Factors associated with relief overdemanding in the disaster response phase: a qualitative content analysis

Demand for relief increases after disasters. The scientific literature shows that the number of relief resources required to meet post-disaster relief demand is significantly higher than preliminary estimates, especially in low- and lower-middle-income countries. Therefore, this study was conducted to investigate factors associated with relief overdemanding in the disaster response phase. In this qualitative content analysis study, participants were selected using purposive sampling method to obtain information-rich items. The study population included all managers with first-hand experiences in the field of resource allocation and post-disaster needs assessment. Recruitment of participants continued until theoretical data saturation was achieved. Unstructured face-to-face interviews were used to collect the participants' experiences. All interviews were recorded with the consent of the participants by a digital tape recorder. After assigning a code to each interview, the text of the interview was typed, read several times, and coded. For data analysis, MAXQDA10 software and "continuous comparison" and "microanalysis" methods were used, and eventually primary codes, sub-categories, and the main category were formed. Finally, 21 people agreed to participate in the study. The main theme extracted in this research was "excessive demand for relief due to feelings of dependency, chaos, and uncertainty." The interviews uncovered several factors associated with relief overdemanding, which were divided into three categories: factors related to affected people, crisis managers, as well as officials.


Introduction
The number of disasters is increasing dramatically and is estimated to increase five times in the next 50 years (Liu et al. 2018) (Mahdavi et al. 2015). After disasters, the demand for relief and receiving resources increases dramatically. When a disaster happens, various resources and equipment are used in the relief logistics process to effectively manage the crisis and deliver the necessary relief commodities to the affected people (Lu et al. 2016).
Relief logistics operations are carried out in environments with uncertain and dynamic features (both on the supply and demand sides) (Zhan and Liu 2016), and post-disaster relief demand is specifically difficult to quantify because the magnitude, location, and timing of disasters could be highly unpredictable (Ozdamar 2017). However, the scientific literature shows that relief resources required to meet the demands of disaster victims are significantly higher than preliminary estimates, especially in low-and lower-middle-income countries (Afshar and Haghani 2012;Falasca and Zobel 2011;Khankeh et al. 2011).
Relief overdemanding imposes great financial burdens on disaster-affected governments and communities. According to recent studies, humanitarian and rescue organizations spend billions of dollars annually to help victims of natural disasters (Falasca and Zobel 2011;Gossler et al. 2019;Zhan and Liu 2016). In 2017, US$27.3 billion was allocated to international humanitarian responses (7). In this context, it is noteworthy that relief logistics operations account for a considerable proportion (up to 80%) of disaster relief costs and tasks (Hein et al. 2020).
Remarkably, meeting the needs of affected people through logistics processes is the most costly part of disaster response operations, but the proper implementation of these processes could save resources, improve the quality of care, and ultimately reduce economic and social problems (Gossler et al. 2019;Schulz 2009).
Furthermore, relief overdemanding in response to disasters often leads to widespread distribution, accumulation, and waste of surplus resources in the affected area. The lesson learned from Bam earthquake management confirms that excessive attendance of rescue organization staff and volunteers in an affected area is a major challenge for disaster management, and providing the daily necessities of these people is a major concern for local managers (Khankeh et al. 2011). Also, appropriate delivery of relief resources to disaster victims is critical for emergency response to disasters since available funds are limited and should be used optimally (Gossler et al. 2019). Although some studies have addressed relief uncertainty, and so far several problems related to relief logistics have been discussed in some studies (Lin et al. 2020;Sheu and Pan 2015), unfortunately the literature on relief demand is very limited, and factors associated with relief overdemanding have not yet been studied. Therefore, this study was designed and conducted with the following objectives.
1. To discover participants' experiences in relief demanding and resource allocation 2. To investigate factors associated with relief overdemanding in the disaster response phase.
The rest of the paper is structured as follows (Fig. 1).

