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ISSN 0251-4494

Disaster relief and development

In an earlier issue of this Newsletter we addressed the problem of developing a standardized method for assessing immediate needs in the wake of disasters. Here we will attempt to examine a related issue that is a rising concern of affected communities and relief workers alike: the connection between emergency assistance and the long-term development needs of affected countries. We hope that our readers will respond by sharing their experiences and opinions on the subject.

One of the most widely held myths regarding earthquakes, hurricanes, floods and other natural disasters is that they are "great equalizers." They bring to mind the wrath and power of an untamed nature that hits men and women, young and old and rich and poor alike.

In fact, natural disasters are not great equalizers. There is sufficient evidence by now to demonstrate that they affect populations selectively: the poor are the most vulnerable, the least prepared, the hardest hit. Among them, the most seriously threatened by mortality and morbidity are often those already known to be at greatest risk in normal times: women, children, older people.

Relatively speaking, in national terms, disasters have a much more lasting impact in developing countries than in industrialized nations. This may seem to contradict estimates of damage when these are reviewed. Serious floods in the United States, for instance, will be reported to have caused dollar losses much higher than the amount reported for a similar disaster in a developing country. When the figures are compared as relative proportions of total available resources, however, another picture emerges.

Providing resources for the repair or construction of permanent chlorinating facilities would be a wiser relief measure then emergency supplies of disinfection tablets. Photo: Julio Vizcarra/PAHO

A major natural disaster not only damages or destroys part of the economy and service infrastructure directly but also affects other areas outside the disaster zone as funds, supplies and personnel are diverted, albeit unwisely, for the recovery effort. Especially in times of financial crisis - when Third World countries can barely muster the resources to preserve what gains have been made in economic development and social services - a natural disaster can cause a setback that lasts for years.

The fact that less developed nations can be so seriously set back by natural disasters has important implications for the way in which disaster relief is carried out. Clearly the necessary economic and social development planning is not primarily the responsibility of civil defense, national emergency committees or relief agencies. However, they do have a responsibility to ensure that their activities do not hamper, but rather enhance, development programs. This challenge is not limited to outside relief agencies; national authorities of the affected countries themselves often are not used to considering their requests for emergency assistance in this light.

What does this mean in practice for the health sector? It may mean that instead of requesting or supplying collapsible water tanks or tank-trucks on a temporary loan basis to distribute water to an affected population, it could make more sense to invest in the local purchase of storage facilities or the rapid installment of a permanent water reservoir. Instead of donating water purification tablets, often left unused due to their late arrival or lack of infrastructure to organize and monitor their distribution, relief funds could go toward rehabilitating or expanding chlorinating equipment in existing treatment facilities.

The well-known yet repeated post-disaster tendency to both request and provide vaccines for improvised mass campaigns against such diseases as typhoid fever or cholera would be much better replaced by a policy to strengthen the existing immunization programs and extend the coverage in affected areas to combat, for instance, preventable childhood disease in temporary settlements or refugee camps. It would be more beneficial during the immediate emergency and in the long run to donate cold chain equipment and regular vaccines to expand the immunization program in disaster-stricken communities.

At the time of assessing the needs for medical supplies, authorities and relief agencies should concentrate on essential drugs with an extended shelf-life and lasting usefulness. Perhaps victims would be better off during the rehabilitation/reconstruction period when guaranteed access to the drugs listed in WHO's Model List of Essential Drugs rather than witnessing the arrival of first aid kits and/or short-lived emergency items three weeks after the disaster has struck and the need has passed.

Most experienced relief agencies are fully aware of their responsibility to, above all, do no harm. Unfortunately, however, examples of the detrimental effects of ill-conceived assistance on painfully achieved progress are still all too common. The widespread presence of infant formulas and other "baby foods" in famine or disaster conditions and the setbacks in the use of oral rehydration therapy on children with gastroenteritis, due to the arrival of costly shipments of unnecessary I.V. fluids, are only a few of them.

Readers interested in further discussion of this topic may wish to obtain a copy of a recent Earthscan publication, Natural Disasters: Acts of God or Acts of Man?, a portion of which is excerpted in the following article. The publication is available from Earthscan, 1717 Massachusetts Avenue N.W., Washington, D.C. 20036, USA. Cost: US$5.50.

