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date: 23 April 2019

Integrating Access and Functional Needs in Community Planning for Natural Hazards

Summary and Keywords

Populations that are rendered socially invisible by their relegation to realms that are excluded—either physically or experientially—from the rest of society tend to similarly be left out of community disaster planning, often with dire consequences. Older adults, persons with disabilities, linguistic minorities, and other socially marginalized groups face amplified risks that translate into disproportionately negative outcomes when disasters strike. Moreover, these disparities are often reproduced in the aftermath of disasters, further reinforcing preexisting inequities. Even well-intentioned approaches to disaster service delivery have historically homogenized and segregated distinct populations under the generic moniker of “special needs,” thereby undermining their own effectiveness at serving those in need.

The access and functional needs perspective has been promoted within the emergency management field as a practical and inclusive means of accommodating a range of functional capacities in disaster planning. This framework calls for operationalizing needs into specific mechanisms of functional support that can be applied at each stage of the disaster lifecycle. Additionally, experts have emphasized the need to engage advocacy groups, organizations that routinely serve socially marginalized populations, and persons with activity limitations themselves to identify support needs. Incorporating these diverse entities into the planning process can help to build stronger, more resilient communities.

Keywords: access and functional needs, disaster planning, social vulnerability, disability, inclusion, diversity


Disasters lay bare the power flows and inner workings of societies, highlighting normally hidden scalar dynamics that determine the distribution of resources and the structures of social systems (Wisner, Blaikie, Cannon, & Davis, 2004). Groups with the least access to social influence and decision-making are often subjected to amplified risks that translate into disproportionately negative outcomes when disasters strike. Disparities of social influence thus mean that groups exposed to similar hazard agents may be affected by these impacts in vastly different ways, as is often noted by social vulnerability scholars (Davis, Hansen, Kett, Mincin, & Twigg, 2013). Specifically, members of socially marginalized populations tend to suffer the most and for the longest time in the aftermath of a disaster.

Particular segments of society tend to be rendered socially invisible by their existence in realms that are excluded—either physically or experientially—from other parts of the social structure. This invisibility can be detrimental when disasters strike (Klinenberg, 2002). Older adults, persons with disabilities, and others who are excluded from full community participation all tend to suffer disproportionately from the impacts of disaster. As an example, the long historical exclusion of persons with disabilities in Nepal—as has been the case in many other countries—disadvantaged this group in myriad ways during the 2015 earthquake sequence there. Widespread destruction of infrastructure reduced accessibility, particularly for those with limited mobility; structural damage destroyed property and compromised livelihoods, driving those who already existed on the social and economic margins of society further into poverty; and officials’ failure to deliver disaster-related communications in accessible formats left many community members unable to access information (Lord, Bandita, Jeevan, Obindra, & Ghale, 2016). Despite efforts to pursue inclusionary disaster risk reduction policies within the region in the years preceding this event (Handicap International, 2009), the vast majority of persons with disabilities had not been successfully accounted for or consulted in disaster planning at the time of the event, placing them in a state of heightened risk relative to persons without disabilities. Moreover, the social and structural dynamics that had contributed to their marginalization prior to the earthquakes continued to undermine their interests afterward, reproducing inequities into the recovery period through exclusionary and sometimes discriminatory practices in the allocation of relief resources (Lord et al., 2016; Paudel, Dariang, Keeling, & Mehata, 2016).

The reproduction of inequality among individuals with functional limitations within disaster settings is not unique to the context of Nepal. Similar issues have been observed in relation to the Indian Ocean Tsunami, Hurricane Katrina, the Great East Japan Earthquake and Tsunami, and Hurricane Sandy, among others (Priestley & Hemingway, 2006; Brittingham & Wachtendorf, 2013; NCD, 2014). Nor are these dynamics limited to persons with disabilities, as evidenced by the large numbers of residents who were left stranded in the path of Hurricane Katrina due to a lack of transportation (Eisenman, Cordasco, Asch, Golden, & Glik, 2007). Thus, in order to address inequities of access and functional support in community disaster planning, attention must be paid to the diverse ways in which functional limitations are situated within the social environment.

The following sections discuss the state of knowledge about access and functional needs in the context of disaster. I begin by briefly discussing perspectives from the disability literature before describing how functional capacities are conceptualized in relation to disaster planning and response. I then explore the literature on access and functional needs in relation to each stage of the disaster lifecycle to identify key considerations for community planning within these before concluding with recommendations for future research directions.

Defining Access and Functional Needs

Emergency response planning has undergone several shifts in recent decades as high-profile disasters have highlighted failures in systems aimed at saving lives and reducing harm caused by extreme events. Approaches toward accommodating the needs of vulnerable populations have evolved from early practices that lumped together disparate groups under the homogenizing categorization of “special needs” to more modern service delivery models that emphasize inclusivity and functional support. Evolving definitions of disability have played a key role in shaping how systems engage individuals with disabilities and other functional limitations both within and beyond the disaster realm. Below I discuss the World Health Organization’s model of disability, which reflects this evolution of thought and informs current disaster planning. I then briefly examine how these discourses have been translated into the access and functional needs perspective within emergency management practice.

World Health Organization’s International Classification of Functioning, Disability, and Health

The World Health Organization’s (WHO) International Classification of Functioning, Disability, and Health (ICF) incorporates perspectives from disability and health studies, human rights advocacy, and other fields concerned with the social consequences of functional limitations. The ICF draws primarily from two paradigms, the medical and social models of disability, to enable a more holistic understanding of functional barriers and capacities. To summarize, the medical model is oriented toward identifying and treating the physical causes of disability; however, it has been criticized for pathologizing functional limitations as personal defects and obscuring the ways in which exclusionary practices hinder participation among individuals with disabilities (Davis et al., 2013). The social model, on the other hand, focuses primarily on the social origins of disability; however, it tends to underemphasize the role that impairments themselves play in shaping individuals’ experiences (Tierney, Petak, & Hahn, 1988; Thomas, 2009). By consolidating the strongest elements of these and other perspectives, the ICF creates an integrative biopsychosocial framework that addresses multiple dimensions of functional capacity and the contexts that shape its expression (Peterson, 2012). The model highlights functioning as an interaction between corporeal processes and structures, activities, and participation in society, and thus constructs disability as an impairment of bodily processes combined with externally imposed constraints on activity or participation (Reinhardt et al., 2011).

