PSYC 432 Disaster Psychology PDF

**PSYC 432: DISASTER PSYCHOLOGY** **Introduction** In everyday language, the terms disasters and hazards are often used interchangeably. A bad outcome in a process, like a meal under preparation failing to produce the desired effect, is usually described as a disaster. A good starting point in the...

**PSYC 432: DISASTER PSYCHOLOGY** **Introduction** In everyday language, the terms disasters and hazards are often used interchangeably. A bad outcome in a process, like a meal under preparation failing to produce the desired effect, is usually described as a disaster. A good starting point in the study of disasters and eventually disaster psychology is to be grounded in the meaning and scope of disasters. Related terminologies also need to be identified and explained. The types and effects are also important. **Meaning of Disasters** Many things come to mind when people come across the word disaster. For some a disaster is synonymous with earthquakes, accidents, floods, or even war. The term disaster is commonly confused with hazard. The dictionary defines disaster as an even with adverse consequences, or an [event] that [results] in [great] [harm], [damage], or [death], or [serious] [difficulty]. Generally, a disaster refers to a sudden accident or natural catastrophe that causes great damage or loss of life. It is an event with adverse consequences, meaning that it seriously disrupts the functioning of a community. The IFRC observes disasters are serious disruptions to the functioning of a community that exceed its capacity to cope using its own resources. Disasters can be caused by natural, man-made and technological hazards, as well as various factors that influence the exposure and vulnerability of a community. When this definition is unpacked, it yields the following aspects about a disaster - Disaster are sudden and unexpected - They cause severe damage to people and property - They result in injuries and loss of life - They cause severe damage to the environment - They disrupt the normal pattern of life of the affected community - They generate misfortune, helplessness and suffering - The disruption is usually to the extent that the community cannot cope using its own resources. Any event that meets all or most of the above parameters qualifies to be a disaster. Disasters can be caused by many different kinds of **hazards,** and can have devastating impacts on people and communities. The frequency, complexity and severity of their impacts are likely to increase in the future due to factors such as climate change, displacement, conflict, rapid and unplanned urbanization, technological hazards and public health emergencies. But disasters can and should be prevented. We can prevent hazards from becoming disasters by helping communities to [[be prepared]](https://www.ifrc.org/disaster-preparedness), [[reduce their risks, and become more resilient]](https://www.ifrc.org/climate-smart-disaster-risk-reduction). Vulnerability to the effects of disasters refers to the susceptibility of individuals, communities, and systems to suffer harm when exposed to hazards. Several factors contribute to this vulnerability: **Physical Factors** Infrastructure Quality: Poorly constructed buildings and infrastructure are more likely to be damaged or destroyed during disasters. Geographic Location: Areas prone to natural hazards, such as floodplains or earthquake zones, have higher vulnerability. Social Factors Socioeconomic Status: People with lower income levels often live in more vulnerable conditions and have fewer resources to recover from disasters. Education and Awareness: Lack of knowledge about disaster preparedness and response can increase vulnerability. Economic Factors Employment and Livelihoods: Communities dependent on agriculture or other vulnerable industries can suffer significant economic losses. Access to Resources: Limited access to financial resources, insurance, and credit can hinder recovery efforts. Environmental Factors Environmental Degradation: Deforestation, soil erosion, and other forms of environmental degradation can exacerbate the impacts of disasters. Climate Change: Changes in climate patterns can increase the frequency and severity of natural hazards. Demographic Factors Age and Health: The elderly, children, and individuals with pre-existing health conditions are more vulnerable to the impacts of disasters. Gender: Women and girls often face higher risks due to social and cultural factors2. Institutional Factors **Governance and Policies: Effective disaster management policies and strong governance can reduce vulnerability1.