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NIRAPAD Barta A Quarterly Newsletter of Network for Information, Response And Preparedness Activities on Disaster Issue 16, October 2009

Typical Disaster affected family Residing on the Polder Photograph: NIRAPAD from the AILA affected upazilla of Dakob

In this Issue EDITORIAL Protecting Physical and Mental Well Being of Health Services for Disaster Victim during Disaster and Children: Child Friendly Spaces at AILA Affected Area 2 in post Disaster Situation -Md. Harun or Rashid Disaster is a common phenomenon in Bangladesh. From the past few years its -Mostafa Kamal increased intensity and frequency indicate that in future it is going to create huge -Kazi Sunzida Lisa mess in our country. Global warming and climate change also accelerated the disaster events and can affect human health directly and indirectly. Generally after Climate Change and Health Impact disaster we concentrate on food, health, cloth, shelter and livelihood restoring. But in Bangladesh 4 impact of health consequence is not much taken seriously as other after any -Kazi Shahidur Rahman disaster. -Sabkat Kamal After a massive disaster like flood or cyclone, massive health response in needed. Also injuries from disaster, recovery of dead bodies are required. Not only that wide First Aid for Different Disaster Events: CPP 5 spread dead bodies (in case of cyclone), animals and others pollute the water and -Ruhul Amin cholera, diarrhea and other water borne epidemic. Stagnant water and dead bodies Reproductive Health Services for Disaster of animal could lead to a potential environmental disaster as well as health disaster Affected Areas 6 by water contamination. -Tahera Ahmed When a disaster sticks, the affected people necessitate medical assistance as well as the children, people with disabilities (PWDs), women (especially pregnant and Disaster and Climate Change Risk Management lactating mothers), elderly people need protection and psychosocial care. Yet, the Need to be Emphasized in BCS (Health) Cadre medical responses to a disaster lean on a health system which is not fully Foundation Training courses 7 sequenced. Health services for disaster victims during disaster and in post disaster -Dr. Mahmudul Islam situation are poorly equipped to respond to a major disaster with proper planning. Facility and staff resources are limited, misuse of resources, public health and Relief to SIDR Affected People: Drinking private medical sector plans are inadequately coordinated, communications are Water and First Aid in Disaster 7 incompatible and funding is not sufficient to support development of a sustainable -Mirza S I Khaled infrastructure for an effective response. Despite that GO and different development organizations are very concerned about the emergency health management. Health Services for The Flood Affected People of The Haor Area 9 Considering the overall situation, consequences and importance of Health services -Shah Md. Nazmul Haque for disaster victims, NIRAPAD decided to cover Health Services for Disaster Victims in this issue. It presents several articles, expert opinion and case studies of health The Minimum Initial Service Package (MISP) services during disaster and in post disaster situations. We hope our publication will For Sexual And Reproductive Health In be succeeded if it contributes in generating further knowledge and meeting up the Emergency 9 gaps between reached to and unreached people. I would like to acknowledge all the contribution made by the authors, our colleagues, and member NGOs. -Niger Dil Nahar

