Challenges and barriers of Humanitarian Aid Management in 2017 Kermanshah Earthquake: A Qualitative Content Analysis

Examining various problems after disasters is important for affected people. One of the most important problems after disasters is the management of humanitarian aid and donations among the affected people. Therefore, the aim of this study was to explore Challenges and barriers of humanitarian aid management in 2017 Kermanshah Earthquake. This study was conducted using conventional qualitative content analysis method. This study was carried out from November 2017 to January 2018. The data were collected through semi-structured interviews and purposeful sampling and continued until the saturation of the data. Data collection and analysis phases of research proceed simultaneously and with constant comparison. 21 people, including 6 humanitarian aid manager, 6 volunteers, 4 aid workers, and 5 affected people participated in the study. The findings of this study identified two categories and 12 sub-categories concerning challenges and barriers of humanitarian aid and donors’ management during the 2017 Kermanshah Earthquake. During the analysis process two main categories included management and policy barriers, and structural and operational barriers were extracted.

disaster, donation management, humanitarian aid, aid distribution, Iran Abstract Background Examining various problems after disasters is important for affected people. One of the most important problems after disasters is the management of humanitarian aid and donations among the affected people. Therefore, the aim of this study was to explore Challenges and barriers of humanitarian aid management in 2017 Kermanshah Earthquake.

Methods
This study was conducted using conventional qualitative content analysis method. This study was carried out from November 2017 to January 2018. The data were collected through semi-structured interviews and purposeful sampling and continued until the saturation of the data. Data collection and analysis phases of research proceed simultaneously and with constant comparison. 21 people, including 6 humanitarian aid manager, 6 volunteers, 4 aid workers, and 5 affected people participated in the study.

Results
The findings of this study identified two categories and 12 sub-categories concerning challenges and barriers of humanitarian aid and donors' management during the 2017 Kermanshah Earthquake.
During the analysis process two main categories included management and policy barriers, and structural and operational barriers were extracted.

Conclusions
Effective management and proper policies in relation to humanitarian aid and the modifying of structural and operational barriers can resulted in improve performance and effective humanitarian aid management.

Background
In order to achieve a successful disaster management, there is a need for community involvement and collaboration in the phases of disaster management cycles. However, it is clear that the type of assistance can vary according to the characteristics of each particular country [1]. In most cases, after a disaster, national and international aid agencies provide technical and financial assistance to disaster victims. As surely as disasters will happen, volunteers and donations will come [2]. In the case of post-disaster reconstruction in developing countries, UNDRO (1982) supports the community participation approach as a key success [3]. After disasters, humanitarian organizations mobilize a large amount of aid to disaster area. Distribution of these resources is dealt with many challenges included time, cost, coverage, and eligibility [4]. Extreme disasters such as storms, earthquakes, tsunamis, and volcanic eruptions often bring extraordinary acts of helping [5].When in disaster humanitarian aid is to appeal, the donors want their money spent on alleviating the immediate distress in a visible way [6]. The complete of Aid agencies for donor resources can be a barrier to collaboration and cooperation [7]. Distribution in humanitarian aid is associated with many activities, plenty of disaster management stakeholders, great effort and different processes. For effective communication, humanitarian aids distribution activities require up-to-date and appropriate information to prompt collaboration, and improve integration [8]. With regard to disaster management, there are several stakeholders involved in managing the distribution of humanitarian aid. The stakeholders concluding governmental organizations, nongovernmental organizations (NGOs), volunteers and the private sectors, are responsible for managing humanitarian aid to disaster victims [9]. One of the most important factors in donations management in disasters are collaboration and coordination [10]. Humanitarian aid in conflict situations is always accompanied by many challenges. However, in the absence of political engagement, manipulation by state authorities lead to the pervert of aid interventions. [11].
On November 12, 2017, at 18:18:16 UTC (21:48:16 local time), a strong earthquake struck the province of Kermanshah in western Iran, near the Iran-Iraq border. More than 600 people lost their lives and about 10,000 were injured and thousands of structures endured extensive damage [2,12].
Consequently, thousands of affected people were displaced in Sar-e Pul-e Zahab, Ezgeleh and surrounding villages [2]. Help urgently needed for affected people, especially in the first days of the earthquake. Immediately after the earthquake, humanitarian aid began by government organizations, NGOs, and public community from most parts of the country. The humanitarian aid made many problems and challenges. The aim of this study was to explore the challenges and barriers of humanitarian aid management in 2017 Kermanshah earthquake.

