PREPAREDNESS AND MITIGATION IN THE AMERICAS

Issue No. 84 News and Information for the International Disaster Community July 2001

Editorial Protecting the Health Services Network The knowledge gained by the countries of Latin America and the Caribbean in reducing the vulnerability of their hospitals to disasters must be extended and applied to all health services in the country. The past has demonstrated that less complex (although no less important) health infrastructure such as health centers, the offices of coordinating authorities, warehouses and blood banks are just as likely to be affected by floods, earthquakes, hurricanes and other natural hazards.

he health sector’s response to a disaster depends in part on its level of prepared- Tness. But it is also conditioned by the level of damage caused to health infrastructure—hospi- tals as well as smaller health centers, laboratories, blood banks, warehouses, etc.—all components of what is referred to as the country’s health services network. Planning an integrated health sector response to disasters requires knowledge of the physical If disaster response plans are to be effective, countries must vulnerability of its facilities. Emergency prepared- ensure the safety of all components of the health services net- ness plans that have been tested and updated work. Damage to laboratories, as shown here in the wake of Hurricane Keith in Belize, can paralyze disease surveillance become meaningless when a hospital is unable to systems. function following a disaster. Well-established Photo: PAHO/WHO INSIDE epidemiological surveillance programs are of little large degree, on the physical and functional vul- use if the laboratories required to process the nerability of its infrastructure as a whole. information cannot function. It is not practical to Recent examples point to the need to focus on News from maintain a stock of emergency medicines and sup- the health services network. During the 1997-98 plies if the warehouse is vulnerable; likewise, it is El Niño phenomenon in Ecuador and Peru, more PAHO/WHO 2 useless to establish a hospital referral system to than 34 hospitals and 485 small health centers care for disaster victims if the health services net- were affected by floods—many of these were the Other work collapses. And evacuating patients from only health facilities for miles around. The Organizations 3 well-built health facilities where structural dam- December 1999 floods in Venezuela indiscrimi- age is unlikely can be costly and dangerous to the nately affected health facilities, both large and Member occupants. For all these reasons, health sector small. Hurricane Keith in Belize in 2000 seriously Countries 4 planning and preparedness should be based, to a affected the Karl Heusner Memorial Hospital. The (cont. on page 7) Publications and Multimedia 6 Selected Upcoming course Bibliography 8 • March 2002 - Buenos Aires, Argentina

ISSN 1564-0701 News from PAHO/WHO

Agencies Meet to Discuss a Common Logistical Support System

The logistical management of humanitarian later stage, to those at the intermediate point in the New supplies represents a formidable challenge for any distribution chain. The same approach should be agency that provides immediate assistance to dis- used for all types of emergencies (natural disas- aster victims. Several international organizations ters, complex emergencies, etc.), as the logistical have developed parallel systems to correct certain challenges are similar. aspects of the problem, but for the most part, these Steps are underway to move beyond discus- operate independently with little exchange of sion to action. UNICEF and WFP will lead all information. actors in common classification of items and com- Realizing that sharing information is a first modities that will make it easier to exchange data. step to unclogging the supply chain in humanitari- A capacity-building initiative to strengthen local an operations, more than 50 experts from UN institutions and NGOs will be undertaken, adapt- See the enclosed Organizations, the Red Cross system, humanitari- ing and expanding the experience of SUMA in the flyer for more an NGOs and national disaster coordinators from Americas. This SUMA Global initiative will be information about affected countries met at WHO headquarters in led by WHO. Channels of communication among PAHO/WHO’s Geneva to discuss and identify steps toward a all interested parties will be strengthened by newest publica- common approach to logistical support in emer- OCHA to provide for continuous dialogue and tion on supply gencies. WHO, WFP and OCHA co-sponsored exchange of information as this initiative moves management this interagency workshop with PAHO. forward. The participants agreed that the result of a More information on the progress toward a common logistical approach can best be described common logistic support system for humanitarian as a common "data warehouse" on supplies, from operations will appear in future issues of this those in the pipeline (three months) to those enter- Newsletter. ing a disaster-stricken country or area, and at a

