Decision-making for emergency preparedness

The increase in global vulnerability

Major emergencies and disasters have occurred throughout history and, as the world’s population grows and resources become more limited, communities are increasingly vulnerable to the hazards that cause disasters. Statistics gathered since 1969 show a rise in the number of people affected by disasters (see Fig. 1). However, since there is little evidence that the actual events causing disasters are increasing in either intensity or frequency, it can only be concluded that vulnerability to disasters is growing.

Emergencies and disasters do not affect only health and well-being; frequently, large numbers of people are displaced, killed or injured, or subjected to greater risk of epidemics. Considerable economic harm is also common, and Fig. 2 shows how economic and insured losses have risen since 1960. This has led to a restructuring of the insurance industry, with insured parties bearing more costs, and governments assisting the insurance and reinsurance markets (2). Uninsured and economic losses are creating immense burdens on communities, economies, and governments. As Fig. 3 shows, these disasters are not confined to a particular part of the world; they can occur anywhere and at any time.

A disaster can be defined as any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area (3).

A recent Latin American study indicated that for each disaster listed in officially recognized disaster databases, there are some 20 other smaller emergencies with destructive impact on local communities that are unacknowledged. Hence, the actual harm caused by emergencies and disasters probably far outweighs the accepted disaster statistics.¹

¹Maskrey A. Communication at Seventh Scientific and Technical Meeting of the International Decade for Natural Disaster Reduction, Paris, 1995.

Fig. 1. Number of people reported annually as affected by disasters^a (WHO 97542)

^aReproduced from reference 1 by permission of the publisher.

Fig. 2. Economic and insured losses from natural disasters, 1960-1996^a

^aReproduced from reference 2 by permission of the publisher.

Fig. 3. Number of disasters with natural and non-natural triggers by global region in 1994^a (WHO 97544)

^aReproduced from reference 1 by permission of the publisher.

Fig. 4. Value of humanitarian assistance (in US$) by year^a

^aReproduced from reference 1 by permission of the publisher.

Disasters are causing greater harm to people, communities, and countries every decade, affecting current populations and existing infrastructure and threatening the future of sustainable development.

Clearly, neither communities nor governments can afford to wait for emergencies and disasters to occur before responding to them. The suffering caused by injuries and deaths, social and economic disruption, and the destruction of the environment can be reduced through various measures designed to reduce vulnerability.

The effects of inappropriate humanitarian assistance

Often, the international community’s reaction to disasters is to provide large amounts of humanitarian assistance and increased aid to the affected countries or communities. This might appear a fairly simple solution - to reduce short-term suffering and allow the community to rebuild. Figure 4 shows how humanitarian assistance has increased over the last three decades, from US$ 3 million in 1969 to US$ 3.2 billion in 1993. In 1995, it exceeded US$ 4 billion. Estimates show that, in 1980, global humanitarian assistance formed less than 1% of total overseas development assistance and that this figure had increased to 7% in 1993 (4).

Fig. 5. How humanitarian assistance can increase vulnerability (WHO 97546)

Frequently, humanitarian assistance takes the following course. It is not requested by the affected country and not integrated with the country’s normal services or with community development. Assistance funds are diverted from those otherwise provided for development, thus reducing development opportunities in areas most vulnerable to emergencies and disasters. Delivery channels that parallel existing national channels are established for allocating and managing these assistance funds, leading to inefficiency and undermining existing development programmes. Hence, humanitarian assistance that is not properly coordinated at the national and community level can increase vulnerability and lead to greater dependence on further assistance, further social crises - and a need for more humanitarian assistance (see Fig. 5).

Badly coordinated humanitarian assistance clearly is not the answer and is a poor investment of time, resources, and money. Effective emergency preparedness, however, built in at an early stage, can establish the necessary structures and processes for an affected country to integrate humanitarian aid - provided only when requested - within its infrastructure in a cost-effective manner.

Vulnerability reduction and the focus on communities at risk

Coordinated efforts are also needed to halt emergencies and disasters by tackling the source - the deteriorating environment, the hazards that bring harm to communities, the vulnerability of communities to those hazards. Such efforts may be collectively termed “vulnerability reduction”.

