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Home , Carabobo, Falcon, Hurricane Bret, Hurricane Gert, Hurricane Gert (1999), Hurricane Lenny

PREPAREDNESS AND MITIGATION IN THE

Issue No. 79 News and Information for the International Disaster Community January 2000 Inappropriate Relief Donations: What is the Problem?

f recent disasters worldwide are any indication, Unsolicited clothing, canned foods and, to a lesser the donation of inappropriate supplies remains extent, pharmaceuticals and medical supplies, I a serious problem for the affected countries. continue to clog the overburdened distribution networks during the immediate aftermath of highly-publicized tragedies. This issue per- sists in spite of health guidelines issued by the World Health Organization, a regional policy adopted by the Ministries of Health of and the , and the educational lobbying efforts of a consortium of primarily European NGOs w w w. wemos.nl). I N S I D E Now the Harvard School of Public Health has partially addressed the issue in a com- prehensive study of U.S. pharmaceutical News from d o n a t i o n s (w w w. h s p h . h a r v a r d . e d u / f a c u l t y / PAHO/WHO r e i c h / d o n a t i o n s / i n d e x . h t m). Although the 2 study correctly concluded that the "problem A sports complex in Valencia, , which served as the main temporary shel- Other ter for the population displaced by the disaster, illustrates what happens when an may be more serious in disaster relief situa- Organizations enormous amount of humanitarian aid arrives suddenly in a country. Critical items tions than in developmental aid," it failed to 3 w e re mixed together with non-priority goods, and posed a serious challenge for SUMAvolunteers (see story p. S-4). (cont. on page 7) Member Photo: FUNDESUMA/J. Venegas Countries 4 Review of The Inter-American System and Disaster Reduction Publications 6 wenty-five years ago disaster management In the Americas, the Organization of American was "simple." Disaster management was States is now mobilizing its vast institutional and Upcoming limited to humanitarian emergency response political resources for the purpose of reducing the Meetings T 6 and was broken into two camps: the aff e c t e d vulnerability to disasters—from prevention to country and the international community. concerted response. The OAS General A s s e m b l y Selected To d a y, we realize that disaster prevention and has established the new Inter- A m e r i c a n Bibliography 8 preparedness are also essential components. They Committee on Natural Disaster Reduction require the mobilization and participation of all (IACNDR), which is now taking an active role in Supplement on levels: local, national, subregional, regional and coordinating the resources of the Inter- A m e r i c a n Venezuela S1 global. System to achieve this objective. (cont. on page 2)

