Superfluous to requirement! / by John Bland

Superfluous to requirement! r Mohammed Assai expressed it all quite simply. "The aid volun- teers themselves are pos- ing a problem. They all need food and water, yet the supply lines have been totally disrupted. They all need latrines, since the sewers v.ithout exception have been totally disrupted." Or Assai talked to me in a win- dowless freight container, hot as an oven but with a good quality Persian carpet as flooring, which served as headquarters for him and his 120- strong rescue team from the distant Iranian province of Yazd. All around his little encampment lay the smashed ruins of what had been the thriving small town of Manjil until the earthquake of 21 June last year struck in the middle of the night. Manjil's high street had been Main Street Anywhere; a wide road lined with solid brick and breeze-block shops, offices and homes. Many of the buildings had been re- inforced with steel girders. But the power of the quake was such that the girders now poked futilely out of the by John Bland rubble, twisted into grotesque shapes. The very mountains had been shaken. The road from Teheran to Manjil crosses a huge plain, then descends into a long ravine where the first shattered houses suggested we were entering a war zone. And the rocky slopes above were scored and littered with immense rockfalls. Where houses lay in their path, they added to the human toll of the disaster which, within one week of the quake, was assessed at 37,000 dead, 38,000 injured and 350,000 homeless. Mr John Bland is the Editor- in-Chief of World Health. At Teheran Airport I had seen at least half a dozen eager volunteer teams from many countries. They brought with them kitbags bulging with first-aid equipment, oxygen cylinders, stethoscopes. There were even tracker dogs, trained at locating survivors or bodies in the ruins. Some of these volunteers told me they didn't know where to go to begin the process of reaching the disaster area; they had no names of contacts for instructions and just hoped to "muddle through." There were lan- guage problems; none of the volun- teers spoke Farsi, and in towns such as Manjil few people speak anything else. Later, in a Teheran hotel, I heard some grumbling from foreign aid teams, who felt frustrated at not getting to the right spot, or thought they had been accorded a low priority when they did get "where the action is." It was Dr Assai, again , who commented: "I guess that about 8,000 of the 12,000 inhabitants of this town died in the earthquake. Of the survi- vors, some 60 per cent have left the region to stay with relatives or friends far from here. But the Iranian soldiers and volunteers, and all the volunteer teams from abroad, now outnumber the remaining survivors by five times or The face of suHering. In a Teheran hospital, a little girl recovers from her injuries after being rescued from her ruined home near Rudbar. more, and this in itself poses severe health problems." He added: "The only 'experts' we need now are in sanitation and healthy water and, after that, in rehabilitation." His own team from Y azd Province had arrived within 48 hours of the 7.3 Richter scale earthquake which devas- tated all the area around the large town of Rudbar, 500 km. north-west of Teheran, the smaller towns of Manjil and Lushan and all the surrounding villages. There had been a frantic struggle to find and extricate survivors @ . ..c from the rubble, then to bnng out the g bodies and bury them in mass graves. ~ After a frugal lunch of chicken and @ rice, washed down with bottled water, ~ as we squatted on the Persian carpet -g in the hot container, Or Assai showed 8 me with some pride how his team had ~ improvised washing and sanitary facil- ities with material commandeered from an adjoining builder's yard. The team slept in military tents pitched among the wrecked homes. Others I talked to in Iran confirmed Or Assai's view that many (not ail) of the enthusiastic young foreigners had come too late - and too many. Eight long years of war with neighbouring Iraq had inadvertently equipped Iran with the skills to handle a catastrophe with extraordinary efficiency. Mobile field hospitals, emergency dressing stations, military surgical teams - all had been drafted to the area. Within three days they had brought out the living and the dead from the ruins, ensured medical treatment for the injured and dispatched the worst hurt to hospitals in Teheran or other large towns. The big modern hospital out- side Rudbar was itself a casualty; its heavy concrete walls now tilted at precarious angles, and at the entrance to what had been an operating theatre a clock's hands were stuck at 35 minutes past midnight, when the world stopped. Further after-shocks T ented encampments sprang up and some of these housed survivors. But most local people - rightly in fear of further after-shocks - had made their way to stay with relatives living far away. One worker in the ruins told me: "There is nobody local to help; they were all dead or injured here." The Iranian army was efficiently running what remained of the towns, keeping traffic moving - much of it trucks bringing foodstuffs and vital equipment - and warning rash visitors 1! like myself against seeking vantage a! points for photographs in buildings still ~ standing but needing only an incau-i WORLD HEALTH. January - Februa ry 1991 tious footfall to topple them over. The Iranian Red Crescent too had planted its emergency tents every- where, and had done sterling work in carrying out amputations and saving lives. There would be longer term health consequences to deal with too, as I discovered in an old bus parked under olive trees in Rudbar. A Pakistan Army medical team was using the bus as a clinic. A young woman, apparently uninjured, had come for a consul- tation. The Pakistan major in charge told me she dare not go to sleep. "If I fall asleep, I only dream of death," she told him. Her only child had died in her arms when the roof of their home fell in. I asked the major: "A boy or a girl?" The woman understood or sensed my question. "Tochtir," she said; a daughter. And her eyes filled with tears. Or Omer Suleiman, the WHO resident representative in Teheran, was the first international expert to reach the site, and promptly sent back a list of urgent requirements to UNORO in Geneva. Subsequently WHO made available US $100,000 and eight tons of medical kits and other supplies. The Organization's Eastern Mediterranean Regional Office allocated an additional $50,000 for urgent needs not met by donors. Or Suleiman also located potential donors for a prefabricated hospital in the stricken province. He later arranged an inter-agency workshop on emergency preparedness in Iran in the context of the country's efforts to draw up a National Emergency Plan. The Plan will look closely at housing design, since it was clear that many lives could have been saved if ordinary houses had been expressly built to The very mountains shook. Three days after the disastrous Iranian earthquake, a second tremor sent dust rising from fresh rockfalls, and was reported to have killed and injured rescuers still digging in the rubble. withstand severe quakes. Within one week of the disaster, most of the foreign aid visitors, however well-meaning, were frankly "superfluous to requirement." Their vehicles were adding to the long queues of local traffic at critical points where roads were perilously cracked or only partially cleared from landslides. Once in the little townships, they had difficulty finding food and water supplies; and for sanitation, they had to take to the fields or woods. Might the money they had spent in coming to Iran have been better employed in cash payments directly to the emergency preparedness authorities in Teheran? I am anxious not to paint too black a picture. Another disaster-stricken country might be less mobilised than Iran to handle the chaos that follows hard on disaster. In different circum- stances the foreign aid teams have frequently saved lives and, by tending the injured, have eased the burden on the existing health services. The real need is for all disaster- prone countries to have some focal centre whose telephone and telefax numbers must be made known to all serious volunteer aid agencies. And the national centre's staff must be capable of making snap decisions as to whether foreign teams are needed and, if so, what sort of equipment they should bring. • 21