Introduction: The 2021 European floods in Germany, Belgium, and the Netherlands significantly impacted healthcare. With climate change increasing flood risks, healthcare preparedness is essential. Floods affect healthcare directly and indirectly by disrupting patient access, damaging infrastructure and impeding care continuity. Our interdisciplinary research in the Netherlands systematically assesses flood impacts on healthcare, optimises disaster preparedness, patient logistics, and continuity and explores crisis governance, incorporating lessons from coronavirus disease-2019 (COVID-19). Methods: Our multi-sited, interdisciplinary project titled “Pandemic lessons for flood disaster preparedness” includes literature reviews on: (i) the (in) direct impacts of floods on healthcare, (ii) disaster decision-making strategies and (iii) patient logistics during crises. Empirically, ethnographic methods (interviews, focus groups, document analyses, and observations) will: (a) assess hospital flood preparedness, (b) explore decision-making and crisis management strategies and (c) analyse the dynamics of health system governance during floods. Data from these sources and flood scenarios will inform models on healthcare impacts and decision-making, culminating in a simulation game for research and training. Discussion: This study offers a comprehensive, interdisciplinary approach to understanding and improving healthcare system preparedness for floods. By integrating diverse fields such as healthcare governance, disaster risk management, logistics and hydraulic engineering, we provide a unique lens on resilience. A key strength is the incorporation of lessons from the COVID-19 pandemic, allowing us to draw parallels between pandemic response and flood preparedness. In addition, our simulation game serves as a robust tool for translating knowledge into practice. However, the study’s reliance on collaboration with busy healthcare and disaster response professionals may limit engagement. Moreover, the absence of direct public and patient involvement in the research design, though partially mitigated by engaging representative organizations, presents a potential limitation. Lastly, the challenge of obtaining real-time data from flood events could introduce recall bias, but triangulation of various data sources aims to address this issue. Despite these challenges, the study’s integration of long-term data from recent floods and focus on healthcare-specific crisis governance provides valuable insights for improving disaster preparedness.

In emergencies, high stake decisions often have to be made under time pressure and strain. In order to support such decisions, information from various sources needs to be collected and processed rapidly. The information available tends to be temporally and spatially variable, uncertain, and sometimes conflicting, leading to potential biases in decisions. Currently, there is a lack of systematic approaches for information processing and situation assessment which meet the particular demands of emergency situations. To address this gap, we present a Bayesian network-based method called ERIMap that is tailored to the complex information-scape during emergencies. The method enables the systematic and rapid processing of heterogeneous and potentially uncertain observations and draws inferences about key variables of an emergency. It thereby reduces complexity and cognitive load for decision makers. The output of the ERIMap method is a dynamically evolving and spatially resolved map of beliefs about key variables of an emergency that is updated each time a new observation becomes available. The method is illustrated in a case study in which an emergency response is triggered by an accident causing a gas leakage on a chemical plant site.

Humanitarian and military organizations face deeply uncertain, continuously changing environments due to disasters and conflict. Information sharing is vital to adapt to these disruptions effectively and ensure the timely availability of essential equipment and supplies anywhere in the world. However, little is known about the role of information sharing in adapting to a changing environment. We use an agent-based discrete-event simulation to study information-sharing mechanisms, specifically delayed information-sharing behavior, and analyze how they impact the adaptation of decision-making structures over time. Drawing upon adaptation models from literature, we develop a model in which agents share information and endogenously create these structures. We experiment with various levels of information delays in dynamically changing environments and assess how this affects adaptation and performance. Our findings unveil that horizontal delays lead to earlier hierarchical expansion and vertical delays slow decision-making in crisis response environments.

High Impact Low Probability events (HILPs), often referred to as outliers, are becoming more important in disaster management because they are linked to complex risks and tipping points in interconnected systems. Recent events, such as the cascading effects of the coronavirus pandemic, rising uncertainties from global geopolitical instability, and successive and concurrent extremes driven by climate change, underscore the limitations of relying solely on severe but plausible scenarios for risk practitioners and policymakers. Despite the critical need to integrate HILPs into risk assessment models and emergency preparedness, the field is fragmented, with inconsistent definitions and methodologies. We present a perspective developed under the HORIZON AGILE project (AGnostic risk management for high Impact Low probability Events), which introduces two comprehensive definitions of HILPs and a taxonomy designed to enhance risk assessment, resilience analysis, and crisis management. We provide a validated scientific definition for the academic community and an operational definition tailored for practitioners and stakeholders. Additionally, our taxonomy offers a structured framework to address outlier events that often fall below traditional risk thresholds, ensuring that low-probability, high-impact scenarios with cascading and concurrent dynamics are effectively integrated into risk registers, legislation, and standards development. This study shows how this approach improves methods like stress testing and scenario modelling, especially for the loss of critical services. This empowers policymakers, practitioners, and stakeholders to include more scenarios in their strategies, enhancing resilience and preparedness.