** **Community Preparedness: Communities with robust disaster preparedness plans and active participation in risk reduction activities are less vulnerable** **Rationale for Studying Disaster Psychology** Studying disaster psychology is crucial for several reasons: 1\. Understanding Impact of disasters on humans: Disasters can have profound psychological effects on individuals and communities. By studying disaster psychology, we can better understand these impacts, including trauma, stress, anxiety, and PTSD. 2\. Improving Response and Recovery: Knowledge in disaster psychology helps in developing effective interventions and support systems. This includes immediate psychological first aid and long-term mental health care, which are essential for recovery. 3\. Enhancing Resilience: Understanding the factors that contribute to resilience can help communities and individuals better prepare for and recover from disasters. This includes building strong social support networks and developing effective coping strategies. 4\. Informing Policy and Practice: Insights from disaster psychology can inform policies and practices in disaster management. This ensures that mental health considerations are integrated into disaster preparedness, response, and recovery plans. 5\. Supporting Vulnerable Populations: Certain groups, such as children, the elderly, and those with pre-existing mental health conditions, are more vulnerable to the psychological impacts of disasters. Studying disaster psychology helps in tailoring interventions to meet the specific needs of these populations. 6\. Promoting Public Awareness: Educating the public about the psychological effects of disasters and the importance of mental health support can reduce stigma and encourage individuals to seek help when needed Terminologies in Disasters Here are some key terminologies commonly used in the field of disaster management: 1. **Disaster** -- A serious disruption of the functioning of a community or a society involving widespread human, material, economic or environmental losses and impacts that exceed the ability of the affected community or society to cope using its own resources. It is a natural or human-caused event which causes intensive negative impacts on people, goods, services and/or the environment, exceeding the affected community's capability to respond. 2. **Hazard:** A potential source of harm or adverse effect on a person or persons. Hazards can be natural (e.g., earthquakes, floods) or human-made (e.g., industrial accidents). 3. **Vulnerability**: The susceptibility of a community, system, or asset to the impacts of hazards. Factors such as location, socioeconomic status, and infrastructure quality can influence vulnerability. 4. **Risk**: The combination of the probability of an event and its negative consequences. Risk is often expressed as the product of hazard and vulnerability. 5. **Capacity**: The resources, means, and strengths that exist within a community, society, or organization to manage and reduce disaster risks. 6. **Mitigation**: Efforts to reduce or eliminate the long-term risk to human life and property from natural and human-made hazards. This can include building codes, land-use planning, and public education. 7. **Preparedness**: Activities and measures taken in advance to ensure effective response to the impact of hazards. This includes emergency planning, training, and public awareness campaigns. 8. **Response**: The immediate actions taken during and after a disaster to ensure safety, reduce economic losses, and alleviate suffering. This includes search and rescue, medical care, and providing shelter. 9. **Recovery**: The process of restoring and improving the community following a disaster. This includes rebuilding infrastructure, restoring services, and economic revitalization. 10. **Resilience**: The ability of a system, community, or society to resist, absorb, and recover from the effects of a hazard in a timely and efficient manner. 11. **Disaster** Risk Reduction (DRR): Strategies and practices aimed at minimizing vulnerabilities and disaster risks throughout a society, to prevent or mitigate the adverse impacts of hazards. 12. **Emergency**: This refers to a situation generated by the real or imminent occurrence of an event that requires immediate attention. Paying immediate attention to an event or situation as described above is important as the event/situation can generate negative consequences and escalate into an emergency. 13. **Vulnerability** -- Refers to the characteristics and circumstances of a community, system or assets that make it susceptible to the damaging effects of a hazard. It is the extent to which a community's structure, services or environment is likely to be damaged or disrupted by the impact of a hazard. 14. **Mitigation** -- The measures employed towards preventing, lessening or eliminating of the adverse impacts of hazards and related disasters. 15. **Prevention** -- The outright avoidance of adverse impacts of hazards and related disasters. 