Proceedings from the WHO Conference on the Health Aspects of the Tsunami Disaster in Asia
Phuket, Thailand, 4-6 May 2005
Neglected issues in the public health management of disasters
18. The initial health response to the Tsunami focused on the rescue of the living, treatment of casualties, and recovery of essential services. These critical tasks were undertaken by many partners with varying degrees of success that depended on the extent of the devastation and the practical difficulties of access and assistance delivery, availability of resources, competence of service providers, and cooperation between them and local and national counterparts.
19. Emergency rapid needs assessments should focus on basic health needs, as well as on health determinants such as access to food, water, sanitation and shelter. The uneven availability and distribution of food was exacerbated by the wide dispersion of displaced people in often remote locations. The risk of malnutrition, morbidity and mortality increases among vulnerable populations such as infants, under-fives, pregnant and lactating mothers, and the elderly.
20. Assistance efforts had to be sensitive to the psychological trauma of survivors, many of whom were also troubled by the uncertainty of not knowing the fate of their loved ones. The tsunami experience suggests that unregulated counselling and other psychosocial interventions were problematic in several locations. Mental health is often given inadequate recognition as an integral part of the health and wellbeing of individuals. However, the only interventions that should be provided are those that have been shown to be efficacious.
21. The most effective rescue and relief teams include community health workers who are able to provide social support and psychological first aid, and who do this in ways that reinforce innate strengths and coping mechanisms within communities. Every effort should be made to normalize the life of individuals, families, and communities as soon as possible, through strenuous efforts to ensure prompt access to livelihoods, schooling, and housing. Responsibility for psychological support to those who are distressed should not be restricted to medical practitioners, as only a minority is likely to need clinical mental health services. Clear guidelines for the use of psychotropic medication for disaster-affected populations should be developed by WHO.
Management of mass casualties
22. Reviews of the tsunami experience revealed that most countries were ill-prepared to handle large numbers of casualties. They lacked standardized triage systems and pre-established networks of hospitals for referrals and burden-sharing. Most of the immediate assistance given to the injured was provided by other, less-injured, survivors. This suggests that training of members of the public in first aid techniques could have a large-scale life-preserving benefit.
23. The management of casualties in future disasters could be strengthened through: keeping contingency plans up-to-date; testing and rehearsing them; establishing networks of critical health institutions; and training - at both professional and community levels. The special role of National Red Cross and Red Crescent Societies, supported by the International Red Cross and Red Crescent Movement, was commended during the conference. Reference was made to cooperative arrangements between the societies, national and local health authorities and WHO.
Forensic aspects of disaster fatalities management
24. Participants questioned whether excessive human resources were devoted to the handling of the dead while the survival and welfare needs of the living were not being met. They recognized that political and cultural factors were often key determinants of practices used to dispose of human remains, with decision makers often influenced by the myth that dead bodies generate disease. There are other reasons for not rushing to cremate or bury victims. The lack of an identified body impedes attempts by survivors to establish their rights over assets and property, to grieve over the loss of a loved one and to perform the rituals required at the time of death.
25. Participants heard of the many gaps in systems for managing mass fatalities in the Tsunami-affected countries. Recommendations for more effective action in future disasters include the development of more appropriate and affordable methodologies for dead victim identification. The choice of method is guided by four factors: the number of victims, the rate at which remains are being recovered, disposal practices (are remains being cremated?) and the existence of a list of persons who are thought to be missing (a manifest). Arrangements for the rapid procurement of body storage facilities at a time of need should be planned in advance. Participants asked WHO to convene a task force of forensic experts to promote the sharing of expertise, development of standards, and building of national capacity. This should include a review of existing guidelines in the management of dead bodies is important in order to incorporate cultural and social factors observed during the Tsunami experience.