|European Workshop on Educational Aspects of Health in Disasters (Council of Europe, 1982, 50 p.)|
Workshop for preparedness in facing health
from natural disaster emergency situations
(Rabat 22-25 November 1981)
This meeting was convened with the financial support of the Commission of the European Communities and the Office of the United Nations Disaster Relief Co-ordinator, and with the technical assistance of the WHO collaborating centre on disaster epidemiology at the University of Louvain, Brussels. It brought together 55 physicians, teachers and senior officials from 13 countries, as well as representatives of 5 international organisations other than WHO. Its purpose was to review the current state of preparedness for dealing with health problems associated With emergency situations and, more specifically, to identify the measures that should be taken immediately after the disaster in order to:
- reduce the number of people killed or
injured at the time, or who die as the result of their injuries;
- make services for assistance to survivors more effective;
- preserve the existing health facilities or enable them to be restored as soon as possible.
The participants stressed at the outset that natural disasters are part of a continuum, ranging far beyond the emergency situation to encompass prevention before the catastrophe to long-term rehabilitation after it. Emergency measures cannot be dissociated from this context; and it is important to recognise that effective relief depends on sound preparation, just as prevention or alleviation of the effects of future disasters depend on experience gained during earlier ones.
Furthermore, although they are very important, health problems are only part of the disaster picture. Other problems include reactivation of the economy, protection of the agricultural or industrial capacity, maintenance of law and order, and restoration of social structures. Also, the effectiveness of health action is entirely dependent on the functioning of administration, transport, communications and an entire network of services. It is therefore essential that the health intervention forms part of a whole series of measures to deal with the emergency situation.
Referring to a number of case studies conducted in countries of the Mediterranean basin following earthquakes, and their own experience, the participants then discussed the different problems encountered in dealing with emergency situations due to disasters.
The problems were studied from five points of view, by five working groups which considered the experience acquired by different groups of people, namely:
- people who were on the spot during an earthquake and were able to observe the reactions of the population during and after the disaster;
- people who were not on the spot but who were responsible for taking immediate emergency action (eg provincial administrators for the disaster area who received the first requests for assistance);
- people at a central level with responsibility for overall co-ordination of relief in the country and submission of requests for international aid (eg ministries of health or offices of the Red Cross or Red Crescent);
- people who came to the area immediately after the disaster, with the relief teams;
- people responsible for external aid.
It emerged from the group discussions that the problems of emergency assistance could be considerably reduced if efforts were made in three areas as follows:
- greater participation by health professionals in planning for emergencies;
- greater use of local resources of the community concerned for the provision of emergency assistance;
- better information for channelling of emergency aid.
The above requirements are complementary, and while it is essential that they be met in assistance after earthquakes, which are among the natural catastrophes that pose the greatest problems in providing emergency medical care, they apply equally to other disasters.
Conclusions and recommendations
1. Studies have shown that if first aid is to be effective it must be provided within hours of the disaster; it should therefore be an integral part of primary health care. Consequently, health staff at all levels who work in disaster risk areas should have the necessary training to enable them to work in emergencies. The content of the training should be developed on the basis of actual experience in recent situations.
2. Local health facilities (hospitals, health centres, dispensaries) should be designed to serve as meeting points and as survival centres or action centres for emergency care and co-ordination of health services on the site. During the first few hours they should also serve as focal points for collection and transmission of data on the severity and extent of the material damage and on the number of victims.
3. To allow for cases where the local health facilities are destroyed or put out of service, arrangements must be made for the twinning or preferably networking of units in areas which may or may not be contiguous, depending on the available means of access and communication, so as to allow rapid intervention by substitute facilities.
4. If external aid is to be effective, it must be given in response to specific requests and meet specific needs. Although, in the first few hours following a disaster, aid can be given to meet what are presumed to be the essential needs (rescue work, first aid, food, shelter), any overhasty and disorganised relief work carried out subsequently will only add to the confusion and cause chaos. It is therefore essential to channel the provision of external aid on the basis of information that is as correct as possible. In many cases it would certainly have been preferable to delay some outside interventions and thereby make them more effective, rather than acting in haste. It would undoubtedly be worthwhile to conduct studies in the countries at risk in order to decide which measures should be taken without delay, even on the basis of uncertain information, and those for which it would definitely be preferable to obtain additional Information even if this caused some delay.
5. Areas at particularly high risk of earthquake should be surveyed in advance with reference to: density of population, geographic situation, microzones, housing, vulnerable structures (public buildings) and the environmental hazards of industrial facilities, power plants, dams, piping systems, etc, and risks for specific population groups. The resulting risk maps should facilitate planning of appropriate measures for prevention (reinforcement or reconstruction), evacuation or rescue. Particular attention should be paid to hospitals.