The following is excerpted from Natural Disasters: Acts of God or Acts of Man?, A. Wijkman, L. Timberlake.

Relief

Disaster aid from Northern governments sometimes tends to conform to the donor country's foreign policy rather than to the recipient country's need. Much "relief" is merely the export of surplus food and materials which are inappropriate for the disaster conditions. When the surplus in the donor country dries up, so does the aid. Biases in disaster relief dictate that sudden, dramatic, "newsworthy" catastrophes tend to receive more aid than disasters which grind people down slowly. Food aid saves lives but can also undermine long-term local self-sufficiency. When injudiciously supplied, it can disrupt local markets and make food too expensive for the poor. Free food may act as an incentive to corruption and in the long term may actually increase starvation. Some critics of relief operations claim that their main goal is to return victims to the status quo. Yet it is the status quo which makes them disaster-prone and vulnerable.

News from PAHO/WHO

PAHO Names New Disaster Preparedness Adviser for Central America

The Pan American Health Organization has named Dr. Hugo Prado as its new subregional adviser for the Emergency Preparedness and Disaster Relief Coordination Program in Central America. The establishment of this post will permit PAHO/WHO to Strengthen technical cooperation with the health sector of the governments of Central America to carry out disaster preparedness activities as well as to improve the assistance given to temporary settlements of displaced persons or refugees. The Organization will closely coordinate its efforts with those of other U.N. agencies, especially UNHCR and UNDRO, the League of Red Cross

Societies, through its regional office in Costa Rica, and bilateral agencies providing technical assistance in disaster preparedness such as the Office of U.S. Disaster Assistance (OFDA/AID). After 1 April contact Dr. Prado at the PAHO/WHO Office, Calle 16, Avenida 6 y 8, Distrito Hospital, San José, Costa Rica.

Joint AMRO/WPRO Workshop on Disaster Preparedness

The World Health Organization's Regional Offices for the Americas and the Western Pacific will jointly sponsor a workshop for health officials from 3-14 November 1985 in Honolulu, Hawaii.

The workshop will provide a forum for the exchange of information and experiences among health professionals responsible for providing health care delivery services, particularly in smaller countries with limited resources, in the wake of natural disasters. Participants from WHO's headquarters in Geneva and regional offices, the United Nations Disaster Relief Office (UNDRO), the League of Red Cross Societies, the Caribbean Community Secretariat (CARICOM), the East-West Center in Hawaii and the U.S. Public Health Service, among others, are expected to attend.

For further details contact the Editor of this Newsletter. Readers in the Western Pacific may contact Dr. R.D. Mercado, Bureau of Health Services, World Health Organization, Western Pacific Regional Office, P.O. Box 2932, Manila, Philippines.

Notes from other agencies

Report of FEMA Planning Conference

The Federal Emergency Management Agency (FEMA) has released a report of the planning conference it hosted last November on emergency health and medical training for disasters and mass casualty incidents. The participants, recognized for their expertise in emergency medical care and disaster response, were encouraged to make recommendations on the preparedness measures required for effective medical response to natural disasters. For a copy of the report write Mr. Joseph A. Moreland, Assistant Associate Director of Emergency Management Programs, State and Local Programs and Support Directorate, Federal Emergency Management Agency, Washington, D.C. 20472, USA.

UNHCR Publishes Spanish Manual

The United Nations High Commissioner for Refugees has released the Spanish edition of its Manual for Emergency Situations. Titled in Spanish Manual para Situaciones de Emergencia, Primera Parte: Operaciones sobre el Terreno, the manual contains information on assessing needs after an emergency, satisfying the refugee's basic needs of food and housing, and safeguarding their health. Concrete solutions to solving problems of health and basic sanitation which arise in the wake of disasters are offered. Limited number of copies available from the Editor of this Newsletter or through the local UNHCR representative.

Radiological Emergency Preparedness Program

FEMA has assumed federal responsibility for off-site emergency preparedness programs for areas surrounding U.S. nuclear power plants. FEMA has taken over this role from the Nuclear Regulatory Commission (NRC) which now limits itself to overseeing emergency actions inside the boundaries of the nuclear plant. The NRC is the licensing authority for commercial nuclear power plants and will continue to consider FEMA's recommendations and findings in its deliberations.

