Disaster Components and Definitions

Components of a Disaster

• Johan von Schreeb MD, PhD, a general surgeon and professor in Global Disaster Medicine at the Center for Research on Health Care in Disasters, directs the Centre for Health Crises and is part of the Department of Global Public Health.
• King Karl XIII founded Karolinska Institutet in 1810.
• The institute was established as an "academy for the training of skilled army surgeons" following high soldier mortality in the Finnish War against Russia.
• One in three soldiers wounded in the Finnish War against Russia died in field hospitals.
• The medical skills of the army barber-surgeons were inadequate, leading Sweden to train surgeons for future war preparedness.

Definition of a Disaster

• United Nations International Strategy for Disaster Reduction (UNISDR) definition of disasters in 2009: a serious disruption of a community or society's functioning involving widespread human, material, economic, and environmental losses and impacts, exceeding the community's ability to cope using its own resources.
• UNISDR definition of disasters in 2019: a serious disruption of the functioning of a community or society at any scale due to hazardous events interacting with exposure, vulnerability, and capacity conditions, leading to human, material, economic, and environmental losses and impacts.
• Disasters trigger reflexes such as sending aid, setting up field hospitals, dispatching trauma surgeons, and providing material and medicines.

Hazard and Vulnerability

• A disaster occurs at the intersection of a hazard and vulnerability.
• Vulnerability is influenced by socioeconomics (low-, middle- or high-income).
• Age distribution affects vulnerability, along with the burden of disease, health system capacity, governance, resilience, and experience.

Socioeconomic Factors and Health

• A world health chart by Gapminder in 2019 presents average lifespans and incomes for countries, indicating health and wealth distribution.
• Level 1 income countries have low lifespan and are poor, whereas Level 4 income countries have high lifespan and are rich.
• Age distribution is influenced by the income level of the country.
• Low-income countries have 1–2% of the population over 70 and 50% under 20 years.
• High-income countries have 15–20% of the population over 70 and 20% under 20 years.
• Health expenditures per capita vary significantly.
• In 2021-2022, the United States spent $12,500 USD, Sweden spent $6,500 USD, Lebanon spent $1,000 USD, Ukraine spent $528 USD and the Democratic Republic of Congo spent $45 USD

Natural and Man-Made Hazards

• Natural hazards include seismic events (earthquakes, volcanic eruptions, tsunamis), and climatic events (high winds, precipitation, lightning, temperature extremes, erosion, drought, desertification, floods, avalanches).
• Mixed hazards combine natural events and human causes.
• These include drought, desertification, floods, erosion, landslides/mudslides, fire, and health-related epidemics.
• Man-made hazards include technological disasters and conflict (armed conflicts like conventional war and civil strife, complex human emergencies and terrorism), and unarmed conflicts such as sanctions.
• Natural hazards can have direct or indirect health effects.
• Direct: loss of lives, severe injuries requiring complex treatment.
• Indirect: Risks of communicable disease increases after incidents.

Health Care After Natural Disasters

• Health care needs after an earthquake change over time.
• There’s an initial surge in hospital resource needs.
• Field hospitals are set up in countries like Iran, Haiti, Indonesia and Pakistan after a sudden disaster.
• Prehosp Disaster Med. 2008 Mar-Apr;23(2):144-51

Turkey Earthquake (2023)

• 50,000 injured were evacuated by helicopters, ambulances, or cars within 48 hours.
• Medical diagnoses were mainly scabies, ARI, diarrhea, and NCD, according to a WHO report.
• Only 10% of these were directly related to the earthquake, with 63% having no relation.

Climate Change & Armed Conflicts

• Climate change can have various impacts on human health including injuries, fatalities, mental health impacts, asthma, cardiovascular disease, malaria, dengue, encephalitis and respiratory allergies.
• The number of armed conflicts worldwide has increased.
• Conflicts in Sudan, Democratic Republic of the Congo (DRC) and Palestine were two-thirds of new conflict movements in 2023.
• 3.4 million people were displaced in the Gaza Strip in the last quarter of 2023, leaving 1.7 million internally displaced by the end of the year.
• Man-made hazards have direct and indirect health effects.
• Direct effects include trauma from bombings or bullet injuries and mental health problems.
• Indirect effects include displacement and Public health-related issues or destruction of health facilities.