Responding to this shift in thinking, researchers and practitioners in the disaster realm have similarly begun to characterize disability as an interaction between an individual’s physical or mental functioning and the broader environmental factors that can shape their ability to participate in society. This approach positions functional support as a basic right and underscores the need to include persons with functional limitations in disaster risk reduction activities (Ronoh, Gaillard, & Marlowe, 2015). For example, the WHO’s World Report on Disability is written in conversation with the UN Convention on the Rights of Persons with Disabilities (WHO, 2011, p. 3), a human rights treaty that seeks to ensure that individuals with disabilities are consulted as autonomous, contributing members of society rather than simply acted upon as passive recipients of protective action (United Nations, 2012). The World Report reinforces concepts of inclusion and functional support as necessary for the success of efforts to address the disproportionate disaster vulnerability and impacts that individuals with disabilities face worldwide.

Applications to Disaster Planning

The access and functional needs perspective, around which the remainder of this chapter will be oriented, has increasingly guided policy development since the 1990s with its orientation toward practical solutions for including people with diverse abilities as contributing members of communities (Davis et al., 2013). Rather than fixate on individual diagnoses, this perspective reflects a growing push for rights and recognition among individuals with functional limitations, instead highlighting conditions that support functional independence (Parsons & Fulmer, 2007). As applied to disaster planning, this framework emphasizes the importance of operationalizing needs into specific mechanisms of functional support. For instance, Kailes and Enders (2007) propose five categories of function-based needs: communication, medical, maintenance of functional independence, supervision, and transportation (C-MIST).

Further clarifying the flexibility of this approach, Kailes (2008, p. 34) describes the groups to whom it may apply as: “those who have disabilities; who live in institutionalized settings; who are elderly; who are children; who are from diverse cultures; who have limited English proficiency; or who are non-English speaking; or who are transportation disadvantaged.” Applying an access and functional needs perspective in disaster planning expands approaches to service delivery beyond the deficit orientations embedded within the medical model and the absence of impairment within the social model. The focus on rights implicit within this framing also better accommodates groups for whom notions of disability are contested, such as deaf populations that view themselves as linguistic minorities (Engleman et al., 2013).

Access and Functional Needs Across the Disaster Lifecycle

While much of the literature that specifically incorporates the terminology of access and functional needs focuses on emergency response during extreme events, community planning need not and should not be limited to a single portion of the disaster lifecycle. Each stage provides an opportunity to incorporate more inclusive disaster management practices. Below I discuss how this perspective can be applied in disaster preparedness, response, recovery, and hazard mitigation.

Disaster Preparedness

Disaster preparedness activities typically involve outreach to individuals and collaboration among agencies to establish a coordinated system that can be activated when communities are overwhelmed by hazard impacts. Efforts to encourage individual or household-level disaster preparedness are most effective when tailored to the specific needs of the audience; however, persons with access and functional needs have not historically been included in exercises that identify potential disaster impacts and develop guidance consistent with those threats (Tierney et al., 1988). As a result, the generic information typically disseminated to communities often fails to provide appropriate directives for these populations (National Council on Disability, 2005). In some cases, instructions may be impossible for many individuals to follow and are thus nearly useless to them. For example, although earthquake guidance typically involves instructions to drop to the ground and seek shelter under a heavy piece of furniture, individuals with mobility limitations often cannot follow these directives or may be harmed in the course of doing so (Tuohy, Stephens, & Johnston, 2014). Failure to provide alternative guidance leaves these groups disproportionately vulnerable to injury or death. Creating equitable access to preparedness planning requires that proposed actions are inclusive of a range of functional capacities; however, in practice, this kind of tailored messaging remains in a nascent state. As follows, the state of empirical literature on these efforts and their impact is similarly limited.

Individual and Household Preparedness

Promotion of individual and household preparedness is a cornerstone of emergency management. Guidance associated with this objective typically involves steps such as drafting an individualized disaster response plan, stockpiling supplies, and creating a preparedness kit. However, research indicates that persons with disabilities and other access and functional needs are often constrained by contextual factors that limit their ability to prepare for disasters. For instance, lower average incomes within this population may make the purchase and storage of extra supplies difficult, and indeed Americans with disabilities and multiple chronic illnesses tend to report that they do not keep such supplies on hand (National Council on Disability, 2005; Bethel, Foreman, & Burke, 2011). In a global survey of persons with disabilities, less than 30% reported that they had a personal disaster preparedness plan, and most of these were reliant upon support from family (UNISDR, 2014).

Thus, in order to be effective, preparedness guidance should account for the constraints that persons with access and functional needs experience while still empowering these individuals to become more resilient to disaster impacts. For example, Eisenman and colleagues (2009) conducted focus groups on disaster preparedness with low-income Latinos in the Los Angeles area to identify common challenges, concerns, and opportunities for preparedness. They then used this information to design preparedness guidance that was culturally appropriate and consistent with the realities of these residents’ daily lives. This approach yielded recommendations about targeted content, such as the language to be used in discussing preparedness, as well as targeted methods, such as best practices for information uptake. Recommendations derived from these inquiries produced guidance that could benefit other linguistic minorities, highlighting the value of universalist—as opposed to identity-based—approaches to preparedness planning.

When possible, programs may also be designed to overcome barriers to disaster readiness by providing the necessary resources. For example, Phillips (2015) recommends that civic organizations create emergency kits and partner with trusted entities such as medical centers to distribute them to persons with disabilities. Alternatively, these community partners could co-host preparedness fairs to raise awareness and conduct outreach to people with disabilities. Regardless of the specific group identities targeted, strategies for increasing individual- and household-level disaster preparedness include the following, as seen below.

  • Consultation with individuals with diverse access and functional to assess barriers to preparedness.

  • Tailoring of disaster preparedness guidance to constraints faced by intended audience.

  • Dissemination of information through trusted channels.

  • Collaboration with service providers and advocacy organizations that serve target groups to address preparedness needs.