Study design
This study was conducted using conventional qualitative content analysis method. In this method, data is collected directly and without any pre-suppositions; then codes, sub-categories, and categories are derived through an inductive process. In fact, qualitative content analysis is a research method used to interpret the content of text data. The conventional content analysis is generally used in designing the study which aims at describing a phenomenon. This design is often appropriate when the theory or the research literature about a phenomenon is limited [13]. The researchers avoid using the pre-assumed notions, instead, they allow the categories and codes be extracted from the data. Codes and categories are extracted by an inductive process and were conceptually ordered considering developed properties and dimensions [14].

Participants and study setting
This study was conducted in Kermanshah province, Iran from November 2017 to January 2018. A total of 21 participants in the affected area were selected for interviews using a purposive sampling method. The participants included 6 humanitarian aid managers, 6 volunteers, 4 aid workers, and 5 affected people. People who were involved in humanitarian aid management during the Kermanshah earthquake, and were interested in participating in the study and discussion of aid management barriers in their experiences, were selected to conduct interviews. Also some affected people in earthquake area were participated. The questions for a semi-structured interview were designed based on a review of the literature and a deep interview with first interviewees who had begun the study. The interview questions were reviewed and eventually approved by the researchers several times. After completing each interview and listening to the recorded information several times, the researchers transcribed the word recording as soon as possible. In addition, taking notes simultaneously with the recording and recording of data during the interview was also considered.
Interviews reached saturation in the 21 interview and data collection was stopped at this stage.

Data collection and analysis
Data were collected through in-depth and semi-structured interviews, and field observation. Since researchers seek the meaning of Individuals' experiences, the best strategy to obtain the meaning of experiences is to asking individuals and understand their experiences through interviews. The participants were requested to read and sign an informed consent form and invited to participate.
Interviews began with a wide question about experiences of participants. The main points of questions that only served as an interview guide were: "Please describe your experience of earthquake? How about humanitarians and aids and donation? What are the barriers to aid and donations management? Then these questions continued with exploratory or in-depth questions such as "Could you please explain more?" Take a sample from your own experience. The interview continued to saturate the concepts. Each interview lasted between 30 and 60 minutes. All interviews were recorded, transcribed verbatim and analyzed using constant comparative method. Data analysis process was done according to the Graneheim and Lundman (2004) simultaneously with data collection [15]. After transcription of each interview, codes and categories were extracted via open coding through line by line reading of the text. Then, categories were identified by constant comparison process.

Trustworthiness of data
The strategies recommended by Guba [16] for trustworthiness of the data were used. According to this recommendation, the criteria necessary for trustworthiness include credibility, dependency, confirmability, and transferability. To ensure data credibility, the researcher actively engaged in the disaster field for 2 months while continually making observations and compiling field notes. Also peer debriefing was used to provide inquirers with the opportunity to test their growing insights and to expose themselves to searching questions. Furthermore, triangulation involves the use of multiple and different methods, investigators, sources and theories to obtain corroborating evidence was used.
In addition, member checks, negative case analysis, and persistent observation were used to ensure data credibility [17]. Dependency of data was assessed by an audit trail, stepwise replication, coderecode strategy, and peer examination. To assess confirmability of data, reflexive journal or practice, and assessing integrity of research findings were used. For this, the background and personal interest of the researcher on the subject and maintaining documents of study were used for confirmability of data [17]. To ensure transferability of data a thick description of data, and do theoretical/purposive sampling was used [17]. The context of the interviews, codes, and extracted categories were reviewed by the research team and other professional colleagues in the field of qualitative research.
Using sampling with a maximum variation, the researchers were able to collect a wide variety of different comments, observations, and interpretations.

Public education management
Most of the participants claimed that the lack of public education in the humanitarian aids provided by society to the people affected by disasters has been considered as one of the most important barriers. Such an education encounters with weaknesses and challenges in many aspects since people are not familiar with the ways for helping and people who are interested in humanitarian aids do not know which kind of donation, to whom, in which time, and how should be delivered. In addition, the local trustees are not well familiar with the ways of taking part in the identification of the needs and the needy people, and in delivery, and distribution of the donations. Thus, not only the people affected by disasters suffer from lack of knowledge, but also the volunteers, managers, and the relief staff and governmental organizations are not sufficiently knowledgeable in this regard.
"Our donors do not know which goods, when and to which organizations should be delivered. Most of them go to the affected areas individually to deliver aids. At the time of distributing the aids to the rural people, we did not know to whom we should deliver the aids. The villages' trustees were mostly old and were not capable of receiving and distributing the donations."