In order to assist state and local governments in developing emergency plans, FEMA has published a document entitled "Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness in Support of Nuclear Power Plants."

Those interested in obtaining a copy of the document, commonly known as NUREG 0654, may contact Mr. Ray Baker, Publications Branch, Federal Emergency Management Agency, Washington, D.C. 20472, USA.

Supplemental Feeding Manual

The Disaster Management Center of the University of Wisconsin has prepared a self-training manual on supplemental feeding programs (SFPs), with special emphasis on refugee camps and displaced persons. The manual's introduction states that "while the primary aim of SFPs is to provide additional food to individuals who are malnourished, SFPs can also be used to monitor and reinforce essential health services." The manual emphasizes techniques and procedures for carrying out SFPs for the benefit of the greatest number of people under less than ideal conditions. More information available from Mr. Don Schramm, Disaster Management Center, University of Wisconsin-Extension, Dept. of Engineering and Applied Sciences, 432 Lake Street, Madison, WI 53706, USA.

National preparedness programs

Jamaica: Disaster Preparedness and Relief Coordination

The following article was contributed by Dr. M. Fitz-Henley, Department of Social and Preventive Medicine, University of the West Indies.

Jamaica's size and geographical location have made it an easy target for natural disasters such as hurricanes, floods and earthquakes. Severe flooding in 1979 prompted the government to create the Office of Disaster Preparedness and Emergency Relief Coordination (ODPERC) to formulate preparedness plans for natural disasters.

One of ODPERC's first tasks was to develop a National Disaster Plan in 1980. The plan outlines steps for dealing with different types of natural disasters. In addition to the national plan, ODPERC has created preparedness plans for individual parishes and communities, recognizing that initial relief efforts often take place at this level.

In the area of disaster planning and research, ODPERC examines such areas as building codes and the control of land use, having determined that appropriate land use decreases the severity of disasters. Previous disasters have been documented and reviewed and ODPERC maintains close contact with agencies providing warning and forecasting services.

ODPERC is active in promoting the exchange of information among health-sector personnel and has designed training sessions for ministries, volunteer agencies, and parish councils. Another priority area is educating the public about the level of risk and the appropriate course of action for responding to a disaster. It is interesting to note that the results of a recent survey indicate that the nation's "more educated" citizens responded poorly to hurricane disaster warnings and were skeptical of potential risks. The unnecessary loss of life which resulted heightened the need for stepped-up public education programs.

The results of a survey carried out in 1983 indicated that very little information on disasters and disaster preparedness was included in the curriculum of health-related institutions. Responding to this need, the health authorities conducted a workshop to review and update training modules, assist in curriculum design and train professionals to teach the subject.

The workshop also included a simulation exercise of a mass casualty situation, patterned after a train crash which had occurred in Jamaica. It served as an excellent learning experience for all, clearly demonstrating the problems and difficulties encountered in managing real disaster situations.

The University of the West Indies in Kingston has incorporated lectures on emergency preparedness into its undergraduate curriculum, illustrating these lectures with slide series on Emergency Health Management after Natural Disaster prepared by PAHO. PAHO's scientific publications also serve as reference material. In addition, the University is considering using simulation exercises as one component of the curriculum.

The University's post-graduate programs in public health and community health now include an introduction to disasters and disaster preparedness, and lectures on the management of mass casualties and environmental management.

Jamaica and the University of the West Indies initiated a pilot program in late March using satellites to transmit courses and lectures on disasters to personnel throughout the Caribbean.

For further information on developments in teaching disaster preparedness in Jamaica, contact the Department of Social and Preventive Medicine, University of the West Indies, Mona Kingston 7, Jamaica.

Member countries

Argentina and Chile: Earthquakes Strike

An earthquake measuring 5.9 on the Richter scale caused extensive damage to the city of Mendoza and surrounding areas on 26 January 1985. Public services such as water, waste disposal, gas and telephone suffered minimal damage and were restored fairly rapidly. The number of victims was surprisingly low in contrast to the extensive damage caused to housing. UNDRO estimates that 28,000 urban residents were placed in temporary shelters and an additional 10,000 continued to live in inadequate quarters close to their devastated homes. For an update on the situation contact Mr. Ricardo Gabrielli, Engineer, Chief of Environmental Sanitation for the Province of Mendoza, Mendoza, Argentina.

