MARGARET K. SEMAKULA

ObjectivesAt the end of the unit participants should be able to:Define concepts related to public health emergencies or disasters Identify the aetiologies and describe the common disasters in Uganda

Describe elements of disaster management cycle

Describe the activities to be undertaken during the various phases of an emergency/disaster

Discuss the activities undertaken at various levels of the emergency response structure.

Definitions of Concepts - IEmergency Sudden, unexpected phenomenon Causing loss of lives and harm to population Destruction of community property Damage to environment (Pierre Perrin 1996)

Definition - IIDisaster Defined as the confluence of risk and vulnerability (Wilches Chaux 1989) Risks x Vulnerability = Disaster

Any disruption of the human ecology that exceed the capacity of the community to function normally (Dick 1991)

Definition - IIIDisasterA serious disruption of the functioning of a community or society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources (WHO 1998).

Definition -IV RisksProbability of harmful events to occur

VulnerabilityIncapacity to absorb the effects of a given change (individual, community, national levels)

Condition of exposure to (hazards, risks)

Definition -VHazardsA life threatening of potentially damaging phenomenon

Definition -VIDefinition of Complex Emergency (CE)Deep social crisis in which large numbers of people die from war, displacement, hunger owing to man made disasters (Klugman 1999)

Humanitarian crisis where there is break down in authority due to internal or external conflicts that requires international response (OCHA 1999)

Characteristics of CEExtensive violence

Massive displacement

Wide spread damage to society-administrative, economic and political collapse

Long lasting and widespread

Exploitation of and exacerbation of existing differences (economic, social etc) within civil society.

Characteristics of CEDispute over legitimacy of authority (government or rebels).

Vulnerable population at greatest risks.

Need for large scale multi-faceted humanitarian assistance.

Hindrance of assistance by political or military forces.

Catastrophic public health emergencies

Vulnerability Types - ISocial Human (individual, family, community) and Institutional (lack-weak structure)

EconomicIndividual Family, Community, National and International

Vulnerability Types- IIPoliticalAuthoritarian political regimeBureaucracyAbsence of disaster contingency planWeak legal system

Ecological Geo-physical and social behaviour

Vulnerability FactorsHuman factorsSocio-demographic Cultural Immunity

Resourceshealth and social serviceshuman (trained personnel)

Environmental factorsWeather and climatic conditions

Socio-economic factorspolitical, economic situation

Causes and Classification of Disasters - I Genesis-Aetiology Natural e.g earthquakes, volcano, cyclones Man made/technological e.g wars, nuclear disaster, terrorism

Speed of Onset/Impact Sudden onset e.g volcano eruption, earthquakes Slow onset e.g warfare, epidemics

Causes and Classification of Disasters - IIHierarchyPrimary events-no human interventions

Secondary events, consequence of primary events

Common Disasters In Uganda A.Natural DisastersDrought

Epidemics e.g. HIV/AIDs, malaria, Ebola

Floods

Landslides

Earthquakes

Common DisastersB.Man made Technological

Conflicts - Forced displacements

Transport accidents

Environmental degradation and pollution

Fires

Structural collapse

Disasters Management CycleIncludesPre-disaster phaseMitigation Preparedness

Disaster/Attack phase Response

Post-disaster phaseRecovery/rehabilitation

Disaster ManagementDisaster risk managementIncludes Mitigation

Preparedness

Response

Recovery

Disaster risk reduction (pre)Disaster risk reductionIncludes Mitigation Preparedness

Advantages of disaster risk reductionMore efficientMore cost effectiveMore humane

MitigationStructural activities e.g.

Floods - building barriers

Earthquakes - Hospital constructed/designed to withstand

Droughts - Early warning systems

Warning or Alert PhaseActivities Disseminate information

Institute safety and preventive measures

Review procedures and action plans

Ensure systems planned are in place

Supervise evacuation

Preparedness PhaseBehavioural Activities Surveillance system

Training

Education

Inventory of resources

Collaboration with key response sectors

Resource mobilisation

Peace building

Objectives of PreparednessIncludes Prevention of morbidity and mortality

Provision of care for casualty

Ensure restoration of normal lives

Re-establish health services

Protect staff

Protect public health and medical assets

Disaster/Emergency Phase Activities

Manage casualties

Surveillance

Collect and disseminate data

Environmental health (water and sanitation)

Emotional and psycho-social support

Recovery Phase Activities

Undertake needs and damage assessment

Rehabilitate individuals physically and psycho-socially.

