Should disaster relief strike : be prepared! / by Claude de Ville de Goyet and Patricia Bittner

Should disaster reBel strike be prepared! - by Claude de Ville de Goyet and Patricia Bittner "i don 't even know where to start. All I can say is that I am more ~ than shocked and still suffering - from shock with the tragedy that has occurred on the island of Montserrat. I must say that I've never seen anything like this in my whole life. I've lost everything I've got. " Outside Plymouth, the capital of Montserrat, a tiny island of 12,000 inhabitants in the West lndies, a sur- vivor of the 1989 Hurricane Hugo movingly recounts his experiences before the cameras. "We must have a solution for the simple reason that all these families are living out of doors . . . Were trying to find out about food . .. No one can tell us anything directly This entire area has been forgotten; it wasn 't reported as being among the damaged. " In Mexico City, anxiety runs high among the hardest-hit survivors of the 1985 earthquake. Yet despite the massive destruction, the overwhelming majority in this metropolis of 18 million inhabitants were not affected. Dr Claude de Vi/le de Goyet is Chief of the Emergency Preparedness and Disaster Relief Coordination Programme at AM RO in Washington. D.C., and Mrs Patricia Bittner is Techni - cal Information Officer with the same programme. Thousands of miles away, far removed from the ravages of nature (at least for the moment), people will watch such scenes on the evening news broadcast or will read about them in the press. The pain is real, the need is genuine. How can one remain unmoved by these catastrophes? How can one possibly resist the urge to send any kind of international aid, and to send it now? In an often-repeated reaction to sudden and brutal tragedies through- out the world, the public races to collect used clothing and canned food, 10 and to empty their medicine cabinets, keeping in mind the distressing scenes they have witnessed. But are these well-meaning people taking the most useful course of action, or are they perhaps compounding the problem? A mixed blessing It is difficult to convince anyone, particularly those who have just been hit by an earthquake, hurricane or volcanic eruption, that international assistance is a mixed blessing. It is crucial to helping a country get back on its feet. But when unsolicited aid does not meet a country's real needs, it competes for attention and space with other more pressing needs, makes the situation even more chaotic, and ulti- mately can lead to a second disaster. WHO/PAHO/ C. Gaggero Imagine for a moment thousands of boxes and containers stacked up at the airport or harbour of a disaster-stricken country. These hastily-assembled donations are unmarked, revealing no clue as to their contents. Do they contain unsuitable clothing, perishable food, or expired medical supplies? Or, on the contrary, are they full of urgently needed supplies? The disaster managers are already overburdened, yet the only way to find out is to take health personnel away from other more important duties to sift through the boxes, sort and classify the dona- tions, label them and store them somewhere until a makeshift distribu- tion system can be devised. Given the urgent problems they face, it may be weeks or months before the appro- W ORLD HEALTH. January -February 1991 Scenes of destruction in the wake of Caribbean hurricanes; a woman smveys her roofless home in Montserrat, and a twin-engined plane "parked" in the trees in Jamaica. priate donations can be distributed. As for the rest, it will be stowed away, since simply disposing of it might create an unneeded political uproar. Health assistance to victims of earthquakes, cyclones, floods and other sudden-impact natural calamities can be effective if we keep several premises in mind. Emergency assistance should com- plement, not compete with, efforts undertaken in the affected country. Most sudden-impact disasters do not affect the entire country (although in the Americas the exception was tiny Montserrat which lay in the direct path of a hurricane.) Generally citizens from unaffected areas of a country donate an abundance of food, clothing and other personal items which are well- suited to local needs. What is needed WOR LD HEALTH. January - February 1991 and what is not available locally: specialised skills, sophisticated tech- nology and replacement of medical supplies used during the emergency. In the medical field, almost everyone, from the country next door to the medical associations all over the world, will tend to focus on the same, highly-publicized and visible needs. WHO's Emergency Health Kit lists those drugs and medical supplies that are appropriate not only for emer- gency situations but are needed under any circumstances. Don't overreact to media images. Despite the tragic images that seem to appear virtually within hours of a major disaster, it is important to wait for the country itself, through its health services, to let the world know what its real health needs are. By providing disaster specialists experienced in the quick assessment of needs, WHO's cooperation has proved instrumental in speeding up a reliable diagnosis of the health situation. It is unlikely that medical volunteers from far away will save lives. The most urgent life-saving medical procedures are usually completed within the first 24 hours. It is simply not possible for medical teams from distant countries to arrive in time to save lives. Most countries in Latin America and the Caribbean have a large pool of medical personnel. They are just as moved by the tragedy and will volun- teer their services. And over the last ten years, an ever-growing percentage of these professionals have received training in disaster preparedness through WHO and PAHO (Pan Amer- ican Health Organization) seminars and workshops. So what can people and agencies do to show their solidarity with a disaster-stricken country? Recognise the fact that each country has its own way of dealing with natural disasters. Perhaps this is not exactly the way things are done in your country; maybe it takes a little longer to assess the situation. But generally, the national health services have the most realistic picture of the country's health needs and definitely the final say on what constitutes appropriate assistance. Whenever possible, donate cash, and channel it through well-established agencies which have been active in the country even before a disaster strikes. These