Most children are vulnerable in disaster situation but the following are especially vulnerable:

1. Those separated from their parents or adult caretakers (the unaccompanied minors)
   
2. Girl children and adolescents
   
3. Disabled children

Preparedness

The community, NGOs, disaster planners and the Government need to be sensitized to address the special needs of this group who are referred to as 'Vulnerable group' in this document.

These children are prone to suffer from malnutrition, infections, dehydration, physical torture, and posttraumatic stress disorders (PTSD). It is only during "normal" time that all those (health workers) who will be called upon to care for them in disaster situation will have to be familiar with the 'Action Plan' in all the three phases.

Rescue Phase

As soon as the disaster strikes it is very natural for the surviving parents/family to look for their children, but there will many instances where they have died or are missing. In such situations it would be helpful to:

1. Identify a group leader / responsible adult (preferably a woman from the same community) as a caretaker for the vulnerable group.
2. Identify a temporary shelter/ area / camp. The area should be safe, secure, well lit and should not be isolated. The areas of bath and toilet should be secure and privacy to be maintained and a woman supervisor should especially supervise these areas.
3. Develop a list of unaccompanied minors (ie, a database) documenting the name, parents name, address, name and address of relatives or friends/neighbors both within and outside the disaster area.
4. Identification tags should be prepared and worn by all children.
5. Ensure that they are given priority for basic needs like water, food, clothing and medical care.
6. The distribution of food, water, fuel, clothing etc, should not be done in an isolated place/corner. It should preferably be done by female group leaders and should be directly distributed especially to the girl child and those with disabilities.
7. Help children overcome the shock and fear by reassurance and emotional support.
8. Tracing parents of unaccompanied minors to unite them should be done on priority. All available sources of publicity and media should be utilized to search for parents of separated children.
9. Families/neighbors should be placed together in the relief camps.

Gender based violence like rape, molestation, torture, exploitation and forced prostitution can occur during these situations. Domestic violence and denial of food etc are also seen. These need to be prevented and taken care of in all the phases of management as outlined.

Recovery Phase

1. The state agency / volunteer groups should continue to address the basic needs of nutrition, clothing, appropriate medical and immunization needs. Those in-charge of the vulnerable groups should have direct access to the Nodal Officer/NGOs to ensure appropriate services.
2. Psychosocial support should be age, gender and culture appropriate. Caretakers should speak the local language and some can be trained for psychosocial counselling to address symptoms of Post Traumatic Stress Disorders (as per the guidelines given in the section on PTSD).
3. Tracing parents of unaccompanied minors should continue as an ongoing process in this phase. The media can be utilized for better results and coordination of these activities in this phase.
4. The activities of the voluntary groups may need supervision by the nodal authorities.
5. If a sexual assault has taken place then:
   1. Ensure physical safety of the victim and provide medical assistance, psychosocial support and legal services. However care should be taken to avoid removing evidence by cleaning, bathing or changing clothes.
   2. Detailed history and examination have to be carried out preferably by health worker of the same sex.
   3. Children may not seek support and the Health worker has to actively look for children who have been assaulted.
   4. Unwanted pregnancy can be avoided by providing emergency contraception to rape victims as given below
      Ovral : 2 pills as soon as possible (preferably <72 hours). Repeat after 12 hours. L-Ovral : 4 pills as soon as possible (preferably <72 hours). Repeat after 12 hours.
      Give these pills with food to avoid nausea.
      Mifipristone (RU 486) - 600 mg single dose.
      

   

   Emergency management for sexually transmitted infections

   Post exposure prophylaxis (PEP) for HIV's as outlined. Address psychosocial needs and the victim and their family should not be stigmatized. Media hype regarding such incidences should be avoided and personal identity of victim and the family should never be disclosed. The reporting and follow up should be discreet and confidential 6. The local government and NGOs        should assist, support and develop        legal and administrative mechanisms        to ensure justice.

Rehabilitation Phase

1. Vulnerable children should be placed under foster care supervised by appointed social workers or NGOs to provide long-term rehabilitation of these groups. The credibility of NGOs should be scrutinized to avoid possibility of child trafficking under the garb of social work. Institutional care should be the last resort.
2. Foster and nurture a sense of hope for the future in children by establishing routines. Experience has shown that reopening/establishing schools are the best way to rehabilitate children.
3. Children in disaster situations should not be available for adoption. It should not be permitted for a reasonable period (normally at least two years) during which time all possible steps to trace parents or other family members should have been carried out
4. Finally, the state should provide appropriate legislative, administrative, social and educational measures to protect an individual of the vulnerable group from all forms of physical and mental violence, injury or abuse, neglect, maltreatment or exploitation. In order to ensure that justice is done, some systems need to be put in place. It is recommended that:
   1. Trained police personnel who are equipped to deal with a rape survivor who needs to report the case are available.
   2. Institution of a credible criminal justice system, which is seen to come down heavily on such heinous crimes, with a sentence that meets the crime.
   • In our present system, women are afraid to report rape crimes for many reasons. These include: as fear of not being believed; physical access to police, fear of retaliation.
   • Ultimately many women do not go to the police because they anticipate that in the final analysis their action will not lead to the perpetrator being punished

Finally, the state should provide appropriate legislative, administrative, social and educational measures to protect an individual of the vulnerable group from all forms of physical and mental violence, injury or abuse, neglect, maltreatment or exploitation.

In order to ensure that justice is done, some systems need to be put in place. It is recommended that: Trained police personnel, equipped to deal with a rape survivor, are available.

Institution of a credible criminal justice system, which is seen to come down heavily on such heinous crimes, with a sentence that meets the crime. In our present system, women are afraid to report rape crimes for many reasons. These include: fear of not being believed; difficulty accessing the police, fear of social retaliation.

Thus, many women do not go to the police because they anticipate that in the final analysis their action will not lead to the perpetrator being punished