The second LIDERES course took place in In the early July in San Jose, Costa Rica. The University foreground, of Costa Rica cosponsored this 120-hour course members of and provided the facilities at the university’s the 2001 Faculty of Engineering. Twenty-seven partici- class of pants from 16 countries formed the training group LIDERES, at this multisector, multidisciplinary event. As 2001 and the with the LIDERES 2000 course in Quito, Ecuador Arenal last September, the participants were all high-level San Jose, volcano, site managers responsible for emergency management Costa Rica of one of the in government and non-governmental sectors. field visits. 2 - 19 July This year’s LIDERES course featured field visits to the municipalities of San Jose, Moravia and Santa Ana to discuss local experiences and risk management capacity and to observe, first- hand, the risks facing these communities. Costa Rica’s Arenal volcano was the site of the second field visit, where participants had the chance to discuss with community leaders and the local emergency committee the state of preparedness and how communities viewed their own disaster risk.

2 Disasters: Preparedness and Mitigation in the Americas • July 2001 Other Organizations IFRC Publishes 2001 World learn how to participate and for more ideas. Disasters Report www.unisdr.org. The 2001 edition of the New Director Named at ISDR World Disasters Report looks at how humanitarian agencies The U.N. Under-Secretary-General for Huma- and governments can best nitarian Affairs has announced the appointment of help disaster-affected commu- Mr. Salvano Briceño, a national of Venezuela, to nities to recover, to become the post of Director of the International Strategy stronger and more disaster- for Disaster Reduction (ISDR) in Geneva. Mr. resilient. Published annually Briceño has taken up his position and may be con- since 1993, the World Disasters Report pres- tacted at [email protected] . ents trends, facts and analysis of global humani- tarian crises. University of Cranfield Offers Available online at http:www.ifrc.org/publi- cat/wdr2001. Disaster Degree The University of Cranfield (U.K.) is offering World Disaster Reduction a Master of Science Degree in Disaster Management through the university’s Disaster Campaign Targets Vulnerability Management Centre. The full-time program lasts The theme of the 2001 World Disaster 45 weeks and attempts to strike a balance between Reduction Campaign is Countering Disasters, the theoretical and the practical; considers the dif- Targeting Vulnerability. The campaign aims to ferent stages of planning necessary for a wide give practical examples of what society can do to variety of disasters—complex, natural and man- be less vulnerable to natural hazards. Information made—and takes into account distinct levels of on how to target vulnerability falls under the head- social, economic and technological development. ings of science and technology in disaster reduc- Request the complete syllabus or additional infor- tion, building disaster-resistant infrastructure and mation on costs from the Administrator, Cranfield mobilizing local communities. The ISDR has Disaster Management Centre at disprep@ organized risk mapping contests for children and rmcs.cranfield.ac.uk. or by fax (44-1793) 785- local communities. Visit the ISDR web site to 883.

Contribute to the Next Biblio-des

he importance of community participation 1) community participation in the process of build- in disaster preparedness and prevention is ing an organized community; 2) community partic- Tbecoming more and more important. It is ipation in the design and use of local risk maps; key to reducing vulnerability and improving the and 3) preparing and putting into practice commu- response, both during and in the aftermath of nity response guidelines. emergencies. Helping communities to organize If your organization has articles (maximum 3 themselves to face disasters requires sustained pages in length), publications or other documents efforts in planning and participation. related to the topic of community participation CRID, the Regional Disaster Information which could be included in the next Biblio-des, Center, PAHO and ISDR are preparing the next please send them to the CRID at the address on issue of Biblio-des, the series of selected bibliogra- page 8 before 1 October. View the latest issues of phies on specific disaster-related topics. This new Biblio-des at http://www.crid.or.cr/crid/eng/servic- issue of Biblio-des will focus on three broad areas: es/services.htm.

