Transcript
MARGARET K. SEMAKULA
Objectives
At 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 - I
Emergency
Sudden, unexpected phenomenon
Causing loss of lives and harm to population Destruction of community property Damage to environment (Pierre Perrin 1996)
Definition - II
Disaster 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 - III
Disaster A 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
Risks Probability of harmful events to occur
Vulnerability Incapacity to absorb the effects of a given change (individual, community, national levels)
Condition of exposure to (hazards, risks)
Definition -V
Hazards A life threatening of potentially damaging phenomenon
Definition -VI
Definition 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 CE
Extensive 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 CE
Dispute 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 - I
Social
Human
(individual, family, community) and Institutional (lack-weak structure)
Economic
Individual Family,
Community, National and International
Vulnerability Types- II
Political
Authoritarian Bureaucracy Absence
political regime
of disaster contingency plan Weak legal system
Ecological
Geo-physical and social behaviour
Vulnerability Factors
Human factors
Socio-demographic Cultural Immunity
Resources
health and social services
human (trained personnel)
Environmental factors
Weather and climatic conditions
Socio-economic factors
political, 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 - II
Hierarchy
Primary
events-no human interventions events, consequence of primary
Secondary
events
Common Disasters In Uganda
A. Natural Disasters 1) Drought
2) Epidemics e.g. HIV/AIDs, malaria, Ebola 3) Floods 4) Landslides 5) Earthquakes
Common Disasters
B. Man made – Technological
1. 2. 3.
Conflicts - Forced displacements Transport accidents Environmental degradation and pollution
4.
5.
Fires
Structural collapse
Disasters Management Cycle
Includes Pre-disaster phase
Mitigation Preparedness
Disaster/Attack phase
Response
Post-disaster phase Recovery/rehabilitation
Disaster Management
Disaster risk management Includes
Mitigation
Preparedness
Response
Recovery
Disaster risk reduction (pre)
Disaster risk reduction Includes Mitigation Preparedness Advantages of disaster risk reduction More efficient More cost effective More humane
Mitigation
Structural activities e.g.
Floods - building barriers
Earthquakes - Hospital constructed/designed to
withstand
Droughts - Early warning systems
Warning or Alert Phase
Activities Disseminate information
Institute safety and preventive measures Review procedures and action plans
Ensure systems planned are in place
Supervise evacuation
Preparedness Phase
Behavioural Activities Surveillance system
Training Education Inventory of resources Collaboration with key response sectors Resource mobilisation Peace building
Objectives of Preparedness Includes
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 I
Interventions- Refugee Emergency Setting 1. Initial Assessment
2. Measles Immunisation 3. Water and Sanitation
4. Food and Nutrition
5. Shelter and Site Planning
Emergency Response Interventions - II
6. Health Care in Emergency Situations 7. Control of Communicable Diseases
8. Public Health Surveillance
9. Human Resource Training
10. Co ordination
Emergency Intervention 1. Initial Assessment
Health 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 Intervention 2. Measles Immunisation
Severe 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 Intervention 3. Water and Sanitation
Water Drinking water is top priority
During
first days 5 litres per person per day is required for physiological requirement 20 litre/person/day
Recommended Poor
and inadequate water is associated with diseases - water borne, water based, water washed, and water related diseases.
Emergency Intervention Water and Sanitation
Sanitation
1st
days emergency latrine 50-100 persons to 1 latrine for 20 persons
Improved
Ideally
1 per family
Emergency Intervention 4. 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 malnutrition
Protein
Energy malnutrition (PEM) spectrum i.e Kwashiorkor, Marasmus, Marasmic Kwashiorkor and Underweight).
Emergency Intervention
Food 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 Intervention 5. Shelter and Site Planning
Importance of shelter
Protection
Security Privacy
Recommended 3.5 sq metre per person
Appropriate shelter site
Secure location away from border Access to water
Emergency Intervention Shelter and Site Planning (ii)
Appropriate shelter site contd.
Availability of land
Location population socially and culturally
agreeable
Emergency Intervention 6. Health Care in Emergency
Aims 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 Intervention 7. Control of Communicable Diseases
Intervention Strategies
Attack 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 Intervention 8. Public Health Surveillance - i
Surveillance
Defined as continuos systematic collection,
analysis, interpretation of data and provision of feedback for the purpose of disease prevention and control
Emergency Intervention Public Health Surveillance - ii
Objectives
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 Intervention Public Health Surveillance - iii
Key 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 Intervention 9. Human Resource and Training
Objective 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 Intervention 10. Co-ordination - i
Rationale-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 Intervention Co-ordination - ii
Ensure 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 - Uganda
Level
National
Structure
Ministries (Health)
District
District Disaster Committee
Sub-county Disaster Committee
Sub-district
Structure and Functions - i
National Level
Policy Planning Co-ordination
Resource mobilisation
Technical support Hazards mapping Reporting Research
Structure and Functions - ii
Sub-National Level
Planning Implementation Training Co-ordination
Resource mobilisation
Reporting and communication