Incident Command System (ICS)
According to the participants, the multiplicity of the organizations responsible for the emergencies and disasters is considered as a serious challenge of managing humanitarian aids and donations. The participants believed that people were confused due to lack of information about the way they should deliver the aids. Further, the victims were not informed of where to refer for receiving the aids. Lack of a unique commandership led to the multiplicity of decision-taking centers, useless attempts, and lack of efficient, and effective accountability.
"Many organizations from governmental ones to NGOs, offices, universities, local councils, and many other departments collected the aids and set out for the affected districts. Some of the people received help from several organizations or institutions while some other could not get any help." Communications and information barriers were the main concerns of the participants. They regarded rumor-fabricating and rumor-mongering as a factor of disturbance in preparedness and proper reacting and they were dissatisfied with the weak performance of the media and lack of control on the several social networks. The multiplicity of media and lack of a unique and influential management for organizing supervision and monitoring on the news, and the existence of ample inauthentic news sources were among the most significant challenges.
"Different news was heard in any moment. The news broadcasted from governmental and cyber space channels were completely contradicting. There was no unique news about the extent of casualties, damaged areas, and amount and ways of delivering aids. Many rumors were heard from people and different institutions in the cyber space."

Coordination and cooperation
According to the subsequent interviews and the obtained data, assisting organizations were not sufficiently coordinated and cooperative in various levels from management and strategic to the operational levels. In other words, due to the lack of coordination, resources included staff and equipment, were sent to the affected regions but they were not coordinated.
"The military forces, the NGOs like Red Crescent, and governmental organizations all were simultaneously involved in the aid and rescue operations without any coordination among them.
Crowding and congestion of the forces and equipment were themselves transformed into a crisis."

Security
The participants pointed out that lack of adequate security was the most significant barrier for delivering humanitarian donations and aids operatively. They asserted that the security of the mobilized facilities and equipment -especially the ones sent overland-were not duly provided.
Additionally, thieves' rush from other regions to the affected areas, overcrowding, and fraud all with malicious intentions bring about disorder in security.
"We heard that the trucks having been carrying the some aids were assaulted and the aids were stolen. Perhaps, they were actually in need and did not intend to steal anything, but in my idea, it would rather have been better to escort the trucks by security forces"

Supervision and transparency
Most of the participants regarded the consistent supervising system as an important factor. They "As a rescuer who was the supervisor of an assisting group, I did not know which village or district of the cities was more in need and whether any aid had been sent to those regions or not. Some other people came to receive goods, foods, clothes, and other things. We had no idea which families had disabled members or elders or pregnant women who had lost their husbands because they were not able to refer to assisting centers to receive aids".

Preservation and distribution
According to the interviews, the barriers and challenges regarding reservation and distribution of the humanitarian aids were categorized into 12 subcategories, which can be divided into three main phases. The first phase was the barriers related to the collecting and arrival of the aids and donations to the affected areas i.e. any procrastination in common participation in delivering the aids and the inaccessibility of the damaged region due to the damaged connecting roads and the remoteness of some villages led to prediction in transferring the aids to the regions. The second phase was the challenge of preservation of the goods in the affected areas. The participants reported that foods were preserved under sunlight and rain in an unhealthy condition and some mercenary persons rushed to the deposit places and stole things many times. The third phase involved the challenges related to the distributions including having no preceding plan for distribution, non-observation of equivalence in distribution, and untargeted distribution.
"I myself saw that the aids arrived to some remote villages with delay. In other villages whose roads were damaged, the food packages were thrown down from rescue helicopters which caused the packages to become spoiled due to crashing into the ground... People's aids were collected in one of the city squares and they were covered by a canvas. The foods on the ground were in contact with the rain water and they were exposed to sunlight during the day".

Cultural barriers
The participants believed that cultural barriers had a significant role in managing the humanitarian aids. They emphasized that lack of community trust in governmental organizations versus the excessive trust they had in celebrities and renowned persons to be one of the main challenges. The responsible governmental organizations and the NGOs were inattentive to people's culture and customs, leading to a disturbed in the management of humanitarian aids. Furthermore people's inattentiveness to the culture of waiting in the queues was another cultural barrier.
"If people had trusted the governmental organizations as they trusted the celebrities, there would not have been that much misuse. People are also to be blamed because they are affected by emotions for collecting aids in the first days after disasters; the afflicted people also rush for receiving the aids. For instance, when a truck arrived for assisting, they did not stand in queues but they wanted to get the goods all at once".