Organizational Preparedness Planning

Collaboration among community-based organizations and government agencies can help to promote more inclusive disaster planning by leveraging trusted relationships and population-specific expertise to strengthen service delivery (Nick et al., 2009; National Council on Disability, 2008; Alexander, 2012). Though much of literature examining integration of these organizations into community disaster planning efforts involves small-scale evaluations and guidance documents, researchers and advocacy organizations have produced useful insights. Among these is the observation that faith- and community-based organizations, nonprofits, and other service providers can make valuable contributions to community disaster plans that would not be feasible within emergency response organizations alone, and vice versa. Levin, Berliner, and Merdjanoff (2014, p. S81) argue that

the inclusion of [Community Human Service Organization] direct service delivery personnel, who have intimate knowledge of their clients’ vulnerabilities and can best identify specific key issues and planning considerations throughout all phases of a disaster, provides targeted planning and management for CHSOs, their staff, and emergency planners.

While CHSOs and other community-based organizations (CBOs) hold expert knowledge about their client populations, it cannot be assumed that they are natural experts in disaster preparedness (Engelman et al., 2013). Personnel within these organizations need training to help ready their clients for disaster and to plan for their own involvement in community response efforts. Neuhauser et al. (2013) examined the availability and readability of emergency preparedness materials distributed through CBOs that served older adults and deaf/hard of hearing populations. They found that (1) less than half of the CBOs even offered such materials to their clients, and that (2) the vast majority of these materials, when offered, tested above the recommended literacy level for these populations. The development of disaster preparedness outreach strategies thus requires input from a range of stakeholders, from emergency managers, to service providers, to individuals with access and functional needs themselves (National Council on Disability, 2009; Neuhauser et al., 2013). Efforts to incorporate organizations that serve vulnerable groups into community disaster planning activities should also include training on internal disaster preparedness to ensure they are able to continue supporting clients in the event of a disaster. This includes planning for continuity of operations, downtime, and displacement, as well as personal preparedness training for personnel (Phillips, 2009, 2015; Davis et al., 2013).

Finally, collaborative disaster planning activities provide an opportunity for the various organizations that will assist persons with access and functional needs in a disaster to anticipate clients’ potential needs, work through logistical issues, and specify the agencies’ various roles. For example, scholars (Parsons & Fulmer, 2007; Enders & Brandt, 2007) suggest that disaster planners and service organizations utilize geospatial data about the locations of persons with disabilities to plan for disaster-related service delivery. Tasuki (2012) notes that this approach was used to create hazard risk maps and registries of persons with functional needs and disabilities in several Japanese communities; however, incorrect assumptions in hazards estimates created inaccurate estimates within risk maps, which were revealed during the 2011 earthquake and tsunami. Moreover, lack of clarity regarding the legality of sharing personal information from the registry deterred local government administrators from providing details to organizations that could have provided resources to these individuals, many of whom had struggled to have their needs met in shelters. Thus, while collaborative disaster planning efforts are important, they are not infallible and therefore require ongoing engagement and testing by diverse stakeholders.

Institutional Disaster Preparedness

Reflecting the broader literature on access and functional needs, the majority of this chapter focuses on issues affecting community-dwelling individuals; however, congregate care facilities and other institutional residential settings must also engage in disaster preparedness activities and should be involved in broader community disaster planning activities. Though such entities are often governed by distinct rules and fall under separate jurisdictions from other planning realms, the assumption that they need not be engaged in planning discussions is inaccurate and potentially deadly (Castle & Engberg, 2011). As an example, in 2017 nine residents at the Rehabilitation Center of Hollywood Hills, a long-term care facility in Florida, died of heat-related illnesses following Hurricane Irma when the institution lost power and indoor temperatures began to rise. As was the case with many other such institutions, the facility had not been included on the local utility company’s list of critical infrastructure buildings that needed to be prioritized for the rapid restoration of power (Berman, Zezima, & Davis, 2017). Moreover, despite the mortal threat that excessive heat is known to pose to fragile elders, staff within the institution missed warning signs that their clients were in danger. This situation, while tragic, was not unheard of. Despite high-profile cases with dramatic mortality rates that shocked the world following Hurricane Katrina (Fink, 2013), nursing homes and other congregate care facilities continue to struggle with disaster preparedness and response (Lane & McGrady, 2016).

Disaster Response

The National Council on Disability (2009, p. 14) notes that the response phase of disaster “remains problematic in part because of a lack of research validating best practices.” The existing scholarship in this area coalesces around points within the response process at which the safety of persons with access and functional needs is compromised due to exclusion or inadequate support. These include warning systems, evacuation support, and shelter arrangements.

Warning Systems

Notification of impending hazard threats is central to the ability to undertake individual life protection measures. However, emergency notifications often utilize communication mechanisms that are designed for and by people “for whom escape or rescue involves walking, running, driving, seeing, hearing, and quickly responding to instructions, alerts, and evacuation announcements” (National Council on Disability, 2005, p. 12). Disaster notification systems are often inaccessible to or otherwise inappropriate for people with disabilities and other functional limitations, and these individuals traditionally have not had a hand in creating them (Kailes & Enders, 2007; Phillips & Morrow, 2007).

Governments and governance institutions have sought to address these disparities by drafting guidance emphasizing the need for emergency information to be communicated via formats that are broadly accessible. For example, in the United States, the Integrated Public Alert Warning System is charged with broadening the reach of the nation’s emergency public warning system to all Americans. The executive order that implemented the system states explicitly that these communications must be accessible to individuals with disabilities and those with limited English language proficiency—features that support a range of access and functional needs (Exec. Order No. 13407, 2006, Davis et al., 2013).

Internationally, the Sendai Framework for Disaster Risk Reduction is an agreement among UN member states that specifically calls on governments to ensure that disaster-related technology and communications are inclusive and accessible (Stough & Kang, 2015). While these top-down directives constitute an important step toward broad systemic change, communities can also play a direct role in creating more accessible local warning systems. For instance, organizations that serve people with disabilities can contribute much needed population-specific expertise to emergency management organizations and connect them with individuals suited to test and give feedback about notification processes (Stout, Heppner, & Brick, 2004; Engelman et al., 2013). In addition to promoting outreach to community-based organizations and other stakeholders, researchers and advocacy groups have outlined key recommendations for creating more inclusive warning systems:

  • Ensure accessibility by formatting alerts and instructions using simple language that is communicated both audibly and in large print (National Council on Disability, 2014).