Disasters: Preparedness and Mitigation in the Americas • July 2001 3 Member Countries

Country Progress Reviewed, Priorities Targeted at Caribbean Health Disaster Coordinators Meeting ipation and public awareness of health issues fol- aribbean Health Disaster Coordinators met lowing disasters. The critical weakness of the in St. Maarten in July to review the Health HDC system was identified as a lack of adequate Disaster Coordinators (HDC) System and C resources for national health disaster programs, to discuss strategies and plans of action to including the lack of full time HDCs in some improve health sector disaster management. countries. Analysis of country reports and a survey of Among the participants’ recommendations the HDC system indicated areas of distinct were improving the allocation and effective man- progress: the monitoring of national health disas- agement of financial resources, designating of full ter programs by senior officers and communica- time HDCs, improving intra and inter-island coop- tion between those senior officers and HDCs; the eration including communication and sharing of use of Internet technology and meeting of national resources among neighboring islands. needs by PAHO. Less success was noted in inte- Highlights of the regional priorities targeted grating health disaster management into national for action included: health programs and promoting community partic- ¥ Sharing of plans/networking and communi- cation. ¥ Standardization of training Ð regular simu- lations including evaluations. ¥ Inventory of disaster related resources. ¥ Review and dissemination of terms of ref- erence for health disaster coordinators. For more information, contact Dr. Dana van Alphen, Subregional Disaster Advisor, PAHO/WHO at fax (246) 436-6447; e-mail: [email protected].

Following is a brief overview of the effects of Earthquake in Peru the June 2001 earthquake in Peru. The PAHO/WHO office in Peru and the Ministry of Health continue to prepare information, available online at: www.disaster.info.desastres.net (click on earthquake in Peru).

Health Effects The June 23 earthquake that struck Peru caused serious damage to infrastructure, housing and the population in the country’s most vulnera- ble regions. As is the case in most major disasters, the following sectors were hardest hit: health, water, sanitation, food and temporary housing.

Damage Assessment Moquegua, in southern Peru, sustained the greatest damage, where approximately 50% of the dwellings were damaged or destroyed. All electric systems failed, partially or totally. 4 In larger cities such as Arequipa and Tacna, Lessons from El Salvador

ore than 200 participants from government institu- The Proceedings of this important workshop will be pub- tions, the armed forces, relief agencies, universities, lished later this year and made available through this Newsletter. MNGOs, municipalities and international organizations For further information contact Dr. Horacio Toro, PAHO/WHO met in El Salvador from 4-6 July to analyze the strengths and Representative in El Salvador, fax (503) 298-0021; e-mail weaknesses in 12 distinct areas of the response to the earth- [email protected]. quakes earlier this year. The Ministry of Public Health, PAHO and the ISDR cosponsored the meeting, which highlighted some of the follow- WORK GROUP ing findings: ON SOCIAL COMMUNICATION

