HEALTH RELATED ISSUES IN HEALTH RELATED ISSUES IN DISASTERSDISASTERS

Knowledge comes, but wisdom Knowledge comes, but wisdom lingers ( Tennyson)lingers ( Tennyson)

Pan American Health OrganizationPan American Health Organization(PAHO)(PAHO)

• Established in 1902Established in 1902• 35 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 Program on Emergency Preparedness and Disaster ReliefPreparedness and Disaster Relief

Pan American Health Organization /Pan American Health Organization /

World Health OrganizationWorld Health Organization

PAHO / WHO PAHO / WHO

NATURALNATURALDISASTERSDISASTERS

OTHERSOTHERSVOLCANICVOLCANICERUPTIONSERUPTIONS

HURRICANESHURRICANESFLOODSFLOODS

EARTHQUAKESEARTHQUAKESLANDSLIDESLANDSLIDES

TECHNOLOGICALTECHNOLOGICALDISASTERSDISASTERS

OTHERSOTHERSCHEMICALCHEMICALACCIDENTSACCIDENTS

EXPLOSIONSEXPLOSIONS

FIRESFIRES

AIRCRAFTAIRCRAFTACCIDENTSACCIDENTS

RADIATIONRADIATIONACCIDENTSACCIDENTS

““COMPLEX”COMPLEX”DISASTERSDISASTERS

Refugees, IDPRefugees, IDP

ARMEDARMEDCONFLICTSCONFLICTS

CIVILCIVILSTRIFESTRIFE

Latin America and the Caribbean move from Latin America and the Caribbean move from Ad Hoc Disaster Response to PreventionAd Hoc Disaster Response to Prevention

Disasters andDisasters andDevelopmentDevelopment

Mitigation andMitigation andPreparednessPreparedness

PreparednessPreparednessand Responseand Response

ResponseResponse19761976

EarthquakeEarthquakein Guatemalain Guatemala

19851985EarthquakeEarthquakein Mexicoin Mexico

19901990IDNDRIDNDR

Program ObjectivesProgram Objectives

Before a DisasterBefore a Disaster After a DisasterAfter a Disaster

Prevention,Prevention,Mitigation,Mitigation,PreparednessPreparedness

CoordinationCoordinationof Internationalof International

AssistanceAssistance

Before a disasterBefore a disaster

• Building national capacity through Building national capacity through training( standardized but adapted to local training( standardized but adapted to local context)context)

• Strengthening Ministry of Health disaster Strengthening Ministry of Health disaster programsprograms

• Special projects:Special projects:• Promote Hospital mitigationPromote Hospital mitigation• SUMASUMA• CRIDCRID

Human Resources Development , Human Resources Development , not stockpiling equipment, is the not stockpiling equipment, is the

key to Preparedness . . .key to Preparedness . . .

University trainingUniversity training

Workshops/Workshops/short coursesshort courses

The National Health DisasterThe National Health DisasterProgram must:Program must:

• encompass encompass entireentire health sector health sector• lead the health sector in disaster lead the health sector in disaster

prevention, mitigation, preparedness, prevention, mitigation, preparedness, response, early rehabilitationresponse, early rehabilitation

• have a multi-hazard scope (natural, have a multi-hazard scope (natural, technological, “complex” disasters)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 The WHO/PAHO standardized methodology and tool to manage methodology and tool to manage large amounts of humanitarian large amounts of humanitarian

supplies.supplies.

Regional Disaster Information Regional Disaster Information CenterCenter

• 12,000 documents on disaster-related topics12,000 documents on disaster-related topics

• ““THE” source of material in SpanishTHE” source of material in Spanish

• Internet AccessInternet Access

PAHO/WHO Cooperation in PAHO/WHO Cooperation in DisastersDisasters

• 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 Coordination with Foreign Affairs, Ministry of Health, National Disaster Agency, UN Org.’sHealth, National Disaster Agency, UN Org.’s

External assistance post disasterExternal assistance post disaster

PAHO/WHOPAHO/WHO

European Union/European Union/ECHOECHO

OASOAS

SICA/SICA/CEPREDENACCEPREDENAC

ConvenioConvenioHipólito UnánueHipólito Unánue

(CHU)(CHU)