Vulnerability concerns the interaction between a community, its environment, and hazards. A community is the smallest social grouping in a country with an effective social structure and potential administrative capacity. The environment is the surrounding support system and processes. Hazards are the potential sources of emergencies of natural, technological, or social origin. A community interacts with its environment and its hazards. This interaction can be positive, resulting in vulnerability reduction and in development, or negative, resulting in a series of crises and emergencies, as well as setbacks in development initiatives.

Vulnerability to emergencies and disasters is a function of the degree of exposure to hazards and of people’s capacity to cope with hazards and their consequences.¹ Community vulnerability has two aspects: susceptibility, the degree to which a community is exposed to hazards, and resilience, the community’s capacity to cope with hazards. It is possible for a community to have either high or low susceptibility and resilience.

¹Vulnerability is different from “vulnerable groups”, such as the aged, women, children, the sick, and the poor. An assessment of vulnerability may identify and describe vulnerable groups, but this is only part of the overall picture. Vulnerable groups have differing degrees of susceptibility and resilience, and exist within the context of communities that themselves have differing degrees of susceptibility and resilience.

For example, many communities are susceptible to frequent severe earthquakes because of their geographical position and geological environment, while others do not experience them. Of the susceptible communities, some, like San Francisco, and many communities in Japan, are highly resilient and some, like Armenia, less resilient. This difference in resilience can be due to:

- different abilities of buildings, and various elements of the infrastructure, to withstand seismic loads;

- differences in emergency preparedness (i.e. the degree to which a community is organized to cope with emergencies);

- the extent of the resources that can be applied to an emergency;

- the degree to which the province or nation can sustain economic and social damage.

The vulnerability of units smaller and larger than a community, such as individual buildings, organizations, national economies, and political structures, can also be described in terms of susceptibility and resilience.

Vulnerability reduction requires a number of coordinated activities, including:

- policy development;
- vulnerability assessment (to describe the problems and opportunities);
- emergency prevention and mitigation (to reduce susceptibility);
- emergency preparedness (to increase resilience).

Without vulnerability assessment, communities will not know in what way they are vulnerable and how hazards may affect them. Without emergency prevention or mitigation, communities are exposed to unnecessary risk. Without emergency preparedness and response mechanisms, an emergency can escalate into a disaster, causing great harm and setting development back years. These aspects of vulnerability should all be addressed by any national policy (see Fig. 6).

Vulnerability assessment, also known as “hazard analysis” and “risk assessment”, is based on a series of techniques for determining the hazards that may affect a particular community, and the impact they may have. It also determines what factors make the community vulnerable to emergencies and disasters, by analysing the community’s social, infrastructural, economic, and demographic composition.

Fig. 6. Vulnerability reduction (WHO 97547)

Fig. 7. Number of cases of malaria following Hurricane Flora, Haiti, 1963^a (WHO 97548)

^aAdapted from reference 5.

Emergency prevention and mitigation involve measures designed either to prevent hazards from causing emergencies or to lessen the likely effects of emergencies. These measures include flood mitigation works, appropriate land-use planning, improved building codes, and relocation or protection of vulnerable populations and structures.

Emergency preparedness requires that emergency plans be developed, personnel at all levels and in all sectors be trained, and communities at risk be educated, and that these measures be monitored and evaluated regularly.

For example, Fig. 7 shows the prevalence of malaria before and after a hurricane. Malaria is just one of the health aspects of this emergency, and health is just one of the sectors affected. Emergency preparedness is required in the health sector to deal with the rapid changes in environment and disease brought about by emergencies.

A lack of preparedness will strain medical services and may ultimately impair development through increased morbidity and mortality in the population.

Because communities may be vulnerable to a broad range of hazards, the all-hazards approach should also be adopted. This approach entails developing strategies for all of the needs created by different types of potential emergencies. Each possible hazard can cause similar problems in a community, and actions such as warning, evacuation, mobilization of medical services, and assistance with community recovery may be required during and following emergencies. Thus, emergency preparedness can be based on common strategies and systems for the many different types of emergencies and disasters that might harm a community.

Certain hazards are of neither natural nor technological origin. Many forms of social exclusion can lead to social unrest, economic disruption, and violence. Such social exclusion may be caused by marginalization of the poor, tension between different ethnic and cultural groups, and other social inequities. One of the primary aims of development programmes with an integrated emergency preparedness component is to defuse potentially explosive social situations, and ensure the safety and security of the community.

