The Summit, now in its third year, was developed to address some major points of need and controversy in the humanitarian field, to establish a dialogue among practitioners and humanitarian strategists, and to promote discussion about complex and controversial issues that face the humanitarian community. What follows in this publication is a detailed review of the goals, deliberations, and recommendations of the Working Groups, concluding with an analysis of future needs. The authors hope that the Summit, and the resulting action items, serve as a launching point for organizational, governmental, and United Nations practices and policies to advance the professionalism, quality and accountability of humanitarian intervention.

The August 2007 earthquake in Peru resulted in the loss of critical health infrastructure and resource capacity. A regionally located United States Military Mobile Surgical Team was deployed and operational within 48 hours. However, a post-mission analysis confirmed a low yield from the military surgical resource. The experience of the team suggests that non-surgical medical, transportation, and logistical resources filled essential gaps in health assessment, evacuation, and essential primary care in an otherwise resource-poor surge response capability. Due to an absence of outcomes data, the true effect of the mission on population health remains unknown. Militaries should focus their disaster response efforts on employment of logistics, primary medical care, and transportation/evacuation. Future response strategies should be evidence-based and incorporate a means of quantifying outcomes.

Humanitarian responses to conflict and disasters due to natural hazards usually operate in contexts of resource scarcity and unmet demands for healthcare workers. Task shifting is one avenue for delivering needed health care in resource poor settings, and on-the-ground reports indicate that task shifting may be applicable in humanitarian contexts. However, a variety of obstacles currently restrict the ability to employ task shifting in these situations, including issues of regulation, accreditation, funding, and a lack of commonly agreed-upon core competencies for different categories of humanitarian health workers. The Human Resources in Humanitarian Health (HRHH) Working Group during the 2009 Humanitarian Action Summit evaluated the potential strengths and weaknesses of task shifting in humanitarian relief efforts, and proposed a range of strategies to constructively integrate task shifting into humanitarian response.

Since the Sphere Project was launched in 1997, it has sought to integrate principles of human rights norms with adherence to technical standards. While the Sphere Handbook has evolved as both a field tool and a resource for articulating human rights, it does not fully offer a rights-based approach to humanitarian assistance. In the handbook's current edition, its Humanitarian Charter asserts and affirms human rights principles, but the technical Minimum Standards Section that follows has yet to truly embody a rightsbased approach; that is, it does not clarify how to operationalize human rights in the field, particularly with respect to the health sector. Using human rights documents, the Sphere documents, and existing, published literature in the field of humanitarian practice and human rights, this article provides critical commentary and suggests how strengthening the link between rights and standards, as well as rhetoric and action, can advance the Sphere Project beyond its current applicability as a handbook of technical standards in the field to operationalizing an effective rights-based approach to humanitarian aid.

Disasters are widely reported, commonplace events that characteristically leave an enormous legacy of human suffering through death, injury, extensive infrastructural damage, and disorganization to systems and communities.The economic costs may be almost incalculable. Professional and civilian first responders play a vital role in mitigating these effects. However, to maximize their potential with the minimum health and welfare costs to first responders, is important to have a good understanding of the demands of such work on them, how they cope, and what enables them to fulfi ll their roles.This review will explore these themes by highlighting important findings and areas of uncertainty.

This study assessed the direct human resource costs of a hospital's emergency preparedness planning (in 2005) by surveying participants retrospectively. Forty participants (74% of the identified population) were surveyed. Using the self-reported hourly salary of the participant, a direct salary cost was calculated for each participant. The population was 40% male and 60% female; 65% had a graduate degree or higher; 65% were administrators; 35% were clinicians; and 50% reported that their job description included a reference to emergency planning activities. All participants spent a combined total of 3,654.25 hours on emergency preparedness activities, including 20.1% on personal education/train-ing; 11.6% on educating other people; 39.3% on paperwork or equipment maintenance; 22.2% on attendance at meetings; 5.6% on drill participation; and <1% on other activities. Considering the participants' hourly salary, direct personal costs spent on emergency preparedness activities at the institution totaled US$232,417. Ten percent, all of whom were physicians, reported no compen-sation for their emergency preparedness efforts at the hospital level.

As much as these results illustrate the strong commitment of the institu-tion to its community, they represent a heavy burden in light of the oftenunfunded mandate of emergency preparedness planning that a hospital may incur. Such responsibility is carried to some extent by all hospitals.