CDERACDERA

CanadaCanada USAUSA

United KingdomUnited KingdomNordicNordic

countriescountriesNetherlandsNetherlands

FranceFrance

JapanJapan

DHA/UNDPDHA/UNDP

WFPWFP

WHO/WHO/PAHOPAHO

UNICEFUNICEF

UNFPAUNFPA

UNHCRUNHCROXFAMOXFAM

MSFMSF

CARECARECRSCRS

Local NGOLocal NGOPADFPADF

Red CrossRed CrossNational SocietiesNational Societies

IFRCSIFRCS

ICRCICRC

Assistance to disaster affected Assistance to disaster affected countrycountry

• Japan, UK, USA/OFDA, Red Cross, ICRC, Japan, UK, USA/OFDA, Red Cross, ICRC, UNDP, CARE, MSF, UNDAC. CIDAUNDP, CARE, MSF, UNDAC. CIDA

• The Netherlands,ECHO, ICRC, local NGO, The Netherlands,ECHO, ICRC, local NGO, IFRC, OXFAM, OCHA, CDERA, RSS, IFRC, OXFAM, OCHA, CDERA, RSS, CARICOM, OAS, CARICOM, OAS,

SUB-REGIONAL AGENCIESSUB-REGIONAL AGENCIES

• CDERA/CEPREDENACCDERA/CEPREDENAC• RSSRSS• PAHOPAHO• Federation of the Red CrossFederation of the Red Cross• OFDAOFDA• AgreementsAgreements

National Support NetworkNational Support Network

• HealthHealth Disaster Focal Points Disaster Focal Points– Ministries of HealthMinistries of Health– PAHO/WHOPAHO/WHO

• Disaster Focal Points Disaster Focal Points – Foreign Affairs ,UN agenciesForeign Affairs ,UN agencies

The principles of CoordinationThe principles of Coordinationand national responsibilityand national responsibility

• Generating reliable InformationGenerating reliable Information• Developing technical experienceDeveloping technical experience• Cultivating the credibilityCultivating the credibility

– Learning to say “no”Learning to say “no”– serving the health sector rather than the serving the health sector rather than the

donors donors

International AssistanceInternational Assistancein Perspective . . .in Perspective . . .

ASSISTANCE FROMWITHIN THE COUNTRY

EXTERNALASSISTANCE

(1-2%)

BILATERAL

MULTILATERAL

NGOs

Health & DisastersHealth & Disasters

• Immediate Needs Immediate Needs

– Managed by local emergency response Managed by local emergency response

– Short Term NeedsShort Term Needs

– Water, Shelter, food , medicines Water, Shelter, food , medicines

Epidemiological Surveillance, Etc.Epidemiological Surveillance, Etc.

• Long Term NeedsLong Term Needs

– Rehabilitation of Health Infrastructure, Rehabilitation of Health Infrastructure,

Health Related IssuesHealth Related Issues

• MythsMyths

– External Emergency Assistance (SAR, External Emergency Assistance (SAR,

field hospitals and surgeons) neededfield hospitals and surgeons) needed

– Any donation is AcceptableAny donation is Acceptable

– Disease Outbreaks Occur w/in the Disease Outbreaks Occur w/in the

Population or from dead bodiesPopulation or from dead bodies

– Immunization is NecessaryImmunization is Necessary

RealityReality

• Local response within the first daysLocal response within the first days• Public health problems and population Public health problems and population

displacement are more frequent and of displacement are more frequent and of slow onset.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 Rehabilitation of hospitals and water

system needed when donors and media system needed when donors and media interest decreaseinterest decrease

ConclusionConclusion

• Disaster management is a multi sectorial Disaster management is a multi sectorial and multi hazard business, so should and multi hazard business, so should training betraining be

• Many actors , therefore coordination Many actors , therefore coordination remains a problemremains a problem

• Local presence and involvement in Local presence and involvement in preparedness and training ensures a good preparedness and training ensures a good response when necessaryresponse when necessary

FROM ONE EXTREME TO THE OTHERFROM ONE EXTREME TO THE OTHER

1980’sNational sovereignity

of the affected countryis absolute

1990’sDonor country

knows best!