ISSN 1564-0701 News from PAHO/WHO Other Organizations Andean Health Ministers Bogota. UNHCR will provide technical and finan- Key Disaster Managers Meet in program with a modest knowledge of the topic cial cooperation, but not relief. ❏ and certain connections to the political level. But Meet…Online Central America recent large-scale disasters—the El Niño phenom- Andean Health Ministers held a “virtual” meet- RADIUS Studies Completed and PAHO hosted a meeting in January for the enon, and the mudslides in ing on the Internet in January to report and evalu- health sector disaster coordinators from Central Venezuela—have demonstrated that this is no ate health issues resulting from the disaster in Available America and the disaster focal points from the longer enough. These disasters have shown that Venezuela. Read the dialogue from this meeting Case studies of urban seismic vulnerability from PAHO/WHO Offices in this region. Also included those with solid experience in managing a disaster at: www.conhu.org.pe/rvirtual/rvirtual.htm. ❏ Guayaquil, Ecuador, Antofagasta, Chile and were representatives from and the program, and who maintain a leadership position Tijuana, , including photographs and full within their institution, were able to make the . The meeting, which took IDNDR Ends, ISDR begins text documents, are available online at h t t p : / / place in , was called to review the greatest contribution to the health sector response. geohaz.org/radius/caseStudies.html. Health Plan for Reducing Disaster Vu l n e r a b i l i t y, They also were more successful in ensuring that As the IDNDR came to an end in 1999, a new The case studies develop scenarios which developed jointly by the region's Ministries of mitigation measures were included in rehabilita- initiative—International Strategy for Disaster describe the consequences of a possible earth- Health, and to identify national strategies that can tion, reconstruction and development activities. Reduction (ISDR)—was established in its place. quake and prepare a risk management and action be used to implement the regional plan. The par- Today, Ministries of Health expect their disaster An Inter-Agency Task Force and a Secretariat will plan for earthquake disaster mitigation. The case ticipants placed emphasis on certain strategic coordinators to possess more than a passing implement the new strategy structured around four studies aim to raise the awareness of decision areas including the mobilization of resources at knowledge of certain specialized topics such as main themes: public awareness; the commitment makers and the public, transfer appropriate tech- the national level, proposal writing and enhanced mass casualty management or evaluation of dam- of communities and public authorities; disaster- nologies to the cities, set up a local infrastructure management techniques, training and improved ages. To d a y, they are expected to manage all resilient communities; and the reduction of socio- for a sustainable plan, promote multidisciplinary information collection and dissemination. T h e aspects of a comprehensive disaster reduction pro- economic losses. ISDR will proceed from an collaboration and promote worldwide interaction. ❏ skills required to formulate, implement and evalu- gram. To meet these changing needs, PAHO/WHO approach of protection against hazards to the man- Read about ate these strategies will be the focus of an inten- is organizing the first of what will be a two-week agement of risk. The task sive training curriculum PAHO is developing for annual course for those responsible for health sec- force will devise strate- PAHO’s disaster health disaster managers throughout Latin tor disaster programs in Latin America and the gies and policies for the e-tools (websites, America and the Caribbean (see next story). ❏ Caribbean. The first course will be held 4-15 reduction of natural haz- September in Costa Rica (in Spanish) and will ards, identify gaps in listserves and PAHO Plans Specialized Disaster include topics that address these skills such as existing policies and pro- databases) at decentralization, information management and grams and ensure com- Management Training Course mobilization of resources. ❏ plementary action by www.idpproject.org www.paho.org/ agencies. For more infor- The Norwegian Refugee Council offers a database of information on the 14 worst Internally Displaced In years past, it was possible to assume the Population countries—including , Peru, Burma and Afghanistan. english/ped/ coordination of a country’s health sector disaster mation please e-mail h m o l i n @ u n d p c o s . www.HumanitarianTimes.com pedhome.htm The Humanitarian Times, which circulates news to aid workers worldwide on international aid and nu.or.cr or fax: (506) 257- crises via email, is now online. 2139. ❏ The Inter-American System www.oge.sld.pe/defensa/ (from page 1) Peru's Office of National Defense, Emergencies and Disasters has a new webpage, with information on UNHCR Opens the latest disasters, SUMA trainings and links. The Secretary General accountability of the First Of Three www.medellin.gov.co/desarrollo/infraestructura/amenaza.html of the OAS, chairman of response and strong pro- The Secretary of Community Development in Medellin's new website on the Geological Hazards in the the IACNDR, has fessional technical coop- Planned Offices Aburrá Valley (Amenaza Geológica en el Valle de Aburrá), Colombia. assigned PAHO the eration both before and The UN High Com- www.cla.sc.edu/geog/faculty/carbone/tropcycl/index.htm responsibility for one of immediately after a missioner for Refugees Guides the viewer through the formation, structure, energy, and movement of tropical cyclones by using three work groups. T h i s disaster. sketches, radar and satellite imagery, and animations. (UNHCR) plans to open group is tasked with It is a long process, as three offices in Colombia www.md.ucl.ac.be/cred/ advising on mechanisms PAHO has learned over The Centre for Research on Epidemiology of Disasters (CRED) at the University of Louvain, Belgium, by the end of 2000 to for a coordinated the course of 23 years of offers a database, covering over 10,000 disasters, including maps, summary data and a search engine assist the government response and prepared- technical cooperation in online. with the country's grow- ness of the entire Inter- this field. The OAS now ing displaced population. An E-Mail List for Disaster Graduate Students American System. has a clear mandate from its member states. T h e The first field office has The "Disaster Grads" e-mail list supports information sharing among students who conduct disaster The Inter-American System can contribute a constructive response of the Inter-American insti- been opened in Barran- research. To subscribe send an e-mail message to [email protected], and in the body of the mes- great deal to a collaborative response that may tutions to this challenge bodes well for the future cabermeja, north of sage write "subscribe disaster_grads [your first name][your last name].” include assessment of needs, transparency and of the region.❏

2 Disasters: Preparedness and Mitigation in the Americas • January 2000 Disasters: Preparedness and Mitigation in the Americas • January 2000 3 Member Countries Remembering the Disasters of '99 A selection of some of the disasters that struck in 1999 and their impact on the Region…