Rehabilitate health and social services

Emergency Response - Interventions (10 point priorities) in Refugee Settings IInterventions- Refugee Emergency Setting1. Initial Assessment

Measles Immunisation

Water and Sanitation

Food and Nutrition

5. Shelter and Site Planning

Emergency Response Interventions - IIHealth Care in Emergency Situations

Control of Communicable Diseases

Public Health Surveillance

Human Resource Training 10. Co ordination

Emergency Intervention1. Initial AssessmentHealth priorities identified on the basis of rapid collection and analysis of data.

Information collected on (e.g background of displacement, risk factors, resources required). Methods of data collection used - quantitative and qualitative techniques ( e.g sample surveys, mapping, interviews, observation etc).

Emergency Intervention2. Measles ImmunisationSevere health problem, kills 1 in 10 children in developing countries.

Led to 40% child hood deaths Tuareg Camp Mauritania.

Factors associated with high prevalence of measles include overcrowding, poor hygiene, low immunisation).

Immunisation to target children 6 months to 15 years. Administered with Vit. A supplement.

Emergency Intervention3. Water and SanitationWaterDrinking water is top priority

During first days 5 litres per person per day is required for physiological requirement

Recommended 20 litre/person/day

Poor and inadequate water is associated with diseases - water borne, water based, water washed, and water related diseases.

Emergency InterventionWater and SanitationSanitation1st days emergency latrine 50-100 persons

Improved to 1 latrine for 20 persons

Ideally 1 per family

Emergency Intervention4. Food and Nutrition - I Population movement both a cause and consequence of food shortage

Malnutrition is an important contributory cause of death

Common types of malnutritionProtein Energy malnutrition (PEM) spectrum i.e Kwashiorkor, Marasmus, Marasmic Kwashiorkor and Underweight).

Emergency InterventionFood and Nutrition - ii Common types of malnutrition contd.Micro-nutritient deficiencies (Aneamia, Scurvy, Pellagra, Beriberi)

Food distribution General Supplementary and Therapeutic

Recommended 2100kcal/person/day

Emergency Intervention5. Shelter and Site PlanningImportance of shelter ProtectionSecurityPrivacy

Recommended 3.5 sq metre per person

Appropriate shelter site Secure location away from border Access to water

Emergency InterventionShelter and Site Planning (ii)Appropriate shelter site contd. Availability of landLocation population socially and culturally agreeable

Emergency Intervention6. Health Care in EmergencyAims to reduce excess mortality in the emergency phase of displacement.

Curative, preventive care crucial.

Manuals and guidelines need be available for standardization.

Tier system of health care (hospital, health centre, health post, and outreach services).

Emergency Intervention7. Control of Communicable DiseasesIntervention StrategiesAttack source of infection (e.g curative care, isolation etc)

Prevent transmission (e.g environment sanitation, personal hygiene etc)

Protect the susceptible (e.g immunisation, chemoprophylaxis etc)

Emergency Intervention8. Public Health Surveillance - iSurveillance Defined as continuos systematic collection, analysis, interpretation of data and provision of feedback for the purpose of disease prevention and control

Emergency InterventionPublic Health Surveillance - iiObjectives Provide early warning/detection of epidemics

Determine the main health problems and their trends

Plan health interventions

Evaluate the coverage and effectiveness of health interventions/programmes

Emergency InterventionPublic Health Surveillance - iiiKey Principles of Surveillance During emergency limit data collection to diseases of public health importance (i.e preventable, high morbidity, mortality etc). Keep surveillance system simple.

Keep frequency of data transmission and analysis regular e.g weekly/monthly.

Data analysis be at field level

Emergency Intervention9. Human Resource and TrainingObjective is to provide human resources capable of performing tasks in emergency programmes and organise services efficiently.

Determine training needs

Train personnel (on job, refresher course)

Co ordinate personnel activities

Emergency Intervention10.Co-ordination - iRationale-Many actors e.g UN agencies NGOs, Hosts etc involved in service provision.

Goal is to achieve greatest impact through management and integration of activities.

Establish clear leadership.

Create co-ordinating bodies (e.g UNHCR for refugees)

Secondary events, consequence of primary events

Emergency InterventionCo-ordination - iiEnsure priorities are shared

Rationalise services by establishing common standards Many actors e.g UN agencies NGOs, Hosts.

Ensure communication occurs amongst stakeholders

Structure for Emergency Response - UgandaLevelStructure

NationalMinistries (Health)

DistrictDistrict Disaster Committee

Sub-districtSub-county Disaster Committee

Structure and Functions - iNational LevelPolicy

Planning

Co-ordination

Resource mobilisation

Technical support

Hazards mapping

Reporting Research

Structure and Functions - iiSub-National LevelPlanning

Implementation

Training

Co-ordination

Resource mobilisation

Reporting and communication