  • Utilize assistive and alternative technologies such as SMS, apps, and other mobile phone-based alerts; email communications, TYY/TDD messaging, and geo-fencing programs (National Council on Disability, 2009; National Organization on Disability, 2009; Lord et al., 2016; Bennett, Phillips, & Davis, 2017).

  • Embrace low-technology solutions such as sirens, bells, flags, posters, interpreters, and face-to-face communications where appropriate (Davis et al., 2013).

  • Disseminate information through trusted entities, such as service organizations, media outlets that cater to linguistic minorities, and other established networks (Phillips & Morrow, 2007; National Council on Disability, 2009).

The key to inclusive public warning systems is a multi-modal approach that accommodates a range of access and functional needs. People with disabilities and other access and functional needs should be consulted in the design and testing of these systems, as their expert perspectives as end-users will help to ensure that they function as intended.


For a variety of reasons, individuals with functional limitations are often unable to evacuate once they do receive official guidance advising them to flee a hazard threat. van Willigen, Edwards, Edwards, and Hessee (2002) report that among households that experienced one of three hurricanes in North Carolina in the late 1990s, households containing a person with a physical disability were 9–25% less likely than others to evacuate. The United Nations’ global survey of persons with disabilities supports these findings. A 2013 study revealed that among individuals with disabilities from some 137 countries, only about 20% reported that they would be able to evacuate immediately without difficulty should the circumstances require it (UNISDR, 2014). Even under conditions that allotted sufficient time, fewer than 40% reported that they would be able to evacuate without difficulty, highlighting a substantial need for evacuation support.

Among the most commonly discussed challenges in the literature on functional needs issues in emergency evacuation are access to transportation and the need for physical support in carrying out evacuation activities (van Willigen et al., 2002; The Washington Post, The Henry J. Kaiser Family Foundation, & Harvard University, 2005; Gerber, Norwood, & Zakour, 2010). People with disabilities are less likely than other members of the population to own personal vehicles or to be able to utilize other transportation options, even in areas where laws require accessible public transportation (World Health Organization, 2011). However, as with other stages of the emergency management lifecycle, ease of mobility has historically been a taken-for-granted assumption in evacuation planning. Fortunately, these obstacles are not insurmountable. Appropriate pre-event planning and outreach can help to ensure that all community members, regardless of functional needs, are able to comply with evacuation guidance.

Scholars and disability advocacy organizations have outlined specific recommendations to address barriers to evacuation. With respect to emergency transportation access, the National Council on Disability (2009) encourages the emergency preparedness community to establish partnerships with nonprofit organizations that serve persons with disabilities and other functional needs to help develop appropriate guidance and prepare accordingly. Parsons and Fulmer (2007) further specify that emergency response planners should create memoranda of understanding (MOUs) and other formal agreements that explicitly establish procedures for resource sharing and coordination during emergency events, particularly regarding the procurement of transportation services, medical equipment, and pharmaceutical supplies. The need for physical assistance, on the other hand, may be addressed through the creation of plans and training programs targeting individuals with functional limitations themselves, those likely to provide assistance when a disaster strikes (e.g., assistants and caregivers), and first responders who support evacuation activities (Rowland, White, Fox, & Rooney, 2007; Handicap International, 2017).

Evacuation can also be particularly challenging within institutions that house medically frail populations. Many may take this measure only as a last resort because of the potential for “transfer trauma”—a potentially life-threatening physical injury or state of psychological stress that can result from rapid forced relocation such as that conducted during an emergency evacuation—and the potential that evacuation sites may fail to adequately accommodate residents’ needs (Fernandez, Byard, Lin, Benson, & Barbera, 2002; Spader, 2005; Davis et al., 2013). However, when circumstances require such dramatic measures, external support may be needed to make the transition safely. Integration into larger community disaster plans thus provides opportunities to establish relationships that can be drawn upon during such emergencies, and can ensure that facilities are incorporated into important protocols (Laditka et al., 2009).

As with other aspects of preparedness, undertaking evacuation planning activities in collaboration with diverse stakeholders within the functional needs community can help to produce a more effective and inclusive disaster response (Phillips, 2015). However, the relationship-building process cannot end there if these benefits are to be sustained. Once established, it is critical that disaster plans are practiced and updated regularly (Kailes, 2002; Rowland et al., 2007). To illustrate, the city of San Francisco routinely collaborates with the Centers for Independent Living for emergency planning purposes, and has integrated a disability services coordinator into its Incident Command System to coordinate with government entities and community partners in support of common goals to meet access and functional needs (Jan & Lurie, 2012). Such activities serve as a model for sustaining relationships in support of equitable access to disaster services.


There is scant research concerning the ways in which public shelters address matters of access and ability during and after disasters (National Council on Disability, 2009). However, the limited body of literature that does exist on this topic suggests that these environments often fail to accommodate the needs of persons with functional limitations (White, Fox, Rooney, & Cahill, 2006; Twigg, Kett, Bottomley, Tan, & Nasreddin, 2011; Veenema et al., 2015). Failure to plan for or even inquire about functional needs among public shelter users leaves many individuals at a disadvantage in these settings. However, for many people this is the only option, as the financial burdens of evacuation to private hotels can be overwhelming and the residences of friends and family—the preferred option for many—are often inaccessible (Nakamura, 2009; Handicap International, 2017). Broad issues of inclusivity are thus key considerations in emergency shelter planning and design.1

The designation of specialized shelter space is also a consideration in shelter planning. Historically, emergency managers have sought to identify separate shelters that were specifically designed to accommodate “special needs” populations on the assumption that these individuals all required highly specialized medical services. Such practices have led shelter workers to mischaracterize functional limitations as acute medical conditions and unnecessarily redirect individuals with disabilities to nursing homes and medical care facilities (National Council on Disability, 2005). In addition to perpetuating incorrect beliefs and inappropriate guidance, segregated sheltering arrangements can also remove individuals with functional limitations from their support networks, further limiting their independence (Twigg et al., 2011). Kailes (2008) further observes that planning for separate spaces typically means that the plans are never completed.