16. **Disaster management** -- the organization and management of resources and responsibilities for dealing with all humanitarian aspects of emergencies, in particular the preparedness, response and recovery in order to lessen the impact of disasters. It aims at reducing the negative impact or consequences of adverse events (disasters cannot always be prevented, but the adverse effects can be minimized). Disaster management is more than just response and relief (it assumes a more proactive approach). **TYPES OF DISASTERS** Disasters can be broadly categorized into two main types: natural and human-made. **Natural Disasters** - **Earthquakes**: Sudden shaking of the ground caused by tectonic movements. - **Floods**: Overflow of water onto normally dry land. - **Tsunamis**: Large ocean waves usually caused by underwater earthquakes. - **Volcanic Eruptions**: Explosive release of lava, ash, and gases from a volcano. - **Hurricanes/Cyclones**: Powerful tropical storms with strong winds and heavy rain. - **Tornadoes**: Violently rotating columns of air extending from a thunderstorm to the ground. - **Droughts**: Extended periods of deficient rainfall leading to water shortages. - **Wildfires**: Uncontrolled fires spreading through vegetation. - **Landslides**: Movement of rock, earth, or debris down a slope. - **Avalanches**: Rapid flow of snow down a mountain slope. **Human-Made Disasters** - **Industrial Accidents**: Incidents such as chemical spills, explosions, or fires in industrial settings. - **Nuclear Accidents**: Release of radioactive materials, as seen in Chernobyl or Fukushima. - **Oil Spills**: Release of liquid petroleum into the environment, often affecting marine life. - **Terrorist Attacks**: Deliberate acts of violence intended to cause fear and harm. - **Transportation Accidents**: Major accidents involving vehicles, trains, ships, or airplanes. - **Structural Failures**: Collapse of buildings, bridges, or dams due to design flaws or poor maintenance. - **Environmental Pollution**: Contamination of air, water, or soil due to human activities. - **Complex Emergencies** These involve a combination of natural and human-made factors, often leading to humanitarian crises. Examples include: **Famine**: Severe food shortages often exacerbated by conflict or drought. **Pandemics**: Widespread outbreaks of infectious diseases, such as COVID-19. **Speed of Onset** Disasters are also categorized on basis of speed of onset. In this case, there are two types namely, sudden onset and slow onset disasters. **Sudden onset**: little or no warning, minimal time to prepare. For example, an earthquake, tsunami, cyclone, volcano, etc. **Slow onset:** adverse event slow to develop; first the situation develops; the second level is an emergency; the third level is a disaster. For example, drought, civil strife, epidemic, etc. **EFFECTS OF DISASTERS** Disasters can have a wide range of effects on individuals, communities, and the environment. Here are some key impacts: **Physical Effects** - **Injuries and Fatalities**: Disasters often result in physical harm or loss of life. For example, earthquakes and tsunamis can cause immediate injuries and fatalities. - **Damage to Infrastructure**: Buildings, roads, bridges, and utilities can be severely damaged or destroyed, disrupting daily life and economic activities. - **Environmental Degradation**: Natural disasters like wildfires and floods can lead to soil erosion, deforestation, and pollution of water bodies. **Economic Effects** - **Financial Losses**: The cost of rebuilding and repairing damaged infrastructure can be enormous. Businesses may suffer losses due to interrupted operations. - **Loss of Livelihoods**: Many people may lose their jobs or sources of income, especially in agriculture and small businesses. - **Increased Poverty**: Disasters can push vulnerable populations further into poverty, making recovery more difficult. **Social Effects** - **Displacement:** People may be forced to leave their homes, leading to temporary or permanent displacement. This can result in overcrowded shelters and refugee camps. - **Disruption of Services**: Essential services such as healthcare, education, and transportation can be disrupted, affecting the well-being of the community. - **Community Cohesion**: While disasters can strain social bonds, they can also bring communities together as they work collectively to recover. **Psychological Effects** - **Trauma and Stress**: Survivors may experience psychological trauma, stress, anxiety, and depression. Post-traumatic stress disorder (PTSD) is common among disaster victims. - **Grief and Loss**: The loss of loved ones, homes, and possessions can lead to profound grief and a sense of loss. - **Resilience and Coping:** Despite the challenges, many individuals and communities demonstrate resilience and develop coping mechanisms to deal with the aftermath. **Long-Term Effects** - **Health Issues**: Long-term health problems can arise from injuries, exposure to hazardous materials, and lack of access to medical care. - **Economic Recovery**: Rebuilding and economic recovery can take years, depending on the severity of the disaster and the resources available. - **Policy and Planning**: Disasters