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Military Preventive Medicine: Mobilization and Deployment, Vol 2 MILITARY PREVENTIVE MEDICINE: MOBILIZATION AND DEPLOYMENT Volume 2 Section 7: Preventive Medicine Efforts Following Disasters Airmen unload boxes of MREs (Meals Ready To Eat) for victims of Hurricane Marilyn. The hurricane hit the US Virgin Islands in September 1995. The role of military organizations in operations other than war is long and distinguished. As the issue of homeland defense evolves, it is likely that the mission of both Active and Reserve Component units will encompass some of the new challenges the United States faces. Department of Defense Photograph: Defense Visual Information Center photo identification number DFST9805176. 1267 ii The Challenge of Humanitarian Assistance in the Aftermath of Disasters Chapter 41 THE CHALLENGE OF HUMANITARIAN ASSISTANCE IN THE AFTERMATH OF DISASTERS TRUEMAN W. SHARP, MD, MPH; FREDERICK BURKLE, MD, MPH; AND KENT L. BRADLEY, MD, MPH INTRODUCTION DISASTERS AND DISASTER MEDICINE PREVENTIVE MEDICINE IN DISASTERS THE MAGNITUDE OF DISASTERS Natural Disasters Complex Disasters Technological Disasters THE CONSEQUENCES OF DISASTERS ASSESSING AND RESPONDING TO DISASTERS PROGRESS IN DISASTER RESPONSE CHALLENGES IN DISASTER RELIEF Alternative Approaches Coping with Violence Improved Strategic Planning and Coordination Improved Emergency Response Need for Research New Threats: Land Mines, Laser Weapons, and Terrorists Vulnerable Populations International Humanitarian Law Using Information Technologies Expanding Professional Boundaries MILITARY INVOLVEMENT IN DISASTERS SUMMARY 1269 Military Preventive Medicine: Mobilization and Deployment, Volume 2 T.W. Sharp, MD, MPH, Commander, Medical Corps, US Navy; Formerly: Preventive Medicine Officer, Headquarters, US Marine Corps, 2 Navy Annex, Washington DC 20380-1775; Currently: Officer in Charge, US Navy Medical Research Unit No. 3, PSC 452, Box 5000, FPO AE 09835-0007 F. Burkle, MD, MPH, Captain, Medical Corps, US Naval Reserve; Deputy Assistant Administrator, Bureau for Global Health, US Agency for International Development, Washington, DC 20523 K.L. Bradley, MD, MPH, Lieutenant Colonel, Medical Corps; Division Surgeon, 7th Infantry Division, Ft. Carson, CO 80913 1270 The Challenge of Humanitarian Assistance in the Aftermath of Disasters INTRODUCTION Military forces of the United States and other to 44 (Military and Public Health Aspects of Natural developed nations are sometimes called on to cope Disasters, Complex Emergencies, and Public Health with the aftermath of the entire spectrum of disas- Perspectives Related to Technological Disasters and ters, from natural events to complex humanitarian Terrorism, respectively) describe the public health emergencies (Table 41-1). While the appropriate consequences of different types of disasters: natural, roles of military forces in the post-Cold War world complex, and technological. Chapter 45, The Interna- and in coping with disasters are controversial, it is tional Humanitarian Response System, and Chapter likely that the military will always play some role 46, Domestic Disaster Response: FEMA and Other in coping with disasters. Governmental Organizations, describe the intricacies This section provides background on the causes of the US domestic and international disaster response and consequences of disasters and the potential roles systems and Chapter 47, Nutritional Assessment and of military preventive medicine personnel. This Nutritional Needs of Refugee or Displaced Popula- chapter focuses on basic definitions, concepts, and tions, describes nutritional aspects of humanitarian future challenges for the growing discipline of di- relief operations. All chapters highlight issues relevant saster medicine. The next three chapters, numbers 42 to the military. DISASTERS AND DISASTER MEDICINE Disaster is a broad term that has been defined in and that are severe enough to overwhelm the re- several different ways.1,2 One commonly used defi- sources of the affected community and necessitate nition is “...events of environmental disruption or outside assistance.”1(p422) An alternate definition is destruction that can be of sudden or gradual onset, “...an event that exposes the vulnerability of indi- viduals and communities in such a way that their lives are directly threatened, or sufficient harm has been done to their community’s economic and so- TABLE 41-1 cial structures to undermine their ability to SELECTED US MILITARY DISASTER survive.”2(p13) Both definitions emphasize the cata- OPERATIONS FROM 1990 THROUGH 1996 strophic nature of disasters and the need for exter- nally provided assistance. Operation Type of Disaster Disasters may be categorized in different ways. Some authors have differentiated between natural Fiery Vigil disasters (such as typhoons) and