HEALTH RELATED ISSUES IN DISASTERS Knowledge comes, but wisdom lingers ( Tennyson)

Pan American Health Organization (PAHO) Established in 1902Established in Member Governments35 Member Governments 3 Participating European Governments3 Participating European Governments PAHO serves as regional office for WHOPAHO serves as regional office for WHO

Program on Emergency Preparedness and Disaster Relief Pan American Health Organization / World Health Organization PAHO / WHO

NATURALDISASTERS OTHERS VOLCANICERUPTIONS HURRICANES FLOODS EARTHQUAKES LANDSLIDES

TECHNOLOGICALDISASTERS OTHERS CHEMICALACCIDENTS EXPLOSIONS FIRES AIRCRAFTACCIDENTSRADIATIONACCIDENTS

“COMPLEX”DISASTERS Refugees, IDP ARMEDCONFLICTS CIVILSTRIFE

Latin America and the Caribbean move from Ad Hoc Disaster Response to Prevention Disasters and Development Mitigation and Preparedness Preparedness and Response Response 1976Earthquake in Guatemala 1985Earthquake in Mexico 1990IDNDR

Program Objectives Before a Disaster After a Disaster Prevention,Mitigation,Preparedness Coordination of International Assistance

Before a disaster Building national capacity through training( standardized but adapted to local context)Building national capacity through training( standardized but adapted to local context) Strengthening Ministry of Health disaster programsStrengthening Ministry of Health disaster programs Special projects:Special projects: Promote Hospital mitigationPromote Hospital mitigation SUMASUMA CRIDCRID

Human Resources Development, not stockpiling equipment, is the key to Preparedness... University training Workshops/ short courses

The National Health Disaster Program must: encompass entire health sectorencompass entire health sector lead the health sector in disaster prevention, mitigation, preparedness, response, early rehabilitationlead the health sector in disaster prevention, mitigation, preparedness, response, early rehabilitation have a multi-hazard scope (natural, technological, “complex” disasters)have a multi-hazard scope (natural, technological, “complex” disasters) coordinate with other sectorscoordinate with other sectors Strengthening Institutions

Belize Karl Heusner Hospital Hurricane Keith Photo Tony Gibbs

Photo Tony Gibbs

The WHO/PAHO standardized methodology and tool to manage large amounts of humanitarian supplies.

Regional Disaster Information Center 12,000 documents on disaster-related topics12,000 documents on disaster-related topics “THE” source of material in Spanish“THE” source of material in Spanish Internet AccessInternet Access

PAHO/WHO Cooperation in Disasters Coordinates International Health AssistanceCoordinates International Health Assistance Provides Technical Cooperation in healthProvides Technical Cooperation in health Assist with rapid needs assessmentAssist with rapid needs assessment Coordination with Foreign Affairs, Ministry of Health, National Disaster Agency, UN Org.’sCoordination with Foreign Affairs, Ministry of Health, National Disaster Agency, UN Org.’s

External assistance post disaster PAHO/WHO European Union/ ECHO OAS SICA/ CEPREDENAC Convenio Hipólito Unánue (CHU) CDERA Canada USA United Kingdom Nordiccountries Netherlands France Japan DHA/UNDP WFP WHO/PAHO UNICEF UNFPA UNHCR OXFAM MSF CARE CRS Local NGO PADF Red Cross National Societies IFRCS ICRC

Assistance to disaster affected country Japan, UK, USA/OFDA, Red Cross, ICRC, UNDP, CARE, MSF, UNDAC. CIDAJapan, UK, USA/OFDA, Red Cross, ICRC, UNDP, CARE, MSF, UNDAC. CIDA The Netherlands,ECHO, ICRC, local NGO, IFRC, OXFAM, OCHA, CDERA, RSS, CARICOM, OAS,The Netherlands,ECHO, ICRC, local NGO, IFRC, OXFAM, OCHA, CDERA, RSS, CARICOM, OAS,

SUB-REGIONAL AGENCIES CDERA/CEPREDENACCDERA/CEPREDENAC RSSRSS PAHOPAHO Federation of the Red CrossFederation of the Red Cross OFDAOFDA AgreementsAgreements

National Support Network Health Disaster Focal PointsHealth Disaster Focal Points –Ministries of Health –PAHO/WHO Disaster Focal PointsDisaster Focal Points –Foreign Affairs,UN agencies

The principles of Coordination and national responsibility Generating reliable InformationGenerating reliable Information Developing technical experienceDeveloping technical experience Cultivating the credibilityCultivating the credibility – Learning to say “no” –serving the health sector rather than the donors

International Assistance in Perspective... ASSISTANCE FROM WITHIN THE COUNTRY EXTERNAL ASSISTANCE (1-2%) BILATERAL MULTILATERAL NGOs

Health & Disasters Immediate NeedsImmediate Needs –Managed by local emergency response –Short Term Needs –Water, Shelter, food, medicines Epidemiological Surveillance, Etc. Long Term NeedsLong Term Needs –Rehabilitation of Health Infrastructure,

Health Related Issues MythsMyths –External Emergency Assistance (SAR, field hospitals and surgeons) needed –Any donation is Acceptable –Disease Outbreaks Occur w/in the Population or from dead bodies –Immunization is Necessary

Reality Local response within the first daysLocal response within the first days Public health problems and population displacement are more frequent and of slow onset.Public health problems and population displacement are more frequent and of slow onset. In kind unsolicited donationsIn kind unsolicited donations Dead bodies are DEAD, no epidemicsDead bodies are DEAD, no epidemics Rehabilitation of hospitals and water system needed when donors and media interest decreaseRehabilitation of hospitals and water system needed when donors and media interest decrease

Conclusion Disaster management is a multi sectorial and multi hazard business, so should training beDisaster management is a multi sectorial and multi hazard business, so should training be Many actors, therefore coordination remains a problemMany actors, therefore coordination remains a problem Local presence and involvement in preparedness and training ensures a good response when necessaryLocal presence and involvement in preparedness and training ensures a good response when necessary

FROM ONE EXTREME TO THE OTHER 1980’s National sovereignity of the affected country is absolute 1990’s Donor country knows best!