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Lessons from the Chilean Earthquake: How a Human Rights How a human rights framework facilitates disaster response MaryCatherine Arbour, MD, Lessons from the Chilean MPH, is Associate Physician Earthquake: How a Human Rights for Research in the Division of Global Health Framework Facilitates Disaster Equity, Department of Response Medicine at Brigham and Women’s Hospital, Boston, MA. MaryCatherine Arbour, Kara Murray, Felipe Arriet, Cecilia Moraga, Miguel Cordero Vega Kara Murray, BA, is an MPH candidate at the Tufts University School of Medicine, Abstract Public Health and Professional Degrees Program, Boston, MA. The earthquake of 2010 in Chile holds important lessons about how a rights-based Felipe Arriet is a psycholo- public health system can guide disaster response to protect vulnerable populations. gist for Chile Crece Contigo, This article tells the story of Chile Grows With You (Chile Crece Contigo), an Ministry of Health, Santiago, Chile. intersectoral system created three years before the earthquake for protection of child rights and development, and its role in the disaster response. The creation of Chile Cecilia Moraga, MA, is a Grows With You with an explicit rights-oriented mandate established intersectoral founding member of the International Association for mechanisms, relationships, and common understanding between governmental groups the Study of Attachment, Chile at the national and local levels. After the earthquake, Chile Grows With You Crece Contigo, Ministry of Health, Santiago, Chile. organized its activities according to its founding principles: it provided universal access and support for all Chilean children, with special attention and services for Miguel Cordero Vega, MSc. those at greatest risk. This tiered approach involved public health and education is National Coordinator to Early Childhood Protection materials for all children and families; epidemiologic data for local planners about System, Ministry of Health, children in their municipalities at-risk before the earthquake; and an instrument Santiago, Chile. developed to assist in the assessment and intervention of children put at risk by the Please address correspon- earthquake. This disaster response illustrates how a rights-based framework defined dence to MaryCatherine and operationalized in times of stability facilitated organization, prioritization, and Arbour at marbour@partners. org. sustained action to protect and support children and families in the acute aftermath of the earthquake, despite a change in government from a left-wing to a right-wing Competing interests: None declared. president, and into the early recovery period. Copyright © 2011 Arbour, Murray, Arriet, Moraga, and Vega. This is an open access article distributed under the terms of the Creative Commons Attribution Non- Commercial License (http:// creativecommons.org/ licenses/by-nc/3.0/), which permits unrestricted non-com- mercial use, distribution, and reproduction in any medium, provided the original author and source are credited. volume 13, no. 1 July 2011 health and human rights • 1 Arbour et al. Introduction economy grew, however, inequality increased more in Chile than in any other Latin American country. The earthquake that shook Chile on February 27, Forty percent of the population now controls less 2010 occurred only 46 days after the quake in Haiti, than 10% of the GDP, and the strongest predictor and was 500 times more powerful.1 Why then were of socioeconomic status for Chilean adults is their the damage and loss of life in Haiti so much worse? socioeconomic status at birth.5 Poor Chilean children Chile’s government proved more resilient not only in have lower preschool enrollment rates and smaller its physical infrastructure but also because of preex- vocabularies than their Latin American peers.6 In isting programs to operationalize a commitment to 2003, Chile ranked 14th in the world for inequality, human rights. This commitment had instituted poli- as measured by Gini index.7 In brief, even in the set- cies to ensure health, housing, and other basic needs, ting of impressive economic performance and pub- informing and facilitating the government’s disaster lic commitment to improving equity, poor Chilean response. children were at significant disadvantage before the fifth-most-powerful earthquake in history shook six This article tells the story of Chile Grows with You of Chile’s 15 regions. (Chile Crece Contigo, hereafter referred to as ChCC), the country’s intersectoral, interdisciplinary early childhood development system, which was designed The earthquake on February 27 to protect child rights, support child development, On February 27, 2010 at 3:34 a.m., an earthquake and promote equity.2 Amid destruction, displace- measuring 8.8 on the Richter scale and lasting 90 sec- ment, and unrest, ChCC responded with a rights- onds struck Chile. Its epicenter was about 100 km based approach focused on the health and well-being from Concepción, the capital of Region IX, and the of all children, with priority on the most vulnerable impact was felt across 630 km. Geologists reported children, including populations