Government agencies provided an adequate rapid first One of the working groups dealt with the quality and flow response to the disaster and local communities and NGOs of health information to the public. This group recognized that a common form to collect field data would have made it demonstrated great solidarity in the response phase, but the quicker to transfer data to the central level in a uniform fash- magnitude of the quakes and the frequency of the after- ion. shocks surpassed the national capacity to respond in a coor- Few alliances had been forged between national authori- dinated and coherent manner. ties and international NGOs. This weakened the position of national health authorities when it came to disseminatng Lesson learned from previous disasters, including the 1986 health information, because in many instances, the foreign earthquake that left more than 1200 dead in El Salvador and press first sought the opinion of the international NGOs. A Hurricane Mitch, were not taken into account, but the les- joint public information plan, crafted by actors from a variety sons brought forth at this meeting, collected in the form of of sectors and institutions, would improve coordination among Proceedings, will be welcome and should be widely dis- them. The social communicators present agreed that the after- seminated. math of a disaster is no time to try to validate the material they are distributing or select the optimal communication channels Weaknesses in social communication and the flow and dis- to ensure the greatest impact. These tasks should be carefully semination of information following disasters were in evi- thought out during the preparedness phase. dence. hospitals suffered the greatest damage. Patient care was inter- low temperatures produced Cases of acute rupted for a time, as damaged areas of the hospital were evacu- an increase in acute respi- respiratory infection 2200 ated and patients relocated. ratory infections. In parts 2000 Three hundred forty eight of the 465 public health facilities of Tacna the number of 1800 1600 in the affected area reported damage. Of these, 322 establish- cases tripled. Epidemiolo- 1400 1200 ments required low to medium-level repairs; five require struc- gical surveillance also 1000 tural reinforcement; and in 11 cases, health facilities will need to showed an increase in 800 600 be completely rebuilt at an estimated cost of US$18 million. cases of conjunctivitis and 400 acute diarrheal disease. 200 0 Water and Sanitation 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 There are 335 water systems in the departments of Tacna, Management of Humanitarian Supplies Arequipa, and Moquegua, and 30% of these were damaged and Peru's Civil Defense system was in charge of the manage- 15% were destroyed. ment of donations and the SUMA system helped to guarantee a Half of the water systems in Tacna collapsed, forcing transparent and expeditious management of relief supplies. approximately 70% of the affected population to consume water Eight foreign and local experts installed the system in the three from unsafe sources sometimes with high levels of arsenic, iron principal points of arrival and distribution: Arequipa, Tacna and or with significant turbidity. Equipment to store, distribute and Moquegua. The SUMA warehouse module was also set up in purify water was a priority. most storerooms of institutions involved in the emergency. After several weeks local personnel had assumed responsibility for the Epidemiological Surveillance system. In the rural areas, a lack of shelter, damage to dwellings and 5 Publications and Multimedia PAHO/AIDIS Publish Guide for Water Systems

New CD-ROMs Although many countries in CD-ROMs have become a widely-used and low- Latin America and the Caribbean cost way to produce and distribute information. PAHO have plans to deal with disasters in has just produced two new CD-ROMs on disaster mitiga- their drinking water and sewerage tion and the SUMA supply management system. Both systems, recent disasters such as have an easy-to-use interface that resembles a web page hurricanes Georges and Mitch and contain information in English and Spanish. (1998), the heavy rains and land- Although created to run on any PC, they work best on at slides in Venezuela (1999), and the least a Pentium 1 or equivalent with a minimum 40Mb earthquakes in El Salvador (2001) hard drive. Both will soon be available on the Internet have shown that it is not enough to (www.paho.org/disasters). A limited number is available for distribution (con- simply have a plan. The plan must tact PAHO at the address on page 8). work and have been prepared based on the specific vulnerability of the Mitigation of Disasters in Health Facilities system in question. Over the last several years, PAHO has published many information products on PAHO and the Inter-American the important topic of disaster reduction. Despite the achievements, we must continue Association of to stress that it is of little use to invest in preparedness, response or reconstruction of Sanitary and health facilities, if the vulnerability factors, and especially the necessary mitigation Environmental measures, are not considered. Engineering This CD-ROM offers training materials to learn about, promote and apply disaster (AIDIS) have mitigation measures, including: prepared this ¥ Two PowerPoint presentations about structural and non-structural aspects of disas- new publica- ter mitigation ¥ A series of posters on hospital mitigation ¥ Eleven publications (English tion (Spanish and Spanish) ¥ The software needed to use this disk. only) which offers practi- SUMA (Supply Management System) cal guide- lines on this Contains: topic. It updates and ¥ The latest Windows version of the SUMA software (and the previous DOS version) enhances other technical and users manuals (English and Spanish). documents published in the past ¥ Training materials for SUMA’s two main components: the software and integral by PAHO, and it constitutes an management of emergency supplies. This section includes manuals and PowerPoint essential complement to the 1998 presentations. Guidelines for Vulnerability ¥ Information about SUMA, including reports from former missions, a list of con- Analysis. tacts and a wide selection of photographs of SUMA operations. The new guide is aimed at man- This CD also introduces a preliminary version of the new SUMA agers, planners and designers, as Pledges module, developed together with CDERA (the well as operations and maintenance Caribbean Disaster Emergency Response Agency). personnel. It provides answers for Parallel to registering incoming donations, this module these professionals to ensure the allows information on needs to be registered. The con- quality and continuity of the servic- solidation of this information will improve how es, and this way, protecting and pre- resources are assigned. serving the population's health. This disk contains all the necessary elements to On the Internet at: www.pa- know more about, use and teach the SUMA System. ho.org/english/ped/agua.htm. A lim- ited number of print copies is avail- able from the Editor (see page 8).

