. ABSTRACTS AND REPORTS 97
DISASTER ASSESSMENT: THE mAK LINK IN
INTERNATIONAL RELIEF EFFORTS
It is common to hear about the inadequa- cies of international relief efforts, the mis- matching of needs and donations, and the mistakes engendered by the perceived ur- gency of assistance requests before a major di- saster recedes from the front pages of the press. In a similar vein, the literature has stressed the importance of making sure that the right relief supplies, properly labeled and classified, arrive at the right place at the right time. One of the reasons that steps in this di- rection have been made only haltingly, de- spite all the attention, is that there is no stan- dardized, universally accepted method to get the right information to the right person on time.
Consider the following fairly typical sce- nario: An earthquake strikes on a weekend or close to a national holiday (just before Christ- mas in Managua, Nicaragua, in 1972; or on Holy Thursday in Popayan, Colombia, in 1983). It affects several major population cen- ters. Casualties are high; there are untold numbers of people injured, houses destroyed, power lines downed, roads blocked, water mains broken, roads impassable, and public employees stranded at home among those affected. The exact extent of the area dam- aged by the earthquake and in need of relief may not be known for days, as news filters in from isolated communities and surveys are completed.
Yet public opinion and special constituen- cies moved by news of the disaster demand prompt and generous action. Gffers of inter- national assistance are received within 24 hours. National relief authorities are acutely aware that once press coverage dies down, funds may dry up or be committed elsewhere. How can needs be accurately determined?
The Information Gap
Getting the necessary vital information to
decision-makers involves: (a) Surveying areas affected by the disaster to determine the ex- tent of damage and disruption of services. This should indicate the impact on the oper- ating capacity of lifeline services and the health of the population. With this informa- tion, it is possible to decide what essential re- sources will be required, in what order, at what time. (b) Surveying resources (person- nel, equipment, warehouses) available. Com- paring the total requirements with the re- sources available locally or near the affected area, or already pledged as assistance, will determine what remains to be requested urgently.
All this sounds reasonably simple. Why, then, are so many appeals and subsequent international relief decisions regarded as ill- advised or ill-timed? The reason is that in many disasters, accurate technical informa- tion does not reach decision-makers in the af- fected country or in countries offering assis- tance in time to help them judge what is needed. Hence, they have to act on stereo- typed notions of a disaster’s effect and re- spond to the pressures of public opinion- however uninformed it may be.
In general, circumstances involving meth- odology, logistics, the limited time available, and the personnel experience and skills re- quired combine to make prompt and objec- tive assessment of needs one of the most chal- lenging problems in the field of emergency management.
98 PAHO BULLETIN l vol. 19, no. 1, 1985
health professionals and experts before disas- ters occur tend to be unrealistically sophisti- cated-more like wish lists for scientific re- search than practical tools for emergency decision-making.
With respect to logistics, field assessment requires that multidisciplinary teams have ac- cess to transportation (helicopters, aircraft) and telecommunications (VHF/UHF) net- works. At the time of a disaster, however, epi- demiologists and other civilian health person- nel often cannot secure priority access to these vital logistical supports.
Another essential element in disaster man- agement is time. Important decisions have to be made immediately, or within 24 hours, with whatever information is available, no matter how sketchy it may be. The deploy- ment of resources for search, rescue, and ex- trication of victims, or for the emergency medical treatment of injuries, cannot wait un- til detailed reports are received and analyzed (see Figure 1).
A second time-related factor is the useful life-span of the resources identified as lack- ing. Instead of focusing on transitory needs that are urgent in the first days after impact but that international assistance will be un- able to meet in time (such as needs for first-
Figure 1. Deaths reported from the February 1976 Guatemala earthquake, hy reporting date. It took roughly four days to learn about half the deaths and roughly 17 days before the full death
toll was known.