often lead to changes in policies and planning to improve preparedness and reduce future risks. **Vulnerability to Effects of Disasters** Vulnerability to the effects of disasters refers to the susceptibility of individuals, communities, and systems to suffer harm when exposed to hazards. Several factors contribute to this vulnerability: - Infrastructure Quality: Poorly constructed buildings and infrastructure are more likely to be damaged or destroyed during disasters. - Geographic Location: Areas prone to natural hazards, such as floodplains or earthquake zones, have higher vulnerability. - Socioeconomic Status: People with lower income levels often live in more vulnerable conditions and have fewer resources to recover from disasters. - Education and Awareness: Lack of knowledge about disaster preparedness and response can increase vulnerability. - Employment and Livelihoods: Communities dependent on agriculture or other vulnerable industries can suffer significant economic losses. - Access to Resources: Limited access to financial resources, insurance, and credit can hinder recovery efforts. - Environmental Degradation: Deforestation, soil erosion, and other forms of environmental degradation can exacerbate the impacts of disasters. - Climate Change: Changes in climate patterns can increase the frequency and severity of natural hazards. - Age and Health: The elderly, children, and individuals with pre-existing health conditions are more vulnerable to the impacts of disasters. - Gender: Women and girls often face higher risks due to social and cultural factors2. - Institutional Factors - Governance and Policies: Effective disaster management policies and strong governance can reduce vulnerability. - Community Preparedness: Communities with robust disaster preparedness plans and active participation in risk reduction activities are less vulnerable **Theories of Disasters** **There are several fundamental theories that explain the nature and causes of disasters:** **Acts of Fate/Acts of God: Historically, disasters were often seen as acts of fate or divine will, beyond human control. This perspective viewed disasters as predetermined events, sometimes interpreted as cosmic or divine retribution for human failings.** **Acts of Nature: With the advancement of scientific knowledge, many began to attribute disasters to natural causes. For example, floods were understood as the result of excessive rainfall exceeding the capacity of the soil and river basins1.** **Interactive Effects of Nature and Society: This theory posits that disasters result from the interaction between natural events and human systems. A disaster occurs when a hazardous natural event impacts a vulnerable human system1. For instance, an earthquake in a densely populated area with poor infrastructure can lead to significant destruction.** **Social Constructions: This perspective views disasters as social constructs, emphasizing the role of human perception and societal factors in defining and responding to disasters. It suggests that the impact of a disaster is shaped by social, economic, and political contexts** **DISASTER MANAGEMENT** **Introduction** Disaster management is more than just response and relief (i.e., it assumes a more proactive approach). It is a systematic process which is based on the key management principles of *planning*, *organizing,* and *leading, and* includes *coordinating* and *controlling*. It aims at reducing the negative impact or consequences of adverse events. Hence, although disasters cannot always be prevented, their adverse effects can be minimized. There is no country that is immune from disaster, though vulnerability to disaster varies. NB: Any disaster can interrupt essential services, such as the provision of health care, electricity, water, sewage/garbage removal, transportation and communications. The interruption can seriously affect the health, social and economic networks of local communities and countries. Disasters have a major and long-lasting impact on people, even long after the immediate effect has been mitigated. Disaster management covers prevention, preparedness, relief and recovery. **Disaster management** is defined as the organization and management of resources and responsibilities for dealing with all humanitarian aspects of emergencies. In particular, it deals with preparedness, response and recovery in order to lessen the impact of disasters. **Rationale for Disaster Management** Disaster management is crucial for several reasons: 1. **Saving Lives**: Effective disaster management can significantly reduce the loss of life by ensuring timely and efficient response and rescue operations. 2. **Reducing Economic Losses**: By preparing for disasters, communities can minimize the economic impact, including damage to infrastructure and loss of livelihoods. 3. **Enhancing Community Resilience**: Preparedness and mitigation strategies help communities recover more quickly and build resilience against future disasters. 