6 Disasters: Preparedness and Mitigation in the Americas • July 2001 Protecting the Health Services Network (from page 1)

Hurricane Season in Full Swing ! loss of the contents of the Central Medical nents of the health services network at the region- Laboratory and the Blood Bank, the only institu- al and national level, countries can focus their The Atlantic hurricane tions of their kind in the country, produced much resources on studying the vulnerability and imple- season started on 1 June, more serious consequences. More recently, the menting the necessary disaster mitigation meas- and so far, only two tropi- earthquakes in El Salvador forced major hospitals ures to ensure they are functional following a dis- cal storms—Allison and in the affected areas to provide services from aster—thus guaranteeing that emergency plans are Barry—have passed, nei- makeshift tents. How the health services network able to meet the needs they were designed for. ther of which (as we go to fares following a disaster has a significant impact Although it is hoped that damage to all infra- press) has become a hurri- on health, as it affects both the quality of and the structure can be minimized in the wake of a disas- cane. access to health services. For this reason, it is ter (an elusive goal given the recent experiences in The World Meteorological necessary to consider overall vulnerability of the the Americas), it is essential that emergency Organization (WMO) se- health services network when planning and response plans take into account the physical and lects the names for storms preparing for disaster response. functional vulnerability of the health services net- and retires the names of Determining how the health services network work. Only in this scientific manner will we be particularly devastating will function in disasters involves identifying able to determine if we can count on the infra- hurricanes. Six lists of what facilities are key to meeting emergency structure that is key to the success of the emer- names are used in rota- needs, taking into account their level of security, gency plan and avoid costly mistakes such as tion. The names of the complexity, available human resources, strategic evacuating facilities that, in the eyes of the occu- remaining 2001 hurri- location and specialized services. The functionali- pants appear unsafe, but that, from an engineering canes and tropical storms ty of these key areas must be guaranteed if the or architectural point of view, may be sound. (which will be used again health sector’s emergency response plan is to be The appropriate design and construction of all in 2007) are: Chantal, successful. For this to happen, the level of dam- new health infrastructure and the carrying out of Dean, Erin, Felix, Gabrie- age they sustain must be minimized. vulnerability studies in existing structures will lle, Humberto, Iris, Jerry, It is not prudent to randomly select certain yield the necessary insight and facts to ensure that Karen, Lorenzo, Michelle, hospitals or health centers as targets of disaster health sector facilities plan and execute a realistic Noel, Olga, Pablo, Rebe- mitigation measures. It is imperative to select the emergency response plan. kah, Sebastien, Tanya, Van right facilities. By identifying the key compo- and Wendy.

