|Assessing Needs in the Health Sector after Floods and Hurricanes (PAHO-OPS, 1987, 90 p.)|
The establishment of temporary camps should be avoided whenever possible, unless necessary to save lives. Uprooting families from their homes and normal environment and grouping them with other unknown families in a confined space with little privacy often leads to psychosocial problems. Furthermore, because their food and basic needs are generally provided for, camp inhabitants have little to do, and it will not be long before suspicions, disagreements, and quarrels begin between families or groups. Complaints against the camp administration are common, and violence sometimes erupts. Moreover, the postdisaster "dependence syndrome" can result in difficulty moving people back to their homes.
From a public health standpoint, most of the risk factors for epidemics (discussed in Chapter 4) are present. Overcrowding and insufficient sanitary facilities are the rule, facilitating the transmission of communicable diseases. The evacuees should be sent back to their homes as soon as possible.
These considerations notwithstanding, camps are often set up unnecessarily, either because of ignorance or because, from an administrative standpoint, it is easier to manage relief operations.
Because they are a source of potential health problems, the camps are "special cases" and the assessment team must pay particular attention to them.
It is not the purpose of this publication to discuss either the recommended physical characteristics of evacuation camps or their administration. The manual prepared by UNHCR in collaboration with WHO (UNHCR, 1982) covers these area. It is worth mentioning, however, that many of the official camps set up in the event of natural disasters are in fact indoor stadiums or schools. The camps that mushroom spontaneously in some cases, such as after the Popayán earthquake of 1983, pose less of a health problem in principle (overcrowding is not severe), but soon become permanent shantytowns.
The team's main objective is to find out what actual or potential health problems exist in the camps and thus what the needs are for shelter, food, medical services, potable water, and sewage and solid waste disposal. This process also involves determining the population size, geographic location of the camps, and the possibility of overcrowding and psychological problems.
When visiting the camp, the team should note its aspect and physical appearance, as well as its location and proximity to any vector breeding sites, the demographic characteristics of the evacuees, the social aspects, medical care, environmental sanitation, and likelihood of outbreaks.
Sources of Information
The assessment team can get data on the total population of the camps and their geographic location from civil defense and sometimes from the Red Cross and health services. From discussions with area authorities, the team can select a sampling of evacuation camps, those that are most representative and in which health problems are likely to develop.
The team should encourage the camp director to fill out the checklist or a similar one and send it to the responsible institution. Certainly the health data should be sent to the public health officer responsible for the region.
· What is the total population of the evacuation
· What is the number and geographic location of the camps?
· Are the camps overcrowded?
· What are the needs for food?
· What are the needs for medical care and supplies?
· What are the sanitary conditions?
· What are the potential psychosocial problems?
· Where did the occupants come from?
· How badly were their home areas affected?
Sources of Information
· Civil defense
· Red Cross
· Health officers in the region
· Total number of camps
· Total population of camps
· Agency responsible for camps
· Physical aspect
- Type of camp:school, church, etc.
temporary shelter: type
- Partition between families, means of privacy
- Area per person
- Water supply
- Proximity to vector-breeding sites Proximity to garbage dumps
· Administrative, social, and demographic aspects
- Agency responsible for the camp
- Camp director's normal occupation/profession* his/her previous experience in evacuation camps
* formal training in camp administration
- Aides (specify number, normal occupation, and responsibility area within camp)
- Total number of evacuees and demographic distribution
- Percentage of evacuees engaged in camp activities and work
- Percentage of evacuees working outside the camp
- Schooling* classroom hours/week
* educational talks
* number of hours/week
- Other social activities (specify)
· Medical attention
- Nurse's aide
- Other (specify)
· Distance to nearest health facility
· Clinic, first-aid center
· Equipment for first-aid
Amounts (or for "x" weeks)
- Antiseptic solutions
- Dermatologic ointments
- Ophthalmic ointments
- Oral rehydration salts
- I.V. fluids
- Water ampules for injection
· Security for drugs
· Epidemiological surveillance system
- Frequency of data collection
- Responsibility of?
- Data sent to?
- With what frequency?
- Daily registry of attendances* type of illness registered
* most common illnessesrate per 100 camp inhabitants
* any outbreaks at present
aThe list of drugs described in the UNHCR/WHO Manual can be modified according to the prevalence of diseases and demographic characteristics of the camp (UNHCR, 1982).
· Environmental sanitation
- Water: piped* no. of persons/faucet
* no. of persons/shower
- Laundry sink(s)* average size
* no. of persons/sink
- Tank* capacity
- Alternative* water truck (frequency)
* other (specify)
- Storage* capacity
· Sewage disposal
- Flush toilets: not/total or per every 10 people
- Septic pit: not/total or per every 10 people
- Trench* length
* no. of holes
- Other (specify)
· Solid waste disposal
- No. of containers
- System of disposal* collected (frequency)
* dumped (distance from the camp)
- Agency responsible
- Types of foods
- No. of meals provided
- Protein mgs/inhabitant/day
- Supplementary feeding program* beneficiariestype
* types of foods
* copy of weekly menu
* central kitchencondition
- Individual/family cooking* fire hazards
- Storage* pest-proof
· Nutritional status
- Surveillance system* describe
* weighing scale
Type* length of board
* tape measure
- Prevalence of undernourished in the vulnerable population