 | Disasters Preparedness and Mitigation - Issue No. 26 - January, 1986 (PAHO) |
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ISSN 0251-4494
International Assistance: The delicate balance between donor and recipient
News of a major natural disaster often reaches the international community minutes after its occurrence. Within hours, government agencies, voluntary organizations and private citizens begin mobilizing resources in a remarkable demonstration of human and international solidarity. When properly directed towards priority needs, international assistance alleviates suffering and contributes to rapid rehabilitation. But when misguided by unsubstantiated donor perceptions of what the health needs "ought to be", this assistance only exacerbates problems and contributes to chaos.
Unfortunately, during the last decade, the latter has remained an all-too-constant feature in the aftermath of earthquakes and hurricanes in the Americas, despite the repeated efforts of agencies such as UNDRO, the League of Red Cross Societies and PAHO/WHO to influence these practices.
This editorial will review several factors which cause some international assistance to create a "second disaster" and suggest possible solutions.
A complex and sensitive challenge
The international community's desire to contribute to the immediate and most critical phase of the relief effort poses a complex challenge to countries facing an emergency situation. In the immediate aftermath, affected countries often are reluctant, perhaps for fear of compromising national sovereignty or self-reliance, to state exactly what type of assistance is required, and perhaps more importantly, what is not.
Multiple government spokesmen offering conflicting official statements, or indiscriminately accepting offers of aid has led to confusion during the first and most critical days after a disaster. Conflicting or unsubtantiated information on needs is as worthless as a lack of information.
In addition, foreign relief assistance serves a complex range of donor interests. Although certainly its intent is generous and altruistic, unfortunately, at times it becomes entangled in and thus offset by domestic politics, public relations or unhealthy competition to appear "the first to arrive on the scene." For example, assistance in the form of a planeload of supplies, hastily assembled and dispatched in time to be the highlight of an early press conference, is apt to be both technically inappropriate and politically counterproductive.
Finally, the fear of breaching diplomatic protocol or offending potential donor countries all too often prevents disaster-stricken nations from being candid about the value of international provided assistance, thus perpetuating traditional errors in disaster management. Fortunately, however, this trend appears slowly to be reversing itself in Latin America and Europe, as countries strive to end the self-defeating cycle of expressing profound gratitude for unsolicited and inappropriate assistance.
Immediate response vs. informed response
The need for and the relevance of immediate international response in Latin America has often been overstated. To be sure, it does play an important role by complementing existing local resources or providing specialized skills and equipment. But the usefulness of international assistance depends on its relevance to actual needs at the time it's delivered, not at the time it is requested or pledged.
Unsolicited medical supplies compete for attention and space with other more urgent needs. - Photo: PAHO
Unfortunately, political expediency and public pressure occasionally lead some donor countries to hurriedly dispatch medical supplies and personnel before the afflicted country can possibly assess its outstanding needs. The recent earthquake in Mexico and the mud slides following the volcaninc eruption in Colombia are highly illustrative of this. The extraordinary size of Mexico's Federal District (pop. 17 million) and its vast resources made any immediate international health assistance, except for highly specialized skills such as search and rescue technology, unnecessary. Mobile hospitals, health personnel, medicines, and volunteers were not required. Despite formal statements issued by the national authorities to this effect. rescue flights left for Mexico from all corners of the hemisphere, causing the American Medical Association to note in its Newsletter of October 4, 1985 that despite the lack of Government invitation, physicians responded to the earthquake tragedy.
Unsolicited medical equipment and supplies such as blood, plasma and other items erroneously presumed to be in short supply following natural disasters. began overwhelming the city, competing for immediate attention, space and transportation facilities with other more urgent needs.
In both instances, because selective media coverage of the death and destruction also implied an urgent and dire need for outside volunteers, thousands generously offered their assistance. However, it has been known that the indiscriminate presence of foreign volunteers in Latin America, a region with considerable human resources, places an overwhelming burden on the already severely-taxed healthcare delivery system. Although many foreign volunteers or medical teams consulted knowledgeable agencies and thus did not travel, others proceeded to the affected countries either misinformed or disregarding the advice they received. One can only echo the concerns of emergency managers in questioning the motivation of international health volunteers pressing their services upon a country willing and able to rely on its own health resources.
Assessing and coordinating needs
The previous observations do not imply that external assistance has no role or place. Indeed, few countries are able to mobilize the resources necessary for relief, rehabilitation and reconstruction following a major disaster. These observations are offered to stress the importance of assessing outstanding needs prior to accepting or providing international assistance so that relief is directed to those areas which the assessment reveals are most in need. Gathering and disseminating the proper information is the key to effective emergency management and the time spent in carrying out these activities is not time lost but rather time well-invested. Not surprisingly, most countries will opt to dedicate their own resources to 'immediate life-saving relief and later will look to the international community for support in restoring basic services and health care to displaced populations.