Study design and population
Until the implementation of this study, relief overdemanding from the viewpoint of crisis Analyzing data using MAXQDA10 software and "continuous comparison" and "microanalysis" methods

SECTION 4
Determining factors and summarizing key conclusions managers had not been investigated in any other qualitative study, and thus no questionnaire was found in this field. Therefore, this study was conducted to investigate factors associated with relief overdemanding in the disaster response phase from the viewpoint of crisis managers. In this qualitative content analysis study, participants were selected using purposive sampling method to obtain information-rich items ( Table 1). The study population included all managers who had first-hand experiences in the field of resource allocation and post-disaster needs assessment and were willing to participate in the study. The response to natural disasters in Iran is mainly led by four organizations, including the National Disaster Management Organization (NDMO), the Iranian Medical Emergency and Accident Management Center, Tehran Disaster Mitigation and Management Organization (TDMMO), and the Iranian Red Crescent Society (IRCS); therefore, the study participants were selected from among the managers of the mentioned organizations. The inclusion criterion was to have at least five years of work experience in the field of resource allocation and post-disaster needs assessment. The exclusion criterion was the inability to be interviewed during the study period. Recruitment of participants continued until theoretical data saturation was achieved. Finally, 21 people agreed to participate in the study.

Data collection
Unstructured face-to-face interviews were used to collect the participants' experiences. All interviews were recorded with the consent of the participants by a digital tape recorder.
The initial interviews were about their experiences in resource allocation and needs assessment. Then some additional questions were asked to fill the gaps in the initial interviews. Probing questions were used during the interview to clarify the topic and guide the interview toward the research topic.

Data analysis
After assigning a code to each interview, the text of the interview was typed in Microsoft office word 2013 software, read several times, and coded. For data analysis, MAXQDA10 software and "continuous comparison" and "microanalysis" methods were used. In the continuous comparison method, the new data obtained in each interview were continuously compared and analyzed with the previous data. In the microanalysis method-which is an open coding method-possible relationships between the extracted concepts were established, and then these relationships were examined based on prior information. Irrelevant items were removed, and interpretations were revised if necessary. Finally, primary codes, subcategories, and the main category were formed, which are shown in Table 2.

Ethical consideration
This study was approved by the Research Ethics Committee of Qom University of medical sciences, Iran (Approval ID: IR.MUQ.REC.1401.033). To observe the ethical principles, the participants who were willing to participate in the study were informed about the study objectives, the approval of the ethics committee, as well as the recording of their voices by a digital audio recorder.

Results
The participants had an average of 15.85 years of crisis management experience. The average age of the study participants was 42 years. The average interview time for each participant was about 51 min. The main theme extracted in this study was "excessive demand for relief due to feelings of dependency, chaos, and uncertainty." The interviews uncovered several factors associated with relief overdemanding, which were divided into three categories: factors related to affected people, crisis managers, as well as officials (Table 2).

Feeling of dependency in affected people
The subcategory of "feeling of dependency in affected people" comprised four concepts, including "believe in the government's responsibility in meeting all the needs of the affected people," "unsatisfied demands due to improper distribution of facilities," "unsupported promises of managers and officials," and "reaction to fear and anxiety." The feeling of dependency among affected people was identified as one of the major causes of relief overdemanding in response to disasters. The feeling of dependency was found to be caused by many individual factors such as the loss of loved ones, job, capital, and other things after a disaster, fear, and anxiety as well as some managerial factors such as the unsupported promises of some officials.
After disasters, fear and anxiety usually increase among people in the community following the dissemination of erroneous, alarming, and exaggerated information, which results in increased dependence and need for help among affected people.
In the Sarpol-e-Zahab earthquake, every relief organization tried to meet the needs of the victims without coordination with other organizations, even without conducting a proper and accurate needs assessment, which led to unfair distribution of facilities and dissatisfaction of the affected people.

Intentional overstatement of local crisis managers
The subcategory of "intentional overstatement of local crisis managers" was composed of five concepts, including "considering the disaster as an opportunity to raise resources," "show off and organizational interests," "lack of information due to inaccurate rapid assessment," "reducing the work of local teams" and "facing people's dissatisfaction." According to the participants, some incompetent managers use disasters as an opportunity to get funds from the central government. They know that the government support for local managers increases after disasters and emergencies; therefore, they attempt to receive as much financial support as possible by bringing officials to the region.
One of the problems in managing the Kermanshah earthquake was that the assessments were influenced by the assessors' desires; the same thing happened in the Arbaeen march because they were looking for opportunities to provide resources for their institutions. Even in the reconstruction phase, the expressed financial losses were related to the buildings that were not damaged by the earthquake.
Sometimes the government agencies themselves overstate their needs because they consider the crisis as an opportunity to raise resources; for example, Gono hurricane (in Iran) caused no casualties and was just a flood, but some local managers overstated the needs in favor of their organizational interests.

