|Earthquakes and People's Health (WHO - OMS, 1997, 296 p.)|
|PART 4 - REHABILITATION|
J. Levett1, C. Ugarte2 and Secretariat
1 J. Levett is Director of International Affairs, National School of Public Health, Ministry of Health and Welfare, Athens, Greece.
2 C. Ugarte is Director, Direccion Nacional Preparacion contra Desastres, Lima, Peru.
Professor M. Gabr of Egypt presented his paper on "Rehabilitation of earthquake victims: social and health aspects (the Cairo 1992 experience)". He first described the consequences of an earthquake of 5.9 on the Richter scale which occurred on 12 October 1992. He mentioned that Cairo sustained the highest damage with the loss of 560 lives, more than 2000 injured and more than 5000 buildings collapsed. Since Egypt is not described as a high-risk earthquake country, Professor Gabr described the event as a rare disaster. This earthquake affected chiefly the districts and administrations of Cairo, Fayoum, Giza, and Kalioubia.
The response and related measures were immediately started by the Ministry of Health with the help of the Egyptian Red Crescent which was responsible for social and psychological follow-up and support of victims. Professor Gabr mentioned that about 50 temporary shelters were immediately constructed for the victims and for health services for them. Strict public health measures were taken and safe running water, soap, refuse disposal bags, and cooking and eating utensils were supplied. Steps were taken to ensure adequate nutrition, psychological care and social support, control of infectious diseases and other health measures.
Subsequently some modest apartments built in Cairo but still vacant, as well as another settlement, were used to house the earthquake victims. The new community was helped to organize sports, adult literacy classes, care for the handicapped, social gatherings and other activities. These activities greatly distracted young people from harmful activities such as drug abuse and violence. Some of the health measures included psychological counselling, nutrition, family planning, vaccinations and AIDS education. As a result, conditions such as depression, insomnia, agitation and other psychological manifestations often seen among disaster victims were not seen. Constraints like bad roads, lack of transport facilities, lack of schools, and security problems were all dealt with within about six months and earthquake victims were provided with an almost more comfortable life than before. Professor Gabr added that the Red Crescent, using some initial seed money, developed a recovery project that financially was virtually self-sustaining.
V.N. Zavgorudko and T.I. Zavgorudko presented a poster entitled "Basic principles of resort rehabilitation of earthquake victims". Having studied the experience of those who work in disaster medicine, including experience after the Neftegorsk earthquake in Russia, they noticed that one universally accepted type of rehabilitation programme was missing. The health status of the Neftegorsk victims demonstrated the need to provide a range of rehabilitation measures, from psychotherapy to complex physical and spa therapy. Such rehabilitation, they argued, is necessary both for the victims and for the rescue workers and others who provide aid in disasters.
Rehabilitation based on active non-medication therapy is rarely used and not well studied by clinicians. A resort has ideal capacity and excellent facilities to provide rehabilitation to disaster victims. It has enough hospital beds, the number of beds can be easily increased, and specialized wards can be organized to provide special types of services according to the needs of the patients. There are also plenty of virtually free but highly effective natural curative remedies such as mineral waters and the therapeutic use of mud. A resort in Russia has well developed transport links and is administratively independent.
Mr Y. Yasuda, General Manager, Kansai Project Development Division, The Sakura Bank Limited, Kobe, Japan, described the aftermath of an earthquake from a bank's point of view. This description was based on the experience of his bank during the Kobe earthquake. Mr Yasuda related how the bank's activities were paralysed during and immediately after the earthquake. This was due mainly to the failure of lifeline services such as electrical power and communication. This means that even if the buildings are strong, one is still vulnerable to major risks and therefore one needs to be prepared. A small number of banks were operational immediately after the earthquake and some provided services on behalf of other banks whose buildings had been destroyed. Special cash supplies were provided from Tokyo and, because there was no shortage of cash, panic or tension never developed.
Mr Yasuda then described the bank's emergency actions, ranging from staff care to making cash available to the public in the shortest time possible. He concluded with a number of lessons learned and recommendations for the future, ranging from the psychological importance of early recovery of cash supplies in a modern society, to help with low-interest loans for emergency spending and reconstruction.
Mr H. Kuramochi of the Hyogo Prefectural Government spoke on "Industrial reconstruction after the Great Hanshin-Awaji Earthquake". Considering that there were existing emergency preparedness plans, the size and extent of the damage took all by surprise. Many lifelines, such as railways, roads, electricity and gas lines, were damaged for months and even years afterwards, and the financial consequences of around 10 trillion yen affected not only Kobe or Japan but to some extent the whole world.
Mr Kuramochi added that early action was taken after the earthquake to invite opinions on rehabilitation from all concerned, including the business community. Support was provided in the form of funds, subsidies, the erection of temporary factories and other measures. He stressed that the industries should not just aim to reconstruct to their pre-earthquake status, but should consider growth and/or diversification for the future. Mr Kuramochi mentioned that such plans included major reconstruction promotion projects such as the Enterprise Zone, KIMEC (Kobe International Multimedia and Entertainment City), a large new convention centre, an import mart and a move from heavy industry to high-technology oriented enterprises and services. Most members of the Great Hanshin-Awaji Economic Revitalization Plan which was formed in December 1995 come from the business community. Within these plans, although still dependent on support from the government, private companies play an important part in Kobe's recovery.
The Prefecture's PHOENIX reconstruction plan has among its
- to attract foreign industry by tax rebates;
- to provide additional incentives to come to Kobe;
- to strengthen the traditional Kobe-Shanghai link;
- to construct a new China town.
Mr Kuramochi mentioned constraints, such as the 1.6 trillion yen shortfall in tax revenues in the next 10 years, the fall in consumer demand associated with reconstruction expenses, and the movement of population from the affected areas. So far, residency has reached only 80% of the pre-earthquake level. Suitable remedial measures also have to be taken to deal with this problem and the solidarity of the whole country is still needed.
Dr D. Jurukovski, Director, Institute of Earthquake Engineering and Engineering Seismology, University "St Cyril and Methodius", Skopje, the former Yugoslav Republic of Macedonia, then described the rehabilitation and reconstruction of Skopje after the 1963 earthquake and the lessons learned from this destructive event. The main conclusions from his presentation were:
· There is a need for an overall coordination of multisectoral efforts that could be performed by a civil protection organization.
· Self-organized communities form a crucial element in the success of relief operations after earthquakes.
· Public health issues related to hygiene, food distribution and epidemic control should have the greatest priority after the initial relief phase.
· Lessons learned need to be captured, documented and applied to future development planning.