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close this bookAssessing Needs in the Health Sector after Floods and Hurricanes (Pan American Health Organization (PAHO) / Organización Panamericana de la Salud (OPS), 1987, 90 p.)
View the document(introduction...)
View the document1. Introduction
View the document2. Critical decisions
View the document3. Magnitude of the impact
View the document4. Morbidity and mortality
View the document5. Environmental sanitation
View the document6. Vectors
View the document7. Food and nutritional status
View the document8. Evacuation camps
View the document9. The health center
View the document10. Surveillance systems
View the documentBibliography

3. Magnitude of the impact

The health sector is not an isolated entity. While many conditions created by floods appear to have nothing to do with health, they may in fact have a considerable direct or indirect effect on the health status of the community. It is therefore necessary that the assessment team have an overview of the total situation before it reviews the health component. If the team is multisectoral, some of its members will have much of the basic data needed. However, if it is composed strictly of health personnel, the data will have to be obtained elsewhere. If the team comprises foreign advisers, it should work with local staff who have a thorough knowledge of the country and its people.

General background information should be sought from high-level officials in the capital of the country, province, state, or department. It will be necessary to interview representatives from the civil defense system or a similar organization that is responsible for coordinating relief activities; from the meteorological services; from ministries such as social security, public works, and agriculture; from the better-established voluntary agencies; and from the international and bilateral relief or development agencies and embassies of donor countries.

An aerial survey of the flooded area may be useful, but is not indispensable. It provides a panoramic view of the situation, yet one that is very crude and lacking information on specific needs.

BASIC QUESTIONS

Among the basic questions that need to be answered during this first approach to assessing the overall magnitude of the disaster's impact are the extent of the geographical area affected; the impact on housing, roads, communications, agriculture, and livestock; and the characteristics of the population of the affected area. These characteristics should include not only distribution by age, sex, and physiological status if possible, but also social and ethnological aspects, taboos, and mores. The assessment team should also determine the current status of relief supplies and stocks.

GEOGRAPHIC AREA AFFECTED

It is important to become familiar with the area on a map and to get to know the "mechanics" of the flood, that is, whether it is the result of torrential rains, distant thawing snow, the overflow of a local river, or the rupture of a dam, and whether it is a slow or a flash flood. These have different implications for the health of the community. While flash floods permit little time for evacuation and result in many deaths, slow floods give ample warning that allows for evacuation from dangerous areas and usually result in a low death toll. However, slow floods may cause long-term public health problems.

Depending on whether the community is in the Andean mountains or in a seaside village, the pathology likely to be found after flooding will be different. For example, it is not uncommon for torrential rains in coastal areas to be accompanied by high winds and strong waves which may destroy seaside houses, adding a new dimension to the disaster.

The team will need to know the state of the roads, alternative means of transport, isolated communities, measures that have been or may be taken to protect the population, and the location of actual or potential evacuation areas and their proximity to health care facilities.

Sources of Information

Some countries have a hydrology department that is responsible for monitoring rivers and expected water levels. The department of meteorology frequently can predict the severity of the rainy season and its duration.

There is usually some government department or unit (a national geographic institute, for instance) responsible for drawing and updating maps of the country. In some countries this is the responsibility of the army. As a last resort, road maps may be obtained from a local automobile association or tourist organization.

AFFECTED POPULATION

The assessment team should acquaint itself with the characteristics of the affected population, the history of repeated disaster episodes, and the possible "disaster culture" (tares, 1977) that may govern the community's response to the situation.

The socioeconomic characteristics of the affected population are important. It has been said that only poor people are victims of disasters. In fact, this means that the lower economic strata of the population comprise those who live in old and vulnerable houses (such as those built of adobe) that may not resist an earthquake, or in marginal areas close to ravines that are subject to landslides. These groups cannot afford to keep food and other basic supplies in stock for possible shortages. The disaster may produce secondary effects that weaken the purchasing power of the community and indirectly result in nutritional problems, for example, when floods destroy crops, whether they are for food or for cash. Isolation of a population group may prevent the breadwinner from traveling to work; in other cases, the workplaces themselves may be destroyed.

Sources of Information

Red Cross volunteers or civil defense personnel usually conduct a population census in the flooded area to plan distribution of relief supplies or accommodations at evacuation centers.

Often more than one institution carries out a separate and independent census. Sometimes the degree of thoroughness with which each operates may result in varying and conflicting figures.