Interview: Mahbuba Nasreen 10 Kazi Shahidur Rahman Editor and Coordinator, NIRAPAD Protecting Physical and Mental Well Being of Children: the traumatic children. In that case, the children also program. They referred to the Professional Counselor if necessary. took overall Child Friendly Spaces at AILA Affected Area responsibilities · Joyful learning: In the CFS center, the adult workers for the running Md. Harun or Rashid, Manager-ECB Project, Save the Children What is Child Friendly Space (CFS) created such kind of environment where children can E-mail: [email protected]; as well as A space, where services to children are provided to ensure learn joyfully through playing, drawing, to tell a story, responsible for Mostafa Kamal, Coordinator-BELT, Save the Children their protection in short term or long term basis during the singing or drama, etc. The children of all ages enjoyed E-mail: [email protected]; disseminating natural calamity or after the natural calamity is called child the learning system. the information Kazi Sunzida Lisa, Program Officer-Research & Documentation, NIRAPAD, friendly spaces (CFS) for children. This is a comprehensive E-mail: [email protected] · Recreation: The materials for play or to spend leisure to the children. effort to recover physical and mental loss of children through time or for recreational were also preserved locally in the Above all, they providing some services such as psychosocial support, joyful May 25, 2009 witnessed the landfall of Cyclone Aila that hit space. maintained learning, nutrition, recreation and health as well as turn back India and Bangladesh coast, impacting 3.9 million people and close liaison with the local administration and local people for them to normal life. As a whole, this is an attempt to support 2. Safe water killing more than 190 people across 11 districts in coordinating the overall task. 1 their normal development and as well as the preparedness for Safe water was preserved in the service center. The water was Bangladesh . Although the death and injury toll was much less future emergencies. Community participation compared to cyclone SIDR, the effect of storm surge on the purified by water purification tablet or boiling. The CFS people and families living in mainland chars and isolated chars Objectives of the CFS in Aila affected areas service workers were tried to aware the children to use safe A Committee named “CFS Management Committee” was was substantial. The storm surge rose 10-12 feet over water for household purpose. formed. The members of the committee included the local · To ensure protection of the children in the immediate leader, UP member, Imam of mosque, school teacher and astronomical tide destroyed homes, household belongings, aftermath of the AILA disaster. 3. Nutrition food stocks, water sources and sanitation facilities of the poor social workers. The main task of the committee was to help to properly establish and run the CFS. The CFS Management communities. · To support children to return back to normal life. Nutritional food supplied or provided to the children regularly and adequately to maintain their nutrition. The food Committee is responsible to maintain close liaison with local Initial assessments of the affected areas showed the crucial · To increase accountability of local people, policy makers was produced or cooked locally. The food items were selected government, schools etc. need for child to ensure protection of children during the disaster. in consultation with the children. This includes vegetable, Staff/Volunteers protection mixed khichuri (hotchpotch), vitamin enriched biscuits, fruits including creation · To increase skill and participation of children. collected from the local area etc. Two staff/volunteers were assigned to operate each CFS. of safe · To support children to return to or start education. Staff/volunteer had considered the following to operate the environment for 4. Clothes and education material safe space: Participants of the CFS children, clean Children can return to school clothing as school uniforms and · A staff/volunteer should never hit physically, mentally or drinking water and The children who were victimized mentally or physically educational material was also provided. Moreover the sexually abuse children, such as slap, hit with the fist, sanitation systems, during the calamity or after calamity may come to the space. organization cooperated with the local school and supports scolding, verbal discipline, intimidate, comparing, etc. ? and medical The ages of the children were usually between 5 years to the children to start school as soon as possible. Never act in ways intended to shame, humiliate, belittle assistance in the 16/18 years. But in special cases, less than 5 years of children 5. General treatment or degrade children or otherwise perpetrate any form of prevention of also came with their parents. The children of the community emotional abuse. disease outbreak. were motivated to visit the CFS. General treatment facilities were provided in the safe space. In As in most emergency, some medicine according to the doctor advice for · Need to ensure child participation. Location of the CFS emergency treatment was preserved to ensure children’s disasters, children · health facilities. In special cases, special arrangement kept to Take action immediately if the children have possibilities have been severely The CFS is a community based service centre. In a to be a victim of any kind of oppression. affected by the community, more than one CFS could be operated according bring the children to the local hospital and regular follow up. · effects of the cyclone. Many children have lost their homes to its necessity. It has been operated in Child Club, School, and Timetable to operate the safe space daily Keep monitoring that one child might not be victim by and are now displaced, creating a sense of insecurity. Some Community Space or in home of the community people. But other children. also have lost family members and friends. Schools and health Child Club was given priority to establish and operate the safe The CFS opened 09:00am to 05:00pm daily. It ensured that The Child Friendly Spaces lessons learned workshop which centers have been damaged and destroyed, creating a need for space. every child can be returned safely to their parents before the was held at Dhaka on 12th July, 2009 revealed that CFS was a protective environments, education, and water and health sun set. Services Provided very timely and useful intervention to meet the immediate services. The most crucial problem faced by the children were Duration of Safe Space needs of the vulnerable children. CFS played a very crucial mental agony and depression caused by the terrible In the immediate aftermath of AILA there was an urgent The duration of operating of the safe space depended on role for protecting their physical and mental well being and experience of AILA. need to protect the children from violence and abuse, there taking the children back to normal life. CFS can be viewed and was a need for the children to try to overcome the needs in the local community – when schools were re-opened In the immediate aftermath of AILA, Save the Children itself and how soon children can return to normal life. In the taken as an entry point for wider child protection and through its partners have established Child Friendly psychosocial distress induced by AILA and there was a need interventions in the community. An organization can have to support the children to return to school. Therefore the aftermath of AILA the CFS was operated for about three to Spaces (CFS) in the disaster affected area to protect physical four months in the 3 affected districts. good understanding and trust worthy relationship with and mental health of the children. Save the Children has also main activities were: children and their families’ through CFS. CFS creates collaborated with the two members of Emergency Capacity 1. Psychosocial Support Child Club and Child Friendly Space opportunity to work more closely with the disaster affected Building (ECB) Project - World Vision and Catholic Relief There are some child clubs in the affected districts where CFS communities especially for the protection of children. It can · Services (CRS)-CARITAS who have strong presence there Counseling: According to the need of the children, was a part of activities of Child Club. Members of Child Club play a great role in mitigating and responding to any kind of for establishing Child Friendly Spaces (CFS) and thus group counseling or individual counseling support also helped other affected children as to overcome their neglect, exploitation, abuse etc. However, CFS should be protecting the affected children and families in AILA affected provided to the children. The better support provided to mental depression and return to the normal life gradually. operated in very professional manner otherwise it can increase the risks and vulnerabilities of the children. (This areas of Khulna, Patuakhali and Shatkhira districts. These 1. Comprehensive Disaster Management Program AILA situation report 11th June 09. Adult responsibilities organizations altogether have established about 145 CFS to 2. The Emergency Capacity Building (ECB) project is joint effort of six international article has been written based on the CFS guideline and CFS Lessons humanitarian organizations (Care, Concern Worldwide, CRS, Oxfam, Save the Children Adult workers mainly work with the children as facilitator Learned Workshop report of Save the Children) cover approximately 8000 affected children. and World Vision) to improve the speed, quality and effectiveness of emergency responses. (from the implementing organization)/volunteers in this