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Be an effective donor Following are some suggest dos and don'ts for potential donors to consider: For governments, private organizations and NGOs: · consult with your national health sector disaster preparedness and relief experts, the Ministry of Health of the disaster-stricken country and/or PAHO/WHO before sending supplies or health personnel. · avoid donations of: - food and used clothing - usually donated in excess at national level; · If consultation cannot take place, provide: - drugs from the WHO list of essential drugs with a long shelf life - the affected country probably has spent its entire annual budget for medicines during the three first days of the emergency; For individuals wishing to assist: · consult with your national health authorities, the Red Cross, or the PAHO/WHO office in your country; In short, institutions and individuals should offer the same kind of assistance they would like their own community to receive in case of disasters. The Pan American Health and Education Foundation (PAHEF) is
a non-profit foundation that serves as a link between donors and recipients.
Incorporated in 1968, PAHEF has become recognized throughout Latin America and
the Caribbean for administrative efficiency, fiscal reliability and appreciation
of health needs. PAHEF is a collaborating partner of PAHO, and accepts donations
for specific purposes (i.e., the relief efforts in Mexico and Colombia). All
donations are placed in a special trust fund for the exclusive use of this
designated activity. Contributions can be sent to: Pan American Health and
Education Foundation, 525 Twenty-third St. N.W. Washington, D.C. 20037,
USA. |
News from PAHO/WHO
Colombia: Nevado del Ruiz Volcano Erupts
Mudslides following the eruption left 23,000 dead. An additional 10,000 were left homeless.
Those who survived could only be rescued by air.
The mudslide, several km wide in places, buried nearly 85% of the town of Armero.
Photos: Julio Vizcarra/PAHO
After nearly 150 years of lying dormant. the Nevado del Ruiz volcano, located 55 km northwest of the capital of Bogotá, erupted fiercely on 13 November 1985. The intense heat and seismic activity accompanying the eruption melted several glaciers and transformed rivers flowing from the volcano into tumultuous streams of mud, debris, and ash. almost completely burying the town of Armero with an estimated population of 30.000.
Volcanic mudflows are known as lahars. Lahars rush down the slopes of volcanic mountains with speeds as great as 100 km/hr. Because of their frequency, lahars rival or even surpass glowing avalanches as the prime volcanic agent of destruction.
After several days of intense search and rescue operations, hampered by the fact that access to the stricken area was possible only by air, the death toll hovered at 23,000. The disaster affected a 1.000 square km. area which had constituted an important source of agriculture for the country. Other affected towns in the provinces of Tolima and Caldas included Chinchina where an additional 2,000 persons were reported dead or missing, Mariquita, where 20,000 persons were evacuated, and Guayabal. An estimated 10,000 were left homeless, and bridges and roads destroyed.
More than 4,000 persons required immediate emergency medical attention. The 1,200 who required hospitalization and could not be attended to in the immediate area were transported to surrounding areas including Bogotá.
No outbreaks of communicable diseases were detected, although strict epidemiological surveillance continued to be carried out, particularly in temporary shelters and overcrowded areas. Gastroenteritis can pose a problem to those areas where the drinking water supply has been affected but public health education campaigns on hygiene are underway to alert the population to these dangers.
With the exception of the continuing activities of the Expanded Program on Immunization, no massive vaccination campaigns were envisioned. Mass antityphoid vaccinations were not only unnecessary but would have been counterproductive.
In the early hours of 4 January the volcano again began to rain sulfuric acid on the area, prompting the evacuation of an estimated 40,000 persons within a 30-mile radius of' the Nevado del Ruiz volcano.
As we go to press, close seismic monitoring of the area continues as all indications point to the possibility of further eruptions and catastrophic lahars.
Multi-Agency Training Courses
The World Health Organization's Office of Emergency Relief Operations, the International Committee for the Red Cross, and the Faculty of Medicine of the University of Geneva jointly have organized a three-week course encompassing eight interrelated fields dealing with emergency situations. HELP 86 (Health Emergencies in Large Populations), a training course for managing international assistance, will be held from 2-21 June 1986 in Geneva and conducted in English. It is designed to train experienced health personnel who deal with disaster situations to improve coordination between agencies involved in disaster relief, select methods of assessment tailored to specific emergency situations and stimulate research in this particular field. Applications from health professionals with previous experience in emergency situations must be received by 1 March 1986. Registration fee SF1,500. Write: International Committee for the Red Cross, Medical Division-HELP 86, 17, Avenue de la Paix, 1202, Geneva, Switzerland.