Hurricane Lenny Storm Season in Review Volcanic Activity in Ecuador TROPICAL STORM ARLENE: June 12-18. Formed south and east of urricane Lenny was the 12th storm of the lifeline facilities damaged, utilities disrupted and . Winds of 60 mph, briefly threatened Bermuda before dissipating. ince October 1998, strong volcanic activity CIDAFunded Project Assists Health 1999 season, and social and economic activities interrupted for pro- from the Guagua Pichincha and the : Aug. 19-22. Formed east-southeast of Ta m p i c o , Situation appeared in the southwest Caribbean on longed periods following the hurricane. Tunguruhua volcanoes (15 and 150 km from H Mexico, and became a Category 4 storm with winds estimated at 140 mph. S PAHO and the Ministry of Health are imple- 17 November as a category 4 hurricane, bringing The Eastern Caribbean Donor Group, under Quito respectively), has kept the country on alert. menting a project funded by the Canadian with it heavy rains, wind and storm surges. High CDERA's coordination, activated their regional HURRICANE CINDY: Aug. 20-31. Formed far out in the Atlantic. It reached Many Ecuadorians have downplayed the danger International Development Agency to improve the seas and thunderstorms associated with the hurri- response mechanism early and an assessment its peak intensity as a category 4 storm (140 mph) on the 28th. from these volcanoes, attributing the warnings to following areas in the four most aff e c t e d cane resulted in extensive damage to coastal areas team assisted many severely-affected countries: : Aug. 24-Sept. 5. Intensified to a category 2 (105 attempts by authorities to deflect attention away provinces: and severe flooding in the southern Wi n d w a r d , , St. Kitts and mph) on the 28th. Produced heavy rains over North Carolina (U.S.) and the from other problems. However, the permanent • Epidemiological surveillance . , , and St. Vincent and the mid-Atlantic States. "presence" of the volcanoes—smoke clouds, ash- Volcanic ash can cause respiratory diseases and Grenadines. TROPICAL STORM EMILY: Aug. 24-28. Gained tropical storm status on fall, lava flows—is a constant reminder of the skin, intestinal and problems. The most fre- An Unusual Storm… the 24th and on the 28th became absorbed within Hurricane Cindy's circu- need to make preparations for what could be a quent ailments related to ashfall will be identified Lenny devel- Health Sector Concerns lation. volcanic emergency on the scale of or to prevent further adverse health effects. oped rather late The health sector’s main concern was the pro- : Sept. 8-17. See story. Pinatubo in the Philippines. • Water and sanitation in the season, tection of drinking water supplies, waste disposal : Sept. 12-23. Gert reached its peak intensity on the Ashfall, mud flows and lava have the greatest when most and the treatment of stagnant water to prevent an Evacuated Populations 15th with winds near 150 mph. It passed east of Bermuda and then very contaminating effect on water. It is essential to countries were increase of mosquito breeding sites. A l t h o u g h Pressure to return evacuated populations to their close to . chlorinate rural water supplies and cover reser- not expecting very few casualties were reported, the number of homes in high and medium-risk areas is compli- TROPICAL STORM HARVEY: Sept. 19-22. Became a storm while in the voirs and small sources to protect against ashfall. any more hurri- dead posed serious problems. No damage cating matters for authorities. On two occasions, central and produced tropical storm force winds over por- • Mental health canes. It is the to hospitals or health structures was reported. shelters were set up in Quito in tents and churches tions of . The focus will shift from shelters to those who only known hurricane or tropical storm to track to house 1,500 persons, although shortly thereafter have returned home. Personnel are being trained eastward across nearly the entire , International Funding : Oc.t 13-19. Developed south of , becoming a they were returned home because of the Guagua to deal with mental health issues during an from Tobago in the south to in the north. Donor agencies were quick to provide funding hurricane in the Florida Pichincha’s temporary stability. Straits. evacuation. to the affected countries for purchasing health and The problems associated with the Tu n g u r a h u a • Supply management Damages and Local Response sanitation supplies. These funds came from TROPICAL STORM KAT- volcano are more complex. Responsibility for the S U M A courses were given for warehouse per- L e n n y ’s strength and its path were responsible OFDA, CIDA, DFID, the Caribbean Development R I N A : Oct 29. Developed e m e rgency is divided among the three provinces sonnel and computers installed in key locations. A for the extent and range of the damages. In the Bank and others. ❏ in the southwestern Gulf closest to the volcano. The evacuated population more comprehensive supply management course northeast Caribbean, flooding, blocked roads and and moved northwest ward continues to return home even though the risk is is being organized for health personnel. Local and minor infrastructure damage were common, while over and still high. Local authorities have been forced to . regional data on supplies have been processed, all of the affected islands including the provide training and awareness programs to the thanks to good coordination between authorities Windwards suffered severe coastal damage and : Nov. returnees. Some 3,000 people are estimated to be and the warehouses where SUMAhas been set up. beach erosion. Lives were lost, homes destroyed, 13-21. See story. residing again in the town of Baños, which is located on the flanks of the volcano.

