Rapid Assessment of Health Needs in Mass Emergencies REVIEW PDF

- 171- RAPID ASSESSMENT OF HEALTH NEEDS IN MASS EMERGENCIES: REVIEW OF CURRENT CONCEPTS AND METHODS Debarati Guha-Sapir Disasters requiring international action are occu...

- 171- RAPID ASSESSMENT OF HEALTH NEEDS IN MASS EMERGENCIES: REVIEW OF CURRENT CONCEPTS AND METHODS Debarati Guha-Sapir Disasters requiring international action are occurring necessary for planning rapid response and with increasing frequency and expenditures on em- serving as early warning signals, has been identified ergency relief are absorbing significant proportions as a key element in the improvement of health of development aid. Although no accurate records management in disasters (2). are maintained on emergency relief, incomplete re- ports from national and international agencies es- timate relief disbursements at over US$ 1 000 million Differential impact of natural disasters and each year. The Sahelian famines of the early 1970s, the relevance of an epidemiological approach the earthquakes in Tangshan (China) (1976). Mexico (1985) as well as the Armero volcanic eruption dem- The impact of disasters on populations varies accord- onstrated the need for a professional approach to ing to the type of disaster, but specific population mass emergency responses and the importance of subgroups also differ in their vulnerability to disaster preparedness in developing countries. In addition, impact. A greater increase in the lethality impact of there has been a significant increase in mortality in some disasters has been observed. For example nearly all types of disasters between the periods earthquakes have shown the greatest increase in 1960-1969 and 1970-1979. The mortality rate in- mortality in the last two decades. When aggre- creased from 750 per event in the previous decade gated over countries, mortality and morbidity from to 4 871. (Table 1). This increase is probably largely disasters seem to be significantly higher for coun- due to rampant urbanization, environmental degrad- tries with a low GNP than for more affluent countries, ation and population pressures on land (1). Finally, even when controlled for population density the long-term consequences of acute nutritional (Table 2). stress resulting from famines or harvest loss in floods and cyclones, waterborne diseases and dis- Table 3 presents data from two different earth- ability are rarely assessed and addressed by emer- quakes, one in Managua (Nicaragua) and the other gency programmes. in San Fernando Valley, California. The earthquake in California resulted in 60 deaths, while the smaller As a result of current inefficiencies in the approach to quake in Managua left over 5 000 dead. Although health management in disasters, the ever-increasing many other factors besides seismic intensity and expenditures have not had any visible results in socioeconomic factors influence the number of attenuating or preventing the ravages of nat- fatalities and injuries from an earthquake, this table ural disasters in the developing world. The handling gives some indication of the significant influence of of relief as purely charitable exercises, providing socioeconomic conditions on the mortality and whatever aid is readily available regardless of needs, morbidity resulting from earthquakes. has characterized emergency aid. Health response in emergencies has been typically ad hoc action that is The risk of diaster-related mortality and morbidity is generally inappropriate and usually late. Today, field also determined by demographic characteristics. agencies, donors and national governments rec- Figs 1 & 2 present data from selected disasters ognize the need for rationalizing the response to where the vulnerability of older children to mortality emergencies so that the needs are assessed correctly was substantially higher than other age groups. De and on time (2). The importance of preparedness, Bruycker et al. (4) in their study of the earthquake in especially regarding the availability of information Campania (Italy) also observed that children between 5 and 9 years were at higher risk of injury and death 'Deputy Director, Disaster Epidemiology Research Centre, School of than smaller children. This could be explained by the Public Health, Louvain Catholic University, Brussels, Belgium. fact that parents take care of small children in crisis TABLE 1. CHANGES IN DISASTER MORTALITY BETWEEN THE PERIODS 1960-1969 AND 1970-1979 TABLEAU 1. EVOLUTION DE LA MORTALITE PAR CATASTROPHE ENTRE LES PERIODES 1960-1969 ET 1970-1979 Mortality per 1 000 exposed Importance of change Deaths/event - Deces/evenement Mortalite pour 1 000 personnes exposees Importance Disaster- Catastrophe 1960-1969 1970-1979 1960-1969 1970-1979 du changement a Famineb.................................... 