Thus, vulnerability reduction addresses susceptibility by dealing with the causes of emergencies and disasters, and resilience, by strengthening communities that are still at risk.

Vulnerability reduction and development

Just as inappropriate humanitarian assistance can increase vulnerability, so vulnerability reduction can protect and enhance development. But how are vulnerability, hazards, and emergencies related to development?

It has been said that the purpose of development is to broaden people’s range of choices. At the heart of this concept are three essential components:

- equality of opportunity for everyone in society;

- sustainability of opportunity from one generation to the next;

- empowerment of people so that they participate in and benefit from development processes (6).

Vulnerability to hazards is not spread equally throughout communities, and vulnerability reduction thus helps ensure equality of opportunity by reducing the susceptibility to harm of vulnerable groups. Emergencies are a direct threat to development, diverting development money to humanitarian assistance and damaging the structures that assist development. Vulnerability reduction is, like development, a process of empowering communities to take control of their own destinies.

Investing in vulnerability reduction protects human development achievements. Emergency preparedness also helps stricken communities limit the consequences of major emergencies and overcome them at an early stage, allowing development to resume.

Figure 8 illustrates how prepared communities can maintain and improve their level of development, despite emergencies. A prepared community will react to a potential disaster effectively, perhaps limiting it to the level of an emergency.

Fig. 8. The effects of disasters on the development of prepared and unprepared communities (WHO 97549)

Fig. 9. Emergency management cycle^a (WHO 97550)

Note: Emergency management and development are linked. Prevention and preparedness measures should be integrated into development planning, in order to minimize the disaster impact. Response and rehabilitation are humanitarian activities which should contribute to sustainable development. Emergency management is a continuing process which is relevant not only at the time of the disaster impact, but also as an integral part of sustainable development.

^aReproduced from reference 7.

Thus, although the event may affect community development, its impact will be tempered. An unprepared community, however, may take years to recover from a severe setback in development.

Preparedness is a feature of many successful organizations in the world today. When a new or existing programme in an organization is being assessed, the risks, costs, and benefits are analysed. This allows the organization to ensure that its investment is protected, leading to a more secure future. These risk-management practices can be applied to communities: vulnerability reduction and emergency preparedness components should be built in to each new development, and whenever existing developments are reviewed (see Fig. 9).

The comprehensive approach combines prevention (and mitigation), preparedness, response, and recovery (rehabilitation). It is important that all sectors and organizations are active in each of these areas.

The responsibility for vulnerability reduction

Vulnerability reduction is often perceived as the exclusive domain of one organization, sector, or level of society and government. But a disaster - by definition - exceeds the coping capacity of an entire community, and no single sector can manage vulnerability. Therefore, vulnerability reduction must be integrated into every sector of a country at every level - government, the private sector, and nongovernmental organizations (NGOs) - that is, both vertically and horizontally. Policy and standards for vulnerability reduction should come from the national level but implementing the various measures should begin at the community level (see Fig. 10). Six sectors at each administrative level should be involved in implementation, with a representative task force to coordinate the work. These sectors are: communications, health, police and security, search and rescue, social welfare, and transport and “lifelines”.

Fig. 10. Vertical and horizontal integration of vulnerability reduction (WHO 97551)

Other sectors, such as education and environment should be included as appropriate, bearing in mind that vulnerability reduction must be integrated within the political and administrative context of each country.

The most successful management system for emergencies and disasters will be multisectoral and intersectoral. The multisectoral and intersectoral approach is one in which all organizations - government, private, and community - are involved in emergency management. Emergency management may entail different priorities for specific organizations (8), including:

- protecting their own interests and personnel;
- protecting the community from hazards arising from the activities of the organization;
- providing a public service to protect the community from likely hazards.

However, the emergency management work of each organization must be brought under a single, coordinated umbrella. If this approach is not applied, emergency management becomes fragmented and inefficient (7). The multisectoral and intersectoral approach will also help link emergency management to development, by institutionalizing emergency management and the use of its principles in development projects.

A key aspect of the multisectoral approach is that emergency management neither duplicates normal government administration nor acts independently of government. The control of government organizations should not be considered except in exceptional emergency circumstances.

In particular, it is imperative that organizations are not limited to the areas of emergency management in which they seem most active. So-called “response” and “relief” organizations should participate in all aspects of emergency management, including vulnerability assessment, prevention, mitigation, and preparedness.