4. **Promoting Health and Safety**: Disaster management includes measures to prevent disease outbreaks and ensure the health and safety of affected populations. 5. **Improving Coordination**: It ensures better coordination among various stakeholders, including government agencies, NGOs, and the community, leading to more effective disaster response. 6. **Building Back Better**: Post-disaster recovery efforts focus on rebuilding infrastructure and systems in a way that reduces future risks and vulnerabilities. These efforts are guided by international frameworks like the Sendai Framework for Disaster Risk Reduction, which emphasizes understanding disaster risk, strengthening governance, investing in resilience, and enhancing preparedness **Goals of Disaster Management** The ultimate purpose of disaster management is to save lives, preserve the environment and protect property and the economy. The main goal of disaster management is to:- a. reduce, or avoid the potential losses from hazards, b. assure prompt and appropriate assistance to victims of disaster, c. achieve rapid and effective recovery. Disaster management is thus made up of four individual risk-reduction functions namely mitigation (prevention), preparedness, response and recovery. Disaster management is a crucial vehicle for disaster risk reduction (DRR). These functions /aspects are better understood in the light of the disaster management cycle. **Theories of Disaster Management** Disaster management theories provide frameworks for understanding how to effectively prepare for, respond to, and recover from disasters. They include: - **Protection Motivation Theory (PMT**): This theory explains how people are motivated to protect themselves from harm. It suggests that individuals assess the severity of a threat, their vulnerability to it, the effectiveness of the protective action, and their ability to perform the action. This assessment influences their motivation to take protective measures. - **Person Relative to Event Theory (PrE**): This theory focuses on the relationship between individuals and the disaster event. It examines how personal characteristics (e.g., experience, knowledge) and event characteristics (e.g., magnitude, frequency) influence people's responses to disasters. - **Protective Action Decision Model (PADM)**: This model outlines the process by which people decide to take protective actions in response to a disaster. It includes stages such as receiving warnings, understanding the threat, believing the warning, and deciding on a course of action. - **Social-Cognitive Preparation Model**: This model emphasizes the role of social and cognitive factors in disaster preparedness. It looks at how social influences (e.g., family, community) and cognitive processes (e.g., risk perception, decision-making) affect preparedness behaviors. - **Theory of Planned Behavior (TPB):** This theory suggests that people's intentions to engage in a behavior (e.g., disaster preparedness) are influenced by their attitudes toward the behavior, subjective norms, and perceived behavioral control **Murphy's Law** Murphy's Law is a popular adage that states: "Anything that can go wrong will go wrong." This concept is often used humorously to explain the seemingly inevitable nature of mishaps and failures. The law is named after Edward A. Murphy Jr., an American aerospace engineer, and it gained widespread recognition in the late 1940s. **Corollaries to Murphy's Law** - If there is a worse time for something to go wrong, it will happen then. - If anything simply cannot go wrong, it will anyway. - If you perceive that there are four possible ways in which a procedure can go wrong, and circumvent these, then a fifth way, unprepared for, will promptly develop. - Left to themselves, things tend to go from bad to worse. - It is impossible to make anything foolproof because fools are so ingenious. - Whenever you set out to do something, something else must be done first. - Every solution breeds new problems. These corollaries expand on the original idea, emphasizing the unpredictability and complexity of real-world situations, especially disasters. They are often used in various fields, including engineering, project management, and everyday life, to highlight the importance of thorough planning and preparation. Murphy's Law is often applied in disaster management to emphasize the importance of thorough planning and preparation. Here's how it relates to disaster management: - **Anticipating Failures**: Murphy's Law encourages planners to anticipate potential failures and design systems that can handle unexpected problems. This means considering worst-case scenarios and ensuring that there are contingency plans in place. - **Redundancy and Resilience**: By acknowledging that things can and will go wrong, disaster management strategies often include redundant systems and resilient infrastructure. This ensures that if one part of the