title: Adverse impact of international NGOs during and after the Bam earthquake: health system's consumers' points of view.
abstract: BACKGROUND
  On December 26, 2003, an earthquake occurred in the city of Bam in Iran which completely destroyed the city. National and international responses to the calamity were quick and considerable and nongovernmental organizations (NGOs) from all over the world conducted extensive emergency assistance, fulfilling a crucial role during the emergency. The present study discusses some difficulties and problems which originated from the activities of international NGOs during their response to the Bam earthquake.
  
  
  METHODS
  A qualitative study using semistructured interview technique was conducted with nineteen public health and therapeutic affairs managers who were directly responsible for response and recovery in Bam. Analysis of the data was carried out by the framework analysis technique and supported by qualitative research software, the Atlas.ti.
  
  
  RESULTS
  The study found that although international NGOs did their best to help people in the region, they also had some adverse impacts on the community in the disaster affected areas. The problems originated from lack of knowledge of cultural issues, inefficient timing for the delivery of funds and services, uneven goods delivery, and poor communication with local people and authorities.
  
  
  CONCLUSIONS
  The study's findings could have implications for the international aid organizations including the United Nations (UN). Some activities such as roles and responsibilities of the NGOs; networking; and coordination and education of the NGOs could serve as the cornerstone for improvement of their efforts during disasters.
authors.affiliation: School of Health Services and Information Management, Iran University of Medical Sciences, Tehran.
authors.forename: Seyed Hesam
authors.initials: SH
authors.lastname: Seyedin
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Aflatoonian
authors.forename: James
authors.initials: J
authors.lastname: Ryan
mesh_terms: D054521:Cultural Competency; D055866:Earthquakes / Q000401:mortality*; D005160:Facility Design and Construction; D006801:Humans; D007391:International Cooperation; D007492:Iran; D011639:Public Opinion; D012066:Relief Work / Q000458:organization & administration*; D018635:Rescue Work / Q000458:organization & administration*; D012189:Retrospective Studies; D055883:Structure Collapse / Q000517:prevention & control