H. Nakajima, Director-General, World Health Organization

I am pleased to welcome you all to this international symposium, the second to be organized by the WHO Centre for Health Development in Kobe since it was inaugurated in March 1996.

During this symposium you will deal with the subject of earthquakes and people's health, a topic of major importance to the global community and to the people of Japan in particular. Two years ago, the Great Hanshin-Awaji Earthquake struck the urban area of Kobe. It is difficult to adequately express the extent of suffering and disruption caused by such disasters which endure for a long time.

In the last decade, several highly destructive earthquakes have hit urban areas: Mexico City in 1985, Spitak (Armenia) in 1988, Loma Prieta (USA) in 1990, Erzincan (Turkey) in 1992, Northridge in 1994 and finally Kobe in 1995. These earthquakes have shown the devastating impact disasters can have on areas with high population densities. An additional and major factor of risk for people's health in these areas is the concentration of industrial hazards such as chemical or nuclear plants. This underscores the importance of planning and coordinating carefully at all stages of urban development, so as to reduce the city's overall vulnerability to both natural and man-made disasters.

The United Nations General Assembly designated the 1990s as the International Decade of Natural Disaster Reduction, focusing on the cycle of prevention, mitigitation, preparedness, response and recovery. Within its own area of competence, WHO has been an active partner in this international cooperation effort. In particular, it has promoted multisectoral approaches to emergency management, vulnerability analysis and planning. These include designing frameworks for country programmes, working out technical standards and indicators, and providing support for training.

WHO has a global network of collaborating centres which is an extremely valuable source of expertise on specific aspects of emergency preparedness and response. Since 1992, a WHO expert panel has advised Member States on emergency-related issues and humanitarian action. We have been developing close working relations with various partners in the public and private sectors, including intergovernmental, nongovernmental and community-based organizations.

One important part of WHO’s work in the area of vulnerability reduction and emergency preparedness is the definition of standards and guidelines and their dissemination through the publication of manuals on technical matters related to this area of responsibility. A number of these manuals are prepared in partnership with such bodies as the Office of the United Nations High Commissioner for Refugees (UNHCR), UNICEF, the International Committee of the Red Cross, the International Federation of Red Cross and Red Crescent Societies and Médecins Sans Frontières. At present we are preparing guidelines on:

- rapid health assessment, to ensure an effective response to the immediate health needs of the population in an emergency;

- community preparedness, to assist local government, planning officers and community leaders in building up their capacity to prepare for and respond to emergencies.

The work cosponsored by WHO also covers issues such as environmental health, nutritional needs, and generic specifications for emergency relief items. These specifications include guidelines for drug donation. WHO has repeatedly drawn attention to the need to ensure that donated emergency medical aid should be appropriate, safe and effective. This standardization work must be done in advance, as part of emergency preparedness, so that precious time and manpower are not wasted on sorting out donations when disasters occur and thousands of people have to be cared for urgently with safe and effective drugs and equipment.

There are many illustrations of the need for such standardization. After the Armenian earthquake in 1988, 5000 tonnes of medical supplies and drugs were donated. Of the 2500 tonnes of drugs sent, only one-third was immediately usable; nearly a quarter had to be rejected or destroyed upon arrival, and one-fifth was inappropriate for an emergency. In the recent Rwandan crisis, a large donation of unwanted and unrequested antibiotics was sent. Aid workers and local health officials then had to find a way to destroy six million tablets, which presented an added risk of producing multidrug resistance in the local population. Clearly, international agreement is needed on which medical supplies and drugs are most necessary in the early phases of an emergency. This will contribute to providing care, avoiding waste, and improving the effectiveness and coordination of national and international action.

Another important part of our work is related to prevention. In earthquake-prone areas, particularly large cities, this involves advocating and supporting the improvement of construction standards and reinforcement of infrastructure such as bridges, elevated roads and railway lines. I know that the Japan Civil Engineering Association, for example, is devoting much of its attention to this very difficult problem, learning from the tragic Kobe experience. "Cities at risk" was the 1996 theme of the United Nations International Decade for Natural Disaster Reduction. The theme was part of the Habitat II agenda, which dealt with the more general issue of human settlements and town planning for the next century. Cities are growing rapidly, especially in the developing countries: by the year 2000, half the world's population will be living in urban areas, and by the year 2025, 80% of these urban areas will be in the developing world.

There are many ways in which the health sector can contribute to making cities less vulnerable. These include close cooperation with town planners and local government to prevent the development in urban areas of industries that would present major health risks in an emergency. Preparedness in the health sector should include training health professionals to deal with emergencies, ensuring proper construction and maintenance of, and access to hospitals and health care centres, enlisting community participation in identifying risks, and providing information and resources to deal with them. In 1994, the World Conference on Natural Disaster Reduction adopted the Yokohama Strategy and Plan of Action for a Safer World in the 21st Century. To achieve vulnerability reduction, the strategy highlights the importance of community-based approaches, training, and involvement at all stages of intervention, including planning. The strategy stresses that preventive measures are most effective when they involve participation at all levels, from the local community, through national government, to the international community. Well-prepared communities can stop emergencies from turning into disasters.

The mission of the WHO Kobe Centre for Health Development is to carry out research on the relations between health and its determinants, including social, demographic, economic, technological and environmental factors. As emphasized by its Executive Board, WHO has an essential role to play in facilitating the exchange of information, knowledge and know-how among various partners from both the public and the private sectors, including civil society, and drawing on the wealth of scientific data, expertise and experience that is available around the world. The Executive Board particularly stressed the importance of taking full advantage of WHO’s network of collaborating centres. A key function of the WHO Centre in Kobe should be to serve as a hub for such networking.

The first symposium held by the WHO Kobe Centre in March 1996 focused on urbanization and the complex challenge it presents worldwide. It dealt with the public management of urban health, including the organization of health systems and services, and the problems linked to housing, water, sanitation and waste management. It also touched on the issue of health emergencies in large-scale urban disasters. The International Symposium on Earthquakes and People's Health takes up many of these issues again but with a slightly different perspective.

At the end of 1996, WHO devoted an issue of its World Health magazine to health needs in natural and man-made emergencies. As the magazine rightly puts it, we live in a world fraught with danger. And while we must keep up our effort to improve preventive measures and early warning systems, we must also be aware that some risk will always remain. In the face of danger, preparedness and response can be effective only if we join forces and act together. Solidarity and coordination at local, national and international levels are indispensable for reducing vulnerability, caring for the afflicted, and restoring the life and hope of the whole community.

The strong support of the Kobe community and officials, the Hyogo Prefecture, and the Japanese government for this WHO Centre demonstrates their determination to be part of this movement for international solidarity and coordination in support of health research and development. I should like to express our sincere gratitude to them all and our firm commitment to the Kobe Centre and its objectives.