Social vulnerability assessments play a crucial role in guiding the allocation of budgets and resources for effective disaster preparedness and humanitarian response. Climate change, escalating conflicts, and the climate finance and humanitarian funding gap make social vulnerability assessments essential. Despite advances in data collection, availability, and analysis, there remains a lack of consensus regarding the most suitable method to assess social vulnerability. This study sheds light on the consequences of methodological choices on social vulnerability assessments by comparing two commonly used methods in space and over time: the inductive principal component approach and the hierarchical INFORM approach. Our analysis focuses on a case study of the 351 communes in Burkina Faso from 2015 to 2022, a period marked by conflicts and extreme weather events. By comparing the two methods, we find important differences in the rankings of the communes’ social vulnerability. By investigating the spatial and temporal results, we offer insights into the potential consequences of using different methodological choices. Our findings underscore the need for contextualized approaches.

Increasing frequency of climate-related disruptions requires transformational responses over the lifecycles of interconnected urban systems with short- and long-term change dynamics. However, the aftermath of disruptions is often characterised by short-sighted decision-making, neglecting long-term urban shifts. In this study, we present a first attempt to develop the theoretical foundation for temporal dynamics for increasingly disrupted yet ”connecting and moving” cities that can be used in planning for urban resilience. Using the lens of climate urbanism, we conceptualise the interplay of temporal dynamics to empirically examine how planning practice perceives and addresses temporality in two regions - Amsterdam, the Netherlands, and Mumbai, India. Our findings reinforce that disruptions do not inform long-term planning. Endogenous and exogenous dynamics of change are not viewed together nor used to embed short-term planning goals within long-term resilience visions. To address the lack of systematic planning approaches that can leverage temporal dynamics, we propose two options for temporally flexible urban planning processes.

Urban areas are dynamic systems, in which different infrastructural, social and economic subsystems continuously co-evolve. As such, disruptions in one system can propagate to another. However, open challenges remain in (i) assessing the long-term implications of change for resilience and (ii) understanding how resilience propagates throughout urban systems over time. Despite the increasing reliance on data in smart cities, few studies empirically investigate long-term urban co-evolution using data-driven methods, leading to a gap in urban resilience assessments. This paper presents an approach that combines Getis-ord Gi* statistical and correlation analyses to investigate how cities recover from crises and adapt by analysing how the spatial patterns of urban characteristics and their relationships changed over time. We illustrate our approach through a study on Helsinki’s road infrastructure, socioeconomic system and built-up area from 1991 to 2016, a period marked by a major socioeconomic crisis. By analysing this case study, we provide insights into the co-evolution over more than two decades, thereby addressing the lack of longitudinal studies on urban resilience.

Increasingly, our cities are confronted with crises. Fuelled by climate change and a loss of biodiversity, increasing inequalities and fragmentation, challenges range from social unrest and outbursts of violence to heatwaves, torrential rainfall, or epidemics. As crises require rapid interventions that overwhelm human decision-making capacity, AI has been portrayed as a potential avenue to support or even automate decision-making. In this paper, I analyse the specific challenges of AI in urban crisis management as an example and test case for many super wicked decision problems. These super wicked problems are characterised by a coincidence of great complexity and urgency. I will argue that from this combination, specific challenges arise that are only partially covered in the current guidelines and standards around trustworthy or human-centered AI. By following a decision-centric perspective, I argue that to solve urgent crisis problems, the context, capacities, and networks need to be addressed. AI for crisis response needs to follow dedicated design principles that ensure (i) human control in complex social networks, where many humans interact with AI; (ii) principled design that considers core principles of crisis response such as solidarity and humanity; (iii) designing for the most vulnerable. As such this paper is meant to inspire researchers, AI developers and practitioners in the space of AI for (urban) crisis response – and other urgent and complex problems that urban planners are confronted with.