02 A Quarterly Newsletter of Network for Information, Response And Preparedness Activities on Disaster Issue 16, October 2009 03 Protecting Physical and Mental Well Being of Children: the traumatic children. In that case, the children also program. They referred to the Professional Counselor if necessary. took overall Child Friendly Spaces at AILA Affected Area responsibilities · Joyful learning: In the CFS center, the adult workers for the running Md. Harun or Rashid, Manager-ECB Project, Save the Children What is Child Friendly Space (CFS) created such kind of environment where children can E-mail: [email protected]; as well as A space, where services to children are provided to ensure learn joyfully through playing, drawing, to tell a story, responsible for Mostafa Kamal, Coordinator-BELT, Save the Children their protection in short term or long term basis during the singing or drama, etc. The children of all ages enjoyed E-mail: [email protected]; disseminating natural calamity or after the natural calamity is called child the learning system. the information Kazi Sunzida Lisa, Program Officer-Research & Documentation, NIRAPAD, friendly spaces (CFS) for children. This is a comprehensive E-mail: [email protected] · Recreation: The materials for play or to spend leisure to the children. effort to recover physical and mental loss of children through time or for recreational were also preserved locally in the Above all, they providing some services such as psychosocial support, joyful May 25, 2009 witnessed the landfall of Cyclone Aila that hit space. maintained learning, nutrition, recreation and health as well as turn back India and Bangladesh coast, impacting 3.9 million people and close liaison with the local administration and local people for them to normal life. As a whole, this is an attempt to support 2. Safe water killing more than 190 people across 11 districts in coordinating the overall task. 1 their normal development and as well as the preparedness for Safe water was preserved in the service center. The water was Bangladesh . Although the death and injury toll was much less future emergencies. Community participation compared to cyclone SIDR, the effect of storm surge on the purified by water purification tablet or boiling. The CFS people and families living in mainland chars and isolated chars Objectives of the CFS in Aila affected areas service workers were tried to aware the children to use safe A Committee named “CFS Management Committee” was was substantial. The storm surge rose 10-12 feet over water for household purpose. formed. The members of the committee included the local · To ensure protection of the children in the immediate leader, UP member, Imam of mosque, school teacher and astronomical tide destroyed homes, household belongings, aftermath of the AILA disaster. 3. Nutrition food stocks, water sources and sanitation facilities of the poor social workers. The main task of the committee was to help to properly establish and run the CFS. The CFS Management communities. · To support children to return back to normal life. Nutritional food supplied or provided to the children regularly and adequately to maintain their nutrition. The food Committee is responsible to maintain close liaison with local Initial assessments of the affected areas showed the crucial · To increase accountability of local people, policy makers was produced or cooked locally. The food items were selected government, schools etc. need for child to ensure protection of children during the disaster. in consultation with the children. This includes vegetable, Staff/Volunteers protection mixed khichuri (hotchpotch), vitamin enriched biscuits, fruits including creation · To increase skill and participation of children. collected from the local area etc. Two staff/volunteers were assigned to operate each CFS. of safe · To support children to return to or start education. Staff/volunteer had considered the following to operate the environment for 4. Clothes and education material safe space: Participants of the CFS children, clean Children can return to school clothing as school uniforms and · A staff/volunteer should never hit physically, mentally or drinking water and The children who were victimized mentally or physically educational material was also provided. Moreover the sexually abuse children, such as slap, hit with the fist, sanitation systems, during the calamity or after calamity may come to the space. organization cooperated with the local school and supports scolding, verbal discipline, intimidate, comparing, etc. ? and medical The ages of the children were usually between 5 years to the children to start school as soon as possible. Never act in ways intended to shame, humiliate, belittle assistance in the 16/18 years. But in special cases, less than 5 years of children 5. General treatment or degrade children or otherwise perpetrate any form of prevention of also came with their parents. The children of the community emotional abuse. disease outbreak. were motivated to visit the CFS. General treatment facilities were provided in the safe space. In As in most emergency, some medicine according to the doctor advice for · Need to ensure child participation. Location of the CFS emergency treatment was preserved to ensure children’s disasters, children · health facilities. In special cases, special arrangement kept to Take action immediately if the children have possibilities have been severely The CFS is a community based service centre. In a to be a victim of any kind of oppression. affected by the community, more than one CFS could be operated according bring the children to the local hospital and regular follow up. · effects of the cyclone. Many children have lost their homes to its necessity. It has been operated in Child Club, School, and Timetable to operate the safe space daily Keep monitoring that one child might not be victim by and are now displaced, creating a sense of insecurity. Some Community Space or in home of the community people. But other children. also have lost family members and friends. Schools and health Child Club was given priority to establish and operate the safe The CFS opened 09:00am to 05:00pm daily. It ensured that The Child Friendly Spaces lessons learned workshop which centers have been damaged and destroyed, creating a need for space. every child can be returned safely to their parents before the was held at Dhaka on 12th July, 2009 revealed that CFS was a protective environments, education, and water and health sun set. Services Provided very timely and useful intervention to meet the immediate services. The most crucial problem faced by the children were Duration of Safe Space needs of the vulnerable children. CFS played a very crucial mental agony and depression caused by the terrible In the immediate aftermath of AILA there was an urgent The duration of operating of the safe space depended on role for protecting their physical and mental well being and experience of AILA. need to protect the children from violence and abuse, there taking the children back to normal life. CFS can be viewed and was a need for the children to try to overcome the needs in the local community – when schools were re-opened In the immediate aftermath of AILA, Save the Children itself and how soon children can return to normal life. In the taken as an entry point for wider child protection and through its partners have established Child Friendly psychosocial distress induced by AILA and there was a need interventions in the community. An organization can have to support the children to return to school. Therefore the aftermath of AILA the CFS was operated for about three to Spaces (CFS) in the disaster affected area to protect physical four months in the 3 affected districts. good understanding and trust worthy relationship with and mental health of the children. Save the Children has also main activities were: children and their families’ through CFS. CFS creates collaborated with the two members of Emergency Capacity 1. Psychosocial Support Child Club and Child Friendly Space opportunity to work more closely with the disaster affected Building (ECB) Project - World Vision and Catholic Relief There are some child clubs in the affected districts where CFS communities especially for the protection of children. It can · Services (CRS)-CARITAS who have strong presence there Counseling: According to the need of the children, was a part of activities of Child Club. Members of Child Club play a great role in mitigating and responding to any kind of for establishing Child Friendly Spaces (CFS) and thus group counseling or individual counseling support also helped other affected children as to overcome their neglect, exploitation, abuse etc. However, CFS should be protecting the affected children and families in AILA affected provided to the children. The better support provided to mental depression and return to the normal life gradually. operated in very professional manner otherwise it can increase the risks and vulnerabilities of the children. (This areas of Khulna, Patuakhali and Shatkhira districts. These 1. Comprehensive Disaster Management Program AILA situation report 11th June 09. Adult responsibilities organizations altogether have established about 145 CFS to 2. The Emergency Capacity Building (ECB) project is joint effort of six international article has been written based on the CFS guideline and CFS Lessons humanitarian organizations (Care, Concern Worldwide, CRS, Oxfam, Save the Children Adult workers mainly work with the children as facilitator Learned Workshop report of Save the Children) cover approximately 8000 affected children. and World Vision) to improve the speed, quality and effectiveness of emergency responses. (from the implementing organization)/volunteers in this

02 A Quarterly Newsletter of Network for Information, Response And Preparedness Activities on Disaster Issue 16, October 2009 03 NIRAPAD Barta

