Humanitarian Health Action

Proceedings from the WHO Conference on the Health Aspects of the Tsunami Disaster in Asia

Phuket, Thailand, 4-6 May 2005

Developing national capacity for disaster preparedness, risk management and vulnerability reduction

5. The conference reiterated the centrality of disaster reduction to national strategies for achieving the Millennium Development Goals.

6. Participants endorsed the need for nations to be better prepared for major disasters: this would include stronger capacity to address health issues both in disaster risk management and in vulnerability reduction. It is anticipated that several governments will commit to such enhancements at the forthcoming World Health Assembly in May 2005, as a key part of their national development strategies. Levels of financial commitment to disaster response are increasing; however, such funding should also be available to support the building of national capacity for disaster preparedness and vulnerability reduction.

7. The findings from Tsunami relief experience at the local and national levels indicated that:

  • Communities that had faced past disasters and developed coping mechanisms were more resilient and responded better to the Tsunami than those which had not;
  • Community bodies and national agencies that had established emergency and disaster response plans, and had undergone regular practice drills, reacted to the Tsunami with greater promptness, and worked in a better-coordinated manner;
  • National and international health agencies with previous experience in emergencies had pre-defined procedures and systems, and had determined that they were more prepared to respond to the disaster;
  • Pre-existing governmental capacities were important in determining the intensity with which the health sector could respond, and speeded up the restoration of service provision;
  • The prompt deployment of military logistic capabilities hastened and facilitated assistance delivery, especially in hard-to-reach areas, thereby enhancing people's chances of survival.

8. Reviews also exposed limitations in the response and recovery phases:

  • Millions of people in South Asia still live in hazard-prone areas without adequate infrastructure to reduce vulnerability;
  • There was a lack of systems for early warning, alert, response and evacuation in the health sector
  • Mechanisms for managing the logistics aspect of the response including customs, warehousing and contingency plans for distributing supplies and drugs were largely absent, obsolete, or under-resourced;
  • Key health facilities were destroyed - though damage was inevitable (given the overwhelming force of the Tsunami), some buildings could have survived if constructed to more robust standards drawn up based on local hazard analysis;
  • The speed of the health response was uneven and existing services were overburdened with a sudden influx of injured; and
  • Unnecessary anxiety over the disposal of dead bodies distracted healthcare staff who could have been better deployed to attend to the living.

9. The participants concluded that a prepared health sector and strong physical infrastructure had the potential to mitigate the impact of disasters, and provide the platform for a rapid, effective response. This emphasized the importance of preparedness and response capacity at community and local level. The health sector is expected to educate the public on the means to assess health risks; how to prepare for and cope with disaster, and on the myths - and truths - about the health consequences of disasters. A prepared health sector can mitigate the impact of disasters by reducing avoidable deaths, injuries and illnesses; anticipating population displacements; establishing disease surveillance systems; managing and preventing psychological and psychosocial problems; planning for food shortages and nutritional deficiencies; monitoring for diseases due to environmental health hazards; preventing damage to health facilities and other infrastructure; and anticipating and minimizing disruption to routine health services.

10. The conference participants recalled that models for cost-effective disaster preparedness exist worldwide, ranging from the epidemiology field-training programme in Thailand to the regional and national preparedness programmes in the Americas supported by WHO/PAHO. They aim to reduce the risk of damage and assure resilience of health facilities to commonly prevailing hazards. Thus, the intention is to maintain priority hospital services, manage mass casualties, rapidly evacuate the injured, and establish disease surveillance and control measures. These require competently–led health workers with skills that are kept up-to-date through training and practice. Partnership between different organizations providing specialized capacities can be useful.

11. Advance planning is vital to ensure that affected populations and individuals are prioritized to receive access to essential health care. This includes addressing specific needs of women and children, older people, those with psychological trauma, disability, chronic illnesses, as well as vulnerable displaced persons.

12. Governments adopted the Hyogo Framework for Action for Disaster Risk Reduction at the conference held in Kobe, Japan in January 2005. This includes strong expectations that governments and United Nations will work in partnership with each other, and with NGOs and the private sector to develop cross-sectoral disaster preparedness capacity through financial and technical backing.