Hurricane Floyd urricane Floyd, the 6th named storm of the '99 season, was accompa- Fortunately, the use of bottled water for drinking is common in nied by high tides and waves. The lower islands of the Bahamas were • During Floyd, public cries to quarantine the migrant workers' villages, in an and the compromised public water supply did not pose a severe crisis. Hsubjected to damages from heavy winds, and the severe impact from attempt to stop epidemics, were prevalent, even though no increase in commu- Damages to housing and infrastructure were not as bad as in previous hurri- sea swells. Many coastal dwellings, villages and roads suffered major damage nicable diseases was reported at the time and did not develop later. canes, although severe damages did occur in low-income communities of or were totally destroyed. • It was also necessary to dispel popular concerns that cholera might be spread water levels caused coffins to resurface migrant populations. Despite the damage to the migrant workers' villages, Floods crippled the Freeport Airport and the power supply, which in turn, at a graveyard where decades ago, cholera victims had been buried. roads were still passable and the water supply, electricity and telephone con- affected the water utilities. Once the power was restored the water supply was PAHO has published several articles, books, and webpages dealing with the topic of the Myths and Realities of nections were quickly restored. This was partly due to the high level of self- up and running. Natural Disasters . For more information on this topic please visit us at: www.paho.org/english/ped/pedhome.htm. ❏ reliance within these communities. Floodwater also impacted the shallow fresh water lenses of the Grand Bahamas, increasing the salinity of the public water supply significantly.