Simply lumping all residents into general shelter service without intentionally developing protocols for addressing a range of abilities is equally problematic, however, as researchers have reported that persons with access and functional needs often struggle to have those needs met in general public shelters. For example, Tasuki (2012) observed that many individuals with disabilities who evacuated to temporary shelters following the 2011 Great East Japan Earthquake experienced barriers to access within these settings, but did not ask for assistance when they needed it because they felt that the shelters were generally unresponsive to their concerns. Similar dynamics were identified following the 1995 Kobe earthquake, when Tanida (1996) concluded that older survivors developed physical and mental illnesses in shelters and temporary housing environments due to poor conditions, a lack of attention by shelter workers, and their own reluctance to vocalize their needs unless directly asked. Instead, they suffered in silence through bitter cold temperatures, inaccessible facilities, dehydration, and insufficient nourishment in the early days after the disaster, then encountered overwhelming isolation in the transition to temporary housing.

Despite the problems of exclusion and inaccessibility that have been observed in general public shelters, scholars (Twigg et al., 2011; Alexander, 2012; Tasuki, 2012) caution that heightened vulnerability and poor outcomes such as those described above are not the inevitable consequence of disabilities or other functional impairments. Rather, these issues largely extend from disaster management policies that are out of step with socially inclusive and universalist approaches that encourage more comprehensive planning. Disability groups and those representing other populations with access and functional needs can provide valuable guidance on how to design and operate public shelters in ways that are more inclusive, but they tend to be an underutilized asset in emergency preparedness and response planning (Jan & Lurie, 2012). To highlight the value such organizations can contribute, White (2006) describes how natural networks within deaf communities in Texas activated to support deaf evacuees following Hurricanes Katrina and Rita. After these evacuees repeatedly encountered inaccessible shelter environments that prevented them from obtaining the help they needed, deaf faith- and community-based organizations stepped up to provide alternative housing, supplies, and emotional support. Proactively tapping into these kinds of networks in the disaster planning stage rather than allowing conditions that prompt them to intervene can help to prevent unnecessary suffering.

Fortunately, there is a growing body of technical guidance aimed at improving public shelter planners’ responsiveness to functional needs. Summarized below are several common problems identified in the literature on disaster shelters in various settings organized around C-MIST criteria, along with guidance that can be used to avoid the pitfalls within each (U.S. Department of Justice, 2004; National Council on Disability, 2005, 2009, 2014; Parsons & Fulmer, 2007; Kailes, 2008; Twigg et al., 2011; Phillips, Wikle, Head Hakim, & Pike, 2012; Handicap International, 2017).

Table 1. Accessibility

Documented Problems

Proposed Solutions

  • Shelter structures and facilities within them (bathrooms, etc.) placed in locations that cannot physically be accessed.

  • Define accessibility and identify criteria for achieving accessibility in shelter environments.

  • Visit shelter locations alongside representatives of disability advocacy organizations to assess accessibility.

Table 2. Needs Assessment

Documented Problems

Proposed Solutions

  • No systematic means of collecting information required to determine what functional needs exist and/or information is not used to ensure needs are accommodated.

  • Design intake procedures that inquire about functional needs.

  • Review registration information to identify supports required.

  • Monitor shelter conditions and check in with evacuees to ensure needs are met.

Table 3. Medical Support

Documented Problems

Proposed Solutions

  • Lack of storage for medications that need refrigeration.

  • Difficulties accessing medical supplies/equipment or obtaining replacement medications.

  • Plan for the procurement and delivery of durable medical equipment, pharmaceuticals, and medical supplies using MOUs and other contractual agreements.

  • Ensure that shelters are equipped with backup power supply to maintain functioning of medical support equipment.

  • Consult with faith-based organizations, advocacy groups, and NGOs to arrange options for mental health support.

Table 4. Communication

Documented Problems

Proposed Solutions

  • Announcements and instructions delivered in inaccessible formats.

  • No procedures for creating accessible supply distribution or assistance application processes.

  • Information available only in dominant language.

  • Deliver information in multiple languages and formats (e.g., words and images) designed to accommodate a range of functional capacities.

  • Create accessibility guidelines and provide technical/personnel support at assistance stations.

  • Arrange sign language interpreters via MOUs and mutual aid agreements.

Table 5. Supervision

Documented Problems

Proposed Solutions

  • Threats to safety among individuals with cognitive disabilities or memory problems due to lack of supervision.

  • Train shelter staff to identify potential supervision needs and determine appropriate action in the context of capacity.

Table 6. Accommodation

Documented Problems

Proposed Solutions

  • Lack of staff and volunteers trained to support people with disabilities.

  • Inability to meet special dietary needs.

  • Policies banning service animals.

  • Inadequate support equipment.

  • Consult subject matter experts to assess shelter operations protocols.

  • Train personnel on legal rights to access and functional support.

  • Work with organizations that serve people with functional needs to stockpile assistive devices and engage in meal planning.

  • Establish multiple application submission options.

Table 7. Maintaining Independence

Documented Problems

Proposed Solutions

  • Inadequate assistance provided to support functional independence.

  • Arrange support services for activities of daily living.

  • Create guidelines to ensure evacuees are not separated from durable medical equipment, support products, or services.


The post-disaster recovery period can serve as an opportunity to rebuild communities that are more inclusive and resilient than they were prior to the event (Priestley & Hemingway, 2006; Handicap International, 2017). Yet this is also a part of the disaster lifecycle in which pre-existing social dynamics and power structures tend to reassert themselves, as the same conditions that contributed to inequitable distributions of risk in the first place yield influence over recovery priorities and the flow of resources. While long-term recovery is the least studied period in the disaster lifecycle, several challenges have been documented consistently across different events and geographies. The following sections outline primary areas of disruption that have been found to influence the quality of post-disaster recovery among persons with functional support needs and recommendations for addressing them in community planning.

Environmental Impacts

Damage to the physical environment triggers upheavals across multiple domains of life, from essential services such as healthcare to basic necessities such as housing and transportation. While such disruptions are known to create hardship across the spectrum of disaster survivors, particular dimensions of these conditions overwhelmingly affect individuals with access and functional needs by constraining independence and creating potentially life-threatening complications.


Restored access to housing ranks among the most significant milestones on the path to disaster recovery. Persons with disabilities in particular often struggle to find housing that is affordable, safe, and appropriate for their needs. In relation to the first point, the sharp increases in the cost of housing that often occur in the aftermath of a disaster can place even modest living spaces out of reach, financially (Stough, Sharp, Resch, Decker, & Wilker, 2016). Worldwide, individuals with disabilities disproportionately live in poverty, even in the absence of extreme events (World Health Organization, 2011). When a disaster strikes, these individuals thus face an increased risk of homelessness and substandard housing (Kett, Stubbs, & Yeo, 2005; National Council on Disability, 2009).