man-made disas- Philippines, 1990 Volcano ters (such as war). Others have grouped disasters Provide Comfort into sudden-onset events (such as earthquakes) and Northern Iraq, 1991 Complex emergency long-term situations that develop over months or years (such as refugee crises). Technological disas- Sea Angel ters, which are events such as the Chernobyl nuclear Bangladesh, 1991 Tropical cyclone accident that involve major exposures to chemicals JTF Andrew or radiation, are often placed in another category. Florida, 1992 Hurricane Terrorist actions involving conventional explosives Restore Hope or weapons of mass destruction are regarded as an Somalia, 1992 Complex emergency increasingly important type of disaster.3,4 Any categorization scheme is somewhat arbitrary JTF Hawaii Hawaii, 1992 Hurricane and may oversimplify the interaction of many fac- tors. For example, a disaster in Durunka, Egypt, in Support Hope 1994 combined elements of both natural and tech- Rwanda, 1993 Complex emergency nological phenomena. Torrential rains led to severe Uphold Democracy flash-flooding, which disrupted fuel depots located Haiti, 1994 Complex emergency in flood-washed ravines. Fuel-contaminated water Joint Endeavor flooded downstream villages and caught on fire. Bosnia, 1996 Complex emergency The majority of the 580 deaths that occurred were not due to drowning but to burning fuel.5 Also, JTF: Joint Task Force some disasters can be difficult to categorize. Land 1271 Military Preventive Medicine: Mobilization and Deployment, Volume 2 mines may be considered as a technological disas- TABLE 41-2 ter or as an aspect of conflict. Natural disasters are CATEGORIES OF DISASTERS* often part of the dynamic of conflict and complex emergencies. The 1971 India-Pakistan war and sub- sequent refugee crisis was triggered in large part Natural by a cyclone when the disruption caused by this Flood natural event exacerbated political unrest. A severe Tropical cyclone drought was the principal catalyst for the civil war and humanitarian crisis in Somalia from 1991 to 1992.6 Hurricane While the term “disaster” invokes connotations Earthquake of the forces of nature to many, the hand of humans Tornado is found in almost all disasters. What is identified Volcano as the disaster, even when it is a natural event, is Tsunami often better understood as a trigger event that exposes Drought underlying societal problems. Virtually every fam- ine since 1977 has been the result of underdevel- Complex opment, armed conflict, inadequate economic and Civil conflict social systems, failed governments, and other man- made factors.3,7 War The term “complex emergency” (also complex Famine humanitarian emergency or conflict-related complex Mass migration or displacement of people emergency) was coined to refer to disasters that Technological involve an intricate interaction of political, military, economic, and natural factors and that have armed Explosions conflict as a central feature.8 These types of disasters Fires have been increasingly common since the end of the Chemical Exposures and Spills Cold War. Victims are usually large populations or Radiation Exposures specific ethnic groups or cultures; armed conflict against Terrorist Actions these groups is almost always a critical factor.9 Soma- lia in 1992 is an example in which civil violence was *This is not a comprehensive list of all disasters. the most visible, proximate cause of the disaster, but years of underdevelopment, governmental failures, superpower intervention, ethnic conflict, drought, and famine all contributed substantially to the situation. evolving to include other types of disasters. This To provide a basic approach to the subject of di- chapter will use a broad definition for disaster sasters, this section will consider three basic types medicine: “The study and collaborative application of disaster: natural, complex, and technological of various health disciplines—eg, pediatrics, epide- (Table 41-2). Some events that could be considered miology, communicable diseases, nutrition, public disasters, such as a disease outbreak, are consid- health, emergency medicine, social mending, commu- ered in other chapters. nity care, international health—to the prevention, The discipline of disaster medicine is rapidly immediate response and rehabilitation of the health evolving. Disaster medicine has its roots in the problems arising from disaster, in cooperation with emergency activities undertaken in the immediate other disciplines involved in comprehensive disas- aftermath of natural disasters, but the discipline is ter management.”10(p23–24) PREVENTIVE MEDICINE IN DISASTERS One way to understand disasters, especially com- police, judiciary, communications networks, trans- plex emergencies, is as catastrophic public health portation
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