Argentina and Chile: Earthquakes Strike

A strong earthquake shook central Chile on 3 March at 19:48 hrs. local time. In the capital of Santiago, three after-shocks occurred later that same evening. Intensities on the 12-point Mercalli scale reached the highest in Valparaiso (7-8), Santiago and Talca (6-7) and Copiapó (4-5). The latest estimates place the number of casualties at 150 with 2,000 injured. Many of the casualties occurred in Santiago and Valparaiso where older buildings collapsed. Updated information may be obtained from Dr. Miguel Gueri, Subregional Adviser, Emergency Preparedness and Disaster Relief Coordination Program, Pan American Health Organization, P.O. Box 2117, Lima 26, Peru.

Costa Rica: National Emergency Commission Appointed

The Minister of Health of Costa Rica has appointed a National Health-Sector Emergency Commission (CONESS) to coordinate the multi-institutional efforts of those agencies providing health care services to victims of disasters. CONESS is composed of representatives of several national hospitals and government health departments. Further information available from Mr. Armando Arauz Aguilar, Vice President of Costa Rica, President of the National Emergency Commission, San José, Costa Rica.

El Salvador: Montebello Rescue Operation

The Resource and Control Administration of the city of San Salvador has issued a report on the rescue and sanitation operation in Montebello and other outlying areas of the capital, in the wake of devastating floods in late 1982. A year prior to the flooding, a national Pluvial Emergency Plan was established to mitigate the effects of flooding on marginal communities. The report credits the communication channels and preventive measures previously established under this emergency plan with the Municipality's quick and effective response to the dangerous situation. The report chronicles the well-planned relief effort and offers sound strategies in post-disaster management. A limited number of copies of the report available from the Editor of this Newsletter.

Guatemala: Courses on Hospital Preparedness

The Ministry of Public Health and Welfare has scheduled a comprehensive training program on disaster preparedness. Short courses on mass casualty management for hospital personnel will be organized in every hospital in the country during 1985. For information contact Dr. Alejandro E. Giammattei Falla, Ministry of Public Health and Welfare, Dirección General de Servicios de Salud, 9a. Avenida 14-65, Zona 1, Guatemala, Guatemala.

Panama: Hospital Disaster Preparedness Course

Through the combined efforts of the Ministry of Public Health and PAHO, a national training course on hospital disaster preparedness is tentatively scheduled for 3-7 June. An estimated 40 participants from the health sector are expected to attend, including hospital administrators, doctors and nurses.

St. Lucia: Workshop on Emergency Planning

Under the auspicies of the Pan Caribbean Disaster Preparedness and Prevention Project (PCDPPP), participants from St. Lucia, Grenada, St. Vincent and the Grenadines and Dominica met in St. Lucia from 19-23 November 1984 to improve training in vulnerability analysis, develop preventive measures, and strengthen or develop emergency operations planning. Participants made extensive use of their own disaster experiences including hurricanes, volcanic erruptions and heavy rainstorms. For a complete report contact PCDPPP, P.O. Box 1207, St. John's, Antigua, West Indies.

Venezuela: Disaster Preparedness Curriculum

A course outline on civil defense and first aid, directed toward students of medicine, nutrition and bioanalysis, has been submitted to the Universidad Central de Venezuela by Dr. Luis Oswaldo Báez. Included in the present curriculum is a course on civil defense and emergency medicine for 7th semester medical students. The new course outline complements the already existing course and is designed to reach a broader audience. For a copy of the course outline contact Dr. Luis Oswaldo Báez, Apartado Postal No. 78219, La Urbina, Caracas, Venezuela.

Mexico: Commission to Create National Plan

As a direct result of the explosion of butane gas holding tanks in San Juan Ixtahuapec, a residential area north of the capital, last November, Mexico's Ministry of Health has formed a high-level Commission whose immediate task will be to create, as soon as possible, a National Emergency and Disaster Health Plan. The Commission, composed of representatives from the Ministry of Health, the Mexican Institute of Social Security, the Social Security Institute for Federal Workers, Coordinated Public Health Services from the State of Mexico and the General Direction of Medical Services of the Department of the Federal District, will also define mechanisms for enlisting the collaboration of institutions and citizens. See the box at right for the latest data on the disaster.

