Preserving health standards during emergencies

6 World Health • 49th Year, No.6, November-December 1996 Preserving health standards during emergencies Samir Ben Yahmed & Robin Gray Emergency management was long thought to need little special technical or professional competence. But the climate is changing and today there is increased understanding of the normative role that WHO con and does ploy in this area. Yl:O's normative role in-olves setting standards and gtving guidance on health- related matters for governments, institutions, organizations and indus- try. This is usually done through meetings which bring together the experience and expertise of interna- tionalleaders on health matters and through reports. The aim is to ensure that health standards are ethically acceptable and technically effective. Emergency management was long thought to need little special technical or professional compe- tence. But the climate is changing and today there is increased under- standing of the normative role that WHO can and does play in this area. Health standards are just as applica- ble to emergency situations, where the need is to be prepared and to reduce vulnerability, as they are to drugs. Inevitably, major emergencies have a destructive impact on devel- opment. A more scientific and technical approach to emergency management is needed to limit this Armed conflict overburdens health facilities with those wounded in the fighting impact. The United Nations General Assembly designated the 1990s as the International Decade of Natural Disaster Reduction (IDNDR), focus- ing on the cycle of prevention, mitigation, preparedness, response and recovery. A council and a scien- tific technical committee for the IDNDR were established. They bring together some of the most renowned scientists in the field, with the aim of gearing international efforts to a more scientific approach in dealing with natural disasters. WHO has played a key role in promoting the IDNDR strategies and goals. As the specialized agency for health, WHO has exercised leader- ship in designing and developing approaches, norms and technical references in this field . WHO's work in this area can be grouped for convenience into several overlap- ping categories. Activities include working out conceptual approaches, framing country programmes, draw- ing up technical standards, providing training and selecting indicators. Conceptual approaches The design and promotion of new approaches and concepts have been undertaken within the IDNDR through a number of jointly orga- nized meetings and conferences. Thus two main plenary sessions of the World Conference on Natural Disaster Reduction were arranged by WHO and resulted in valuable guidance on how the public sector, private sector and voluntary organi- zations can work together. WHO strongly advocates a multisectoral approach to emergency manage- ment, involving vulnerability analy- sis and joint planning. It also promotes the idea of integrating vulnerability reduction components into sustainable human development strategies and projects. WHO assists countries to set up national programmes for emergency preparedness and response by pro- viding technical support for their development. Guidelines for assess- ing disaster preparedness in the World Health • 49th Year, No.6, November-December 1996 health sector have been drawn up to help countries set up such pro- grammes or improve existing ones. Workshops and seminars are held regularly to share experience and to better orientate national preparedness programmes. Several United Nations and World Health Assembly resolutions have emphasized the policy and technical aspects of such programmes. Technical guidelines are drawn WHO promotes emergency preparedness through training courses and seminars, such as this one in Tunisia. 7 up primarily to assist those responsi- ble for emergency preparedness and response both nationally and interna- tionall y. WHO works closely with a network of collaborating centres that have special expertise in various aspects of emergency preparedness. These act as points of reference both for WHO and for national emergency preparedness programmes. Since 1992, a WHO expert panel has ad- vised Member States on matters relating to emergency preparedness and response, and humanitarian actions. Guidelines, documents and manu- als on technical aspects of vulnera- bility reduction and emergency management are prepared in partner- ship with such bodies as UNHCR, UNICEF, the International Committee of the Red Cross, the International Federation of Red Cross and Red Crescent Societies (IFRC) and Medecins sans frontieres . Besides a wide range of publications issued over the last 20 years, a num- ber of technical works are being prepared for distribution (see box). Guidelines and manuals in preparation Rapid health assessment protocols The initial response to an emergency is to assess the extent of damage and estimate the immed iate needs of the population. Standardized protocols have been drawn up for nine types of common emergencies with the help of staff from collaborating centres and organizations w ith much field experience in humanitarian assistance. Community emergency prepa-edness manual This multivolume work is intended to assist national emergency planning officers, local government offic ials and commun ity leaders in developing their emergency management capabilities. The manual shows how to foster this process and underlines the key technical areas in building national emergency preparedness and response capabi lities. Environmental health in emergencies and disasters - a practical guide The top prior ities in emergencies which involve large populations are sufficient safe water, shelter, food and security. San itation needs to be establ ished rapidly, otherwise the population 's health w ill be increasingly put at risk. This manual sets out the practica l