at-risk before the that the earthquake was so strong that it moved the earthquake as well as those children most affected Earth on its axis, shortening the day by 1.26 micro- 8 by the earthquake. It illustrates how a rights-based seconds. framework defined and operationalized in times of stability facilitated organization, prioritization, and While the earthquake caused significant damage, the sustained action intended to protect and support ensuing tsunami accounts for most of the lives lost. children and families in the acute aftermath of the Less than 20 minutes after the earthquake, waves up disaster, despite a change in government from a left- to 12 meters high inundated a number of coastal 9 wing to a right-wing president, and into the early towns. The early warning system was plagued by recovery period. communication problems, with the first alert at 3:55 am arriving 21 minutes after the first wave. Some towns reported that they never received a warning.10 I. Background According to experts, the warning should have been When Chile joined the Organization for Economic issued within 10 minutes of the initial quake. Co-operation and Development in 2009, it was the culmination of a 40-year national journey from pov- President Michelle Bachelet immediately declared erty to relative affluence.3 Between 1970 and 2000, a national emergency, and the following day she the gross domestic product (GDP) quadrupled, declared a state of catastrophe in two provinces. maternal mortality fell from 17.2 to 2.9 deaths per She did not accept offers of international aid for 10,000 women, infant mortality declined from 82.2 two days, citing Chile’s relatively strong domestic to 8.9 deaths per 1,000 live births, and life expectan- resources and human capacity and a reluctance to cy at birth extended from 61.5 to 77 years. 4 As the siphon international resources from Haiti.11 After an 2 • health and human rights July 2011 volume 13, no. 1 How a human rights framework facilitates disaster response outbreak of looting, President Bachelet dispatched 10,000 troops to the affected zones to restore order The plan also anticipated a transition to early recovery: and deliver basic supplies. She implemented a mili- “[A]fter sudden-impact disasters like the earthquake tary curfew for the first time since the end of the and tsunami…the pattern of health care needs in the country’s 17-year military dictatorship in 1990.12 The population changes rapidly, from relief and wound magnitude of the disaster soon became apparent. care, acute care patients and patients with exacerbat- More than 370,000 homes were damaged and 81,444 ed chronic conditions to the maintenance of mater- were completely destroyed.13 Strict building codes nal and pediatric care.”19 Such a transition was natural helped to limit fatalities to 521, but more than 12,000 for Chile in 2010: over the preceding three years, offi- people were injured, 800,000 displaced, and two mil- cials had built the landmark early childhood develop- lion affected.14 Medical facilities were ravaged: 71% ment system ChCC, and along with it, intersectoral (133) of the country’s hospitals were damaged, with relationships, infrastructure, and a network linking 17 classified as completely inoperable and 62 as seri- the institutions that provide services for children — ously damaged.15 More than 20% of the regions’ hos- including early education (Junta Nacional de Jardines pital beds were lost.16 As need for medical services Infantiles, JUNJI, and Fundacion INTEGRA of the rose, damage to roads complicated and compromised Ministry of Education, MINEDUC), social protec- delivery of medical supplies. tion (MIDEPLAN), and health (MINSAL). Over the same time period, MINSAL had increased attention The government, local, and international non- to mental health. ChCC participated in the inter- government organizations built more than 4,500 ministerial National Committee for Mental Health makeshift homes in 107 internally displaced person in Emergencies and Disasters (Comité Nacional de (IDP) camps.17 The government created the Village Salud Mental en Emergencias y Desastres), which Program (Programa Aldeas) and charged the Ministry was activated by the earthquake, and helped the of Planning (MIDEPLAN) with construction of group to conceptualize the populations’ needs and to temporary housing, camp oversight and administra- devise a strategy to fulfill them. tion, including hygiene and sanitation, citizen par- ticipation, access to healthcare, and security and safe Building on its national intersectoral network, its spaces for children and senior citizens.18 rights-based orientation, and MINSAL’s focus on mental health, ChCC developed a tiered response to the disaster, incorporating population-wide educa- Responding to the disaster tion messages, informational materials for caregivers The General Health Care Plan in Emergencies and and mental health volunteers, epidemiologic data to Disasters (Plan General de Atención Sanitaria en help target services, and a child assessment tool. All Emergencias y Desastres), developed after the erup- of this was possible because of ChCC’s history.
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