Effective Disaster Donations: We’re Not There Yet ! o be sure, a disaster alone is enough to These and other recommendations are the challenge the logistical preparedness of any topic of a new PAHO/WHO brochure, produced in Tcountry or agency. Why add another com- collaboration with the Italian Cooperation and plicating factor to the already difficult equation? UNDP. Contact the Editor for copies or to find out Yet spontaneous or uncoordinated in-kind dona- how you can duplicate this brochure for your tions often do just that when they are more bur- organization. Also available on the Internet at densome than beneficial. www.paho.org/disasters. The well-meaning desire to help Ð on the part of organizations, governments or individuals— should be tempered by an understanding of what to give in different disaster situations, according to the conditions of the affected population. It is bet- ter to take a few extra moments and adhere to time-tested principles: know the real needs of the victims; find out and refrain from sending what is not needed; cash is the best kind of donation; avoid double standards when it comes to in-kind donations—what is unacceptable in the donor country is also unacceptable as a donation.

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In: confinados." espacios en "Trabajos M. Juan Doval, Mouriño

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Apdo. 3745-1000, San José, Costa Rica Costa José, San 3745-1000, Apdo.

Women’s Eyes. pp. 45-54, 1998. 45-54, pp. Eyes. Women’s

Regional Disaster Information Center Information Disaster Regional

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Apr. 1999. 1999. Apr. E-mail: [email protected] E-mail:

Meeting on Central America’s Reconstruction and Transformation. and Reconstruction America’s Central on Meeting Tel: 202-974-3522 • Fax: 202-775-4578 Fax: • 202-974-3522 Tel:

Washington, D.C. 20037, U.S.A. 20037, D.C. Washington, Consultative Group Consultative vulnerability." ecological and "Social Hermán.

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El Salvador: La sociedad civil sociedad La Salvador: El " Nidia. Umaña, Ileana; Gómez,

Correspondence and inquiries should be addressed be should inquiries and Correspondence

Department for International Development of the U.K. the of Development International for Department AprÐ Jun 1997. Jun AprÐ

International Development (OFDA/AID), and the and (OFDA/AID), Development International

Prehospital and Disaster Medicine, pp. 49-60, vol. 12, No. 2, No. 12, vol. 49-60, pp. Medicine, Disaster and Prehospital aster.”

Foreign Disaster Assistance of the U.S. Agency for Agency U.S. the of Assistance Disaster Foreign C.9

learned and unsolved public health problems after large-scale dis- large-scale after problems health public unsolved and learned

Development Agency (IHA/CIDA), the Office of Office the (IHA/CIDA), Agency Development

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Assistance Division of the Canadian International Canadian the of Division Assistance

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Revista Ingeniería Sanitaria y Ambiental, pp. 13-17, Nov. 1998. 1998. Nov. 13-17, pp. Ambiental, y Sanitaria Ingeniería Revista

has been made possible through the finan- the through possible made been has Newsletter

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vo en instalaciones sanitarias en hospitales y edificaciones.” y hospitales en sanitarias instalaciones en vo policy of the Organization. The publication of this of publication The Organization. the of policy

"Plan de mantenimiento preventivo y correcti- y preventivo mantenimiento de "Plan Alberto. Sanz, Bisbal nor do the statements made necessarily represent the represent necessarily made statements the do nor

grams do not imply endorsement by PAHO/WHO, by endorsement imply not do grams

Organization. The reported events, activities and pro- and activities events, reported The Organization.

erence code listed to the left of the publication title when requesting articles. requesting when title publication the of left the to listed code erence

Regional Office for the Americas of the World Health World the of Americas the for Office Regional . A complete list of reprints is available upon request. Please quote the ref- the quote Please request. upon available is reprints of list complete A . Newsletter

Program of the Pan American Health Organization, Health American Pan the of Program

duced and recently added to the collection of articles available from the Editor of this of Editor the from available articles of collection the to added recently and duced

Preparedness and Disaster Relief Coordination Relief Disaster and Preparedness responsible for disaster preparedness, mitigation and relief. They have been repro- been have They relief. and mitigation preparedness, disaster for responsible

The articles listed in this section may be of interest to health professionals and others and professionals health to interest of be may section this in listed articles The is the Newsletter of the Emergency the of Newsletter the is Americas

Disasters: Preparedness and Mitigation in the in Mitigation and Preparedness Disasters:

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ibliography elected