When longer-term housing is available, the search takes on a different set of challenges (National Council on Disability, 2009). Affordable and subsidized units are often located far away from services, jobs, and other sources of support. Additionally, physical obstacles such as stairs that cannot be navigated with wheelchairs can render available units unsafe or unusable. These problems may be insurmountable due to property owners’ inability or unwillingness to make modifications. Research suggests that landlords may balk at or even refuse requests to accommodate people with access and functional needs by physically altering dwellings, particularly when the demand for housing is high (Nakamura, 2009; Bourke, Hay-Smith, Snell, & Schluter, 2017). Even among persons whose pre-disaster domiciles are left standing, a safe living environment is not guaranteed. For instance, blind residents needed assistance conducting inspections on their homes following the 2011 Canterbury earthquake sequence because they could not independently assess them for indications of structural damage (Phibbs, Williams, Woodbury, & Good, 2012).

In light of the span of documented barriers to housing, researchers and advocacy organizations have articulated key recommendations to better support access and functional needs in temporary and permanent post-disaster housing. These include the allocation of targeted support, such as specialized housing vouchers, registries of affordable and accessible units, or partnerships with voluntary organizations to aid with housing search (Phibbs et al., 2012); the inclusion of human services organizations into housing task forces and planning groups (Levin et al., 2014); incorporation of universal design principles into rebuilding processes (Stough & Kang, 2015; Handicap International, 2017); and utilization of high-occupancy housing arrangements such as accessible hotel/motel rooms for temporary housing (National Council on Disability, 2009). In cases where accommodations are not provided as specified by legal guidance, lawsuits have helped to push government entities into compliance with legal rights to accessible housing (Phillips, 2015).


Access to jobs, services, and housing is often contingent on the availability of transportation, yet disasters can severely constrain mobility options among individuals with access and functional needs, thereby threatening their ability to live independently. Additionally, as people transition from shelter settings to temporary or permanent housing arrangements, disaster services become less centralized. Inadequate planning for transportation access during these shifts can keep people with functional needs from obtaining supplies and other forms of assistance (Brittingham & Wachtendorf, 2013). Mobility challenges can also persist long after the disaster has passed. For example, in examining barriers to long-term recovery among individuals with disabilities after Hurricane Katrina, Stough and colleagues (2016) identified lack of transportation access as a foundational problem that affected multiple aspects of daily life. Displacement had physically removed many of these persons from social connections that had previously provided mobility assistance, and damage to the local public transportation infrastructure or relocation to areas with limited transit service created new navigational challenges. These obstacles extended the time needed to accomplish even routine tasks, thereby hampering recovery.

Consistent with recommendations for improving transportation access in other stages of the disaster lifecycle, researchers have recommended partnerships between disaster recovery planners and advocacy or human services groups to develop inclusive transportation solutions. These may involve enrollment in home delivery programs for supply distribution, volunteers to help with navigating new transit routes, and other mobility support programs (Phibbs et al., 2012; Handicap International, 2017).

Essential Services

Social and human services support independence among individuals with access functional needs under routine circumstances in many areas, and can play a critical role in facilitating their recovery after a disaster (Fox, White, Rooney, & Cahill, 2010). However, disruptions in these services can exacerbate the instability caused by the disaster itself. Among those who are forced to relocate to new communities, navigating the complex bureaucratic requirements needed to resume social support services—a burdensome task in its own right—may be particularly fraught when paired with applications for disaster-related services, which entail their own maze of paperwork and administrative processes (National Organization on Disability, 2009; Stough et al., 2016). Appointing case managers who are familiar with access and functional needs and coordinating with organizations that routinely work with populations requiring functional support can foster better recovery outcomes and help to avoid further deterioration in their quality of life (Stough, Sharp, Decker, & Wilker, 2010; Campbell, 2016).

Health Concerns

A number of physical and mental health conditions are known to manifest themselves during the disaster recovery period, and studies have identified specific groups as being particularly vulnerable to these outcomes. Children with disabilities are more likely than those without them to experience abuse and neglect in the aftermath of disaster, threatening their wellbeing (Boon et al., 2011). Individuals suffering from mental health problems, older adults, persons with pre-disaster disabilities, racial and ethnic minorities, and those with chronic health conditions face an increased risk of developing new disabilities and illnesses following a disaster (Bourque et al., 2007; Reinhardt et al., 2011; Alderman, Turner, & Tong, 2012; Adeola & Picou, 2012; Leonardi et al., 2016). As an example, lifestyle disruption caused by housing damage incurred during the 2011 East Japan Earthquake and Tsunami led to declines in cognitive functioning comparable to the impacts of a stroke among some older survivors (Hikichi et al., 2016). Disasters can also directly produce new impairments that survivors may struggle to manage in environments where resources are stretched thin. For instance, the 2010 Haiti earthquake created thousands of new amputees and further taxed disability support services that had already been struggling to keep up (Danquah et al., 2015).

In many communities, particularly within low-income countries, accessible health services are inadequate and lack the capacity to support access and functional needs populations prior to a disaster, creating even greater disparities in the wake of extreme events. For example, Paudel et al. (2016) identified large gaps in public health services following the 2015 earthquakes in Nepal, citing a lack of standards for measuring disability and lack of inclusion of disability status in past censuses as encumbrances to planning and service delivery within the national healthcare system. They call for better data collection and monitoring as part of a national strategy in addition to the creation of community-based rehabilitation programs to augment access to local services.

The collapse of physical and social infrastructure also poses a specific health threat. Such disruptions contribute to chronic stress, depression, and other mental health problems that, without intervention, can remain untreated for years after the event and produce secondary health problems (Adams et al., 2009; Stough et al., 2010, 2016; Campbell, 2016). Access barriers to rehabilitative, reproductive, and other non-emergency health services have been found to exacerbate existing health issues among persons with disabilities, setting them up for spiraling declines that can result in persistent impoverishment (Lord et al., 2016). In sum, the risk of long-term health problems increases in the aftermath of disaster for a variety of reasons. Rather than simply focus on emergency medical services, recovery planning activities should include considerations about capacity and access across the spectrum of healthcare sectors (Runkle, Brock-Martin, Karmaus, & Svendsen, 2012).