system fails, others can take over. - **Continuous Improvement**: Murphy's Law highlights the need for continuous improvement and learning from past mistakes. After a disaster, reviewing what went wrong and why can help improve future responses. - **Comprehensive Planning**: It underscores the importance of comprehensive planning that covers all possible angles, including those that might seem unlikely. This involves detailed risk assessments and scenario planning. - **Flexibility and Adaptability**: Disaster management plans must be flexible and adaptable, ready to change as new information becomes available or as situations evolve. By integrating the principles of Murphy's Law, disaster management can become more robust and effective, ultimately reducing the impact of disasters when they occur. **Disaster Management Cycle** The Disaster management cycle illustrates the ongoing process by which governments, businesses, and civil society plan for and reduce the impact of disasters, react during and immediately following a disaster, and take steps to recover after a disaster has occurred. The mitigation and preparedness phases occur as disaster management improvements are made in anticipation of a disaster event. Developmental considerations play a key role in contributing to the mitigation and preparation of a community to effectively confront a disaster. As a disaster occurs, disaster management actors, in particular humanitarian organizations become involved in the immediate response and long-term recovery phases. The four disaster management phases do not always, or even generally, occur in isolation or in this precise order. Often phases of the cycle overlap and the length of each phase greatly depends on the severity of the disaster. Disaster management is a cyclical process; the end of one phase is the beginning of another, although one phase of the cycle does not necessarily have to be completed in order for the next to take place. Often several phases take place concurrently. Timely decision making during each phase results in greater preparedness, better warnings, reduced vulnerability and/or the prevention of future disasters. The following are the main phases of the disaster management cycle:- The disaster management cycle is a comprehensive framework used to manage and mitigate the impacts of disasters. It consists of several key stages that help communities and organizations prepare for, respond to, and recover from disasters. Here are the main stages: **Prevention/Mitigation**: **Mitigation refers to the efforts put in place to either eliminate or reduce the impacts and risks of hazards, mainly through pro-active measures.** This stage involves identifying potential hazards and taking steps to reduce their impact. This can include building codes, land-use planning, and public education campaigns to minimize risks. **Mitigation falls into two main categories namely structural mitigation and non-structural mitigation. Structural mitigation involves use of engineering technologies, and includes building suitable structures, erecting speed bumps, installing lightening arresters, constructing gabions, reinforcing tornado safe rooms, burying electric cables, constructing dams, to name but a few. Non-structural mitigation on the other hand involves measures that are non-engineering, like hazard mapping, enforcing land-use and zoning practices, enforcing and implementing building codes, flood-plain mapping, public awareness and insurance, among others.** **Preparedness**: In this stage, plans and procedures are developed to ensure an effective response to disasters. This includes training, conducting drills, and establishing communication systems and emergency supplies. Though not all disasters, particularly natural disasters, can be prevented, the risk of loss of life and injury can be **mitigated** with good evacuation plans, environmental planning and design standards. These activities are designed to minimize loss of life and damage -- for example by removing people and property from a threatened location and by facilitating timely and effective rescue, relief and rehabilitation. Preparedness is the main way of reducing the impact of disasters. Community-based preparedness and management should be a high priority in physical practice management. **In order for mitigation measures to be effective, they are taken before an emergency or a disaster occurs. Mitigation helps to reduce loss of lives and property by lessening the impact of a disaster or preventing it altogether. It is noteworthy that disasters can happen at any place, any time. If people are not prepared, the consequences can be fatal. There is therefore need to understand the local risks a community is exposed to, address the hard choices, and invest in long-term community wellbeing. Without mitigation, people jeopardize their safety, security and self-reliance.