Aftermath of the Earthquake in Mexico
Rescue workers frantically search for survivors amid the ruins of the Juarez Hospital. An estimated 900 persons died at this site.
Survivors were still pulled from the destruction as late as 10 days after the quake.
Broken pipelines caused severe water shortages in some areas of the city.
Photos: Julio
Vizcarra/PAHO
Upcoming Meetings
April
2-4: The Maryland Institute for Emergency Medical Services Systems (MIEMSS) will hold the Second International Assembly on Emergency Medical Services - Focus on Disaster. The Assembly, cosponsored by the Federal Emergency Management Agency and USAID's Office of' Foreign Disaster Assistance, will focus on models for prehospital and in-hospital EMS disaster response and risk assessment and review selected recent mass casualty incidents. Aimed at emergency planners and health care professionals and administrators involved in mass casualty incidents, the Assembly also will discuss mechanisms and networks for national and international cooperation. For further information write: Ms. Patricia McAllister. MIEMSS. 22 South Green Street, Baltimore. Maryland 21201, USA.
12-16: The annual conference of the American Society for Public Administration, to be held in Anaheim. California will include a special panel on Emergency Management in the Third World. Panelists from universities and international organizations will present papers on their specific experiences in emergency preparedness and disaster relief in the Caribbean, Latin America and other Third World countries. For further information contact Ms. Llewellyn Toulmin, 3312S, 2nd Street, Arlington, Virginia 22204. USA.
May
Partners of the Americas will hold a seminar on assessing and responding to disasters. The seminar will deal with assessing the human and physical effects of disasters, organizing and administrating an appropriate response and identifying areas vulnerable to disasters by risk mapping and other methods. Write: Partners of the Americas, Emergency Preparedness Program, 1424 K Street N.W., Washington, D.C. 20005, USA.
Member Countries
Argentina: Heavy Flooding Continues
Heavy rainfall, which last May caused more than 100,000 persons to be evacuated in the Province of Buenos Aires, continued to pose a threat to the area as the Luján, Matanzas and Reconquista Rivers again overflowed their banks leaving an estimated 50,000 homeless. Temporary shelters were set up in schools and other public buildings. Considerable damage was caused to livestock. agriculture, roads and bridges. By early December the flood waters were slowly receding and national authorities were able to carry out relief operations.
Brazil: New Civil Defense Publication
For the purpose of communicating and exchanging ideas with both the professional community and the general public, the São Paulo State Civil Defense system has begun publication of their new Newsletter Defensa Civil. The Newsletter's aim is to disseminate information of general interest to the civil defense community. For a copy (in Portuguese) of "Defensa Civil" write: Mr. Olavo Sant'anna Filho, Defensa Civil do Estado de São Paulo, Palacio dos Bandeirantes, Av. Morumbi, S/N, CEP 05598, Morumbi, São Paulo, Brazil.
Caribbean Islands: Disaster Survey
Late last September, the Leeward Islands, the Virgin Islands, Puerto Rico, Turks and Caicos and the Bahamas were put on full alert as Hurricane Gloria raced through the Caribbean with destructive winds of up to 150 m.p.h. National authorities considered this brush with Gloria a good opportunity to test preparedness measures. The Pan Caribbean Disaster Preparedness and Prevention Project (PDCPPP) maintained close contact with their national focal points and contracted a consultant to do a quick survey after the hurricane had passed. It is anticipated that the results of the survey will assist governments and project staff to program certain disaster preparedness activities for 1986. For further information contact: Pan Caribbean Disaster Preparedness and Prevention Project, Box 1399, St. John's, Antigua.
Central America: Nursing Workshops
National hospital preparedness workshops were held in Liberia, Guanacaste, Costa Rica from 4-6 September and in San Pedro Sula, Honduras from 4-9 November 1985. Approximately 40 nurses attended each workshop to receive training and evaluate their role in hospital disaster preparedness. For further information write: Dr. Hugo Prado, Asesor Regional para Situaciones de Emergencia, Oficina Sanitaria Panamericana, Apartado 3745, San Jose, Costa Rica.
