Preparedness

How a community responds to a disaster is determined by how well it has been prepared by the local government and NGOs prior to the event. It is desirable for the country/states to have a clear policy on disaster prevention and management. Legislation should require health institutions to develop preparedness and response plans and to institutionalize the plans as part of their normal activities

The objective of disaster preparedness is to: Ensure that appropriate systems are in place to provide prompt and effective assistance to disaster victims. Prepare the community to handle the disaster in the first 48 hours or so when outside help has not reached and the local administration is itself affected by the disaster.

The key to disaster preparedness is the coordination of a variety of sectors to carry out the following tasks:

• Evaluate the risk of the particular region to disasters
• Develop a Disaster Action Plan
• Organize communication, information, and warning systems
• Develop and conduct community education programs ?
• Organize disaster simulation exercises and tighten response mechanisms.
• Health institutions should develop individual disaster preparedness plans.
• Disseminate the plan widely. People with roles to play in the disaster plan must be trained for it.
• Compile a comprehensive database of the health facilities in and around the area.
• Local government must appoint a Health Disaster Coordinator who is in charge of preparedness activities and coordinating plans with government agencies, armed forces, and foreign relations divisions; United Nations and other international agencies; Red Cross and other NGOs; and agencies responsible for housing, communication, power, and water services
• Media plays a very important role before, during and after a disaster. Ongoing meetings or seminars between members of the media and disaster managers is very important to clarify these roles and responsibilities as part of disaster planning
• The media also plays an essential role in educating the community about simple but critical measures that can be adopted to lessen the effects of disaster. The health sector should use the media to convey such messages on disaster preparedness and mitigation.

Rescue Phase

Disaster can occur with (like floods) or without warning (like earthquakes). Whatever the type of disaster, for some hours the community and local health personnel have only themselves to fall back upon, till outside assistance arrives. This period is normally of 48 to 72 hours and is called the "Rescue" phase.

After disaster has struck, the local authority/community leaders must at once set up a Disaster Committee with the task of coordinating actions.

Make a Chain

The foremost task of the committee will be to enroll group leaders right at the "Mohalla" or housing block level and thus make a chain for disseminating as well as collecting information.

Take Stock

The committee takes stock of the consequences of the disaster and concerns itself with the essential problems. Major functions of the committee are assessment of requirements and coordination with the intermediate-level or central authorities to prevent chaos and confusion.

A. General information assessment of the number of homeless, estimate of the number of victims, evaluation of the type, extent and seriousness of the material damage, information on isolated villages, information on people cut off from their families, forecasts as to how the natural phenomena responsible for the disaster will develop.

B. Requests for assistance machines for clearing rubble, means of transport, fuel, shelters (tents, materials for constructing shelters, caravans, other), blankets, clothing, boots, raincoats, food, tools, batteries, containers, materials, persons specializing in rescue work

C. Requests made by the local health personnel on the basis of the number of people needing assistance and the type of health care required: health equipment and material, medicaments, any health personnel required, suitably equipped hospitals to which patients may be sent who cannot be looked after on the spot, means and organization for evacuating the injured and the sick.

*Table from "Coping with Natural Disasters: The Role of Local Health Personnel and the Community:
Working guide (WHO - OMS, 1989, 108 p.)"

Coordination of groups from outside:

One of the important tasks of the Disaster Committee would be to monitor assistance from external groups (volunteers, associations). The help from external groups is important but steps must be taken to see that they do not act on their own agenda and are report to the Disaster Committee. The aim of the outside groups should be to encourage the local authority, the local health personnel and the community and help them organize so as to regain control of the situation. However, the community will be unable to coordinate disparate groups with their separate aims, resources and funding, unless the national government makes it obligatory for outside groups to consult the committees in the stricken communities and to act only with their consent.

The volunteers who come from outside should be Physically fit and capable of enduring very inhospitable conditions. Familiar with culture and customs of the affected community. Knowledge of the local language is very helpful. Trained to work under disaster conditions.

International bodies can play an important role by themselves consulting the local committees and inviting the donors and outside groups to do the same.

Recovery Phase

This is the period (usually after 2 to 3 days) when outside help starts and when the reality of disaster begins to sink in the affected population.

Rapid steps must be taken to establish a system of continuous contact with the families stricken by the disaster. Community can be subdivided into groups and a group leader selected/nominated as suggested in the "Rescue phase".