Interference of other officials
The subcategory of "interference of other officials" was composed of six concepts, including "overdemand of propaganda officials and publicity in the media," "low confidence in accident managers" "partisanship of officials," "advertising and excitement," "incorrect or insufficient information," and "party interests." Sometimes the needs are overstated by some VIPs, for example, when the representative of the region aims to show off and show sympathy to the people. During the Khorasan earthquake, the representative of the region criticized the government on the radio and said "why are there so few facilities in the region?" in order to show his bold support for the affected people because the election was just around the corner.
One of the problems is that provincial officials do not know how to deal with the crisis and interfere in the crisis management process.

Discussion
In the present study, "excessive demand for relief due to feelings of dependency, chaos, and uncertainty" was identified as the main theme. In this study, factors such as the feeling of dependency in affected people, the intentional overstatement of local crisis managers, and the interference of other officials were identified as the main factors associated with relief overdemanding.

Factors related to affected people
Affected people are the main source of information for needs assessment and distribution of equipment and facilities (Bathaei et al. 2019). Therefore, if they overstate their needs, the demand for relief will increase significantly. In this study, some individual factors related to affected people were found to be associated with relief overdemanding. According to the participants, reactions to fear, anxiety, and stress were the main causes of relief overdemanding in affected people. Also, unsatisfied demands due to improper distribution of facilities were another reason for relief overdemanding. Stein et al. (2004) found that during terrorist attacks, health care seeking increased among people who were not really at risk or affected by disasters but sought health care due to fear and anxiety. Also, following the Tokyo anthrax attacks in 2001, thousands of people who were not at risk or affected by the disaster obtained prescriptions for antibiotics (Stein et al. 2004). Makwana (2019) reported that post-disaster stress could disturb interpersonal interactions and emotions of community members (Makwana 2019). Similarly, Liu et al. (2018) found that affected people had difficulty meeting their life needs, at least for a short time, and were likely to exaggerate their reconstruction needs (Liu et al. 2018).
According to the participants' experiences, in developing countries including Iran, disaster-affected people expect their needs to be fully met by the central government, which causes them to become psychologically dependent on government assistance and act passively in the response phase and the reconstruction process, resulting in a tendency to overstate their actual needs. In addition, due to their limited experience, some crisis managers prefer not to involve the affected people in the response phase and the reconstruction process, which ultimately leads to a decrease in people's satisfaction with meeting their needs. In a study on post-disaster housing reconstruction, Afshar and Haghani (2012) showed that beneficiary satisfaction was higher in the owner-driven approach compared to the donordriven approach (Afshar and Haghani 2012). According to Maya (2013), post-disaster needs assessment should be done with the involvement and participation of the affected community, and they should not be considered only as recipients of services and assistance. Thus, a participatory approach should be adopted to understand the real needs of the affected people and take the necessary measures to meet these needs (Maya 2013).
The results show that in the absence of an appropriate program for the distribution of facilities, the emotions and feelings of rescuers and other people lead to excessive distribution and waste of resources. Thus, some affected people are deprived of receiving resources. According to Lyles (2005), to avoid chaos in the allocation of resources, there is a need for a comprehensive coordination between the government and non-governmental organizations because the lack of such coordination leads to arbitrary allocation of resources (Lyles 2005). Sheu (2007) considered two problems as the main challenges in the distribution of facilities during disasters, including delays in the provision and allocation of resources and facilities among disaster victims and the lack of accurate and timely information about the amount and type of requirements of the affected population (Sheu 2007). Finally, in the competition to receive any assistance, many disaster victims tend to overstate their needs in comparison with their actual needs (Henstra 2010).