Photo: Excelsior

Mexico: Update on Natural Gas Explosion

The following data on the medical care received by victims of this disaster has just been made available by Mexico's Ministry of Health.

SITE OF SERVICES	TYPE OF MEDICAL SERVICES PROVIDED	NUMBER OF INJURED
Immediate Disaster Area and Shelters	Out-patient		5,262
Area Hospitals	Out-patient Hospitalized	1,083 886	1,969
TOTAL	INJURED		7,231

The following chart offers data on the medical services provided to the 886 persons hospitalized as a result of the disaster.

INSTITUTION	HOSPITAL ADMISSIONS	HOSPITAL DISCHARGES		REMAIN HOSPITALIZED AS OF 12/11/85
		IMPROVED	DEATHS
Ministry of Health	118	112	-	6
Mexican Institute of Social Security	600	499	90	11
Social Security Institute for Federal Workers	72	41	29	2
Department of the Federal District	80	45	25	10
Others hospitals	16	13	-	3
TOTAL	886	710	144	32

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 PA HO. 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.

Earthquake Information Bulletin, Volume 16, No. 2, U.S. Geological Survey. 122 pp. (English)

This issue is devoted exclusively to accounts of the eruptive activity of Mt. St. Helen's since 1980. Excellent photos, charts and illustrations document the physical changes brought about by each successive eruption. Presents a detailed account of monitoring activities, including seismic and deformation studies, ground-crack and thrust fault measurements, tilt measurements and gas emission, all of which are credited with the successful prediction of post-1980 eruptions.

- US$4.25. Branch of Distribution, Text Products Section, U.S. Geological Survey, 604 S. Pickett Street, Alexandria, VA 22202, USA.

Emergency Refugee Health-Care, A Chronicle of Experience in the Khmer Assistance Operation. Centers for Disease Control, Public Health Service, U.S. Department of Health and Human Services, 191 pp. 1983 (English)

Recounts the Khmer Thailand-Kampuchea refugee relief effort between 1979 and 1982. Part I is limited to presenting morbidity and mortality data and an overview of the health situation in these specific refugee camps. The information contained in Part 11, however, is applicable to refugee relief efforts in general and relief workers in similar situations will benefit from the health-related lessons learned.

- Available free of charge, Centers for Disease Control, Editorial Service Office, Epidemiological Program Office, Building 16, 1600 Clifton Road, Atlanta, GA 30333, USA.

Emergency Response to Hazardous Materials Incidents. D.R. DePol and P.N. Cheremisinoff. 118 pp. 1984 (English)

Deals with the "ever-increasing problem of hazardous materials in today's society, in particular, the problems which occur when a hazardous material is accidently released into the environment, either through a transportation accident, process upset, fire, or explosion. Topics covered include legal responsibility and liability and contingency planning, as well as the response process. The latter involves identification, notification, evacuation, and action. Guidelines are given for handling emergencies involving materials in the various Department of Transportation Hazard Classes, as well as safety equipment and procedural recommendations."

- US$19.00. Technomic Publishing Company, Inc., 851 New Holland Avenue, Box 3535, Lancaster, PA 17604, USA.

Manual Básico de Socorrismo. T. Alvarez, J. Restrepo, A. Noreño. 194 pp. 1980 (Spanish)

This collection of articles, written primarily for medical students, gives an overview of what is involved in providing medical services during emergency situations. Defines basic terminology and describes situations common in emergency medicine. Clearly and simply answers some of the most frequently-asked questions regarding disasters and the relief personnel and facilities needed to deal with them.

- Universidad de Antioquia, Educación Médical Apartado Aéreo 1226, Medellin, Colombia.

Technological Hazards. D. Zeigler, J. Johnson, S. Brunn. 103 pp. 1983 (English)

Touches on the problems associated with technological hazards as opposed to natural hazards. Discusses ways to identify and estimate risks and hazards and how to respond to technological disasters. Includes a section on technological hazards of the future. Extensive bibliography.