relating climate and health with a broad range of consumption and associated greenhouse gas emissions, Climate Change and Health Impact in Bangladesh socioeconomic environments. reduce deaths from both cold and heat, and in poor countries, Vector-borne disease control programmes have to be reduce the need for burning of biomass fuels and the impacts Kazi Shahidur Rahman, Coordinator, NIRAPAD, E-mail: [email protected] Those that are relatively direct, usually caused by weather implemented, based on interventions developed using risk- of indoor air pollution. Sabkat Kamal, Assistant Program Officer- Research and Documentation extremes; the health consequences of various processes of assessment and cost-benefit technologies. Also, research on Supporting programmes to combat infectious disease E-mail: [email protected] environmental change and ecological disruption that occur in primary prevention of vector-borne diseases through control improve water and sanitation services and respond to natural response to climate change; the diverse health consequences of the ecology of mosquitoes or vaccination has to be disasters helps to reduce health vulnerability to future climate From the tropics to the arctic, climate change is currently – traumatic, infectious, nutritional, psychological and other – boosted. change. The organization also works directly to build capacity considered as one of the most critical issues. Climate change that occur in demoralized and displaced populations. to adapt to climate change. signifies that, today, we are altering Earth’s biophysical and The health impacts that climate change will have on Currently, malaria is not considered a major challenge in the ecological systems at the planetary scale – as is also evidenced national health sector programme because its prevalence is by stratospheric ozone depletion, accelerating biodiversity restricted to certain geographic zones principally in the losses, stresses on terrestrial and marine food-producing ICDDR,B-Prothom Alo Roundtable Chittagong Hill Tracts and similar areas. Even so, over 10 systems, depletion of freshwater supplies, and the global Protecting Health from Climate Change million people are at risk of malaria. The Anopheles dissemination of persistent organic pollutants Climate mosquitoes tend to prefer a temperature range from 24 to 27 A roundtable discussion jointly organized by ICDDR,B and the leading Bangla daily Prothom Alo was held on 17 April 2008 at the Change incidence in past few years caused serious weather degrees Celsius. If the overall temperature were to rise as Sasakawa International Training Centre of ICDDR,B. The deliberations and discussions focused on the central theme of this year’s World extremes, such as heavy rains, floods, and hurricanes, which Health Day: “Protecting Health from Climate Change.” predicted, their habitat may be reduced, leading to a possible also have severe impacts on health. Approximately 600,000 decrease in malaria with climate change. But that’s where the Dr Hubert Endtz, Director of the Laboratory Sciences Division of ICDDR,B pointed out He said, ICDDR,B has sound infrastructural deaths occurred world-wide as a result of weather-related good done by climate change ends. Dengue is an increasingly a facilities, including several surveillance systems for collection of field-level data on various diseases. However, it is difficult to know which natural disasters in the 1990s; and some 95% of these were in common place virus in Bangladesh, and most government of the diseases prevalent in different parts of the country have resulted from the adverse effects of global warming and climate change. poor countries killed approximately 30,000 people. (WHO emphasis has been on improving treatment, but global However, a season-specificity in the prevalence of certain infectious diseases is evident in Bangladesh, implying occurrence of diseases Assessment Report). warming would produce more rapid replication of the due to temporary changes in the climate. For example, floods and cyclones are events of the monsoon that have a close relationship with Climate change can affect human health directly and dengue virus. certain diseases and deaths. Our broader concern is the consequence of global warming and climate change, which is a very slow process. indirectly. Climate change can affect human health directly Morbidity and mortality due to this change in the climate is, thus, an apprehension. “We hope, within the next three-year period, ICDDR,B Cholera and other Diarrheal diseases are an obvious risk in will be able to establish a database on the management of health problems originated from global climate change too”, said Dr Endtz. e.g., impacts of thermal stress, death/injury in floods and Bangladesh. There is an established link between cholera outbreaks and blooms of Bangladesh is almost beyond the realm of the quantifiable. Conclusion blue-green algae. These are sensitively Chronic malnutrition caused by shrinking food grain Climate change is impacting by increasing intensity of various associated with weather extreme. Fluctuated absorption—which is turn will be caused by more frequent disaster, this also intensify health related problems. Different and rapid weather outbreaks can cause rapid flooding—will make those at the margins of Bangladesh’s types of diseases are increasing also. Impact of climate increase of infectious disease. healthcare and nutrition initiatives even more vulnerable. change is affecting social, economic, Psycho-social and Marked short-term fluctuations in weather Carefully planned mitigation policies can also bring direct environmental consequences. A database on the can cause acute adverse health effects. health benefits. For example, well-designed urban transport management of health problems originated from climate Extremes of both heat and cold can cause systems can reduce greenhouse gas emissions, while change is required to estimate the health impact of climate potentially fatal illnesses, e.g. heat stress or simultaneously reducing the major health impacts of urban change. Some concrete research on the health impact of hypothermia, as well as increasing death rates air pollution and physical inactivity. climate change could help to take appropriate initiatives. from heart and respiratory diseases. In cities, Housing with efficient insulation can cut energy Therefore taking adequate step at right time can address the stagnant weather conditions can trap both problem properly. warm air and air pollutants - leading to smog storms, compromise the supply of freshwater, increasing episodes with significant health impacts. First Aid for Different Disaster Events: CPP working in risks of malnutrition, population displacement and indirectly Because of the disasters brought about by climate change, the Coastal through changes in the ranges of disease vectors (e.g. food security has become a major issue. Climate impacts may Ruhul Amin, Assistant Director, CPP & Programme Coordinator area under mosquitoes), water-borne pathogens, water quality, air quality, decrease the production of staple foods in many of the CPP-CDMP Training Project, E-mail: [email protected] CPP. and food availability and quality. Below the figure shows the poorest regions, increasing risks of malnutrition. relationship between climate change and human health. Undernourishment includes wasting (thinness), stunting The idea of CPP started in 1965 to support the establishment CPP provided 2 days basic Health Impact in Bangladesh (shortness), or being underweight (low weight for age due to of warning system for the population living in the coastal belt. wasting/stunting). In longer term it can appear as a major One of the major objectives of CPP is to increase the training for With the combination of scientific facts by academics and health problem and can negatively impact on health, life- efficiency of volunteers and provide First Aid to the people the volunteers theoreticians with cold, hard, reality, it is becoming expectancy, work productivity and economies. injured by a disaster. and 3 days increasingly difficult to shy away from the truth. Poor First aid countries like Bangladesh, climate change is not just posing a Some Recommendations CPP is the programme in the field of Disaster Management training for threat to livelihoods, food security, and ecology; it is Epidemiology, therefore, has a major role to play. It has to which consistent of 42,675 (male – 28,450 & female- 14,225) those who are increasingly a threat to the lives of millions of people. One of continue documenting the associations between climate volunteers in 2845 units at 274 unions of 32 upazillas (6 first aid volunteers. The first aid volunteers are retrained the most devastating ways that a changing climate will impact change and health outcomes more specifically both in terms Zones) of 11 coastal districts of the Bangladesh. Each unit is within 2/3 years based on the fund. There are several mock the lives of the poorest sections of society is through the of exposures and outcomes. Research needs to be conducted consistent with 15 Volunteers which deviated into 5 groups drills for the volunteers and community people. CPP threat to health that it will pose. A change in climatic on future scenarios based on advanced modeling, applying and first aid is one of the major groups. Each unit has three provided 1 first aid kits for each group’s first aid volunteer conditions can have several kinds of health impacts. projections at local or regional level downscaling the current first aid volunteers - 1 Male Volunteer, 1 Female and 1 Male team. After any cyclone or disaster or any accident the projections and dynamics based on several climate models; volunteer is Assistant. 9,835 First aid Volunteers are now volunteers serve the community.