** **Response:** This stage occurs immediately after a disaster strikes. It involves mobilizing emergency services and first responders to provide immediate assistance, such as search and rescue operations, medical care, and shelter for affected individuals. The response phase includes the mobilization of the necessary emergency services and first responders in the disaster area. This is likely to include a first wave of core emergency services, such as fire-fighters, police and ambulance crews. They may be supported by a number of secondary emergency services, such as specialist rescue teams. In addition volunteers and other non-governmental organizations (NGOs) such as the local Red Cross branch or St. John Ambulance may provide immediate practical assistance, from first aid provision to providing tea and coffee. A well-rehearsed emergency plan developed as part of the preparedness phase enables efficient coordination of rescue efforts. Emergency plan rehearsal is essential to achieve optimal output with limited resources. In the response phase, medical assets will be used in accordance with the appropriate triage of the affected victims. **Recovery**: The focus here is on restoring the affected area to its pre-disaster state. This can involve rebuilding infrastructure, providing financial assistance, and offering psychological support to help communities recover. The aim of the recovery phase is to restore the affected area to its previous state. It differs from the response phase in its focus; recovery efforts are concerned with issues and decisions that must be made after immediate needs are addressed. Recovery efforts are primarily concerned with actions that involve rebuilding destroyed property, re-employment, and the repair of other essential infrastructure. An important aspect of effective recovery efforts is taking advantage of a \'window of opportunity\' for the implementation of mitigative measures that might otherwise be unpopular. Citizens of the affected area are more likely to accept more mitigative changes when a recent disaster is in fresh memory.  The recovery phase starts when the immediate threat to human life has subsided. In the reconstruction it is recommended to reconsider the location or construction material of the property.   In long term disasters the most extreme home confinement scenarios like war, famine and severe epidemics last up to a year. In this situation the recovery will take place inside the home. **Reconstruction**: This stage involves long-term rebuilding and improving infrastructure and systems to better withstand future disasters. It often includes incorporating lessons learned from the disaster to enhance resilience. **DISASTER INTERVENTIONS** **Essential emergency relief measures include** 1. **Rapid assessment of the emergency situation and the affected population.** 2. **Provide adequate shelter and clothing.** Exposure to the climatic conditions in disaster situations can increase caloric requirements and lead to death. Community level: Find short-term shelters for all homeless individuals, particularly focusing on vulnerable populations. Shelters should be appropriate for the climate. Keep individuals within their communities and family networks as much as possible. In general, it is recommended to direct resources to rebuilding within the community, rather than building large camps or temporary settlements outside the disaster area. 3. **Provide adequate nutrition.** Large-scale bulk food requirements are typically calculated based on a minimum of 2,100 kcal/person/day. Community level: Communities must plan to distribute food equitably and include vulnerable groups. As global food resources improve, establish targeted supplemental and therapeutic feeding programs for malnourished individuals. 4\. **Provide elementary sanitation and clean water**. The estimated minimum requirement for drinking water is 3-5 L/person/day of clean water but 15-20 L are recommended for all needs including washing and cooking. Community level: Re-establish supplies of clean water and effective sanitation and waste disposal services as soon as possible. In an emergency, there should be at least one latrine per 20 individuals. As the situation stabilizes, each family of 5 should have one latrine. 5\. **Set up diarrhea control program.** An increase in diarrheal disease is a predictable outcome of disasters because of infrastructure and health care services disruption. Community level: Rapidly implement community-based education on appropriate household sanitation measures, diarrhea prevention, and household case management, particularly for young children with diarrhea. Health care centers should anticipate the needs for additional cases of dehydration, using appropriate low-cost strategies (ORS/ORT) and recognize possible cases of cholera and dysentery. 6\. **Immunize against measles and provide vitamin A supplements.