4 Disasters: Preparedness and Mitigation in the Americas • January 2000 Disasters: Preparedness and Mitigation in the Americas • January 2000 5 eview of ublications . . . what is the problem? R P (from page 1) New Training Material on Disaster Mitigation SUMA volunteers outline the basic distinctions between these two sort through donat- situations. However, the authors did recognize ed medical items …And now it’s floods! The heavy rains which provoked flooding and mudslides in Venezuela in late several of the study’s limitations, but these were that began arriving December is the latest in a series of natural disasters to affect hospitals and other health installations in conveniently "overlooked" by the pharmaceutical the region. This disaster damaged almost 300 health facilities in the entire country. In the state of industry and the mass media in quoting specific in Venezuela shortly alone, two hospitals and six health centers suffered irreparable damages. As was the case in past disas - statements. after the disaster. ters, much of the damage could have been avoided had disaster mitigation plans been in place and appro - The study was sponsored by a consortium of priate measures taken. PAHO has produced new disaster mitigation material that focuses on developing U.S. pharmaceutical companies and NGOs, and vulnerability studies and applying practical mitigation measures in health facilities. included: • an in-depth analysis of the shipments of two major U.S. NGOs (unnamed) Fundamentals of Disaster most important doc- Mitigation in Health • interviews and questionnaires with a larg e r uments on disaster number of U.S. NGOs F a c i l i t i e s is a multidiscipli- . . .“Vencido” (or mitigation. It con- • field studies and interviews conducted in nary publication that “Expired” ). . . many tains new and previ- Tanzania, Armenia and . replaces and updates several items never make it to ously published books • The in-depth analysis of the two U.S. NGOs, previous PAHO publica- those for whom they and slides in electron- selected from a list generated by the study's spon- tions. Graphics and up-to- were intended . . . See ic format. T h e sors, identified very valuable findings and recom- date information on vul- the Special CDROM contains: mendations on routine (non-emergency) donations nerability studies from Supplement for more • Two new Power- of supplies. Nevertheless, it failed to address the Latin America reflect information on the point slide series on structural real issue and investigate the worst off e n d e r s : the region’s experi- and non-structural aspects of Venezuela disaster. ences in the application of hos- small, uninformed, ad hoc charities, the small disaster mitigation in health facili- minority of greedy pharmaceutical wholesalers pressure of the emergency situation, opportunities pital mitigation measures. It is presently ties, designed for training activities. available in Spanish online at who seek not only a tax deduction but also an present themselves for well-intentioned or for • The new publication Fundamentals of Disaster undeserved public relations coup, and above all, unscrupulous dealers to bypass any control by w w w. p a h o . o rg / s p a n i s h / p e d / p e d s r e s . h t m; the Mitigation (mentioned previously), and the English version will be ready by May 2000. A the large number of misinformed but well-inten- health authorities in recipient countries. In the book “Lecciones Aprendidas en América Latina tioned individuals who have been deeply moved words of a Turkish diplomat, "it would have been limited number of Spanish-language copies is sobre la Mitigación de Desastres en available through CRID (see p. 8). by the coverage of the disaster. political suicide" to reject donations. Instalaciones de Salud”, published in 1997. • The interviews of the b ro a d e r range of The midst of a full blown humanitarian effort is Disaster Mitigation in Health Facilities (Both are available in PDF format at NGOs from the list suffer from the same sampling definitely not the right time to try to educate the (CDROM). PAHO created this CDROM (Spanish www.paho.org/spanish/ped/pedsres.htm. flaws. The voluntary responses by agencies from public by informing them that their heartfelt only at present) to make it easier to locate and A limited number of copies of the CDROM are within a group of development NGOs and their efforts to collect a truckload of supplies may turn consult, in one single location, the Organization’s ❏ available through CRID (see p. 8). pharmaceutical partners are not exactly represen- out to be more harmful than useful. tative of the situation we have encountered in The time to explain the apparent paradox—that disasters. well-meaning supplies are not needed when the • The field studies are much more enlightening. victims are shown to be in greatest need of assis- pcoming eetings On the one hand, they show the complexity of the tance—is before an emergency. Let's not underes- U M drug donation process in normal times, which timate the capacity of the public to understand the links many actors from industry, established inter- rationale and compelling logic of exercising w w w. i a d b . o rg / e x r / a m 2 0 0 0 / i n d e x . h t m o r e d u / m e x i c o c i t y. h t m or contact Dr. Felipe national NGOs, their local counterparts, and the restraint and discipline in the immediate aftermath IDB Meeting on Disasters ❏ e-mail: [email protected]. Cruz Vega at e-mail: [email protected] health authorities at central level and in the receiv- of disasters. The challenge of teaching how to be The 2000 Inter-American Development ❏ or fax: (525) 5282-4406. an effective donor is no more insurmountable than B a n k ’s Annual Meeting will be held in ing institutions. On the other hand, they also the challenge of developing a culture of disaster New Orleans (USA). One of the semi- Second Meeting of W AD E M reveal pragmatism on the part of the recipients in dealing with this issue. They are concerned that reduction and prevention. nars, "Confronting Natural Disasters: A The World Association for Disaster and AIDIS Congress strict regulations and bureaucratic control may dry An international educational campaign involv- Matter of Development" from 25-26 Emergency Medicine (WADEM) is host- AIDIS, the Interamerican A s s o c i a t i o n up this source of assistance, imperfect as it may ing the mass media, hopefully on a non-commer- March, will bring together multisectoral ing its 2nd Pan American Congress 22-24 of Sanitary Engineering will host the 11th be, which is essential for their operations. cial basis, is within the reach of the humanitarian specialists to identify policies and proj- May 2000 in Mexico City, in collabora- Congress on Sanitation and the The problems faced in sudden-impact disasters c o m m u n i t y. It is a challenge appropriate to the ects that will improve the capacity of tion with PAHO and several medical Environment from 10-12 May 2000 in are distinct: normal dialogue or consultation beginning of a new century, a challenge that the member countries to confront natural dis- associations in Mexico. For more infor- Mendoza, A rgentina. Consult their we b - processes often break down; routine safeguards humanitarian community in the U.S. and the rest asters. For more information visit mation visit h t t p : / / p d m . m e d i c i n e . w i s c . site at: ww w .a i d i s a r .o r g/ . ❏ and quality control no longer function. Under the of the Americas should assume. ❏

6 Disasters: Preparedness and Mitigation in the Americas • January 2000 Disasters: Preparedness and Mitigation in the Americas • January 2000 7 Selected Bibliography