organizations have a long- standing relationship with the local population and are in the best position to understand the post-disaster situation. Despite the fact that most relief organizations rely on public donations to sustain themselves, reput- able organizations can be expected to sacrifice an immediate and highly- visible relief effort, (and the ensuing revenue it may generate), by waiting until the country concerned de- termines exactly what it needs. Don't be a burden Refrain from travelling to the dis- aster site unless you are certain that you are needed and wanted. It is very easy to become a burden to the local health authorities if they have to provide shelter, food, transport and translation services for foreign medical personnel, especially when what the person has to offer can just as easily be provided by a citizen of the affected country. Although personally it is much less rewarding, it might be preferable to donate the money that would have been spent travelling to the scene of the disaster. Do not turn the page too quickly - as the headlines fade, so too do the interest and support of the public. With 11 Should disaster relief strike the devastating images fresh in the minds of a caring world community, a disaster-stricken country may find itself deluged with support immediately after the impact. But several weeks later, the tragedy and the urgency have faded. Other news, perhaps even that of another disaster, fill the front pages. Unfortunately, this is just when the people and the health sector are beginning to need the most help from the international community. As the Prime Minister of St Lucia (a neigh- bour island of Montserrat) stated after Hurricane Hugo: 'The response from the international community has started to come in ... Jamaica has sent assistance, Barbados has sent some people. Dominica has sent some assis- tance. The Caribbean community has also sent assistance. We appreciate the immediate response. But we are look- ing for continued assistance over the long run to reestablish the infrastruc- ture." . Does the public hear this plea clearly enough? After several weeks, disaster-stricken countries have exhausted their own emergency stocks and face the draining chore of dealing with medium- and long-term needs. Yet sometimes donors are more eager to spend US $500,000 to "loan" and airlift a mobile field hospital for just a few weeks than to donate $300,000 to permanently rehabilitate or rebuild a hospital. Some highly-visible gestures are politically good for donors, but Relief supplies arrive in Montserrat, hard-hit by Hurricane Hugo in 1989. 12 medically, for the victims of earth- quakes and other short-duration natu- ral disasters, they are ineffective. It would be unrealistic and unwise to try to stem the tide of well-intentioned donations that are sent to a disaster- stricken country. It may not even be necessary. For today, health sector disaster managers are noting that the patterns of providing aid are changing, and many donations are having a positive and beneficial impact on those they are intended to assist. We would like to think that in some small measure this may be due to continuing work by such bodies as WHO/ PAHO, the League of Red Cross and Red Crescent Societies, and others. But certainly WHO, as the body that coordi- nates the international health response to disasters, should pursue its efforts to make post-disaster assistance more effective in meeting the genuine short- and long-term needs of the victims. A concerned public For any country vulnerable to national calamities, it is comforting to know that, should disaster strike, they need not face it alone. It is reassuring to know that there is a concerned public, ready to send aid that tran- scends ethnic, racial and religious boundaries. In Mexico City, a relief worker hastily scrawled a sign and hung it over the entrance to a ware- house filled to capacity with donations for the victims of the devastating 1985 earthquake. This sign probably said it all more succinctly and movingly than anything else. It read: "Gracias, henna- nos"- thanks brothers. • WHO/PAHO A living library The video crew of the Pan Amer-ican Health Organization (PAHO/ AMRO) has travelled with the organization's Disaster Assessment and Response Team to the site of every major disaster in the Americas since 1985. Hurricanes can give them as much as two or three days warning. But they are so unpredict- able that the crew may be left sitting on the wrong Caribbean island for a day or two until weather conditions allow them to reach the stricken area. At other times, there is no advance warning. This was the case when the Nevada del Ruiz volcano erupted in Colombia, burying the city of Aimero under tons of mud and killing 23,000 victims. A day's work had just begun when word of the disaster reached PAHO. As 'the Organi- zation's Emergency Preparedness Programme went into top gear, the video crew scrambled to pack their gear, filling three trunks that weighed more than 100 kilos. Under these and other difficult circumstances, PAHO's video and photo team has brought back a wealth of material on the health consequences of disasters; every- thing from the disaster's impact on hospitals and clinics to damage to water supply systems; from impro- vised vaccination campaigns to the mass handling of corpses. This material has been greatly enriched by on-the-spot interviews with survivors, disaster managers, national health authorities, non- governmental organizations, and others. Today, PAHO's library of footage on the health aspects of disasters is . certainly among the best in the world. But it is more than just a collection of videotapes. lt is a "living library" that preserves the institutional disaster memory of the health sector in the Americas. lt is also the source for a variety of disaster preparedness training pro- grammes produced through PAHO. In recent years, the document- aries have reached wider audi- ences. Myths and Realities of Natural Disasters, made primarily for the general public, has also been used frequently by the media and groups working in this field. Its novel approach debunks traditional myths associated with the impact of disasters on health, just as mythological explanations of the origins of disasters have been dispelled by scientists. Myths and Realities has also been released in French, Japanese, Portuguese, Spanish and Creole, and more than 1 ,000 copies have been distributed worldwide. WORLD HEALTH. January -February 199 1