/harvard-trauma-questionnaire/

25 Mollica, R. F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S., & Lavelle, J. (January 01, 1992). The Harvard Trauma Questionnaire. Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. The Journal of Nervous and Mental Disease, 180, 2, 111-6.

Reflections

The household survey highlights a range of risks and vulnerabilities confronting Filipinos in disaster-affected areas. It also underlines protective factors and impressive coping strategies, not least in relation to remittences from abroad. The assessment emphasizes the differential impacts of the disaster between urban and rural regions, but also the ways in which effects are segmented across demographic groups. Such data can be used to help shape baselines and set short-term priorities, but also to measure and evaluate whether needs are being met in the medium- to long-term. A major concern in any natural disaster is rapid and reliable data on the scope and scale of impacts on populations. Relief workers are often confronted with information scarce environments and the imperative to prioritize delivery over information collection. This rapid household survey, drawing as it does on methods pioneered in other crises affected areas, highlights the possibility of gathering solid quantitative data within weeks of a traumatic emergency.