Disasters: Preparedness and Mitigation in the The articles listed in this section may be of interest to health professionals and others A m e r i c a s is the Newsletter of the Emerg e n c y responsible for disaster pre p a redness, mitigation and relief. They have been re p ro - Preparedness and Disaster Relief Coordination duced and recently added to the collection of articles available from the Editor of this Program of the Pan American Health Org a n i z a t i o n , Newsletter. A complete list of reprints is available upon request. Please quote the ref - Regional Office for the Americas of the World Health erence code listed to the left of the publication title when requesting articles. Organization. The reported events, activities and pro- grams do not imply endorsement by PA H O / W H O , Tweeddale, Mark, “The nature and handling of risk,” A u s t r a l i a n nor do the statements made necessarily represent the Z.8 Journal of Emergency Management, pp. 2-4, Spring 1996. policy of the Organization. The publication of this Newsletter has been made possible through the finan- Laporte, Ronald E. et al., “Global epidemiology and public health in cial support of the International Humanitarian Z.9 the 21st century. Applications of new technology,” AEP, Vol. 6, No. Assistance Division of the Canadian International 2, pp. 162-167, March 1996. Development Agency (IHA/CIDA), the Office of Foreign Disaster Assistance of the U.S. Agency for Armenian, Haroutune K. et al., “Long term mortality and morbidity International Development (OFDA/AID), and the Z.10 related to degree of damage following the 1988 earthquake in Department for International Development of the U.K. Armenia,” American Journal of Epidemiology, Vol. 148, No. 11, pp. Correspondence and inquiries should be addressed 1077-1084, 1998. to: The Editor B a x t e r, Peter et al., “Actividades médicas preventivas ante erup- Disasters: Preparedness and Mitigation A.1 ciones volcánicas,” Prevención, No. 18, pp. 16-25, Agosto 1997. in the Americas Pan American Health Organization Quirós, Gerardo, “La cadena logística de los suministros en casos 525 Twenty-third Street, N.W. A.2 de emergencia,” article prepared for Doctors without Borders, Washington, D.C. 20037, U.S.A. Regional Office for Emergencies in Central America and the Tel: 202-974-3522 • Fax: 202-775-4578 Caribbean, 1996. E-mail: [email protected] www.paho.org/english/ped/pedhome.htm Delgado, Mónica et al., “Plan de control de desastres—Hospital A.3 Vozandes Quito,” Revista Médica Vozandes, Vol. 10, No. 1, pp. 51- CRID 56. Regional Disaster Information Center Apdo. 3745-1000, San José, Costa Rica Fax: (506) 231-5973 E-mail: [email protected] www.disaster.info.desastres/net/CRID No. 1 A Supplement to Disasters: Preparedness and Mitigation in the Americas January 2000 the quarterly newsletter of PAHO/WHO

The 1999 Venezuelan disaster was not only the worst tragedy in Venezuela's history but also one of the most severe disasters in the Americas this century. Between 1-16 December 1999, rainfall in Venezuela was eight times the usual amount for that time of year. As a result, in many areas of the Cerro Avila (the mountains that surround and its neighboring states) landslides caused severe mud and debris flows that buried entire villages and affected a total of eight states, including Caracas. Most of the content of this sup - plement was prepared by the PAHO/WHO office in Venezuela. It is available online at w w w . o p s - o m s . o r g . v e / (in Spanish only). Selected portions have been translated into English and are online at www.paho.org/english/ped/ped-venezuela.htm.

being set up, alternative measures, such as in the acquisition of Water and Health 30,000 portable toilets, are in place. Nearly 600,000 people were left without drinking water after Another emerging problem is the lack of a proper solid waste the disaster. Next to fatalities and injuries, damaged water and management system, since landfills have been rendered useless sanitation systems were the most serious problem. due to the floods. The lack of a means for disposing of waste Despite the severity of the situation, Venezuela rapidly took poses a health hazard, and in response, local communities have steps to correct matters. Eight of the 11 states recovered their taken action to control disease vectors by burying or burning water supply in just three weeks after the flooding. Alternative waste. means were used to provide water to many localities. These included special pumps attached to the water network, large water-transporting ships, tanker trucks, and portable purification and desalinating plants. However, in the three worst-hit states (Vargas, and Falcon), where more than 70% of the infrastructure and key facilities were damaged, much remains to be done. Once the water supply is reestablished, a drainage sys- tem for sewer and stormwater will also have to be made opera- tional to deal with the wastewater. The country is acquiring systems and equipment which can be installed immediately upon arrival. While these systems are