Social Impacts

Even under routine conditions, social marginalization hinders individuals with activity limitations from advancing their interests through socially embedded resources. For instance, research suggests that persons with disabilities have less access to social capital and other forms of social support relative to those without disabilities, and that these disparities are even more pronounced among individuals with intellectual—as opposed to physical—impairments (Mithen, Aitken, Ziersch, & Kavanagh, 2015; Lippold & Burns, 2009). Similar inequities have been reported for working class older adults, who tend to maintain fewer and less beneficial kinds of social connections compared with younger and wealthier persons (Gray, 2009). In practice, this means that those of marginal status are limited in their ability to leverage social ties to access resources that are not otherwise available to them. The socially corrosive effects of disasters may thus be particularly problematic for these groups, as such events typically increase the importance of social connectedness and social capital.

Physical damage ranks among the most obvious impacts of disaster, and most official recovery efforts focus on material losses. However, the social landscape is a key dimension of community life, and social networks thus wield significant influence over the disaster recovery process among both individuals and communities. In particular, survivors’ perceptions of social support and sense of belonging shape their ability to cope with personal losses and ongoing stressors (Norris & Kaniasty, 1996; Adeola & Picou, 2014). For instance, Matsuyama and colleagues (2016) found that, two-and-a-half years after the 2011 Great East Japan Earthquake and Tsunami, individual- and community-level social support helped to protect against psychological distress among survivors. Henderson and Elsass (2015) found that these dynamics continue to play out long into the disaster recovery period. Their analysis of psychological distress in Sri Lankan communities five years after the Indian Ocean Tsunami revealed that social support continued to serve a psychologically protective function among survivors.

Breakdowns within the social infrastructure can erode the personal and organizational networks that they use to support their independence and psychological wellbeing. Disruption of individual and community networks can thus serve as a powerful blow that reverberates over months and years following a disaster. For example, Stough, McAdams, Ducy, and Holt (2017) examined narratives from persons with disabilities three years after their displacement by Hurricane Katrina, identifying key themes about changes that occurred within their social relationships. This research found that, rather than focus on loss of property or other tangible resources, interviewees expressed grief over the erosion of social relationships and a lost sense of connectedness to their community. Similarly, Campbell (2016) observed that older adults displaced by the 2013 Colorado floods overwhelmingly evaluated their recovery in terms of expressive (e.g., social and emotional support) rather than instrumental (e.g., material resource) needs. The isolating effects of displacement and loss of community were particularly traumatic for seniors with limited mobility and other unmet functional needs.

For decades, scholars have advocated for the preservation of community networks in disaster-stricken communities to mitigate secondary trauma from the deterioration of social ties (Erikson, 1976; Gill, 2007; Kaniasty, 2012). The documented negative consequences of damaged social networks, paired with the unique barriers that persons with access and functional needs face within post-disaster environments, further underscore the need to incorporate the maintenance of communality into recovery planning. Interventions oriented toward this goal may take on myriad forms, from group relocation programs, to community-building schemes, to targeted support provided by advocacy organizations (Hobfoll et al., 2007; Koyama et al., 2014; Handicap International, 2017). As an example, Kiyota, Tanaka, Arnold, and Aldrich (2015) describe the construction of an Ibasho café, or an accessible communal space that specifically sought to engage older adults, as playing a key role in encouraging the development of social capital and supporting disaster recovery. This environment helped to produce multigenerational social connections and create a sense of belonging among residents of Ofunato, a city that had been devastated by the 2011 Great East Japan Earthquake. Examples such as these demonstrate that intentional efforts to combat disaster-induced social disruption have the potential to produce broad benefits that include and extend beyond community members with activity limitations, highlighting the value of inclusive design.

Hazard Mitigation

Disaster risk reduction can best be achieved by taking measures to reduce hazard exposure and increase resilience before a specific threat emerges; however, mitigation activities often take place as a corrective measure when communities are recovering from disaster. Mitigation can occur at the individual or community level, and can include structural (e.g., modifications to the built environment) or non-structural (e.g., preparedness planning and capacity-building) measures. While such measures have the power to significantly reduce the risks faced by individuals with disabilities and those who have other access and functional needs, they must be designed with these groups in mind (NCD, 2009). To this end, key mitigation features that support these aims are outlined below.

Structural Measures

Community-level structural mitigation typically involves large-scale modifications to the built and natural environments, such as levee systems, community safe rooms, wetland restoration, or controlled burns in woodland areas. Infrastructure improvements and other community projects present local planners and emergency managers with opportunities to maximize inclusivity while enhancing public safety. As an example, Phillips (2015) describes how Baldwin County in the American state of Georgia obtained a federal grant to strengthen two facilities that regularly served individuals with physical and cognitive disabilities. These projects, which included a safe room with a capacity of 430 people and modifications to another structure against severe wind speeds, were groundbreaking in the support that they provided to community members who are often overlooked in emergency planning.

Structural mitigation initiatives within communities may also incorporate mechanisms that encourage smaller-scale measures, such as grants designed to help group homes and low-income households build safe rooms, retrofit living spaces, et cetera (Kailes, 2008). Such programs may be particularly necessary for individuals with disabilities and other activity limitations because, as noted above, they are overrepresented among the poor and are thus more likely to need support in order to make such modifications feasible (World Health Organization, 2011). Other kinds of household-level mitigation measures may require physical—rather than financial—assistance. For example, a retrospective analysis of the 2003 California wildfires found that residents with functional limitations had been unable to create defensible spaces around their homes by clearing vegetation (California State Independent Living Council, 2004). Officials’ inattention to the possibility that some community members would be unable to adequately follow formal guidance about wildfire mitigation left these residents without the support they needed to protect themselves. This in turn rendered them particularly vulnerable when wildfires broke out. Circumstances such as these again call attention to the need for inclusive emergency management practices to ensure equal access to protection. They also once again highlight the need for collaboration between emergency managers, advocacy organizations, private sector groups, and other stakeholders to ensure that the concerns of people with functional limitations are considered in structural mitigation initiatives and guidance (Kailes, 2008; NCD, 2009; DHS, 2013; Phillips, 2015).

