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Policy Development in Disaster Preparedness and Management: Lessons Learned from the January 2001 Earthquake in Gujarat, India

Published online by Cambridge University Press:  28 June 2012

Rannveig Bremer
Rannveig Bremer*
Affiliation:
Joint Medical Services, Military Medical Training and Competence Center, Norway
*
Edvard Munchs vei69, 1063 Oslo Norway, E-mail: rfjar@mil.no
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Abstract

Introduction:

During the last decades, several humanitarian emergencies have occurred, with an increasing number of humanitarian organizations taking part in providing assistance. However, need assessments, medical intelligence, and coordination of the aid often are sparse, resulting in the provision of ineffective and expensive assistance. When an earthquake with the strength of 7.7 on the Richter scale struck the state of Gujarat, India, during the early morning on 26 January 2001, nearly 20,000 persons were killed, nearly 170,000 were injured, and 600,000 were rendered homeless. This study identifies how assigned indicators to measure the level of health care may improve disaster preparedness and management, thus, reducing human suffering.

Methods:

During a two-week mission in the disaster area, the disaster relief provided to the disaster-affected population of Gujarat was evaluated. Vulnerability due to climate, geography, culture, religion, gender, politics, and economy, as each affected the outcome, was studied. By assigning indicators to the eight ELEMENTS of the Primary Health Care System as advocated by the World Health Organization (WHO), the level of public health and healthcare services were estimated, an evaluation of the impact of the disaster was conducted, and possible methods for improving disaster management are suggested. Representatives of the major relief organizations involved were interviewed on their relief policies. Strategies to improve disaster relief, such as policy development in the different aspects of public health/primary health care, were sought.

Results:

Evaluation of the pre-event status of the affected society revealed a complex situation in a vulnerable society with substantial deficiencies in the existing health system that added to the severity of the disaster. Most of the civilian hospitals had collapsed, and army field hospitals provided medical care to most of the patients under primitive conditions using tents. When the foreign field hospitals arrived 5 to 7 days after the earthquake, most of the casualties requiring surgical intervention already had been operated on. Relief provided to the disaster victims had reduced quality for the following reasons: (1) proper public health indicators had not yet been developed; (2) efficient coordination was lacking; (3) insufficient, overestimated, or partly irrelevant relief was provided; (4) relief was delayed because of bureaucracy; and (5) policies on the delivery of disaster relief had not been developed.

Conclusion:

To optimize the effectiveness of limited resources, disaster preparedness and the provision of feasible and necessary aid is of utmost importance. An appropriate, rapid, crisis intervention could be achieved by continual surveillance of the world's situation by a Relief Coordination Center. A panel of experts could evaluate and coordinate the international disaster responses and make use of stored emergency material and emergency teams. A successful disaster response will depend on accurate and relevant medical intelligence and socio-geographical mapping in advance of, during, and after the event(s) causing the disaster. More effective and feasible equipment coordinated with the relief provided by the rest of the world is necessary. If policies and agreements are developed as part of disaster preparedness, on international, bilateral, and national levels, disaster relief may be more relevant, less chaotic, and easier to estimate, thus, bringing improved relief to the disaster victims.

Keywords

Aidhumanitariancoordinationdisaster managementdisaster preparednessdisaster reliefdisaster responsesearthquakeIndiaintelligenceneed assessmentpolicy developmentpreparednessprimary health carepublic healthrisk evaluation
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 18 , Issue 4 , December 2003 , pp. 372 - 384
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2003