24 -
22.7;a
4 5 6 7 a 9 10 111213 141516 17 la19 20 21 OAYSINFEBRUARY1976
aid equipment, medical personnel, and field hospitals), the assessment team should try to forecast the critical needs of the next phase, where outside help could make a difference.
Failure to consider these built-in delays at the time that the assessment of needs is being carried out leads to the common result that most medical and surgical supplies, person-
nel, and field hospitals arrive long after most
patients have received primary care and na- tional priorities have shifted to food, water, and shelter.
It should also be noted that assessing needs calls for skills from many disciplines-includ- ing medical care, planning, epidemiology, en- gineering, architecture, etc. The added re- quirement of previous experience in dealing with emergencies makes it particularly diffi- cult to form the kind of assessment team that is really needed. The fortunately low fre- quency with which major disasters occur in any given country means that every major di- saster is a “first experience” for most key health officials.
Suggested Measures
It clearly should not be necessary to wait for weeks to collect detailed information on every aspect of social and environmental changes in order to determine what has to be done. Al- though each disaster is different, all disas- ters-especially those of a particular type such as earthquakes or hurricanes-nonethe- less have certain characteristics in common; these have been reviewed in the literature and are known by the people who work in pre- paredness and relief programs. The charac- teristic outcomes in turn imply a characteris- tic set of decisions that must be ma,de by national authorities in the relief and rehabili- tation effort. Hence, what is needed is a list of
crude key indicators that will make it possible to determine quickly where the key problems of any specific disaster lie and how they are likely to evolve.
l ABSTRACTS AND REPORTS 99
national agency working in disaster prepared- ness and relief has its own rules of thumb for deciding what it considers to be proper relief assistance. So do national authorities, volun- tary agencies, and the ever-growing number of private sector experts in the field.
As a first step toward pooling this experi- ence gained in different sectors, a meeting was held in Mexico in which representatives of national institutions and international agencies’ involved in disaster relief came to- gether to discuss the critical information needed in the three major phases of disaster relief: the emergency phase (one to seven days), the delayed emergency phase (seven to 30 days), and the rehabilitation phase (one to 12 months).
The system they are designing is “decision- driven.” That is, the list of critical decisions that must be made at each phase serves as the starting point to determine what information is required, and therefore what indicators are called for in the assessment process,
For example, after an earthquake a com- mon decision is whether or not to deploy per- sonnel and equipment to supply emergency water rations to the affected population. To make this decision soundly, the technical staff must provide the policymakers with informa- tion on the number of people who lack water as a result of the emergency, whether the sup- ply system has been damaged, what the water
I PAHO/WHO, the Economic Commission for Latin America (ECLA), the United Nations Food and Agricul- ture Organization (FAO), the United Nations OfTice of the Disaster Relief Coordinator (UNDRO). and the World Food Program (WFP).
quality is, and how long it should take to rees- tablish the normal delivery system. In order to provide this information, the technical staff or assessment teams need a set of indicators such as the number of complaints from users; the level of water production, storage, and distribution; the result of water tests; etc.
The same kind of “flow chart” of decisions- to-indicators is being developed for all the major areas of public health, food and nutri- tion, communications, infrastructure, and transport by the agencies involved. This deci- sion-driven method will eventually reduce the field of all possible information to a manage- able set of targeted data. The expectation is that this will permit determination of needs and hence international assistance to be ac- complished better.
However, the system is based on the as- sumption that the persons designing it are aware of all the important decisions that must be made in a disaster. One possible drawback of the model is that it may have omitted some critical decisions that are important as start- ing points. Whether or not this is a serious limitation will only become clear once the model has been tested. Overall, it is hoped that the model can lead to a more methodical approach to requesting and sending interna- tional assistance, and that ultimately it will enable affected countries to recover more rap- idly by targeting assistance accurately and re- ducing waste.
Source: Pan American Health Organization. Assessing needs: The weak link in international relief efforts, Di- suster Prepredrzess in the Americus. October 1984, pp.
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