Urban vulnerability is affected by changing patterns of hazards due to climate change, increasing inequalities, rapid urban growth and inadequate infrastructure. While we have a relatively good understanding of how urban vulnerability changes in space, we know relatively little about the temporal dynamics of urban vulnerability. This paper presents a framework to assess urban vulnerability over time and space to address this gap. We apply the framework to Amsterdam, Rotterdam, and The Hague, the Netherlands. Using high-resolution, anonymised ambulance calls and socio-economic, built environment, and proximity data, we identify three temporal patterns: ’Midday Peaks’, ’Early Birds’, and ’All-Day All-Night’. Each pattern represents a unique rhythm of risk arising from the interaction of people with diverse demographic and socio-economic backgrounds and the temporal flow of their daily activities within various urban environments. Our findings also highlight the polycentric nature of modern Dutch cities, where similar rhythms emerge in areas with varying population densities. Through these case studies, we demonstrate that our framework uncovers the spatio-temporal dynamics of urban vulnerability. These insights suggest that a more nuanced approach is necessary for assessing urban vulnerability and enhancing preparedness efforts.

Qualitative research is a powerful means to capture human interactions and behavior. Although there are different methodologies to develop models based on qualitative research, a methodology is missing that enables to strike a balance between the comparability across cases provided by methodologies that rely on a common and context-independent framework and the flexibility to study any policy problem provided by methodologies that focus on capturing a case study without relying on a common framework. Additionally, a rigorous methodology is missing that enables the development of both theoretical and empirical models for supporting policy formulation and evaluation with respect to a specific policy problem. In this article, the authors propose a methodology targeting these gaps for ABMs in two stages. First, a novel conceptual framework centered on a particular policy problem is developed based on existing theories and qualitative insights from one or more case studies. Second, empirical or theoretical ABMs are developed based on the conceptual framework and generic models. This methodology is illustrated by an example application for disaster information management in Jakarta, resulting in an empirical descriptive agent-based model.

Involuntary displacement from conflict and other causes leads to clustering of refugees and internally displaced people, often in long-term settlements. Within refugee-hosting countries, refugee settlements are frequently located in isolated and remote areas, characterized by poor-quality land and harsh climatic conditions. Yet, the exposure of refugee settlements to climatic events is underresearched. In this article, we study the exposure of the 20 largest refugee settlements worldwide to extreme variations in climatic conditions. The analysis integrates exposure of camp locations compared to the national trends for both slow- and rapid-onset events and includes descriptive statistics, signal-to-noise analyses, and trend analyses. Our findings show that most refugee settlements included face relatively high exposure to slow-onset events, including high temperatures (for settlements in Kenya, Ethiopia, Rwanda, Sudan, and Uganda), low temperatures (in the case of Jordan and Pakistan), and low levels of rainfall (in Ethiopia, Rwanda, Kenya, and Uganda) compared to national averages. Our findings for rapid-onset events-heatwaves, coldwaves, and extreme rainfall-are less conclusive compared to country trends, although we find relatively high exposure to extreme rainfall in Cox's Bazar, Bangladesh. Our analyses confirm that refugee populations are exposed to extreme weather conditions postdisplacement, which, in combination with their sociopolitical exclusion, poses a threat to well-being and increased marginalization. Our findings call for an inclusive and integrated approach, including refugees and their host communities, in designing climate adaptation and sustainable development policies, in order to promote equitable sustainable development pathways in refugee-hosting countries.

Covid-19 has dramatically changed life in cities across the globe. What remains uncertain is how national policies and appeals to comply with suggested rules translate to changes in the behaviour of citizens in urban areas. This lack of local knowledge leaves urban policy makers and planners with few clues as to the determinants of social resilience in cities during protracted crises like a pandemic. Methods are required to measure the capacity of people to conduct routine activities without risking exposure to a prevalent disease, particularly for those most vulnerable during a health crisis. By spanning the fields of urban resilience, human geography, mobility studies and the behavioural sciences, this study explores how to measure social resilience in cities during a protracted crisis. Using a public participation GIS online platform, we observe changes in citizen behaviour within urban spaces during the Covid-19 pandemic. Inhabitants from three districts of a Dutch city mapped their activity routines during the lockdown period and during the year before the pandemic. Spatio-temporal analysis reveals changes in the clustering of activities into what we describe as ‘activity bubbles'. We reflect on the influence of the urban space on these changes and assess the contribution of this exploratory research methodology for gaining insights into behavioural change. Implications for urban planning and resilience theory are discussed.