04 A Quarterly Newsletter of Network for Information, Response And Preparedness Activities on Disaster Issue 16, October 2009 05 NIRAPAD Barta

04 A Quarterly Newsletter of Network for Information, Response And Preparedness Activities on Disaster Issue 16, October 2009 05 NIRAPAD Barta NIRAPAD Barta

Reproductive Health Services for Disaster their continuation or side effects will occur and new borns evident during a conflict situation but could also arise after a References may need urgent medical attention. natural disaster when all infrastructures or official ‘Human Rights and Natural Disasters, Operational Guidelines and Field Manual on Affected Areas machineries are not functional in the affected areas. Human Rights Protection in Situations of Natural Disaster’, Approved by the IASC, In a study undertaken by HDRC [2] funded by UNFPA on UN. March 2008. Tahera Ahmed, Former assistant Representative the situation of pregnant women during the floods of 2007 it Conclusion ‘Delivering Babies in Emergency Situation: Where and Under which circumstances’, UNFPA, Bangladesh was found that 25 % of the respondent mothers had their Natural disasters have been occurring since time immemorial. Study conducted by HDRC, commissioned by UNFPA, with funds from NORAD. August 2008. E-mail: [email protected] ‘first children’ born during the 2007 floods. Though most Some are predictable and some occur suddenly. However all ‘Minimum Initial Services package (MISP) for Reproductive Health in Crisis women preferred to deliver at their parental homes, 12% of countries should have a disaster recovery plan which is Situations: a distance learning module’. Published by the Women’s Commission for Natural Disasters the births took place at open places. Again it was found that implementable and easy. Numerous documents and Refugee Women and Children, NY 2007. Natural Disasters are the consequences of events triggered young adolescent girls and pregnant women were subjected examples exist on this and many countries have the plans in ‘Guidelines for Gender based Violence in Humanitarian Settings’, IASC (Inter Agency Standing Committee, UN) September 2005. by natural hazards such as earthquakes, floods, tsunamis, to gender violence, pregnant women standing in queues for place. With clear forethought and participation of all relevant drought etc. These are so sudden that the normal relief were teased, taunted and even physically pushed away. stakeholders it is also possible for Bangladesh to develop and infrastructure cannot cope with the situation. As a result In several field visits the author was told by the women of implement such a plan which will minimize the effects of the normal functioning is disrupted and there are wide spread total lack of any toilet facilities for women. They often would disasters on the victims and provide them an easy and early losses to human lives as well as material and economic losses. wait till dark and then go out under the trees to relieve recovery to a normal life situation. People are often displaced and need to seek shelter from the themselves. This often was very insecure as it provided an effect of the disasters. opportunity for violence and abuse. In Bangladesh, natural disasters are common especially The need for a clear plan for addressing the needs of the Disaster and Climate Change Risk the following issues/topic are delivered. seasonal floods and cyclones. There is a long history of women during and after a disaster is essential. This means Management Need to be Emphasized in BCS 1. Sustainable development: concepts and issues disasters happening nearly every year, yet a strategy to prepare preparedness of those living in those disaster belts and 2. Environmental policies and laws in Bangladesh for the disasters is not yet available. All responses have been coastal areas and involvement of the full community in the (Health) Cadre Foundation Training courses 3. Environmental Pollution in Bangladesh post –disaster and ad-hoc. Though there have been planning and implementation. 4. Disaster: definition, types and management Impact immediate responses from national and international bodies, Dr. Mahmudul Islam Crisis Preparedness Learning and Development Specialist and measures yet many losses in human lives as well as untold sufferings of How does one prepare for a crisis? Since Bangladesh is Comprehensive Disaster Management Programme (CDMP) 5. Disaster management in Bangladesh the victims have occurred. Most of these are preventable E-mail: [email protected] provided adequate steps are taken much earlier. known to be prone to cyclones and floods these areas need to Considering the present Scenario of Climate change and its be clearly identified and marked. Then Area Coordinators Human Rights and Natural Disasters All the Bangladesh Civil Service (BCS) Cadre Officials need impact on life, livelihood and nature, these issues has great have to be selected who would be from those who are already to undertake Foundation Training from Public Training importance to include in the module. Besides, disaster risk According to the IASC Operational Guidelines [1], persons in place in those areas and in a suitably high position. Institutes, which is mandatory for their services. There are reduction in health sector, emergency and hospital affected by natural disasters should enjoy the same rights and Component wise Deputy Coordinators would have to be in presently four Institutes namely, Bangladesh Academy for preparedness for large scale disasters and emergency freedom under human rights laws others in the country. place responsible for each sector like Health, Water, Rural Development (BARD), Kotbari, Comilla, Rural management, its principles and practices need to be included Countries have the primary duty and responsibility to provide Sanitation, Women, and Security etc. Officials of Development Academy (RDA) Bogra, Academy for Planning in the Foundation packages of BCS health officials as well the assistance to persons affected by natural disasters and to Government and other service delivery points like District and Development (APD), Nilkhet, Dhaka and Bangladesh other cadres. Thus the public servants will be well-equipped protect their human rights. All communities affected by Hospitals, MCWCs. Upazilla Health Complex will need to Institute of Administration and Management (BIAM), with the present concerns of climate change and disaster risks disasters have also the right to early warning information. have a minimum training to be able to start the procedures as Dhaka, are presentably given the tasks to carry out the Special and its impact on health, while working in the field. Again protection and security against acts of discrimination soon as the early warning is given. In addition buffer stocks of Foundation Training of BCS Health Cadre Officials. This Under the Comprehensive Disaster Management or violence is also a human right. basic life saving medicines, drugs etc will have to be in stock special course is a 2 months tailored course, where a short Programme (CDMP), imparting training with the BCS health Every affected person has the right to access to essential food and replenished regularly to prevent stock outs and expiry of version of 4 months Foundation Course Modules is being officials have been pilot tested at BARD and RDA, where and water, basic shelter and appropriate clothing. The aid medicines. The whole preparedness exercise needs to be delivered. All the modules are approved by National Training clear interest have shown by the participants to include the should be available to them in a non discriminatory manner is carefully planned and recorded. There are many UN Council (NTC). sessions in their modules so that their competency required all the affected persons should have equal access to the documents on the steps for disaster preparedness and these Disaster management is a part of the module of for the official may have positively changed to serve better for assistance. In addition, special measures may be necessary for have to be consulted to adapt to our situation. “Environment and Sustainable Development”, where, the nation. the protection of vulnerable persons like the pregnant and The Minimum Initial Service Package (MISP) [3] lactating mothers, sick, elderly and children. Essential medical implemented by UNFPA focuses on the need for immediate care and services should be available to them. supply of RH Kits, medicines and supplies. The supplies can Relief to SIDR Affected People: Drinking Water and First Aid in Disaster Reproductive Health (RH) in Crisis Conditions be ordered immediately and are packaged and ready for When disaster strikes, most of the health facilities cannot delivery. These are sent all over the globe whenever the Mirza S I Khaled cyclone which hit Patharghata between 8 to 10 pm on the cope immediately with such situation. The first need is the cry request is placed by the government through the Director, Sangkalpa Trust Patharghata,Barguna,Bangladesh. fateful night of 15th November disrupted communication for food, water and a safe place to stay. Governments are hard Representative. E-mail: [email protected], [email protected] with the rest of the country by destroying all the placed to respond to these basic needs immediately. Often communication mediums. The affected people were looked- The UN ‘Guidelines for Gender based violence The damage done by SIDR is being published in the media epidemics break out and medical providers are fighting hard for first aid and fresh drinking water. Interventions in Humanitarian settings’ [4] lays out clearly even now after 2 years of the happening. The calamity has left to contain them as well as prevent further spread. As a result the different steps for ensuring the protection of women and a deep scar on the memories of those who were affected. All the rivers, ponds, streams and lands were poisoned with of the immediate needs the RH components are often girls in a crisis situation. The guidelines say ‘Gender based the saline water of the bay. The carcasses of human, domestic Patharghata Upazilla of Barguna district is the ruined upazilla neglected. Yet pregnant women will need help including safe Violence is especiall`y problematic in the context of complex animals and fish made the water body so polluted that it was which resides just beside Bay of Bengal. The population of delivery, those who are on long term contraceptives will need emergencies and natural disasters ….”. This is particularly totally unsuitable for drinking purpose. Due to the structure the upazila is one hundred and sixty two thousands. The super of the underground land of Patharghata, it was very tough to