Health Resources in Conflicts

• Health care needs in conflicts fluctuate with armed conflict events with essential public health needs.
• Health resources decrease. Trauma care needs will require specialized tools.

Health in Ukraine

• Life expectancy for men is 65 years (82 in Sweden).
• Health expenditure per capita is 5% of Sweden.
• There are 130,000 medical doctors working in a varying context (60-20-20).
• There have been 1,300 attacks on health care facilities.

Health in Gaza (2025)

• 40% of the population is under 20 years old.
• Well-educated and unemployed doctors.
• 95% of the population has been affected.
• There’s been a displacement with 5-10 times increased mortality rates.
• 70% of hospitals are non-functional.
• There is an estimate of it costing 10 billion USD to rebuild the health system within the next 7 years.

Needs and Risk Assessment

• Assessments should analyse hazard, vulnerability, exposure (population affected), capacities, and time.
• Time is a key component for risk assessment.
• In a mass casualty event, the need has to be addressed in an optimal order.
• Public health should be triaged in the following order : water and sanitation, Shelter, Food, and health care should be addressed.
• Preventative and curative measured should be taken including preventive measured.

Humanitarian Assistance

• A reflex/humanitarian imperative, intended to save lives, alleviate suffering, and maintain human dignity during disasters.
• It has to stay neutral, independent and impartial.
• As of 2022, 274 million people needed humanitarian assistance.
• In 2021, 31 billion USD was allocated.
• Faces significant ethical challenges : Utalitarian principles quantity vs quality.

Disasters and Assistance

• Health expenditure influence the need for interventional assistance following major disasters.

Emergency Medical Teams (EMT)

• Type 1: Offer outpatient care
• Type 2: Offer inpatient care, including surgery
• Type 3: Offer advanced inpatient care, ICU care
• Specialised Care Teams: offer specific care/support
• International EMTs offer surge capacity for clinical care surgery

Rehabilitation in Disasters and Health Crises

• Rehabilitation, as a health strategy, can improve health outcomes.
• Rehabilitation is a set of interventions designed to optimize functioning and reduce disability in people with health problems.
• It is related to how people interact with their environment.
• Functioning is linked to disability (Cieza 2018).
• Rehabilitation is the third health indicator (Stucki 2017).
• Rehabilitation can optimize functioning, it can limit disability and it can increase independence in activities and participation in society and facilitate recovery.

Rehabilitation Workforce

• Diversity of interventions are provided by different health workers: physiotherapists, occupational therapists, orthotists, speech and language therapists and rehabilitation nurses.
• Approximately 1 in 3 could benefit from rehabilitation.

Persons with Disabilities

• Persons with disabilities include those who have long term physical, mental, intellectual or sensory impairments.
• GBD looks at Global rehabilitation needs.
• Results from a 2019 study show that 2,410 persons (millions).

Rehabilitation Workforce and Needs

• 1/10 of needed rehab workforce
• There are many rehabilitation models that are affected by world events.
• Disasters will need a proper work-force equipped to deal with the current crises.
• A model for life and limbs saving.
• Prevent delays by: Having resources, trained teams, and clear access to care. Standards: there should be timely integration of rehabilitation into emergency and preparation. Rehabilitation response plan is based on mitigation, preparedness, recovery and response.
• Acquired Health Conditions . Earthquakes Tropical cyclones Tsunami Floods Conflicts Outbreaks (e.g., measle, diphteria) Famine Pre-Existing disabilities: barriers to access. They also have new onset, have increases to deadly injuries and have unmet basic needs. Rehab resources tend to be scare to address the actual disasters.