BACKGROUND: Prompted by recent shocks and stresses to health systems globally, various studies have emerged on health system resilience. Our aim is to describe how health system resilience is operationalised within empirical studies and previous reviews. We compare these to the core conceptualisations and characteristics of resilience in a broader set of domains (specifically, engineering, socio-ecological, organisational and community resilience concepts), and trace the different schools, concepts and applications of resilience across the health literature. METHODS: We searched the Pubmed database for concepts related to 'resilience' and 'health systems'. Two separate analyses were conducted for included studies: a total of n = 87 empirical studies on health system resilience were characterised according to part of health systems covered, type of threat, resilience phase, resilience paradigm, and approaches to building resilience; and a total of n = 30 reviews received full-text review and characterised according to type of review, resilience concepts identified in the review, and theoretical framework or underlying resilience conceptualisation. RESULTS: The intersection of health and resilience clearly has gained importance in the academic discourse with most papers published since 2018 in a variety of journals and in response to external threats, or in reference to more frequent hospital crisis management. Most studies focus on either resilience of health systems generally (and thereby responding to an external shock or stress), or on resilience within hospitals (and thereby to regular shocks and operations). Less attention has been given to community-based and primary care, whether formal or informal. While most publications do not make the research paradigm explicit, 'resilience engineering' is the most prominent one, followed by 'community resilience' and 'organisational resilience'. The social-ecological systems roots of resilience find the least application, confirming our findings of the limited application of the concept of transformation in the health resilience literature. CONCLUSIONS: Our review shows that the field is fragmented, especially in the use of resilience paradigms and approaches from non-health resilience domains, and the health system settings in which these are used. This fragmentation and siloed approach can be problematic given the connections within and between the complex and adaptive health systems, ranging from community actors to local, regional, or national public health organisations to secondary care. Without a comprehensive definition and framework that captures these interdependencies, operationalising, measuring and improving resilience remains challenging.

Evaluation and testing are significant steps in developing any information system. More attention must be devoted to these steps if the system is to be used in high-risk contexts, such as the response to conflict disasters. Several testing methodologies are designed to guarantee that software fulfills technology requirements; others will assure usability and usefulness. However, there is currently no integrated evaluation framework with agreed standards that bring together the three elements: technology requirements, usability, and usefulness. This gap constitutes a barrier to innovation and imposes risks to responders or affected populations if the technology is introduced without proper testing. This chapter aims to close this gap. Based on a review of evaluation methods and measurement metrics for information systems, we designed an integrated evaluation framework including standard metrics for code quality testing, usability methods, subjective usefulness questionnaires, and key performance indicators. We developed and implemented a reporting and evaluation system that demonstrates our evaluation framework within the context of the EU H2020 project iTRACK. iTRACK developed an integrated system for the safety and security of humanitarian missions. We demonstrate how our approach allows measuring the quality and usefulness of the iTRACK integrated system.

Climate change is one of the main drivers of uncertainty in urban planning, but only a few studies systematically address these uncertainties, especially in the long term. Urban resilience theory presents principles to manage uncertainty but largely focuses on individual urban systems rather than complex interdependent dynamics. Further, most planning and resilience theory originates from the Global North and is unsuitable for capturing the dynamics of the Global South. This study uses an exploratory multi-case analysis towards developing an enhanced understanding of urban planning for climate uncertainty. We argue that long-term urban planning for climate uncertainty can benefit from systematically integrating resilience principles. We use a two-step qualitative research approach: (1) To propose a conceptual framework connecting urban resilience principles, approaches to urban planning under uncertainty and planning responses in urban systems. (2) To use the conceptual framework to analyse climate-related planning responses in two contrasting case studies in the Global North (GN) and Global South (GS) (Amsterdam and Mumbai). We conclude with four propositions towards an enhanced understanding of urban planning for climate uncertainty by drawing upon the empirical insights from the two case studies.

To adapt to a changing climate, decision-makers design, evaluate, and implement measures that have an implication of justice on citizens in the present and well into the future. Decision-makers are often required to make decisions without certainty of the consequences and understanding their effects on intergenerational justice. Thus, managing the impacts of climate change requires novel decision-aiding approaches that consider climate impacts’ temporal and spatial heterogeneity and the uncertainty in climate predictions, preferences, and values. We reviewed the literature on the extent to which principles of intergenerational justice—conservation of options and resources for future generations—have been integrated to traditional approaches in climate resilience decision-making. We explore the extent to which flexibility, i.e., the conservation and expansion of options in subsequent decision periods, can contribute to upholding the principles of intergenerational justice under uncertainty. We illustrate the approach in the case of the Delta Programme in the Netherlands, a complex system designed to protect against sea-level rise (SLR). Designing adaptation strategies to SLR with flexibility as a core concept brings significant advantages in circumstances of uncertainty. The conservation of options in flexible pathways, in this case, contributes to the principles of intergenerational justice. Our civilization’s long-term sustainability and survival may depend on the extent to which individuals can see beyond their gains and toward the gains of the collective society at an intergenerational scale.