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References

1. Noji, EK: The nature of disaster: General characteristics and public health effects. In: Noji, EK, (ed). The Public Health Consequences of Disasters. New York: Oxford University Press, 1997. pp 3–20.Google Scholar
2. Sundnes, KO, Adler, J, Birnbaum, ML, et al: Health disaster management: Guidelines for evaluation and research in the Utstein style. Executive summary. Prehosp Disast Med 1999;14:43–52.Google Scholar
3. Fjaer, RB: The use of military medical teams in disaster. Rev Arm Med Serv 1999;72:119–126.Google Scholar
4. Spiegel, PB, Burkle, FM, Chayan, CD, Salama, P: Developing public health indicators in complex emergency response. Prehosp Disast Med 2002;16: 281–285.Google Scholar
5. Paul, M: Erdbebeneinsatz in Ostanatolien. Wehrausbildung Beiheft 1989;1: pp 33–35.Google Scholar
6. Camerapix Publishers International: Spectrum Guide to India. Kenya 1998, pp 126–132.Google Scholar
7. Aschehoug, G: Great Norwegian Encyclopedia. Oslo Kunnskapsforlaget 1997; Vol 8: pp 223–237.Google Scholar
8. De Ville de Goyet, C, Zeballos, JL: Communicable diseases and epidemio-logical surveillance after sudden natural disasters. In: Baskett, P, Weller, R. (eds) Medicine for Disasters. London: Wright, 1988. pp 252–261.Google Scholar
9. Gunn, SWA: Earthquakes. In: Baskett, P, Weller, R. (eds) Medicine for Disasters. London: Butterworth & Co, 1988. pp 285–290.Google Scholar
10. Noji, EK: Disaster medicine training for earthquakes. Newsletter, Int Society of Disast Med 1991;45:1–4.Google Scholar
11. Fjær, RB: Primary health care in war and disaster and the NorAid System. Prehosp Disast Med 1997;12:183–188.Google Scholar
12. UN Children's Fund: The State of the World's Children 2000. Oxford: Oxford University Press, 1999.Google Scholar
13. Steering Committee for Humanitarian Response (SCHR): McConnan, I: The Sphere Project. Humanitarian Charter and Minimum Standards in Disaster Response. Oxford: Oxfam Publishing, Oxford 2000.Google Scholar
14. Instituto del Tercer Mundo: The World Guide and Alternative Reference to the Countries of our Planet. Oxford: New Internationalist Publications, 2001.Google Scholar
15. Morley, D, Rohde, J, Williams, G: The community health worker scheme: An Indian experiment. In: Practising Health for All. Oxford: Oxford Medical Pub 1987. pp 38–48.Google Scholar
16. Singh, M, Paul, VK: Maternal and child health services in India with special focus on perinatal services. J Perinatol 1997;17:65–69.Google Scholar
17. Khera, AK, Jain, DC, Datta, KK: Profile of epidemic emergencies in India during 1991–1995. J Commun Dis 1996;28:129–139.Google Scholar
18. World Health Organization: Forecasting communicable diseases. Weekly Epidemiological Record. Geneva: WHO. 2000; pp 80–83.Google Scholar
19. Toole, MJ, Steketee, RW, Waldman, RJ, Nieburg, P: Measles prevention and control in emergency settings. Bulletin WHO 1989;87:382–388.Google Scholar
20. Filteau, MF, Tomkins, AM: Promoting vitamin A status in low-income countries. Lancet 1999;353:1458–1459.Google Scholar
21. World Health Organization: Cholera vaccines. Weekly Epidemiological Record 2001;76:117–124.Google Scholar
22. World Health Organization: Mother-Baby Package: Implementing safe motherhood in countries. Maternal Health and Safe Motherhood Programme. Division of Family Health. Genève: WHO, 1996: p 25.Google Scholar
23. Fjær, RB: Primary health care in disasters: The NorAid system. Disasters 1995;19:264–268.CrossRefGoogle ScholarPubMed
24. United Nations High Commissioner for Refugees: Reproductive Health in Refugee Situations: An Inter-agency Field Manual. Geneva: UNHCR, 1999.Google Scholar
25. Chatterjee, P: One year after the Gujarat earthquake. Lancet 2002;359:327–329.CrossRefGoogle ScholarPubMed
26. Denny, FW, Loda, FA: Acute respiratory infection is the leading cause of death in children in developing countries. Am J Trop Med Hyg 1986;35:1–2.Google Scholar
27. World Health Organization: Integrated Management of Childhood Illness. Priorities for Research Support 1988–1999. Division of Child Health and Development: Geneva, 1997.Google Scholar
28. Bhardwaj, N, Hasan, SB: High perinatal and neonatal mortality in rural India. J R Soc Health 1993;113:60–63.CrossRefGoogle ScholarPubMed
29. World Health Organization: The Use of Essential Drugs. The Fourth Report of WHO Expert Committee. Genève. WHO, 1990: pp 1–57.Google Scholar
30. Horgeirzeil, HV, Ross-Degnan, BD, Laing, RO, et al: Field test for rational drug use in twelve developing countries. Lancet 1993;342:1408–1410.Google Scholar
31. Kanji, N, Hardom, A, Harnmeijer, JW, Mamdani, M, Walt, G: Formulation of an Essential Drug Policy. In: Drugs Policy in Developing Countries. London, Zed Books Ltd 1992; pp 24–47.Google Scholar
32. WHO, UNHCR, UNICEF, ICRC, IFRCS, MSF, CAHWCC, OXFAM: Guidelines for Drug Donations. Geneva: WHO. 1996.Google Scholar
33. Seal, A, Taylor, A, Gostelow, L, McGrath, M: Review of policies and guidelines on infant feeding in emergencies: Common ground and gaps. Disasters 2001;25:136–148.CrossRefGoogle ScholarPubMed
34. Fjær, RB: How can international disaster relief be improved? Tidsskr Nor Lægeforen 2000;120:601–606.Google Scholar
35. World Health Organization: Field Guide in Rapid Nutritional Assessment in Emergencies. Alexandria, Regional Office for the Eastern Mediteranian, 1995.Google Scholar
36. World Health Organization: Treatment of Tuberculosis. Guidelines for National Programmes. Genève: WHO, 1993.Google Scholar
37. Horton, R: Ghana: Defining the African Challenge. Lancet 2001;358: 2141–2149.Google Scholar
38. World Health Organization: Global plan to stop the spread of tuberculosis. Weekly Ep Rec 2001;76:335–336.Google Scholar
39. International Federation of Red Cross and Red Crescent Societies: Relief, Recovery and Root Causes in World Disaster Report. Geneva, 2001: pp 9–33.Google Scholar
40. WHO - Emergency and Humanitarian Action: Relief Supply Management System (SUMA). Available at http//www.who.int/disasters/repo/5487.html-76. Accessed 02 June 2004.Google Scholar