Pan American Journal Special report of Public Health The health sector in the face of disasters and climate change in Cuba* Guillermo Mesa Ridel,1 Joel González García,1 María Cristina Reyes Fernández,1 Duniesky Cintra Cala,2 Yudix Ferreiro Rodríguez,1 and José Ernesto Betancourt Lavastida,3 Suggested citation (original manuscript) Mesa Ridel G, González García J, Reyes Fernández MC, Cintra Cala D, Ferreiro Rodríguez Y, Betancourt Lavastida JE. El sector de la salud frente a los desastres y el cambio climático en Cuba. Rev Panam Salud Publica. 2018;42:e24. https://doi.org/10.26633/RPSP.2018.24 ABSTRACT Due to its impact on human health and its capacity to cause damage, disasters are one of the global problems that most concern the international community. However, and in spite of the efforts made by many health systems, the reduction of vulnerabilities and the lack of strategies to avoid or minimize risks have not received enough attention yet. As Cuba is located in an area of permanent danger of disasters, its health sector has accumulated considerable experience in the management of risks and in the assurance of less risky future scenarios, with active partic- ipation of the community and a planned and organized process to address the impact of climate change. This paper summarizes some of these experiences and describes the dangers, vulnera- bilities, and risks of disasters in Cuba, its Civil Defense System, and planning and organiza- tion in the health sector for disaster reduction, as well as the main effects and challenges of climate change in the health system. Lessons learned and good practices support the key role of human resources to reduce vulnerabilities; the greatest challenges are to avoid or minimize risks, to advance research, to train professionals for climate change, and to optimize the organi- zation of health systems and services in the country. Keywords Disasters; climate change; health policy; Cuba. The crises affecting the planet today the environment, the deterioration of preventive strategies to avoid or mini- overlap, complement and reinforce one which puts human life at stake. mize risks. another. Ethical, economic, political and Climate change is affecting human The endorsement of the Sendai Frame- social conflicts are augmented by others health. Studies of climatic variations work for Disaster Risk Reduction 2015– no less complex, such as civil unrest, and change show an increase in aver- 2030 provided a unique opportunity to struggles over food and disputes over age temperature, rapid sea level rise, evaluate the Hyogo Framework for Ac- extreme alterations in rainfall patterns tion and look for efficient, consen- and the habits of certain animal spe- sus-based solutions to disasters and risks * Non-official English translation from the original cies, as well as an increase in disasters from multiple sources in the context of Spanish manuscript. In case of discrepancy, the of unprecedented magnitude and sustainable development (3). original version (Spanish) shall prevail. 1 Escuela Nacional de Salud Pública, Havana, complexity (1, 2). In many countries, This paper summarizes some of the Cuba. Send correspondence to Guillermo Mesa however, health systems remain fo- Cuban health sector’s experiences deal- Ridel, [email protected] cused on reactive responses and pay ing with disasters and the impacts of cli- 2 Representative of the Pan American Health Organization, Havana, Cuba. scant attention to reducing vulnerabil- mate change. It describes disaster 3 Ministerio de Salud Pública, Havana, Cuba. ities and incorporating sustainable hazards, vulnerabilities and risks in This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 IGO License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited. No modifications or commercial use of this article are permitted. In any reproduction of this article there should not be any suggestion that PAHO or this article endorse any specific organization or products. The use of the PAHO logo is not permitted. This notice should be preserved along with the article’s original URL. Rev Panam Salud Publica 42, 2018 1 Special report Mesa ridel et al. • Face of disasters and climate change in Cuba Cuba; the country’s Civil Defense Sys- more than US$30 billion in damage to related to the susceptibility of lifelines tem; and planning and organization for housing infrastructure, agriculture and (water and sewage systems, power lines, disaster reduction in the health sector. industry. Thanks to the alerts built into communications, storage facilities and The main impacts and challenges of cli- the early warning system for tropical cy- roads); and c) functional, referring to or- mate change on the health system are clones (6) and measures adopted to pro- ganization, availability of resources to also described. tect the population, Cuba has been able meet medical needs, patient transport, to reduce the number of human victims hospitalization, monitoring and control DISASTER HAZARDS, caused by these events. of actions, as well as