Course Disasters and their Effects ​on the Population

1. Do a rapid assessment of the emergency situation and the affected population.

An assessment should accurately define needs so that limited resources can be used efficiently to maximize lifesaving and other vital goals.

National level: Assessments are typically carried out by expert teams focused on promptly defining the magnitude of the emergency, environmental conditions, infrastructure damage, the major health and nutrition needs of the affected population, and local response capacity.

Community level: In the immediate aftermath of a disaster, the initial response will primarily come from local resources. Communities must be prepared to carry out a local assessment of disaster impact. Healthcare professionals should be prepared to assess health issues in their community and understand how to share that information with higher levels of authority in order to contribute to regional or national assessments. Assessments need to be repeated, and the quality and specificity of data should be improved during the rescue and recovery phases or whenever any major change occurs, such as an aftershock. Information gathered through assessments is used by resource managers to determine the allocation of resources in any large-scale disaster.

2. Provide adequate shelter and clothing.

Exposure to climatic conditions in disaster situations can increase caloric requirements and lead to death.

Community level: Find short-term shelter for all homeless individuals, particularly vulnerable populations. Shelters should be appropriate for the climate. Keep individuals within their communities and family networks as much as possible. In general, it is recommended that resources be directed to rebuilding within the community rather than to building large camps or temporary settlements outside the disaster area.

3. Provide adequate nutrition.

Large-scale bulk food requirements are typically calculated based on a minimum of 2,100 kcal per person per day.

Community level: Communities must plan to distribute food equitably and include vulnerable groups. As food resources improve, establish targeted supplemental and therapeutic feeding programs for malnourished individuals.

4. Provide elementary sanitation and clean water.

The estimated minimum requirement for drinking water is 3-5 L per person per day of clean water, but 15-20 L per person per day are recommended for all needs, including washing and cooking.

Community level: Re-establish supplies of clean water and effective sanitation and waste disposal services as soon as possible. In an emergency, there should be at least one latrine for every 20 individuals. As the situation stabilizes, each family of five should have one latrine.

5. Set up a diarrhoea control program.

An increase in diarrhoeal disease is a predictable outcome of disasters because of disruption to infrastructure and healthcare services.

Community level: Rapidly implement community-based education on appropriate household sanitation measures, diarrhoea prevention, and household case management, particularly for young children with diarrhoea. Healthcare centres should anticipate additional cases of dehydration, use appropriate low-cost strategies such as ORS/ORT, and recognise possible cases of cholera and dysentery.

6. Immunize against measles and provide vitamin A supplements.

Measles has been a major source of mortality among crowded, displaced populations in which malnutrition is prevalent. Therefore, measles immunization is the only vaccine that is routinely considered for use as a preventive measure immediately following a disaster. Since vitamin A deficiency is common and contributes to measles-related mortality, consider mass distribution of vitamin A for vulnerable populations.

National level: National and international agencies work together to determine if measles immunization or vitamin A distribution is necessary following a particular event. If necessary for all or part of the deemed population, national authorities establish the central logistics (e.g., cold chain, personnel, materials) to manage a mass immunization/distribution campaign.

Community level: Health officers must immediately assess the available cold chain as part of its health care assessment. Health care professionals must monitor for cases of measles and develop a plan for mass immunization and/or mass distribution of vitamin A to the vulnerable groups in their community.

7. Establish minimum reproductive health and HIV services and improve primary medical care.

Immediate casualties (rescue phase) of a sudden impact disaster are likely to include a limited number of trauma victims. In most disasters in fragile communities the larger number of disaster-related deaths (i.e., deaths above the baseline crude mortality rate) will be due to preventable causes of mortality in the weeks and months following the impact. These casualties can largely be prevented by community health education and access to appropriate primary care. This included emergency obstetric and neonatal care, prevention and management of sexually transmitted infections, management of the health effects of sexual violence, ensuring safe blood transfusion and universal precautions in health facilities. Initial efforts should be focused on identifying those who were on treatment before the onset of the disaster and to restart treatment for them.

Community level: Health professionals should know the emergency transport and response systems in their community. Health care interventions during the rescue phase should include minimizing life losses caused by the direct impact of the event (e.g., trauma, drowning). After the rescue phase, health care resources should be focused on re-establishing and improving the access and quality of primary care, particularly for the most vulnerable groups.

8. Set up disease surveillance and health information systems.

Effective health information and disease surveillance systems are necessary to monitor effectiveness of health interventions and reassign priorities.

National level: Health authorities will use available information to define initial priorities in the use of limited resources. They should develop specific surveillance guidelines for each disaster in order to track relevant disease/mortality trends.

Community level: Every health care delivery setting should immediately implement a simple but effective health information collection system based on established WHO, PAHO, or governmental guidelines. Health care professionals should know how to share this information regularly with higher level health authorities.

9. Organize human resources.

The initial shock of an event can make it difficult for a disaster-affected population to effectively respond in a quick and organized fashion. Having a pre-defined emergency plan with clearly-identified leaders can help the local community to cope until more external resources arrive.

Community level: Have an emergency plan and pre-defined community leaders for:

• Conducting rescue operations
• Conducting assessments (e.g., health services, transportation, food, sanitation/water systems)
• Organization of food and water distribution, and the sanitary program
• Health services management
• Corpses and gravesite management
• Identification of unaccompanied minors or other extremely vulnerable individuals (e.g., elderly or persons with a disability) and organization of a caregiver program.

10. Coordinate activities.

National level: In a large-scale disaster there will be many national and international agencies attempting to assess, develop plans, and establish priorities for funding at national and regional levels. Most effective relief efforts have resulted from effective collaboration between many agencies, each bringing their own expertise and experience. However, all of these agencies will ultimately depend on quality assessments from the affected communities to make appropriate decisions and determine the ability of the communities to implement the plans and projects that will help diminish suffering and restore the baseline situation in the communities.

Community level: Develop local emergency plans that link into regional and national plans and agencies. Understand the mechanisms for communication of information (e.g., assessments, surveillance data) during disasters. Build relationships with key individuals within and outside the community before a disaster occurs.