COMMUNICATIONS AND TRANSPORT

Communications and transport are essential in assessing the damage caused by a disaster and in planning relief operations. The team should know, or learn as soon as possible, what were the pre-disaster, normal means of transport-road, railway, sea, or air-and determine which have been damaged and are making access to, and transport within, the region difficult. Isolation is a relative term; sometimes it means using unusual modes of transport to reach communities: donkeys, boats, rafts, 4-wheel-drive vehicles, or helicopters.

Finally, it is necessary to know what type of communication is available: telephone, radio, or other means.

Sources of Information

The ministry of transport, the police, and the army know the condition of the roads.

In most countries a permit is necessary for two-way radios; this is generally issued by the ministry of communications. The same ministry can provide names, locations, and frequencies of amateur radio operators who are invaluable for keeping in touch with isolated areas. "Ham" clubs can also supply data on radio operators. Sometimes even in the remotest areas one finds religious and volunteer organizations that have their own radio communications system.

One or all of these sources can provide the team with information on the needs of isolated communities. However, due to the technical nature of some of the information required, errors in communication are common. Furthermore, information on damages relayed by inhabitants of the devastated area may be highly subjective and colored by emotion.

HOUSING

Lack of housing per se is not a health sector problem. Indirectly, however, it exposes individuals to rain, cold, and possibly overcrowding in temporary shelters which may eventually affect their health. It may also result in psychological and socioeconomic problems for those who have lost their homes.

It is important to know the type of buildings and construction materials commonly used in the flooded area, as this makes it possible to estimate the damage to housing.

As part of the "disaster culture," people living in flood-prone areas often build their houses on stilts. Although the floods are of varying intensity, the inhabitants of this region of Bolivia in the basin of the Mamoré River not only built their homes on stilts, but have adapted to the frequency of the disasters by raising their floors with wooden boards as the flood waters rise.

In another scenario, adobe houses in the northern part of Peru, where no rain had fallen for years, could not withstand the over six months of continuous rainfall brought by the "El Niño" phenomenon of 1982-83.

Sources of Information

People in government departments familiar with the area will know the type of housing in the affected area. The Red Cross and civil defense will have some figures of the number of houses damaged, the need for housing, and the population inhabiting evacuation centers.

AGRICULTURE AND LIVESTOCK

As in the case of housing, the disaster may affect health indirectly through its impact on agriculture. Small landowners with little cash or food reserves will suffer severely from damage to their food and cash crops. The long-term result can be an increase in the incidence of undernutrition. Even if the crops themselves are not lost, damage to the roads can make transporting the produce to market impossible. Thus farmers not producing food face a shortage, while food growers lose income to purchase other foods they do not produce.

When cattle drown, human health may be affected in two indirect ways: less food and less income. Moreover, disposing of hundreds or thousands of drowned animals is a difficult environmental and sanitary problem when flooded terrain inhibits burial of the carcasses.

Sources of Information

The agriculture ministry will obviously have data on the type of agriculture and husbandry practiced in the district and the estimated damage. Civil defense may have similar data, as well as information on the number of families affected.

Closer to the site of the disaster, farmers' organizations and cooperatives frequently have quite accurate information.

RELIEF SUPPLIES RECEIVED AND REQUESTED

Anecdotes abound of donors who send heavy winter clothing to tropical areas and pork sausages to Muslim countries. There are at least as many examples of affected countries issuing long "official lists" in which the "emergency" items requested have nothing to do with the needs created by the disaster.

The problem of unsolicited and inappropriate relief supplies is longstanding and reappears with each disaster. The assessment team must determine if there is a clear, well-defined policy regarding unsolicited supplies, and whether the stated policy is being implemented.

It is also important to know how the supplies are being channeled and who is responsible for coordinating requests and donations, in theory and in practice. Frequently, relief organizations will only send supplies to their own affiliates in the affected country or area.

Within the health sector, the team must find out what donations have been received, what firm commitments for help have been made, and what requests, if any, have been issued.

Sources of Information

In theory, civil defense or similar organizations are responsible in most countries for coordinating aid requested and received. Nonetheless the assessment team should also contact local representatives of donor agencies, particularly the Red Cross and religious organizations.

Often one foreign agency becomes the formal or informal coordinator of information concerning international relief. The representative of the United Nations Development Programme (UNDP) often provides a neutral forum in which agencies and embassy representatives can meet to exchange information about donations and requests.

HEALTH SECTOR

The assessment team must be familiar with the characteristics of the health sector, its structure, operating routine, the surviving facilities and bed capacity in the disaster area, the status of communicable disease control programs, and the number and type of personnel manning them. This information should be gathered not only from the ministry of health but also from all those services that normally comprise the health sector in the region, such as social security, armed forces medical cervices, private centers, and voluntary organizations.