issues involved in achieving the highest possible level of environmental security. The management of nutrition in major emergencies What is the minimal dai ly calorific requirement for refugees, internally displaced people or famine-stricken populations? Scientific investigation has been carried out and the advice in this book is based on a consensus between the main partners in th is field -IFRC, UNHCR, Save the Children Fund (Uni ted Kingdom) and WHO. Emergency relief items, compendium of generic specifications The United Nations system, w ith a view to improving emergency preparedness and response, decided to standard ize all material needed for the early phase of emergencies. The resu lt of close cooperation between United Nations agencies and other humanitarian organizations, this book will assist countries to choose items for their preparedness programmes and wi ll advise donors on appropriate donations. Further information on these materials can be obtained from the Emergency Preparedness Unit, World Health Organization, 121 1 Geneva 27, Switzerland 8 To maintain health standards in the chaos of on emergency, it is essential to be prepared. Human resource development Courses, workshops and conferences play an important role in training staff and in standardizing approaches and methods of operation. For in- stance, the International Diploma Course in Health Emergency Pre- paredness and Crisis Management is a month-long course developed in conjunction with the University of Geneva and designed for managers in the health care sector. An international meeting held in March 1996 in Osaka, Japan, in collaboration with the International Medical Parliamentarians ' Organiza- tion, called on governments, the international community, the United Nations and WHO in particular to take measures to promote vulnerabil- ity reduction and emergency pre- paredness. Similar conferences, with different partners, have been held or are planned to take place in Bali, Bangkok, Budapest, Manila, Tangiers and Tunis. National work- shops organized through WHO's regional offices have been held in Indonesia, Mexico, Mozambique, the Philippines and parts of southern Africa. Future collaboration between universities and national authorities will encourage the development of intersectoral training at undergradu- ate and postgraduate levels. There is at present no systematic collection of data on the frequency and consequences of major emergen- cies, but evidence suggests that the number and the impact of both nat- ural and man-made disasters are increasing. Indicators are needed to quantify the scale of the problem- in terms both of the deficiency of programmes for emergency pre- paredness and vulnerability reduc- tion and of the numbers of people affected . A tentative list of indicators has been drawn up to determine the state of national preparedness, vulnerabil- ity reduction, the number of major emergencies experienced and how many people are affected. Once finalized, these indicators will show ''No rubbish please" World Health • 49th Year, No.6, November- December 1996 where there is need for further action, and ultimately wi ll assist in measuring the impact of pro- grammes and evaluating their effectiveness. • Dr Somir Ben Yohmed is Chief of the Emergency Preparedness Unit, World Health Organization, 12 I I Geneva 27, Switzerland. Dr Robin Gray is a medical consultant on disaster relief. Imagine that the city where you live suffers a terrible earthquake . Thousands of people are kil led, in jured or trapped in collapsed build ings. The world outside responds by sending humanitarian aid. Over the next few days and wee ks, the survivors and the foreign helpers do their best for the homeless, shocked, be reaved, in jured and sick . You lea rn that hundreds, maybe thousands, of The use of lotion against lice and scabies is explained to stoH at Bihoc hospital, Bosnia . Typhus transmitted by lice is a constant threat when people ore living in unsettled conditions. tons of med ica l donations have arrived from abroad. Good, you say; there are so many injured and sick, and it is rumoured that local stocks are exhausted. Unfortu nately, much of this donated material, although no doubt sent with the best of intentions, can only be ca lled , uncharitably, "rubbish". It isn't needed and it clogs the supply system. Sorting the good from the bad takes much time; moreover, the "rubbish" has to be disposed of. Even today, despi te awareness of this problem, much donated emergency medical aid is inappropriate. After the Armenian earthquake in 19 88 , 5000 tonnes of medical supplies and drugs were donated. O f the 2500 tonnes of drugs sent, only a th ird were immediately usable; nearly a quarter should have been destroyed on arrival and a fifth were inappropriate for an emergency. In the recent Rwandan crisis, a large donation of unwanted and unrequested antibiotics was sent. Aid workers and local health officials had to find a way to destroy six million tablets. What can be done? A start has been made. The international organizations that are most experi enced in emergency assistance have agreed on a standardized selecti on of med ica l materials and essen tia l drugs that are most appropriate for the early phase of emergencies. These agencies w ill maintam their own stockpile to meet requests for international assistance. A handbook conta ining the specifications is intended to help donors make better choices and to guide nati onal preparedness and response prog rammes (see box on "Guidelines and manuals" on page 7) Gu idelines for d rug donations are included in the book. The aim of standardizing emergency health relief items and drawing up guidelines for drug donations is quite simple- to help reduce the rubbish. Contributed by Dr Robin Gray, formerly Medical Coordinator for Surgical Activities with the Red Cross, and now a medical consultant on disaster relief.