Colombia: Hospital Emergency Plan
In their monthly bulletin Notidesastre, Medellin's San Vicente de Paul Hospital has outlined their emergency plan which is coordinated and executed by the Department of Social Work, The plan includes specific objectives to be carried out during emergency situations, defines the specific role of department personnel, analyzes personnel requirements during an emergency and outlines an evacuation plan. The plan and the role of the Department of Social Work were the subject of a multi-institution meeting to encourage participants to develop similar plans in their institutions. For a complete description of the Emergency Plan and the role and functions of the Department of Social Work write: Hospital Universitario San Vicente de Paul, Departmento de Trabajo Social, Medellin, Colombia.
Colombia: Multi-institutional Emergency Committee
The Metropolitan Inter-institutional Health Sector Committee (CIMSS) has begun publishing a bulletin to disseminate information on their monthly meetings. CIMSS is composed of representatives of the health sector of Antioquia, the Social Security Institute, several metropolitan hospitals, the national faculty of public health, private clinics and the regional Red Cross. The Committee, which serves as consultant and adviser to various institutional emergency conmmittees, promotes and evaluates vulnerability analysis studies. contingency plans and educational pro grams. It also monitors compliance of member institutions in carrying out their responsibilities in disaster situations. For a copy of the bulletin write: CIMSS, Camara 51D No. 60-36, Oficina 213, Medellín, Colombia.
Costa Rica: Health Sector Disaster Plan
Costa Rica's Ministry of Health has developed a comprehensive national health sector plan for disaster situations. The detailed plan covers general and specific responsibilities of the health sector during disasters, planning and organizational processes, and planning at the community, hospital and national levels. An excellent reference document and model for those interested in developing similar plans. For a copy in Spanish of the "Plan Sectorial de Salud para Situaciones de Desastre" write: Lenín Sáenz Jiménez, Ministerio de Salud, San Jose, Costa Rica.
Honduras: Departmental Emergency Plan
Vulnerability analyses of the Department of Parais, have led Honduras' Ministry of Public Health to create an emergency operations plan specifically for this geographical area. The plan outlines general and specific objectives, its geographical and institutional scope, and enumerates activities to be carried out including inter-sectoral coordination, short- and medium-term training, budget, and execution of the plan. For a copy of the plan in Spanish write: Dr. Saady Oscar Bueso, División de Servicios Móviles y Emergencias Nacionales de Salud, Ministerio de Salud Pública, Tegucigalpa, Honduras.
Jamaica: Flood Evacuation Plan
The very location of the development project of Portmore in Jamaica in a flat coastal area, has made imperative the need for a functional emergency operation plan. In 1982, Jamaica's Office of Disaster Preparedness (ODP) studied the area's hazards and acknowledged that Portmore's natural vulnerability. particularly to flooding and hurricanes, coupled with a lack of knowledge of its residents about potential hazards, necessitated immediate action. ODP has not only prepared detailed evacuation procedures for the area, but has given these procedures a wide dissemination by preparing a special disaster preparedness supplement for a major Jamaican newspaper. The supplement not only outlines evacuation procedures but also gives background information on the natural disasters to which the area is prone and safety tips for residents. For further information on these evacuation procedures, contact: Mr. Franklyn McDonald, Director, Office of Disaster Preparedness and Emergency Relief Coordination, Office of the Prime Minister, Sea Devon Road, Kingston 10, Jamaica.
Venezuela: Meeting on Regional Disaster Assistance
As part of the Venezuelan National Civil Defense Week. the Second Latin American Symposium on Regional Disaster Assistance was held in Caracas from 26-28 September. Participants from Latin American countries had the opportunity to study in detail the work carried out in the region by CELAR, the Latin American Regional Assistance Center, created in 1974 by the International Civil Defense Organization. Agenda items included the administrative and operational structure of different national Civil Defense Plans, the scientific and technical aspects of disasters, and case studies of recent disasters in the Region. For further information write: Colonel Ramón A. Martinez, National Civil Defense Director, Ministry of the Interior, Caracas, Venezuela.
Other Organizations
Disaster Research Center Requests Papers
The University of Delaware's Disaster Research Center (DRC) is calling on the academic community and disaster researchers for papers to update and increase the holdings of its Library. The DRC Library, used by researchers and students of disaster, has a nearly complete collection of English-language Ph.D. dissertations on this subject. The Library now seeks to expand its collection with papers from more specialized sources, primarily those presented at professional meetings. Any relevant papers you have prepared or presented that will enhance this collection may be forwarded to: Dr. E. L. Quarentelli, Director, Disaster Research Center, University of Delaware, Newark. Delaware 19716, USA.