Despite governmental and organizational involvement in emergency management, the community link remains the most critical one. Policy and standards must be defined by the national government, but communities should be allowed to develop and implement their own vulnerability reduction and emergency preparedness programmes because they will be the first to respond to emergencies. Provincial and national levels will support communities in their work, and the national government will provide the connection with international organizations and other countries.

Community emergency preparedness

The need for community-level emergency preparedness is illustrated by the live rescue rates following the Great Hanshin-Awaji (Kobe) earthquake of 17 January 1995 (see Fig. 11). Sixty-five percent of live rescues were accomplished in the first 24 hours. Within the first 3 days, the Kobe Fire Department had made 86% of their live rescues (9). Similarly, in the 1988 Armenian earthquake, 65% of the live rescues were made within the first 18 hours (10).

Fig. 11. Live rescues made by the Kobe Fire Department following the Great Hanshin-Awaji (Kobe) earthquake^a (WHO 97552)

^aReproduced from reference 9 by permission of the publisher.

Only those in the immediate vicinity of an emergency or disaster, i.e. community members, can respond quickly and effectively. A community prepared for emergencies can rescue people rapidly and provide life-saving first aid: reliance on external assistance will lead to greater loss of life and harm to the community.

Because the community provides initial rescue and first aid, its capabilities should never be underestimated and with effective emergency preparedness these can be used to their utmost.

“It is the victims of disaster who take action first to protect their lives, whether digging a neighbour out of the rubble after an earthquake or sifting through the city garbage to find things to sell and food to eat when drought turns grinding poverty into famine. If disaster relief is to be successful, it must build upon this tenacity for survival, working in partnership with, not imposing upon, the disaster victims.” (11)

It has been shown that mortality rates in some types of emergencies can be reduced by 10% by simply placing the injured in the “lateral safety” or “coma” position. External humanitarian assistance may arrive too late, and may not be appropriate. If preparedness measures are taken seriously, families and the whole community will learn this type of self-reliance.

Local communities are at the centre of immediate response and recovery activities. Empowering local authorities to reduce a community’s vulnerability and increase preparedness makes the most effective use of its action. Every level of government and each organization should support communities in this work, through the multisectoral approach.

The individuals in a community are responsible for maintaining its well-being. External assistance may be expected but it should not be relied on. Community members, resources, organizations, and administrative structures should be the cornerstones of an emergency preparedness programme. Listed below are some reasons that communities should prepare for emergencies (7, 11):

· Members of a community have the most to lose from being vulnerable to disasters and the most to gain from an effective and appropriate emergency preparedness programme.

· The positive effects of preparedness programmes can be best measured at the community level.

· Resources are most easily pooled at the community level and every community possesses capabilities. Failure to exploit these capabilities is poor resource management.

· Those who first respond to an emergency come from within a community. When transport and communications are disrupted, an external emergency response may not arrive for days.

· Sustained development is best achieved by allowing emergency-affected communities to design, manage, and implement internal and external assistance programmes.

· Excessive or inappropriate external assistance can destroy self-reliance and normal social and economic patterns, as well as increase both vulnerability and dependence on provincial, national, and international organizations.

This does not mean that each community should introduce a disaster management programme. Most communities are adequately prepared to deal with the harm caused by minor emergencies because experience has taught them to establish the necessary systems and resources. Existing routine emergency experience, organization, and resources can be built on to create disaster management preparedness.

Emergencies arise every day worldwide. An emergency can be defined as:

“A sudden occurrence demanding immediate action that may be due to epidemics, to natural or technological catastrophes, to strife or to other man-made causes.” (3)

Emergency management strategies can be used to prevent and respond to disasters. Methods for coping with severe road traffic accidents can be adapted to disaster rescue and medical services. The emergency management infrastructure can be employed to manage potential disasters since disasters are but the extreme end of the spectrum of harmful events.

“Disasters are an extreme example of normal processes. The normal seasonal hunger turns into famine, the normal annual flood reaches its 20-year high point and the normal rise and fall of economic fortune plummets into economic collapse.” (11)

Emergency management systems and strategies can be used to prevent disasters, despite limited resources for such activities, by better organizing established community resources and building on existing capabilities.