** Measles has been a major source of mortality among crowded, displaced populations in which malnutrition is prevalent. Therefore, measles immunization is the only vaccine that is routinely considered for use as a preventive measure immediately following a disaster. Since vitamin A deficiency is common and contributes to measles related mortality, consider mass distribution of vitamin A for vulnerable populations. National level: National and international agencies work together to determine if measles immunization or vitamin A distribution is necessary following a particular event. If necessary for all or part of the deemed population, national authorities establish the central logistics (e.g., cold chain, personnel, materials) to manage a mass immunization/distribution campaign. Community level: Health officers must immediately assess the available cold chain as part of its health care assessment. Health care professionals must monitor for cases of measles and develop a plan for mass immunization and/or mass distribution of vitamin A to the vulnerable groups in their community. 7\. **Establish minimum reproductive health and HIV services and improve primary medical care.** Immediate casualties (rescue phase) of a sudden impact disaster are likely to include a limited number of trauma victims. In most disasters in fragile communities the larger number of disaster-related deaths (i.e., deaths above the baseline crude mortality rate) will be due to preventable causes of mortality in the weeks and months following the impact. These casualties can largely be prevented by community health education and access to appropriate primary care. This included emergency obstetric and neonatal care, prevention and management of sexually transmitted infections, management of the health effects of sexual violence, ensuring safe blood transfusion and universal precautions in health facilities. Initial efforts should be focused on identifying those who were on treatment before the onset of the disaster and to restart treatment for them. Community level: Health professionals should know the emergency transport and response systems in their community. Health care interventions during the rescue phase should include minimizing life losses caused by the direct impact of the event (e.g., trauma, drowning). After the rescue phase, health care resources should be focused on re-establishing and improving the access and quality of primary care, particularly for the most vulnerable groups. 8\. **Set up disease surveillance and health information systems.** Effective health information and disease surveillance systems are necessary to monitor effectiveness of health interventions and reassign priorities. National level: Health authorities will use available information to define initial priorities in the use of limited resources. They should develop specific surveillance guidelines for each disaster in order to track relevant disease/mortality trends. Community level: Every health care delivery setting should immediately implement a simple but effective health information collection system based on established WHO, PAHO, or governmental guidelines. Health care professionals should know how to share this information regularly with higher level health authorities. 9\. **Organize human resources**. The initial shock of an event can make it difficult for a disaster-affected population to effectively respond in a quick and organized fashion. Having a pre-defined emergency plan with clearly-identified leaders can help the local community to cope until more external resources arrive. Community level: Have an emergency plan and pre-defined community leaders for: - Conducting rescue operations - Conducting assessments (e.g., health services, transportation, food, sanitation/water systems) - Organization of food and water distribution, and the sanitary program - Health services management - Corpses and gravesite management - Identification of unaccompanied minors or other extremely vulnerable individuals (e.g., elderly or persons with a disability) and organization of a caregiver program. 10**. Coordinate activities**. National level: In a large-scale disaster there will be many national and international agencies attempting to assess, develop plans, and establish priorities for funding at national and regional levels. Most effective relief efforts have resulted from effective collaboration between many agencies, each bringing their own expertise and experience. However, all of these agencies will ultimately depend on quality assessments from the affected communities to make appropriate decisions and determine the ability of the communities to implement the plans and projects that will help diminish suffering and restore the baseline situation in the communities. Community level: Develop local emergency plans that link into regional and national plans and agencies. Understand the mechanisms for communication of information (e.g., assessments, surveillance data) during disasters. Build relationships with key individuals within and outside the community before a disaster occurs.