06 A Quarterly Newsletter of Network for Information, Response And Preparedness Activities on Disaster Issue 16, October 2009 07 NIRAPAD Barta NIRAPAD Barta

get clean safe water from deep tube-wells. The tube-wells that Health Services for The Flood Affected capacity. POPI-DRR & VLH’s programme has taken some existed in the two unions were left in ruins. So the only option People of The Haor Areas initiatives to address the probable solution as they minimize left was pond water. This situation existed in the major their loss and enrich capacity as they need. Training on Health portions of Patharghata, Chorduani, Kathaltali, Nachnapara Shah Md. Nazmul Haque, PC-DRR & VLH’s, Peoples Oriented Program Service in the Disaster Situations and volunteer services are and Kalmagha union. Implementation (POPI), Nikli, Kishoregonj, E-mail: [email protected] among of the initiatives. During this miserable situation, both local and foreign aid Three types of volunteer team are provided services during organizations were supplying aid to the people by the means POPI started its journey from 1986, at a village (Jamalpur) of the flood disaster situations. Rescue volunteer team are of helicopter and other way of transport - but what they did Bhairab upazila in Kishoregonj district. Since then, POPI is assigned to give not supply is drinking/ cooking water. One bottle of water being contributed to development services sectors, health first aid to the thrown from the helicopter was like due in the midst of a services, welfare services, rights establishment services, injured people desert. In this situation - SANGKALPA TRUST - next day disaster risk reduction services and micro-credit services to and prepare boat after SIDR tried to make the situation under control in 5 uplift living and livelihood status of most marginalized for serious cases steps. The steps were: extreme poor people living at remotest and flood vulnerable to send the areas such as river basin char land, river basin haor lands of injured people to 1) Remove the broken trees from the roads to make it the 17 districts. usable for aid workers to arrive. nearby hospitals. of joy were heard from among the water collectors. Nikli and Mithamoin upazilla of Kishoregonj district are the The second 2) Clean the existing ponds with lime and bleaching The supply of clean water to the effected mass started in that deepest haor area of Bangladesh. Total population of this health volunteer powder to make it usable again. way. After 10/12 days local and international aid two upazila are about 2,65,000 and 60% of this population teams are 3) Remove rotten/toxic/salty water from any area. organizations established more water purification plants and live under poverty line. They have to struggle with flood and responsible to the river erosion every year for their existence at their safety of the 4) To make people more aware about clean water starting the supply increased. homesteads. People’s Oriented Program Implementation most vulnerable people like-elderly people, PWDs, children at the villages. The demand for water increased as the days went by - so did (POPI) is implementing the project named Disaster Risk and seriously sick people. The teams have to ensure the the supply of SANGKALPA TRUST. Dry season started 5) Supply clean water to villages. Reduction & Livelihood Project (DRR & VLHP) under the necessary needs (food, medicine, shelter etc.) during and post after the SIDR – making finding water more difficult. This River Basin Program (RBP) of Oxfam-GB, to reduce the period of disaster. The role of third community health water crisis started from 15th November all the way up to the suffering of this unfortunate people of this two upazila since volunteer team is very important for the pregnant mother month of May. Rainy season started in June. Although last 2004. especially for delivery case for the remote haor areas in terms SANGKALPA TRUST wanted to stop their water supplying of any emergency. project in March - due to the request of the local government In these areas maximum people cannot afford two meals a – they continued it all the way up to June - when the rainy day throughout the year, all symptoms of poverty crisis are POPY has organized training programme on community season started. existing there. The worst sufferers of chronic poverty are health volunteer (CHV) with 75 beneficiaries of DRR & women who are acutely suffering from food crisis, health care VLH’s programme from two upazilla. The participants were When asked about this Banesa Begum of Chorlathimara crisis, education crisis, and shelter crisis during flood time and selected in such a way that they disseminate the knowledge village said "Whether as aid we get house or rice or not, if we also suffering from social injustices and domestic violence gathered from the training in all the communities of POPI- didn't get drinking water when it was needed, we would not against them. DRR & VLH’s programme areas. These trainings were on have lived nor would our children." Other people of the Frequent hazard due to flash flood or early flood, river first aid and pregnant women care. Some training were also upazilla agree with this matter. The same remark was organized to aware community people. Here people are supported by even the Health Officer of the Upazilla - Omol erosion, cyclone, epidemics etc. are very common for the people living in the haor areas. Due to these hazards, health of informed about what to do in the flood disaster situations, Chandra Roy. He said his fear of water carried diseases did how the people can be prepared to address the basic health not come true due to the supply of pure drinking water. the community people severely affected and needed to take preparation to minimize injure and loss of life as per their problem by themselves and how they can get the heath SANGKALPA TRUST should be thanked for making facilities. Beside these activities, Sangkalpa Trust provided first aid people aware of the importance of clean water and supplying services to the community people through their clinic. them clean water immediately after SIDR as he stated. Doctor of the clinic gave the first aid treatment to the injured people. Here women and children got the priority. After 2 THE MINIMUM INITIAL SERVICE PACKAGE (MISP) FOR SEXUAL AND REPRODUCTIVE HEALTH IN EMERGENCY month, Sangkalpa Trust got a fund for post disaster health Niger Dil Nahar, Program Officer- Training and Monitoring, NIRAPAD, E-mail: [email protected] service and continued the activities. As acquiring safe water in such situation is a difficult task, SANGKALPA TRUST chose to use the only reserve pond Sexual and reproductive health is a state of mortality and morbidity rates. But unlike the of the upzilla and a PSF (sand manufacturing plant) just complete physical, mental and social well being other women and gender issues reproductive beside it. Using (fitkiri) and chlorine water was purified in that and not merely the absence of disease and health is also a neglected issue in the disaster or plant. And then the clean water was supplied afterwards. infirmity, in all matters relating to the in emergency period. Locally made horse-carts and rickshaws were used to take the reproductive system and its functions and In crises or disaster, the Minimam Initial pure water in plastic drums to remote villages. Priorities were processes. A lack of quality sexual and Services Package (MISP) is the model for given to areas where the human suffering was most. Villagers reproductive health services can lead to high addressing the ‘priority reproductive health - women and children waited beside roadside to get water. infant and maternal mortality rates, an increase needs of populations in the earliest phases of They collected water as they needed and took them back in the spread of STIs, including HIV/AIDS, an emergencies’ and for planning for home. There was no bickering among the collectors. As soon increase in unwanted pregnancies and unsafe comprehensive reproductive health services as the sound of the water carrying vehicles was heard - cries abortions, and increased premature women’s when a crises situation stabilizes.