202 2 311 0.5 9.5 ++++ Flood- lnondation..................... 158 213 4.5 3.0 Cyclone...................................... 88 2 291 43.0 122.7 ++ Earthquake- Tremblement de terre................................... 750 4 871 262.5 324.7 + ' Key:- decrease;+ 1-2 fold increase;++ 2-5 fold increase;+++ 5-10 fold increase;++++ 10 fold-increase.- Legende:- diminution; +augmentation de 1-2 lois;++ augmentation de 2-5 lois;+++ augmentation de 5-10 lois;++++ augmentation de 10 lois. b Figures indicate only those deaths directly attributable to the famine- Les chiffres n'indiquent que les deces directement attribuables a Ia famine. Adapted from: Office of Foreign Disaster Assistance, USAID annual reports, various years- Adapte de: Office of Foreign Disaster Assistance, rapports annuels de I'AID des Etats-Unis d'Amerique, diverses annees. Wid hlth statist. quart., 44 (19911  - 172- TABLE 2. DISASTER MORTALITY BY LEVEL OF ECONOMIC DEVELOPMENT TABLEAU 2. MORTALITE PAR CATASTROPHE EN FONCTION DU NIVEAU DE DEVELOPPEMENT ECONOMIQUE Mortality - Mortalite Economy - Economie Low income- Faible revenu Middle mcome- Revenu moyen High income- Revenu E!leve Per event - Par evenement 3 300 500 125 Per 1 000 population - Pour 1 000 habitants 69 28 19 Per 1 000 km' - Pour 1 000 km' 48 8 1 Source: Adapted from reference (1) -Ada pte de Ia reference (1 ). TABLE 3. COMPARISON OF CHARACTERISTICS OF EARTHQUAKES IN MANAGUA (1972) AND SAN FERNANDO VALLEY, CALIFORNIA (1971) TABLEAU 3. COMPARAISON DES CARACTERISTIQUES DES TREMBLEMENTS DE TERRE SURVENUS A MANAGUA (1972) ET DANS LA VALLEE DE SAN FERNANDO, CALIFORNIE (1971) San Fernando Valley Disaster characteristics- Caracteristiques de Ia catastrophe Managua Vallee de San Fernando Richter scale readinga- Degre de magnitude sur l'echelle de Richter a 5.6 6.6 Extent of destruction (Mercalli Intensity Range VI-VII)- 100 km' 1 500 km' Etendue des destructions (VI-VII sur l'echelle d'intensite de Mercalli) Population in affected area- Population des zones touchees 420 000 7 000 000 Dead- Morts 5 000 60 Injured- Blesses 20 000 2 540 " The Richter scale for expressing the intensity of an earthquake ranges from 0 to 8 - L'echelle de Richter, qui exprime Ia magnitude d'un tremblement de terre, va de 0 a 8. Source: Reference (B) - Reference (B). FIG.1 AGE-SPECIFIC MORTALITY, SUMPANGO EARTHQUAKE, GUATEMALA, 1976 MORTALITE PAR AGE, TREMBLEMENT DE TERRE DE SUMPANGO, GUATEMALA, 1976 7 Population 10 850 6- Reported deaths - Deces signales 377 r-- - 5- ~ Cii t 0 E -;!!_ 4-...- r--- 0 -~ I 1---- - - - -- -- - -,.....:._- - - - - -.-=-- - -- - - - 3,5% Cii t 3- 0.---- E -;!!_ 0 2- - r-- 0 I I I I I I I 60 Age group (years)- Groupe d'age (annees) conditions while they expect the older children to Studies on risk for disaster-related mortality and take care of themselves. Guha-Sapir et al. (5) noted morbidity have identified factors linked to population similar vulnerability patterns in a survey of affected density (3), structural quality (6), time of strike (4) and communities in Chad during the 1985 famine. Mor- intensity of seismic activity (7). However, the risk of tality was higher among children >2. They concluded mortality and morbidity in disasters is clearly not that infants were protected against the decrease in only a function of physical characteristics of the event food intake by being breastfed while older children but is also determined by the prevailing socioeco- were mistakenly expected to be able to secure their nomic and health conditions of the affected com- own food. The study also noted the increased vul- munity (8). The differential health impact of disasters nerability to famine of specific occupational groups on a community indicates that the potential for ef- within the community. ficient and accurate rapid assessment techniques can Rapp. trim est. statist. san it. mond., 44 ( 1991)  - 173- FIG. 2 AGE-SPECIFIC MORTALITY DURING TWO EARTHQUAKES (NICARAGUA 1972 AND GUATEMALA 1976) TAUX DE MORTALITE PAR AGE LORS DE DEUX TREMBLEMENTS DE TERRE (NICARAGUA 1972 ET GUATEMALA 1976) 12 Town/Ville Number of deaths Nombre de d