6. In the same way an inventory of medical resources (infrastructure, equipment, personnel) should be prepared and kept up to date, to allow immediate mobilisation of available facilities. A list should also be made of suitable helicopter landing sites; added to this should be an inventory of standard supplies, equipment, tools and materials for survival, to allow rescue of the victims and effective medical care. In case this material should be lacking, arrangements should be made to construct depots at suitable locations throughout the territory.
7. Emergency health measures should be planned not only at national or provincial levels, but also at local and decentralised levels, to ensure that whatever measures are decided upon are implemented as rapidly as possible. This micro-planning calls for prior education of the public and this, in the short term, encourages local communities to assume responsibility for emergencies and, in the long term, helps to prevent the development of attitudes whereby the victims regard themselves purely as recipients of aid.
8. A system for rapid assessment of losses and damage is essential to channel the first aid and external assistance. An information system of this sort, which cannot be improvised, should be Incorporated in the information system for the basic health services. Also, because of the multidimensional nature of the problems caused by a disaster, the degree of uncertainty, and the urgent need for rapid action, the information should be identified, collected and analysed by specially qualified people. Assessment of losses and damage is often beyond the capacity of the local community and hence specialised staff or techniques (epidemiological evaluation by sampling, aerial reconnaissance) must be used.
9. Forecasting indexes and indicators for epidemiological evaluation (mortality, morbidity) in emergency situations should be simple and resiliant and allow immediate decision-making .
10. Information collected at the local level must be communicated to the higher level from a single source responsible for this function. This helps the national authorities both to direct and to channel external aid so as to meet the real needs. Machinery should be established at national level for declining or reorienting unsuitable offers of assistance.
11. External aid to the population in the disaster area should be appropriate to the needs and not duplicate the local human and material resources. It is particularly important to maintain strict control on the entry of volunteers whose services have not been requested.
12. Epidemiological surveillance (in the broad sense, as applied to all aspects of health) is an essential emergency response measure. It will not be effective, however, unless data on the situation before the emergency are available. The arrangements should be part of the area health information system, which should as far as possible be in existence prior to the disaster.
13. To strengthen co-ordination between human and veterinary epidemiological surveillance, it is recommended that more research be undertaken in this field, particularly with reference to long-term effects. Health authorities should pay particular attention to the veterinary aspects of natural catastrophes.
14. The epidemiological surveillance must not be confined to the emergency phase, but continue through the intermediate phase of restoration of normal conditions and subsequent rehabilitation. A system for evaluation of the impact of assistance is a key requirement, in the medium and long term. It is recommended that detailed epidemiological studies be conducted, in conjunction with WHO and specialists, on recent earthquakes in the Mediterranean basin. It would be very useful to establish a standing interdisciplinary consultative group, which could collaborate in such studies with the authorities of the countries concerned.
15. The measures for protection of the population in each country should be the subject of specific legislation, setting out the functions to be performed, the authorities responsible for them and the sources to be made available to them.
16. A system of international co-operation that could be mobilised immediately, be constantly on the alert, and be available to all the countries at risk, on request, might be more valuable than emergency services as such.
17. The effectiveness of international aid to a disaster stricken country naturally depends to a large extent on the machinery established beforehand to ensure co-ordination between the activities of the different international or government bodies involved and rapid communication with the country.
18. WHO should prepare guidelines for countries at risk, setting out the activities to be performed by the primary health services, the preventive measures to be taken by communities and the instructions to be followed by health staff at all levels.
19. WHO-sponsored courses should be organised to train teachers who could provide instruction on health problems in relation to natural catastrophes. Training standards should be established.
20. For countries so wishing, it would be useful to carry out a survey on their present capacity to deal with health problems due to disasters and to evaluate the changes that take place following the present workshop. The outcome of the survey and the results of the implementation of the recommendations should be the subject of a future workshop.
21. WHO should co-ordinate the work of other international bodies; there is a need to clarify their responsibilities, particularly in order to simplify the work of governments. WHO should organise for countries so requesting a technical group on evaluation and identification of appropriate international aid.
22. Noting the proposal of the Italian participants to convene a
further WHO-sponsored workshop in Italy in 1982 on the same topic, with the
specific objective of evaluating the results and implementation of the
recommendations, it would be advisable in the meantime to make a survey of the
capacity to deal with health problems due to earthquakes. The findings of the
survey should provide a basis for the discussions at the next