risk perception, VULNERABILITIES AND RISKS Cuba is also exposed to geological haz- preparation and professional perfor- ards, especially in the southeastern re- mance (13–15). The analysis of hazards or threats is the gion of the country, due to seismic Disaster risk refers to potential losses foundation for identifying vulnerabil- activity from the movement of tectonic from one or more hazardous incidents ities and assessing risk. plates (7). The strongest earthquake— (simultaneous or conjoined) affecting Due to its geographic location in the which occurred in 1932 near ​​Santiago de one or more vulnerable elements at a Caribbean, Cuba shares with its regional Cuba and measured 6.75 on the Richter specific time and place, under specific neighbors the recurring danger of hy- scale—left 20 people dead and more than conditions. A multidisciplinary approach drometeorological events—the forma- 400 injured, and caused major damage to is used to make a qualitative or quantita- tion and movement of tropical cyclones, 80% of the buildings in the city. tive risk assessment for each probable heavy rains, floods, local storms of great In terms of anthropogenic disasters, disaster, according to its recurrence and magnitude, and droughts—, causing ma- the most notable are technological, fun- potential tangible and intangible losses. jor material and economic losses, and af- damentally transportation-linked acci- These risk assessments consider not only fecting human health (4). Between 1926 dents, both automotive and rail (8, 9), potential physical damage to structures, and 1944, tropical storms in Cuba caused and chemical accidents involving spills but also conditions derived from the eco- 3 935 deaths. The most destructive hurri- and toxic leaks at industrial sites and sur- nomic, financial, food-and-nutrition, canes were the October 1926 cyclone that rounding areas, such as the 1990 ammo- health-and-hygiene, psychosocial, en- hit Isla de Pinos (now Isla de la Juven- nia spill in the city of Matanzas, capital of ergy and communications situation, tud) and Havana, causing 583 fatalities; the province of the same name (10). among others (16). the November 1932 hurricane that de- Among health hazards, the most fre- All of this requires a holistic approach stroyed Santa Cruz del Sur in Camagüey quent are those caused by epidemics as- that facilitates understanding of each province, causing 3 033 deaths; and the sociated with the international type of event, and determines the nature October 1944 cyclone that swept Isla de epidemiologic situation and violations of and conditions of vulnerability of the Pinos and Havana, causing 319 deaths. health laws, especially in places charac- population, goods, services, exposed In October 1963, another devastating terized by unfavorable health and sani- livelihoods and the environment. Deci- event, Hurricane Flora, left more than 1 tary conditions combined with low sion-making is based on the following 200 dead in eastern Cuba, thousands of perception of risk among the population two principles: first, protect human lives victims, and extensive damage to agri- (11). Other threats include the possibility and avoid economic losses; second, guar- culture, housing and infrastructure (5). of biological attack. (12). antee disaster reduction activity at the Over the past 20 years, Cuba has been Existing principal vulnerabilities can be lowest possible cost. This analysis is used struck by 30 major atmospheric events: classified as: a) structural, varying ac- to define preventive actions that reduce 10 tropical storms and 20 hurricanes. Of cording to the condition of housing stock vulnerabilities, mitigate impacts, and the latter, 11 were classified high inten- and level of exploitation or lack of pre- take measures that minimize losses and sity (Table 1), causing 54 deaths and ventive maintenance; b) non-structural, lead to rapid recovery. THE CUBAN CIVIL DEFENSE TABLE 1. Number of deaths and people protected in high-intensity hurricanes. Cuba, SYSTEM 2001-2017 Cuba had no efficient civil defense sys- a Hurricane Category Date Deaths People protected tem before 1959. Such activities were ba- Michelle 4 November 2001 5 783 259 sically limited to shelters administered Charley 3 August 2004 4 232 929I by the Ministry of Health and deploy- van 4 September 2004 0 2 266 066 ment of the Fire Department, which did Dennis 4 July 2005 17 1 551 667 not receive effective support from the Wilma 5 October 2005 0 760 168 State. Gustav 4 August 2008 0 467 579 Civil defense (CD) activities were in- Ike 4 September 2008 7 2 615 794 stitutionalized in Cuba in 1962 under Paloma 4 November 2008 0 1 319 433 the title People’s Defense, with the pri- Sandy 3 October 2012 11 343 230 mary mission of organizing the popula- Matthew 4 October 2016 0 1 373 595 tion for the defense of cities and Irma 4 September 2017 10 1 863 589 protection of industries and service cen- a According to the Saffir-Simpson Hurricane Wind Scale, which defines and classifies hurricane categories based on wind speed.