S-1 Health Services Reconstruction and Rehabilitation Almost 300 health centers Venezuelan health authorities were affected by the flooding, are completing an assessment of including 251 outpatient clinics damaged health facilities in the and nine hospitals. In Vargas, affected states. Following the the worst-hit state, all health assessment, the country will facilities, particularly hospitals, begin rehabilitation and recon- were affected and have limited struction projects for each facili- operatting capacity, which pre- ty, including the restocking of sented a major hurdle in treating necessary supplies and equip- victims of the disaster. ment. In the metropolitan Caracas In Vargas State, it will be nec- area, two hospitals were flood- essaary to evaluate whether or ed. Despite these damages, the not to rehabilitate or reconstruct network of hospitals in Caracas damaged health facilities, as the was able to handle the needs of the affected population in the possibility exists that some regions many never again be inhabited. affected areas who had access to hospitals.

Estimate of Damages to Affected Facilities

Federal District Affected Population % of Affected Hospitals % of Outpatient Wards Affected Vargas 215,000 100% 72% Distrito Federal 20,000 16% -- Miranda 45,000 8% 60% Falcon 80,000 33% 31% 2,000 20% 26% Total 362,000 29% 36%

Disease Surveillance and Control Malaria Since October 1999, the number of malaria cases has Syndromic Approach increased. December's disaster exacerbated this situation, putting To achieve better epidemi- affected populations in regions where the disease was already ological surveillance and present at a greater risk. control after the disaster, the In the week following the disaster, 628 cases were reported, Venezuelan health authorities 100 cases more than in the week prior to the disaster. The states activated the "daily syn- in an epidemic situation are Amazonas, Anzoategui, , dromic report" in shelter. and , although among these, only Zulia and Anzoategui This consisted of daily fol- were affected by the disaster. Among the other states affected by low-ups on the epidemiologi- the disaster, is at highest risk for developing a malaria cal behavior by syndromes, epidemic. that is, by groups of symp- toms and clinical signs. The purpose of this type of surveillance is to detect in advance disease outbreaks and to control them immediately. The main syndromes targeted were respiratory, diarrheal, dermatological and febrile. Venezuela’s epidemiological surveillance system has intensi- fied its efforts to report communicable diseases among the affected population, including reporting on special occurrences such as cholera, meningococcal meningitis, measles, diphtheria, whooping cough, and yellow fever, among others. Authorities will also carry out assessments in temporary shel- ters to determine the extent of mental health problems such as depression, alcoholism, physical and sexual violence.

S-2 Disasters: Preparedness and Mitigation in the Americas • January 2000• Supplement Cholera in Venezuela

States Week No. 52 Cumulative Totals

1999 1998 1999 1998 Cases Deaths Cases Deaths Cases Deaths Cases Deaths Zulia 0 0 0 0 0 0 13 0 0 0 0 2 21 2 10 0 0 0 15 1 55 1 247 5 Sucre 13 0 4 0 247 4 43 1 Anzoátegui 1 0 0 0 1 0 0 0 Miranda 0 0 0 0 9 0 0 0 0 0 0 0 53 0 0 0 Total 14 0 19 3 386 7 313 6

Source: Ministry of Health and Social Development

Cholera Dengue Thirteen new cases were reported in Sucre in the last week of Venezuela entered an epidemic phase for dengue in the third 1999, totalling 247 cases for the year. The cumulative total in the week of December. The most affected states were Anzoategui, six states of the country where the disease is present was 386, , Falcon, Merida, and Zulia. All, except for Merida and representing 73 more cases than in 1998. Carabobo, were affected by the floods. Cholera, reintroduced in Venezuela in 1996, increased during From 19-25 December, 26,277 cases were reported, of which 1999. Authorities are on alert for the disease due to the health 2,615 corresponded to dengue hemorrhagic fever. Fifteen of the emergency it could provoke. The greatest problems are located cases were fatal. in Sucre and in Miranda, states affected by the disaster and that Cumulative incidences in 1999 show epidemic situations in the are currently in a cholera epidemic. states of , Falcon, Nueva Esparta, Portuguesa, Sucre, and By the end of the third week of January 2000, 41 new cases of Zulia, four of which were affected by the disaster. cholera had been reported, 29 of which were in the state of Sucre alone.