Sources of Information

Data on the number of centers, their location, capacity, and the population they cover are frequently available at the ministry of health, but the team may have to query other health agencies not attached to the ministry.

Central- or regional-level agencies may have some information on flood damage to the infrastructure of the sector, and should at least know whether or not the main health facilities are operative.

If the centers can be contacted through either their own communications system or the alternatives outlined above, the team should request an estimate as soon as possible, specifying damage sustained by physical structures, equipment, materials, supplies, and drugs, and including the number of personnel, their type, and status.

Community spokesmen frequently use any available means of transport to reach the provincial, district, and sometimes even the nation's capital to present the community's complaints and felt needs to their political representative. The assessment team may take advantage of these trips to request written reports from local health authorities.

CHECKLIST

In carrying out an initial survey, the assessment team or individual will probably be able to answer the following basic questions only roughly -detailed quantification will take time. However, even rough percentages and other approximate calculations, when derived from sound sources, provide invaluable estimates on which to base a preliminary assessment of needs.

Basic Questions

· What is the geographical area affected?
· What are the characteristics of the population affected?
· What was the effect on communications and transport?
· What was the effect on housing?
· What was the effect on agriculture and livestock?
· What is the situation regarding relief supplies and requests?
· What was the impact on the health sector?

Geographic Area Affected

Sources of information

· Civil defense (or similar coordinating agency)
· National geographic institute/geographic department of the army
· Department of meteorology
· Civil aviation
· Department of hydrology

Check

· Detail maps

· Scope of floods (sq. km.)

· Type of flooding:

- slow
- flash

· Estimated duration

· Water level

· Danger of river overflow

· Protective measures taken in a coastal area against:

- high waves
- high winds

· Protective measures taken in a tropical area

· Protective measures taken in a mountainous area

Population Affected

Sources of information
· Civil defense
· Red Cross

Check

· History of frequent floods
· Last flood (date)
· Population distribution (rural isolated, communities, towns)
· Number of communities affected
· Number of people/families affected
· Estimated number of homeless families
· Estimated number of people/families evacuated

- Where to?

· Type of economy (e.g., agrarian, trading, industrial)
· Estimated loss of work (high, moderate, little)

Communications and transport

Sources of information

· Police/army
· Ministry of transport and communications
· "Ham" operator associations
· Religious/voluntary organizations
· Civil defense
· Red Cross

Check

· Transport

- To the region

* only air:

plane
helicopter

* water

* road:

normal vehicle
4-wheel-drive
horse or mule

* railroad

- Within the region

* bridges destroyed
* number and location of airports
* number and location of landing strips

- Communities that can only be reached by:

* air
* water
* 4-wheel-drive vehicles
* horse, mule, or other beast of burden

· Communications

- Communities with no functioning telephone system
- Radio communications


Location

Frequency

* armed forces



* police



* ministry of health



* Red Cross



* 'ham" associations



* religious/voluntary orgs.



* other



Housing

Sources of information

· Ministry of housing
· Civil defense
· Red Cross

Check

· Type of housing common in the area
· Number of homeless families
· Building material/temporary shelter required

- Tents
- Prefabricated housing material
- Building material, type

Agriculture and Livestock

Sources of information

· Ministry of agriculture
· Civil Defense
· Farmer cooperatives

Check

· Type of agriculture (cash, subsistence)
· Type of ownership (large holdings, small farms)
· Main crops
· Hectares destroyed
· Estimated percentage of anticipated harvest destroyed
· Livestock

- Estimated number destroyed and percentage of estimated total

Relief Supplies

Sources of information

· Civil defense
· Red Cross
· U.N. representative and agencies
· Heads of regional organizations
· Main bilateral agencies working in country
· Main voluntary organizations

Check

· Agency responsible for coordinating relief efforts

· Existing mechanism to handle requests

· Transport system to region

· Cooperation of airlines, armed forces

· Coordinating meetings - responsible agency:

formal
informal

· Main types of aid requested

· Firm offers

· Health sector

- Requests already formulated

- Aid received:

mainly classified
mainly unclassified

- Storage:

adequate
inadequate

- Transport to disaster area: adequate inadequate

· Cold chain

- Airport
- Central store
- In transport
- In disaster area
- In communities

Health Sector
Sources of information

· Ministry of health
· Social security
· Armed forces medical services
· Professional associations