08 A Quarterly Newsletter of Network for Information, Response And Preparedness Activities on Disaster Issue 16, October 2009 09 NIRAPAD Barta NIRAPAD Barta get clean safe water from deep tube-wells. The tube-wells that Health Services for The Flood Affected capacity. POPI-DRR & VLH’s programme has taken some existed in the two unions were left in ruins. So the only option People of The Haor Areas initiatives to address the probable solution as they minimize left was pond water. This situation existed in the major their loss and enrich capacity as they need. Training on Health portions of Patharghata, Chorduani, Kathaltali, Nachnapara Shah Md. Nazmul Haque, PC-DRR & VLH’s, Peoples Oriented Program Service in the Disaster Situations and volunteer services are and Kalmagha union. Implementation (POPI), Nikli, Kishoregonj, E-mail: [email protected] among of the initiatives. During this miserable situation, both local and foreign aid Three types of volunteer team are provided services during organizations were supplying aid to the people by the means POPI started its journey from 1986, at a village (Jamalpur) of the flood disaster situations. Rescue volunteer team are of helicopter and other way of transport - but what they did Bhairab upazila in Kishoregonj district. Since then, POPI is assigned to give not supply is drinking/ cooking water. One bottle of water being contributed to development services sectors, health first aid to the thrown from the helicopter was like due in the midst of a services, welfare services, rights establishment services, injured people desert. In this situation - SANGKALPA TRUST - next day disaster risk reduction services and micro-credit services to and prepare boat after SIDR tried to make the situation under control in 5 uplift living and livelihood status of most marginalized for serious cases steps. The steps were: extreme poor people living at remotest and flood vulnerable to send the areas such as river basin char land, river basin haor lands of injured people to 1) Remove the broken trees from the roads to make it the 17 districts. usable for aid workers to arrive. nearby hospitals. of joy were heard from among the water collectors. Nikli and Mithamoin upazilla of Kishoregonj district are the The second 2) Clean the existing ponds with lime and bleaching The supply of clean water to the effected mass started in that deepest haor area of Bangladesh. Total population of this health volunteer powder to make it usable again. way. After 10/12 days local and international aid two upazila are about 2,65,000 and 60% of this population teams are 3) Remove rotten/toxic/salty water from any area. organizations established more water purification plants and live under poverty line. They have to struggle with flood and responsible to the river erosion every year for their existence at their safety of the 4) To make people more aware about clean water starting the supply increased. homesteads. People’s Oriented Program Implementation most vulnerable people like-elderly people, PWDs, children at the villages. The demand for water increased as the days went by - so did (POPI) is implementing the project named Disaster Risk and seriously sick people. The teams have to ensure the the supply of SANGKALPA TRUST. Dry season started 5) Supply clean water to villages. Reduction & Livelihood Project (DRR & VLHP) under the necessary needs (food, medicine, shelter etc.) during and post after the SIDR – making finding water more difficult. This River Basin Program (RBP) of Oxfam-GB, to reduce the period of disaster. The role of third community health water crisis started from 15th November all the way up to the suffering of this unfortunate people of this two upazila since volunteer team is very important for the pregnant mother month of May. Rainy season started in June. Although last 2004. especially for delivery case for the remote haor areas in terms SANGKALPA TRUST wanted to stop their water supplying of any emergency. project in March - due to the request of the local government In these areas maximum people cannot afford two meals a – they continued it all the way up to June - when the rainy day throughout the year, all symptoms of poverty crisis are POPY has organized training programme on community season started. existing there. The worst sufferers of chronic poverty are health volunteer (CHV) with 75 beneficiaries of DRR & women who are acutely suffering from food crisis, health care VLH’s programme from two upazilla. The participants were When asked about this Banesa Begum of Chorlathimara crisis, education crisis, and shelter crisis during flood time and selected in such a way that they disseminate the knowledge village said "Whether as aid we get house or rice or not, if we also suffering from social injustices and domestic violence gathered from the training in all the communities of POPI- didn't get drinking water when it was needed, we would not against them. DRR & VLH’s programme areas. These trainings were on have lived nor would our children." Other people of the Frequent hazard due to flash flood or early flood, river first aid and pregnant women care. Some training were also upazilla agree with this matter. The same remark was organized to aware community people. Here people are supported by even the Health Officer of the Upazilla - Omol erosion, cyclone, epidemics etc. are very common for the people living in the haor areas. Due to these hazards, health of informed about what to do in the flood disaster situations, Chandra Roy. He said his fear of water carried diseases did how the people can be prepared to address the basic health not come true due to the supply of pure drinking water. the community people severely affected and needed to take preparation to minimize injure and loss of life as per their problem by themselves and how they can get the heath SANGKALPA TRUST should be thanked for making facilities. Beside these activities, Sangkalpa Trust provided first aid people aware of the importance of clean water and supplying services to the community people through their clinic. them clean water immediately after SIDR as he stated. Doctor of the clinic gave the first aid treatment to the injured people. Here women and children got the priority. After 2 THE MINIMUM INITIAL SERVICE PACKAGE (MISP) FOR SEXUAL AND REPRODUCTIVE HEALTH IN EMERGENCY month, Sangkalpa Trust got a fund for post disaster health Niger Dil Nahar, Program Officer- Training and Monitoring, NIRAPAD, E-mail: [email protected] service and continued the activities. As acquiring safe water in such situation is a difficult task, SANGKALPA TRUST chose to use the only reserve pond Sexual and reproductive health is a state of mortality and morbidity rates. But unlike the of the upzilla and a PSF (sand manufacturing plant) just complete physical, mental and social well being other women and gender issues reproductive beside it. Using (fitkiri) and chlorine water was purified in that and not merely the absence of disease and health is also a neglected issue in the disaster or plant. And then the clean water was supplied afterwards. infirmity, in all matters relating to the in emergency period. Locally made horse-carts and rickshaws were used to take the reproductive system and its functions and In crises or disaster, the Minimam Initial pure water in plastic drums to remote villages. Priorities were processes. A lack of quality sexual and Services Package (MISP) is the model for given to areas where the human suffering was most. Villagers reproductive health services can lead to high addressing the ‘priority reproductive health - women and children waited beside roadside to get water. infant and maternal mortality rates, an increase needs of populations in the earliest phases of They collected water as they needed and took them back in the spread of STIs, including HIV/AIDS, an emergencies’ and for planning for home. There was no bickering among the collectors. As soon increase in unwanted pregnancies and unsafe comprehensive reproductive health services as the sound of the water carrying vehicles was heard - cries abortions, and increased premature women’s when a crises situation stabilizes.