Those in charge of groups are in daily touch with the Disaster Committee or their sub committee. A system of this kind makes it possible to:

• collect information on requirements,
• route instructions and information,
• distribute where necessary the means of survival (clothing, blankets, food, etc.).

Gradually the Disaster Committee will organize itself to deal with the post-disaster period (Rehabilitation phase), assigning responsibilities in various fields like:

• Water supply, food, means of survival,
• Transport and highway maintenance; communications and information,
• Public works, building,
• Sanitation
• Health,
• Public law and order.

Temporary Shelter

When the disaster has made houses uninhabitable and there has been no evacuation of the area, temporary shelter must be arranged for those affected, for those who generally prefer to remain on the spot, in or near their property. It may happen that the population settles all over the place (waste ground, gardens, parks, squares, parking areas, sports grounds, etc), using anything that comes to hand (planks, plastics, tents, cars, containers, boats, railway wagons, buildings under construction, schools, public buildings, etc.). The sanitary situation may then rapidly deteriorate and it becomes very difficult to assess requirements.

Communities exposed to the risk of disaster (and those that propose to give shelter to displaced persons) should select sites for temporary shelter (before a disaster strikes) and carry out the necessary preparatory work. The sites chosen for erecting shelters should be:

• flood-proof, above high-water level,
• preferably on a gentle slope to facilitate rainwater and waste water drainage,
• not too close to the water table; otherwise the ground could become marshy in the rainy season,
• protected against landslides and subsidence,
• easily accessible, not far from the centre of the population,
• at a higher level than waste tips,
• downstream from sources of drinking-water.

The guidelines presented in the rest of the book will help the committee and the administrators to address some of the critical issues in general and the needs and problems of children in particular.

The local health personnel should prepare periodic reports (weekly at the outset, then monthly) summarizing from the daily information collected bearing the following issues:

• The composition of the community: It is important to know the number and age-structure of the local population in order to adapt health activity programs accordingly and to assess requirements. Since this number keeps changing, the data must be updated periodically.
  
• The number and type of health personnel available, including local and volunteers from elsewhere.
  
• The causes of death, which is an important indicator for assessing the health situation.
  
• The cases that could not be dealt with on the spot, and the reasons behind the decision to evacuate.
  
• The establishments to which people have been evacuated: this makes it possible to adapt the data received from the intermediate level so as to make rational use of support structures and specialized centres.
  
• The symptoms and diseases seen by the local health team: this indicates the disease pattern that is developing and the number of people affected.
  
• The programs and activities under way: this enables the intermediate level to take into account what the local team has already undertaken and to give the team indications on how to adapt its activities to the epidemiological forecasts made at intermediate level and in accordance with the evolution of the health situation in the whole of the disaster area.
  

Dealing with the dead

When the disaster results in a large number of deaths, the community should organize:

• transportation of the bodies,
• a pre-burial area,
• the burial place

While doing so, it is important to remember to:

• Remove the bodies from the disaster area as rapidly and discreetly as possible and note down information necessary for identifying them (place where they were found, information from relatives and neighbors),
• Transport the bodies, which should be covered, to the place where they are to await burial and where personal belongings are also deposited?
• Draw up an official register of the deaths, containing identification particulars.
• Bury the dead as late as is compatible with the laws and customs of the region, so as to enable identification. Common graves should be avoided; the site of the graves, numbered and marked with identification data.
• Hand over personal effects to the nearest relatives.

Dealing with animals

In a disaster animals may be killed (in large numbers in floods, for instance) or dispersed. They may lose their shelter. Endemic zoonoses may spread. Dogs may revert to the wild and go about in packs. The community, possibly using groups of volunteers (who will be more effective if they have been trained in advance), should take steps to carry out the essential tasks:

• Destruction of animal carcasses: Often they have to be sprinkled with petrol and covered with earth to protect them against predators until they can be destroyed or buried.
• Housing of shelterless animals; capture and treatment of stray cattle who must be brought together in specially prepared premises, fed, milked and looked after.
• Re-opening of slaughterhouses: existing ones if they are usable, otherwise in temporary premises or in lorries equipped for the carriage of meat.
• organize the monitoring of communicable animal diseases and of slaughterhouses.

Rehabilitation Phase

This is the phase in which the community is back on the normal life process and in fact is fine tuning their resources to deal with other emergencies. They are thus also in a position to provide help to some other disaster affected area in the manner that they received help and assistance.