Specific goals of the initiative include: ProVention Strategy for • promoting a culture of safety through education and Future Disasters training • supporting public policy that can reduce the risk of natural and technological disasters n 1998, natural disasters claimed more than 50,000 lives • supporting pilot projects disseminating information about and resulted in economic losses of more than US$65 bil- "best practices" that have been proven to mitigate the I lion. These losses are difficult for any economy to absorb, scope and frequency of disasters but the impact upon developing countries --which are dispro- • developing governments' ability to minimize disasters and portionately affected by disasters-- is often devastating. to respond effectively when they do occur An international partnership designed to reduce the human The Norwegian Government, in their remarks, pledged US$ and economic costs of natural disasters in the developing 2 million as "seed" money for the development of the world was launched at the beginning of February 2000 by the ProVention Consortium, while the president of the World World Bank and an international coalition of governments, Bank, James Wolfensohn, announced that 15% of all disaster international organizations, private insurance companies, uni- relief funds from his institution will be dedicated to the reduc- versities, and non-governmental organizations. tion of vulnerability to disasters. The aim of the ProVention Consortium, as the partnership For more information on this initiative visit the ProVention will be known, will be to equip developing countries with the website at w w w . w o r l d b a n k . o r g / h t m l / f p d / u r b a n / p r o v e n t i o n / means to better cope with natural disasters such as earth- i n d e x . h t m l or contact Alcira Kreimer at e-mail: a k r e i m e r @ quakes, hurricanes and floods, and reduce the loss of life and worldbank.org, fax: (202) 522-2125. destruction they cause.

Disasters: Preparedness and Mitigation in the Americas • January 2000• Supplement S-3 Mission in Venezuela

he Humanitarian Supply Management System (SUMA), in response to a request for assistance by the Venezuelan TMinister of Health, set up centers (listed below) in the emergency area to ensure proper management of the daily influx of donations of medicines and other supplies. The most urgently needed items were antimalarials, antibiotics and common phar- maceuticals.

In January two more centers became operational, one working out of Venezuela's Vice Minister of Health's office and the other in the Regional Health Bureau of the state of Miranda. The armed forces were initially in charge of receiving, manag- ing and distributing the assistance to Venezuela. However, they have been transferring these responsibilities to civilian institu- tions such as the Ministry of Health, the Red Cross and local agencies. To view the entire article on Donations and SUMA, including the list of pharmaceuticals required, compiled by the Venezuelan, Ministry of Health, please visit w w w . p a h o . o r g / english/ped/ped-venezuela.htm.

In the states of and Carabobo, which were not affected by floods but absorbed large numbers of victims following the dis- Supply Management…One Month Later aster, the SUMA system was critical in managing the great out- Since the Venezuela mission began 16 December last year, pouring of humanitarian aid. In Carabobo, approximately 14,500 national and international humanitarian aid has not stopped victims were received in a matter of hours. As of 30 December, pouring into the country and SUMA volunteers have contin- nearly 3,000 tons of supplies had been mobilized through the ued with their mandate to sort, classify and prioritize urgently efforts of civil society organizations with several years of train- needed health supplies. ing in emergency management and in the use of the SUMA sys- Recent developments include: tem. • A group of experts from the Ministry of Health, the Lara, with nearly 2,000 victims at 11 comprehensive health National Institute of Hygiene and the Venezuelan Central care centers, has five collection centers for receiving and distrib- University and other agencies conducted an assessment to uting assistance. As of 28 December approximately 1,000 tons of develop accurate information on the most critical medical emergency supplies had been received - 15% of which corre- needs in accordance with the epidemiological profile, histori- sponded to pharmaceuticals. cal consumption and other factors. As a result, a second list of medical priorities was issued and is available from the PAHO For more information Venezuela website at www.ops-oms.org.ve/. FUNDESUMA • In January, a workshop on the Management of Supplies in A.P. 114 Disasters was held at the Pharmacy Faculty of the Central University of Venezuela to train volunteers working with Plaza Mayor 1225 SUMA. The SUMA Project is being considered for part of the San José, Costa Rica syllabus of a disasters course at this university. Many stu- E-mail: [email protected]. co.cr dents, teachers and government representatives attended the Web site: http://www.disaster. info.desastres.net/SUMA/ event.

S-4 Disasters: Preparedness and Mitigation in the Americas • January 2000 • Supplement