08 A Quarterly Newsletter of Network for Information, Response And Preparedness Activities on Disaster Issue 16, October 2009 09 NIRAPAD Barta

The Minimum Initial Service Package (MISP) for emergency settings. Reproductive Health (RH) is a set of priority activities to be MISP is one of the major objectives of SPRINT which is the implemented during the onset of an emergency (conflict or initiative of Australian government and AusAid managed by natural disaster). When implemented in the early days of an IPPF ESEAOR. The program spans from 2007 t0 2010 and emergency, the MISP saves lives and prevents illness, currently covers the ESEAOR region. The scope of its especially among women and girls. Neglecting RH in activities is based on the work of the Inter-Agency Working emergencies has serious consequences: preventable maternal Group on SRS in emergency situation. The MISP is also a and infant deaths; sexual violence and subsequent unwanted standard in the 2004 revision of the Sphere Humanitarian pregnancies and unsafe abortions; and the spread of HIV. Charter and Minimum Standards in Disaster Response for The MISP is a standard for humanitarian actors, outlining humanitarian assistance providers. (This article has been written which RH components are most important in preventing based on website resources.) death and disability, particularly among women and girls, in Interview Mahbuba Nasreen PhD amount of money for health related problems during and after a Associate Professor disaster. In many cases expense on health services for ill family Department of Sociology, University of Dhaka members become more prominent than the survival of affected Email: [email protected] people. 5: What type of indigenous knowledge and technology used 1: How long are you involved in the areas of by the rural people in health services? disaster and health issues? Ans: During flood and post flood situations people become Ans: My involvement in the areas of disaster affected by water born diseases. Women provide health care and health goes back to the 1988 flood when I services under these circumstances using their indigenous have observed the coping mechanisms, knowledge. They use grind tree leaves to get juice out of these, especially of women and denial of their access to various services. make globules form neem leaves, take fresh turmeric for different During my PhD dissertation started in 1991, I have seen the more kinds of water borne diseases. They keep burn turmeric to keep real pictures of the distressed situation of health during disaster. away snakes etc. For feverish household member they sponge the 2: How are women become affected during disaster? whole body, pour water on head. They even are compelled to use Ans: The topic of my PhD dissertation was ‘Coping with Floods: polluted flood water. The Experiences of Rural Women on Bangladesh’. During my field 6: What sort of changes has occurred after the 1988 and 2007 work I have observed that the health services were very inadequate flood? or almost absent: lack of medicine, pure drinking water or water Ans: In my comparative study I have not seen any crucial change purification was common phenomenon. Pregnant women did not occurred in context of providing health services to women. have nutritious food which caused the incident of abortion in many Balance diet is almost absent. However, few government and non- cases. They had to live with stranger men in the flood government national and international organizations providing refuge/shelter. There was no separate toilet for women. In the balanced diet to the pregnant and lactating mothers in a limited areas where there was no flood shelter women had to live on the scale. In 2007 conjunctivitis was more prominent all over the roof top, platform, road side and even on the top of trees. country and there was no medicine distributed for remedy. 3: How women’s needs are addressed during the distribution 7: How this situation can be improved? of relief ? Ans: Health related issues should be included in the programmes Ans: Like children, old, disable, women are also deprived during of Ministry of Food and Disaster Management. Attention should relief distribution. Woman especially pregnant women do not get be paid on increasing the allocation on health sector in the Health nutritious food. Medicine such as Paracetamol was the only policy of 2009. Regular monitoring is needed to check the expiry medicine to use for all types of diseases. After 1988 flood only rice dates of medicine and stored food. Health care facilities should be and wheat had been distributed. But there was no facility for provided according to gender, region, class, ability/disability, women to prepare ruti or bread or cook rice. As a result women had capacities which are not same for all. Emergency Health Unit to suffer a lot in preparing food. should be constructed to provide door-to-door health care 4: How expensive is to get health service during and after a services. disaster? Interviewer; Md. Mehedi Hasan, Sumaiya Akter; NIRAPAD Ans: It is evident that disaster affected people have to spend largest

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10 A Quarterly Newsletter of Network for Information, Response And Preparedness Activities on Disaster