(introduction...)

When looking at health manpower sent to disasters it is logical to divide them into those involved in European disasters and those going to third world countries.

European disasters

Within Europe the personnel demand was for short sudden impact disasters. Where they existed, the main burden of relief, fell upon civil defense and other organisations which can act appropriately. Training here is not exclusively a postgraduate matter and the workshop was conscious that training within organisations needs to be closely integrated with courses of the types proposed.

Third world disasters

A questionnaire was sent to the main European nongovernmental agencies who sent health personnel during 1980-81 to third world disasters, those who replied gave information on more than 700 personnel; of these the largest single group sent to work in the field were nurses (see Table 1). Less than 17% were from professional groups such as nutritionists, water and sanitation engineers, dentists, etc.

Table 1
BREAKDOWN OF HEALTH PERSONNEL

Doctors	33%
Nurses	50%
Other	17%

This is significant because skills in the provision of water supplies, sanitation, logistics, transportation and nutrition, agriculture and administration were needed as much if not more than basic curative care. In future, therefore, either agencies should send a larger proportion of appropriate people, or doctors and nurses need to be given a wider training to encompass these necessary skills.

Over three-quarters of those sent went to refugee camps or war situations in Africa and the Far East with virtually none going to acute disasters (see Tables 2-3). In the past the relief phase in the latter situation generally is too short for help from outside to arrive in time and in these situations the work therefore was done by local organisations.

Table 2
GEOGRAPHICAL DISTRIBUTION OF HEALTH WORKERS

Africa	50%
Asia	40%
Middle East	7%
Latin America	2%
Other	1%

Table 3
PERSONNEL SENT TO DIFFERENT TYPES OF DISASTERS

“Camp” (refugees or displaced persons)	66%
War	21%
Famine	0%
Natural (sudden)	13%

Deficiencies in quality

European disasters

Common failures are:

· delay in assessing the severity of the situation;
· poor co-ordination and planning
· delay in providing first aid
· ignorance of the principle of triage
· poor logistics of supply and referral
· inappropriate relief arriving too late
· personal difficulties of relief workers
· failure to understand the relationship of disaster
· relief to primary health care.

Some of these issues were discussed at the WHO workshop on natural disasters held on 22-25 November at Rabbat (see Appendix IV).

Disasters in the third world

As stated earlier large numbers of European personnel are sent overseas having been recruited by mainly nongovernmental agencies. While there has been some improvement, these workers are often poorly prepared for those tasks which are asked of them. Often too, they are young, inexperienced and poorly briefed.

Common failures are:

· Overemphasis on disease

· Overemphasis on working in clinics as against in the community

· Using inappropriate high technology

· Cultural insensitivity

· Ignoring local resources especially manpower and equipment

· Providing a level of health care which cannot be maintained after the emergency.

· Ignorance of community health including epidemiology, water, sanitation, nutrition and tropical diseases

· Lack of emphasis on training.