Factors related to crisis managers
Considering the disaster as an opportunity to raise resources by some local crisis managers was also found to be associated with relief overdemanding. According to the participants, during disasters when the central government pays more attention to resource allocation, these managers use this situation as an opportunity to compensate for pre-crisis shortcomings. They prefer not to provide accurate statistics of people's needs in order to receive more facilities and equipment. Therefore, they may intentionally overstate the resources required for disaster response. Bonanno et al. (2010) found that disaster managers often believe that the greater the crisis appears, the more support and assistance would be accessible, thereby providing an opportunity for reconstruction (Bonanno et al. 2010). Henstra (2010) also showed that overstating the impact of a disaster could often be accompanied by overstating the resources required (Henstra 2010).
According to the participants, overstatement of needs by local crisis managers may inadvertently occur following a lack of information in the early post-disaster stages. Typically, the type and extent of disaster damage and subsequent needs are determined by a rapid, detailed, and continuous assessment (Bathaei et al. 2019;Bradt and Drummond 2002;Korteweg et al. 2010;Wilson et al. 2016). But after disasters, access to common information sources is almost difficult due to the evacuation and/or dysfunction of many public buildings, damage to communication equipment, and congested telecommunication traffic in the disaster region (Morton and Levy 2011). In addition, obtaining information from ground surveys is time-consuming and costly, and as a result, most assessments are based on estimates that are often overestimated (Morton and Levy 2011;Vecere et al. 2017). Similarly, Colombo and Checchi (2018) found that delays in initial assessments, ambiguity in information about the severity and extent of damage, and the possibility of a secondary accident could lead to overstatement of needs (Colombo and Checchi 2018).

Influencing factors related to officials
Some officials in other organizations may provoke relief overdemanding. Publicity in the media was identified in this study as a leading cause of relief overdemanding by other local officials. Also, the party interests of officials were another reason for relief overdemanding. Ahmed (2013) in Pakistan found that departments concerned with DRM (disaster risk management) were affected not only by inefficiency and political interference but also by rampant corruption, lack of coordination and linkage among the network of disaster management institutions, as well as criminal negligence (Ahmed 2013). Yamamura (2014) also reported that disasters could generate an incentive for officials to engage in corruption, which is generally defined as the use of public office for private gain (Yamamura 2014). Moreover, there have been instances where disasters have created an incentive for politicians to misallocate disaster expenditures in order to increase their chances of re-election (Garrett and Sobel 2003).
The results showed that one of the factors affecting relief overdemanding was the weakness of crisis managers in providing and disseminating appropriate information in a timely manner. According to the participants, the lack of information about the disaster impacts and consequences often creates excitement in national and local authorities and causes them to distrust crisis managers. This leads to their unfavorable reactions, which could be exacerbated by observing the dire situation of the people affected by accident. Incorrect or insufficient information about the disaster situation was also found to be associated with relief overdemanding by officials. Similarly, Colombo and Pavignani (2017) found that in disaster situations, most communities use mass media to obtain data, and officials make guesses when interviewed, which are then reported in a way that usually indicates an uncommon incident and mass casualties (Colombo and Pavignani 2017).

Conclusion
Several factors influencing relief overdemanding were identified in this study, including factors related to affected people, crisis managers, as well as officials. Although relief overdemanding could be somewhat logical only in the super-acute phase of disasters, it could exacerbate the challenges of crisis management in the following stages.
Most of the participants in this study were senior operational crisis managers with a history of participating in disaster response at the national and international levels. Conducting this study in a qualitative way made it possible to investigate all possible factors and use the first-hand experiences of the participants to discover the influential factors.
The results of this study could help crisis managers in the optimal use of resources during disaster response. Using this study results, crisis managers could fairly distribute logistics resources, prevent the wastage of limited resources, and provide adequate relief, which could ultimately increase the satisfaction of affected people.
These factors have not been identified in any other study so far, and the results of this study could be used to improve the quality of post-disaster relief activities.
Due to the nature of qualitative methods, the generalizability of the results is limited. In this study, it was tried to increase the internal and external validity of the study by using appropriate strategies in the design of methods and materials. In addition, during the collection of research data, efforts were made not to interfere with the researchers' thinking and mentality.
It is suggested to conduct a quantitative study with a large sample size by designing a questionnaire in this field. Since this study investigated factors associated with relief overdemanding from the viewpoint of managers, it is suggested to conduct similar studies on disaster-affected people, local crisis managers, and other officials. Given that the present research is one of the few studies conducted on post-disaster relief overdemanding, similar studies are recommended to be conducted in this field using different methods.
Finally, strengthening local management and conducting an efficient needs assessment when responding to disasters could reduce relief overdemanding and prevent the waste of surplus resources in the affected area. It could also save money and resources for disaster managers and increase the access of affected people to disaster relief resources.