Organizing participation of benefactors
Despite the emphasis of the participants on the fact that the benefactors had remarkable and unbelievable participation in the phase of rescuing, assisting, and rehabilitation, they believed that the benefactors had not adequate knowledge in this regard and many charity organizations were not coordinated with each other. Benefactors have a tendency for humanitarian actions in health services rather than other domains and they have scarcely cooperated with and trusted in governmental organizations.
"There are many benefactors in Iran but unfortunately they lack adequate awareness and knowledge and they do not act untidily. It would be better if benefactors become coordinated with each other and each one supplies some parts of the requirements of the injured people. The benefactors visited the affected areas carrying goods on their own. I wish a unique organization can carry out such things".

Public education management /Communication and information barriers
One of the challenges the participants stressed on was the public education regarding humanitarian aids in disasters. People, managers, relief staff, benefactors, and the afflicted population did not have the adequate knowledge on humanitarian aids. Since different organizations with different potentialities, capacities, duties, and interests participate in the humanitarian assistance, it is necessary to focus on improving the performances, designing the standards and educations, and promoting the educational courses by means of sharing their experience in the stage of preparedness. Some studies suggested an attempt for reducing unnecessary aids with low priority through public and professional education [10].
The existence of several broadcasting, rumor-fabricating, and rumor-mongering sources is considered as one of the challenges in the study due to the lack of education and regulation of the news sources and their control. The reliability of the information and confronting with rumors are regarded as the main concerns in the phase of response to disasters because the social networks can present inauthentic information, rumors, and fictitious news due to the lack of any control process and the low quality of the information [18,19]. Therefore, adequate education to the media added to a governmental supervision seems crucial.
Communication barriers in delivering the humanitarian aids at the time of disasters were emphasized by participants as a great challenge. Todays, the social networks are so comprehensive and have a remarkable role in the Communication and coordination between the assisting organizations due to their fast broadcasting of information. The NGOs and volunteers can use social networks for collecting donations in the least time possible [20].
Exact, authentic, and effective information is considered as one of the key factors in the process of distributing humanitarian aids in disasters. Thus, attention should be paid on the unreal and inauthentic reports, which can negatively affect the participation process in delivering and distributing the humanitarian helps [21]. The management of humanitarian aids in disasters is naturally difficult due to the variety of the beneficiaries. In such cases, receiving and sharing apropos information about the infrastructures and supplying the required resources is significant for effective response and social networks can get information about the number of people afflicted by the disasters through internet and make it accessible for them in order to have a fast and effective response [22,23].

Need assessment
According to some participants, since any disaster is unique and the injured people's needs are different based on the cultural aspects, the extent of casualties and the quantity of the individuals and their dispersion, sending donations to the damaged regions should be executed based on the evaluation of the needs of the affected people. Donations should conform to receivers' requirements rather than the donators' preferences [24]. Mobilizing the aids without need assessment leads to the accumulation of abundant unnecessary sources in the afflicted areas, which is not beneficial for the people, and organizing the sources takes much time. Ignoring the requirements of vulnerable groups including women, children, elders, and the disabled at the time of disasters are considered as another great barrier for aid management and donations in the disasters. These groups may not be able to supply their needs due to cultural, religious, and other personal limitations [25]. On the other hand, women and the elderly have the capabilities and capacities that can be effective especially after disasters. The affected people benefit from the capabilities of women included participation in community reconstruction and livelihood efforts [26].

Cultural barriers
The participants maintained that donors' lack of trust in governmental institutions is one of the main barriers for managing donations in the incidents. This causes donations to be collected through groups and unofficial individuals like celebrities and athletes, an affair on which there may be no appropriate control. Further, the ground for misuse is provided [2]. Another structural impediment regarding donations in disasters is related to lack of any respect for cultural beliefs and values of the afflicted society, which should certainly be concerned. In this regard, if donations sent to the affected areas are not congruent with the culture of that community, they will not be utilized [27].