Partners of the Americas Training Sessions
Partners of the Americas has scheduled a series of six disaster management training sessions for Latin American and Caribbean emergency preparedness specialists and planners. Running through the end of 1988, each of the three-week seminars offers participants an opportunity to visit selected sites in the U.S., exchange information with experts who have confronted similar problems, and visit Partner states to learn about local solutions to disaster management problems and design follow-up project activities. Details on the next seminar on assessing and responding to disasters can be found Upcoming Meetings. Future seminars will deal with managing mass casualties, educating the public for disaster preparedness, preventing and controlling fires and managing natural resources to reduce hazards. Individuals wishing to apply for each seminar (participants will be limited to 15 for each session) should contact Mr. Bill Wilcox or Mr. Raymond Lynch, Emergency Preparedness Program, Partners of the Americas. 1424 K Street N.W., Washington. D.C. 20005 USA.
Review of Publications
The books referred to below have been abstracted from review copies received from the publisher by the Editor of this Newsletter. Except where noted otherwise, none of the books are available from PAHO. The publisher and the list price (when available) are included at the end of the abstracts for readers who are interested in purchasing the books.
Disaster Management: Warning Response and Community Relocation. R. W. Perry and A. H. Mushkatel. 280 pp. Ext. ref. 1984 (English)
Within the broad area of disaster management, specifically covers the issues of designing and implementing appropriate warning systems to ensure citizen safety and discusses, through the presentation of case studies, the idea of permanent relocation of populations repeatedly at risk as a step toward hazard mitigation. Although the publication does not touch upon the health risks facing disaster-stricken communities. it may prove useful to planners and management in formulating specific portions of their disaster plans.
- US$35.00. Greenwood Press, 88 Post Road West, Westport, Connecticut 06881 USA.
Disaster Nursing: Planning, Assessment, and Intervention. Loretta Maim Garcia. 387 pp. 1985 (English)
This publication attempts to fill the educational gap in nursing curricula by providing practical information on the potential role of nurses in disasters. Deals with such practical problems as assessment of patients, triage and tagging, treatment of casualties, and the social, psychological, and mental care of victims. Material presented can be adapted to the health care systems of other countries. Excellent text for a course in disaster nursing or as an addition to emergency room libraries.
- US$39.95. Aspen Systems Corporation, P.O. Box 6018, Gaithersburg, Maryland 20877, USA.
Disaster Planning: The Preservation of Life and Property. Harold D. Foster. 275 pp. 48 figures 1980 (English)
Written to go one step beyond emergency preparedness and examine the promotion of safety through comprehensive risk management. Contains sections on developing plans, strategies and safety programs; discusses hazard mapping, predicting and preventing disasters through simulation models and disaster scenarios; and the design, implementation and testing of warning systems. Separate chapter discusses the need for and content of a disaster plan and lists 14 references which may be consulted for further planning.
- US$36.00. Springer-Verlag, Order Department, 44 Hartz Way, Secaucus, New Jersey 07094 USA.
A Guide for Short-Term Volunteer Medical Workers in Developing Countries. James C. Cobey, M.D. 58 pp. 1985 (English)
The author provides, in this book, some insight essential for short-term foreign medical volunteers cooperating with developing countries. Written with orthopaedists in mind, the book nonetheless stresses a public health approach compatible with culture, standards and resources available locally. The section on disaster relief stresses assessment of needs and community participation. The role of foreign volunteers is placed in context when the author states, "what is needed in most instances is not the short-term volunteer but funds." A good, well-balanced book for all those involved with placing and serving as medical volunteers.
- US$6.00 Orthopaedics Overseas, Inc., c/o Washington Station, P.O. Box 65157, Washington, D.C. 20036, USA.
Volcanic Emergency Management. Office of the United Nations Disaster Relief Coordinator. 86 pp. 17 fig. 1985 (English)
Concise handbook presenting general principles of organization and practice relating to volcanic emergencies. Describes the nature of volcanic hazards and reviews some recent emergencies caused by eruptions. Hazard assessment and mitigation measures are also discussed. Cites examples of success. volcanic emergency planning and management worldwide.
- Single copies available, free of charge, from UNDRO, Information and Publications Office, Palais des Nations, Geneva 10, Switzerland.
Volcanoes of the World. T. Simkin et al. Smithsonian Institution. 232 pp. 1981 (English)
Comprehensive reference volume on global volcanism. Primarily divided into four parts: a regional directory providing basic data such as name, latitude and longitude, elevation. status and eruptive characteristics; a chronological sequence of volcanic activity, a gazateer that alphabetically lists names to facilitate cross-referencing, and a bibliography of source documents used in this compilation. Well-researched addition to any reference library on natural disasters.
- US$29.95. Van Nostrand Reinhold Company Inc., Order Department,
7625 Empire Drive, Florence, Kentucky 41042
USA.