Non-Structural Measures

At the community level, non-structural mitigation often involves collaborative processes such as the development of targeted emergency preparedness programming, training, and coordination activities as described above. However, it can also entail investments in the critical civic infrastructure, or the “faith-, community-, and culturally-based organizations and groupings that provide connections and support for community residents on a day-to-day basis and to which vulnerable populations turn during times of crisis” (Tierney, 2014, p. 224). As persons with disabilities and other socially marginalized groups routinely depend on these organizations to help maintain functional independence, it is particularly important that the critical civic infrastructure remains operational in the aftermath of disaster (Zakour, 2008; Stough et al., 2016). Yet the organizations that comprise the critical civic infrastructure often lack the resources to prepare for disasters, and tend to occupy spaces that are likely to be damaged in a major event (Ritchie, Tierney, & Gilbert, 2010). Thus, strengthening their robustness by enhancing social capital (e.g., creating stronger relationships among them that can be used to leverage resources) at the organizational level and providing assistance with mitigation needs can help to ensure the resilience of the social safety net in times of disaster (Norris, Stevens, Pfefferbaum, Wyche, & Pfefferbaum, 2008; Zakour, 2008).

Investments in social capital can also occur at the group and household/individual level. Participation in block parties, civic associations, and other social activities can help residents expand the number of interpersonal connections that they can call upon in times of need (Putnam, 2001). While few studies have linked social capital, functional limitations, and disaster specifically, research on social capital and disasters more broadly indicates that strengthening social connections among individuals and within communities could be a pathway toward building resilience (Aldrich, 2012).2 Underscoring the importance of interpersonal relationships, Roberto, Kamo, and Henderson (2009) found that older adults who fled New Orleans in advance of Hurricane Katrina had relied heavily on support from friends and family to evacuate, find temporary housing, and regain stability in the storm’s aftermath. At a broader scale, Klinenberg’s (2002) analysis of the 1995 Chicago heatwave concluded that mortality rates among elders, which had initially been blamed on fragile physical constitutions and a tendency to live alone, were better explained by community-level social dynamics.

The disaster literature thus suggests that investments in social capital and social connectedness must occur at different scales and among diverse actors. While it has long been recognized that established relationships are essential among organizations charged with responding to extreme events, other kinds of social connections are increasingly being recognized as important. Community planners can help to build resilience by facilitating vibrant community life and encouraging the development of social ties among individuals. However, they must also be aware of the access barriers that community members with activity limitations often face and actively seek to include these groups. Here, too, outreach to non-profit and advocacy organizations that routinely engage diverse populations can support the design of more inclusive practices.


The preceding sections have illustrated why a one-size-fits-all “special needs” designation is an ineffective disaster planning technique that obscures the breadth of functional support needs that exist within a given community. Moreover, this chapter has explained how historical approaches to service delivery have had the unintended consequence of perpetuating existing inequalities and undermining the goals of life protection that are the bedrock of disaster response. Yet this work has also explored new and promising directions that aim to avoid these shortcomings through more comprehensive practices. As exemplified by the World Health Organization’s ICF model, evolutions of thought about the nature of disability and the rights of vulnerable populations have highlighted the need for universalist approaches that emphasize capacities in particular contexts, rather than identities or diagnoses. Similarly, the shift in emergency management toward a focus on access and functional needs has created opportunities for greater inclusivity at each stage of the disaster lifecycle.

More research is needed, however, to assess the extent to which these principles are actually being translated into practice, and to what effect. At the most basic level, there is a need to evaluate processes and document best practices as new programs are brought online. There is also a need to test the assumptions embedded within current thinking and to consider the conditions that shape the outcomes observed. Future research should thus (1) develop and test detailed models for multi-stakeholder engagement, (2) track new directions in service delivery, and (3) explain the conditions that encourage or encumber the adoption of best practices at different scales of analysis, from community planning to international humanitarian response.

Additionally, there is a growing push for researchers and practitioners to acknowledge persons with functional limitations as agentic beings with their own objectives and understandings by engaging them directly rather than inferring their perspectives solely through organizational representatives or by other indirect means. Planning processes that elicit feedback from these lay experts can generate new solutions and ideas that ultimately improve emergency management practice (Davis et al., 2013; Tuohy & Stephens, 2012). In research, collecting data directly from persons with disabilities and other participation barriers helps to improve validity by ensuring that analyses account for subjects’ lived experiences (Stough et al., 2017; Ducy, Stough, & Clark, 2012). For populations that have historically been dismissed as passive subjects in need of protection, this type of involvement is critical.

Finally, as is reflected in the preceding sections, the literature on access and functional needs within the disaster realm remains in a somewhat piecemeal state. For example, while disability scholars have referenced findings from case studies in terms of vulnerability theory, little has been written in conversation across these bodies of scholarship. New theoretical directions could be developed by engaging and linking theoretical perspectives from literatures on aging, disability, social vulnerability, and so forth. Creating these connections would also help bring an intersectional lens to issues affecting persons with diverse functional capacities by highlighting the myriad other factors that shape their experiences. Put another way, this approach would examine how various aspects of identity such as gender, poverty, race, or ethnicity interact to shape how people engage with their broader environment. Returning to the Nepal earthquake example, for instance, while disability writ large was associated with disproportionately negative outcomes, these impacts were also fundamentally shaped by issues of gender and ethnicity such that women and ethnic minorities with disabilities faced even greater social marginalization than men or members of socially dominant ethnic groups with disabilities (Lord et al., 2016). More systematic exploration of these intersecting identities in diverse contexts could thus open the door toward deeper theoretical engagement and a more holistic understanding of why disasters affect people with superficially similar characteristics in vastly different ways.

Further Reading

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Davis, E. A., Hansen, R., Kett, M., Mincin, J., & Twigg, J. (2013). Disability. In D. S. Thomas (Ed.), Social vulnerability to disasters (pp. 199–234). Boca Raton, FL: CRC Press.Find this resource:

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(1.) This section discusses issues relevant to emergency shelters designed for short-term stays during an unfolding disaster. Issues related to temporary housing are discussed in the disaster recovery section below.

(2.) Caution must be taken to not characterize social capital as a cure-all. While strong social ties can be a powerful source of support during crises, the nature of the relationships, actors involved, and larger distributions of power within a community also play a role in determining the extent to which social connections can themselves withstand disaster impacts.