Preservation and distribution
Lack of plan for food preservation and food security was another challenge introduced by the participants. The significance of food security and feeding is among the issues which were focused in Sendai framework, SDGs, and Paris contracts [28]. Lack of concern for food variety in the mobilized aids is regarded as another challenge proposed by the participants. It is necessary to guarantee the variation of foods and consumption of nourishing favorite nutrients, particularly in the first days after disasters [29]. After a serious natural disaster, local residents should have access to distributors for sake of food and social security, while the participants mentioned some challenges regarding discrimination in distributing the aids, inequality and injustice in distribution and rushing for distributing centers. Regarding the inevitability of identification and registration of the beneficiaries, it seems necessary for participants to adopt a controlled and fair strategy for distribution [30]. The participants stated that depositories were defected and the food was exposed to sunlight and insects for a long time and therefore, the necessity of preparedness of depositories was approved. Food and medicine maintenance and preservation are of the first priorities in planning for maximizing security in disasters and they should be accommodated in a dry and cool place having air-conditioning system [31].

Coordination and cooperation
The participants recognized coordination among humanitarian organizations as a great challenge in the management of donations. They regarded incongruence in distributing donations as the result of other factors such as damaged connections and infrastructures, lack of instructed personnel and teams, political, cultural, social, and economic condition of the afflicted region [32]. The participants believed that lack of a managing commitment, improper organizational structure for producing and sharing knowledge, along with lack of a specified policy and planning are the main barriers for coordination [33]. Cluster approach and network subgroups for coordinative operation centers established in the afflicted region are useful actions leading to the contribution of coordination and collaboration in managing humanitarian donations [34].

Lack of collaboration rules regulations
Most of the participants mentioned that the governments have a fundamental role in organizing, coordinating, and executing the humanitarian assistance operations [35]. Therefore, authorization can generate a potential ability for responding to disasters based on law and constitution for disaster management plans [36]. Simulating distribution operations of humanitarian aids is a significant factor for the participation of benefactors, humanitarian organizations volunteers, and the other beneficiaries [37]. Consolidated management of the processes, policies, and legislations can play a fundamental role in managing the aids among people appropriately [38]. Organizing and coordinating the effectual participation of government and benefactors can increase the opportunities in responding to disasters and casualties [39].

Security
Providing security in the areas affected by disasters is considered as one of the main problems mentioned by the participants regarding humanitarian organizations [40,41]. Insecurity brings challenges for humanitarian organizations. On the other hand, it puts the distributors of aids at risk at the time of distribution and, it puts the identity of non-governmental organizations at risk, which should act based on impartiality and independence principles [42]. The operation of distribution of aids through a consistent management of provisional duties including depository keeping, qualified transfer system, and fair access to aids and fair distribution can be effective in managing donations and preventing forage by thieves [43].

Conclusions
Influential management and making sound policies regarding donations and removing structural and policy barriers can improve performance and affective management. Further, developing public education and evaluating the needs based on cultural factors, as well as supervising and clarifying the aids can help reducing the challenges and barriers. Additionally, more participation of nongovernmental institutions and benefactors by means of education and promoting their knowledge can be very effectual in managing humanitarian aids in disasters better. It is essential to establish a responsible organization or lead agency with sufficient authority to supervision the collection, transportation and distribution of humanitarian aids. Since the plurality of organizations and individuals, in particular the celebrities, in collecting and distributing such aids can lead to sources of misuse and sometimes abuse, it is recommended that the government, by adopting laws, provide training and adequate preparation for their intervention, and or supervise them. The registry system can help manage this problem. When distributing assistance, vulnerable groups such as the elderly, children, homeless people, people with disabilities, and pregnant women should be taken into consideration. In addition, training for local authorities and trustees should also be included in the preparedness plans.

Availability of data and materials
The datasets used during the current study are available from the corresponding author on reasonable request.

Competing interests
The authors declare that they have no competing interests.

Funding
No fund was received for this research.

Authors' contributions
Concept and designed the study: HS, MSK, and SF. Collection of data: HS, SF, SM, DP, AS, HG, IF, and AD. Analysis and interpretation of data: All authors. Wrote the manuscript: HS, SF, and MSK. Revision of the paper: HS, and MSK. All authors reviewed and approved the paper. The poor culture of waiting in the queues Not paying attention to the culture and etiquette Organizing benefactors' participation/ charity and philanthropist Lack of knowledge on the humanita Much tendency to work in the section of treatment patients Distrust of the benefactors in the a Useless actions of the charity orga