- US$5.00 Association of American Geographers, 1710 16th Street N.W., Washington, D.C. 20009, USA (202) 234-1450.

New Film

Ready for the Worst. American Red Cross, 40 minutes. (English)

Graphic footage of the destruction wreaked by hurricanes, tornados, and earthquakes in the U.S. is used to chronicle the history of the Red Cross during the last century and its evolution into a major relief agency. Although the visual effects have great impact, the film's usefulness as training and/or educational material is limited.

- Available for purchase through your Red Cross Chapter in the following formats: 16 mm film, US$227; 3/4" or 1/2" VHS format, US$49. Loan copies available from the American Red Cross Audio-Visual Loan Library, 5816 Seminary Road, Falls Church, VA 22041, USA.

Upcoming meetings

June 1985:

10-14: A five day course on Planning for Nuclear Emergencies will be presented by the School of Public Health, Harvard University, in Boston, Massachusetts. Topics include emergency planning both in the U.S. and other countries, with emphasis on accident source terms; standards and guides for emergency actions; training, drills and crisis management; and current research and development in this subject area. For further information contact: Dr. Dade W. Moeller, Associate Dean for Continuing Education, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA (617) 732-1171.

10 June-26 July: Oxford Programme of Development Workshops offering a workshop on disaster management. Intended for experienced professionals in developing countries, the workshop will focus on practical issues and make extensive use of case studies. Emphasis on exchange of information and experiences among participants. Workshops on urban land development and planning and shelter provision and settlement upgrading will also be offered later in the summer and fall of 1985. For further information and program outlines contact Christine Andres, Oxford Programme of Development Workshops, c/o Oxford Polytechnic, Headington, Oxford, OX3 0BP, UK.

September 1985:

10-13: The International Aeromedical Evacuation Congress will take place September 10-13 in Zurich, Switzerland. Under the patronage of the Swiss Red Cross, the Congress will allow physicians and specialists from around the world to acquaint themselves with the latest medical and technological advances in air rescue. For application and program write Interconvention Ltd., "Airmed 85", c/o Swiss Air, CH-8058 Zurich-Airport, Switzerland.

Selected bibliography

The publications listed in this section are articles of interest to health professionals and others responsible for various aspects of disaster relief and preparedness programs. They have been reproduced and recently added to the collection of articles available from the Editor of this Newsletter. A complete list of available reprints will be circulated to our readers Periodically. When making requests, please quote the reference code listed to the left of the publication title.

U.7	Terremoto de Popayán, Consecuencias Inmediatas, N. Guzmán. Pan American Health Organization: 1-20, 1984.
U.8	Ingresos en Servicios de Psiquiatría después de un Desastre Natural, F. Ahearn, Boletín de la Oficina Sanitaria Panamericana 97 (4): 325-335, 1984.
U.9	Proyecto de Manual de Procedimientos Operativos en Desastre, N.R. Morales, Revista de la Sanidad de las Fuerzas Policiales 44 (2): 185-198, 1983.
U.10	Organization of Emergency Medical Services, World Health Organization, 1984.
V.1	Coping with the Media in Disasters: Some Predictable Problems, J. Scanlon, S. Alldred, A. Farrell, A. Prawzick, Public Administration Review: 123-133, Special Edition, 1985.
V.2	Community Planning for Disasters, E.L. Bacot, Jr., Occupational Health Nursing: 310-311, June 1984.

Requests from the Caribbean Those requesting articles from countries in the Caribbean may direct their requests to: Pan Caribbean Disaster Preparedness and Prevention Project P.O. Box 1207 St. John's Antigua, West Indies

Disaster Preparedness in the Americas is the Newsletter of the Emergency Preparedness and Disaster Relief Coordination Program of the Pan American Health Organization, Regional Office of the World Health Organization for the Americas. The reported events, activities and programs do not imply endorsement by PAHO/WHO, not do the statements made necessarily represent the policy of the organization. The publication of this Newsletter has been made possible through financial support of the Canadian International Development Agency (CIDA). Correspondence and inquiries should be addressed to: The Editor Disaster Preparedness in the Americas Pan American Health Organization 525 23rd Street, N.W. Washington, D.C. 20037, U.S.A.