|Disasters Preparedness and Mitigation - Issue No. 07 - April, 1981 (Pan American Health Organization (PAHO) / Organización Panamericana de la Salud (OPS), 1981, 8 p.)|
Earthquakes and hurricanes, to a lesser extent, are the natural disasters most likely to produce mass casualties. The difference between the impact they have upon the health sector and that caused by protracted wars and chronic conflicts is due to the compressed time span in which injuries occur. The need for urgent medical attention is overwhelming but short-lived. Severe structural damage to hospitals and the disruption of communication and transportation systems, intensify the burden on those facilities that are accessible and in operating condition.
How useful are mobile field hospitals in the immediate postimpact phase?
There is no simple answer to this question. The mobilization of field hospitals has always been attractive to public opinion. Such enthusiasm notwithstanding, field hospitals are not a first-line solution to the temporary excess demand for medical care.
First, it may take one week or longer to establish a fully operational mobile hospital from abroad, while most casualties will occur within the first 24 hours. Following the earthquake in Managua, Nicaragua, in 1972, for example, most foreign field hospitals were not operational until three to eight days following the earthquake. In Peru, longer delays were experienced after the earthquake/landslide of Huaraz in May, 1970. For instance, a recent study indicates that the mobile hospital EMMIR (France) was not set up until 16 days after the impact.
Second, although uniquely suited for treatment of a continuous flow of war casualties, mobile army hospitals have proven to be less well adapted to the needs of a civilian population (traumas, gynecologic, pediatric and other medical emergencies).
Third, the cost of mobilizing and operating such a hospital-especially when airlifted-is extremely high and is often deducted from the total aid package pledged by the governmental or private relief source providing it. For example, the average cost of the initial treatment (X-Ray, immobilization, evacuation) of 3 to 5 day-old traumas in a fully staffed military hospital flown to Guatemala following the 1976 earthquake was estimated at over US$2,500 per patient. Many more lives could probably have been saved if this amount had been used for primary health care during the rehabilitation phase.
Lastly, such hospitals are often quite advanced technologically, raising the expectations for the people they serve in a way that will be impossible for local authorities to fulfil during the recovery period.
National authorities responsible for liaison with donors should perhaps also be aware that such hospitals are offered insistently by well meaning donors who, wishing to assist in an emergency, may not adequately consider their usefulness.
In lieu of resorting to the use of field hospitals, health authorities should place a priority on setting up ambulatory first aid stations, distributing serious cases among hospitals outside the disaster area and expanding undamaged local health facilities. Only if these measures are not feasible or likely to be adequate, should staffed, self-sufficient mobile disaster hospitals be considered as an alternative.
Emergency medical team rushes earthquake victim to treatment
If the use of such hospitals becomes necessary, authorities should first consider procuring one from the country itself, or if the disaster occurs in a border area, the hospital may be obtained from a neighboring country. Those from more geographically, culturally or technologically distant countries have the limitations mentioned. Field hospitals may be available through the local military, Red Cross, or private sources.
Packaged Disaster Hospitals
It is not uncommon for national health authorities to be offered "packaged disaster hospitals" (PDH) when a major disaster occurs. The decision to request or accept a PDH for use in the early emergency phase after a natural disaster should be considered with great caution for several reasons:
1) The training required to install and operate PDHs is extensive and buildings suitable for housing them must be located. It may take several weeks or months after the initial offer for such a hospital to become operational.
2) Part of the equipment in the PDH may be obsolete, in poor condition, or unsuited to the needs of the recipient country, since most such hospitals were designed in the 1950s for use after nuclear disasters in developed nations.
3) The hidden cost of such hospitals to a recipient country may be very high in relation to their very limited benefit. Following recent hurricanes in the Caribbean, PDHs were sent several weeks after the impact to some affected countries. The delivery cost of two hospitals amounted to over US$130,000.00, an amount actually disbursed by the agency and consequently no longer available for rehabilitation in the health sector.
Field hospitals appear to have been relied on excessively in past disasters. However, they have at times proven to be of valuable assistance following earthquakes, provided certain conditions were met. The hospital must be designed for a level of sophistication appropriate to local conditions, operational within 24 hours and fully self-supported with staff familiar with the language and conditions of the affected country. Their usefulness following floods and hurricanes remains to be determined. Further investigation and case studies are required. The columns of this newsletter are open to additional opinions and information on this matter.
Human Settlements and Disaster
The Commonwealth Association of Architects (CAA), with the cooperation of the Commonwealth Fund for technical Cooperation and INTERTECT, has produced a series of slides on human settlements and disasters. The series is made up of five sets of 24 slides, each of which has a corresponding taped lecture. There is also a written manual covering all sets.
The series is directed mainly to architects, engineers, planners and administrators. It underlines the need to consider certain basic techniques when improving housing construction in areas that are prone to disasters, in order to ensure greater resistance to earthquakes, hurricanes and floods. Special emphasis is placed on the need to take sociocultural traditions of high risk populations into account to make international cooperation in the construction of temporary housing more effective. The importance of using local materials for housing reconstruction is stressed, as is the participation of the community. The slides examine well-documented case studies, supplemented by instructional diagrams on specific aspects of rural housing construction. Although their relationship to health is only implicit, these are superior slides that can be very useful for multisectoral committees or for educational purposes.
In brief, each set covers the following:
1. Defining an approach for designers. General introduction on risks of disasters according to housing type, and basic recommendations for rural housing construction. Adaptable to Latin America and the Caribbean.
2. Mitigation measures. Practical long-term preventive measures that reduce vulnerability in high risk zones. Adaptable to Latin America and the Caribbean.
3. Simple techniques for making adobe houses more earthquake resistant. Technical principals that should be adopted in adobe housing construction. Adaptable to Latin America and the Caribbean.
4. Making low-income housing wind resistant. Techniques and basic principles for the construction of rural housing typical of India Adaptable to the Caribbean.
5. Emergency Shelter after Disasters. Sociocultural considerations in providing shelter for populations, cost analysis of prefabricated housing, and the need for evaluating cooperation in assistance programs. Adaptable to Latin America and the Caribbean.
The printed manual and the audiotapes are available in English only. Price per set: US$45.00. Interested parties should write: Commonwealth Association of Architects, Room 326, Grand Buildings, Trafalgar Square, London WC2N, HB, England.
Temporary shelters established in Southern Italy after November, 1980 earthquake.