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Managing Health in large-scale disasters
François Grünewald

We owe it to the dead, the wounded and the survivors to ensure that lessons are learned after each major humanitarian operation and that a critical review is carried out. Regarding Health, a very interesting exercise in learning support has been instigated under the auspices of the Panamerican Health Organisation (PAHO) on the initiative of Dr Claude de Ville de Goyet. The analysis of the medical response in the first three months after the earthquake published by PAHO in English (link), with a summary in French (attached), made it possible to review a number of crucial points of the response.

In a country where a Health system exists, no matter how weak, it is essential that it should take part both in operations and coordination. This means carrying out an initial analysis, evaluating its capacity (including how this has been affected by the disaster) and seeing how it can be supported in its national role.

The technical challenges of the response depend a great deal on the impact of the disaster and therefore on the type of disaster. The impact of a tsunami is very different to that of an earthquake or a slow-onset flood. This shows the limits of “Ready to use” kits.

The medical issues involved in an acute emergency are complex, but the key remains the time it takes for the injured to get to the health stations. As such, first aid to stabilize the condition of patients, actions to manage the risks of “crush syndrome” and the distribution of stretchers are crucially important. So too is the technical and psychological capacity to carry out triage and to inform and comfort the families of those who are not selected for emergency interventions.

In Haiti after the earthquake, decisions for the burial of bodies were taken quite quickly. There remains the social and cultural impact of not having been able to grieve the dead which has affected many families. For once, there were no grand declarations about post-disaster epidemics, even though bodies were often trapped under the rubble for a long time.

The management of information is crucial for legal reasons, in order to follow up cases which are often transferred from one health structure to another and in order to set up health monitoring systems as quickly as possible. This last point is particularly important in situations where there is high population density and deteriorated health and sanitation conditions which create public health “time bombs”. This should also contribute to avoiding the inopportune sending of medicine and unusable medical equipment, which clutter up warehouses and cost a lot to destroy. Donor countries which have not yet done so should establish and promote “national codes” to this effect as quickly as possible.

Large-scale disasters affect many aspects of society, including food and economic security (issues of nutrition), mental health (psycho-social issues) and behaviour (increased violence, including gender-based violence). All these aspects contribute to the deterioration of health conditions and reduce access to a quality health system. A global analysis of access to different services (Water, Health and Education) and economic activities is essential. This systemic analysis is made more difficult by the growing sectorisation of aid. An inter-disciplinary and cross-sector approach which is properly coordinated with national institutions will be among the keys to a successful response to the next major disaster in Haiti or elsewhere.