HEALTH SECTOR ASSESSMENTS IN EMERGENCIES

1. HEALTH SECTOR ASSESSMENTSIN EMERGENCIES 3rd ANNUAL REGIONAL TRAINING COURSE ON THE MANAGEMENT OF PUBLIC HEALTH RISKS IN DISASTERS FOR THE EASTERN MEDITERRANEAN MPHR 3 CAIRO, 20-31 May 2007

4. Damage Assessment and Needs Analysis (DANA) • A multi-sectoral, team activity that uses standard protocols to collect data that is analysed to define: • the main problems in relief • the causative factors of those problems • what needs to be done? • the extent of those problems • how much of which resources are needed? • the likely trends • for how long? • the constraints (climatic, geographic, political, social, logistical, organisational etc.) The information is used to: • set priorities and targets for the relief operation • allocate specific responsibilities to participating agencies

5. Which Information? • The population: • demography, culture, geography, climate • baseline causes of morbidity and mortality • The support systems: • coordination • communication • logistics • information flows • resource flows • The basic needs: • Shelter/clothing • Water/sanitation • Food/preparation • Energy/fuel • Security • Acute medical care • Personal hygiene • Waste management • etc.

6. Why assess damage? • Guides planning for repair, rebuilding and reconstruction • Guides the setting of relief priorities: • Function and safety issues –– can a service be delivered, is a building safe (building “triage”) • Evacuate or not ? • Can people access the service? • Repair or provide a temporary service? • Needs caused by damage: • Direct needs e.g. treat the injured – will the damages affect this? • Indirect needs – caused by damage e.g. loss of access to water supply

7. Questions and Answers Work in your groups to answer the following question (30 minutes): • What are the health needs in emergencies ? • Construct the following table.

8. Needs in an Emergency Vector Born Disease, Vaccine Preventable Disease, Diseases of Epidemic Potential, Diseases of Public Health Significance, Potentially Unstable Chronic Disease)

9. Categories of information • The assessment involves the collection of two key categories of information: • Analysis of the damage to: • critical resources • critical infrastructure and fixtures • critical services • Analysis of the needs of the victims • immediate needs arising from the situation • future needs arising from damage/disruption to services/infrastructure

10. Information on victims A report describing the impact of a hazard will provide the number of: • Number of casualties • killed; injured; sick; disabled; • by age, sex, location and probable cause of death • Number of affected • total; severe; critical;

11. Classification based on severity The following is used to describe the severity of the impact on people: • affected • all those living within the geographical area involved • severely affected • those who have lost one or more of their lifelines • critically affected • those who have lost all of their lifelines • OR who have been displaced i.e. those totally dependent on others to support them

12. Critical services – basic needs and lifelines • Basic needs are the minimum requirements needed for the survival of the affected population (also called “pre-requisites for health”): • water • food • shelter (and clothing in cold climates) • energy (fuel) • (acute medical care) • Lifelines are services that are needed to deliver the basic needs: • Utilities (water, electricity, gas) – sources and networks • Communications systems • Transport networks (air, sea, road) • Distribution systems • First priority of Government – restore lifelines and meet basic needs

13. Assessing facilities and services • For each facility or service in the affected area, the assessment classifies facilities according to function: • destroyed / no function possible • more than 50% reduction in capacity • less than 50% reduction in capacity • undamaged / full function

14. Public Health Consequences of Disasters • temporary population displacements • increased numbers of deaths and injuries • new cases of disease and disability • exacerbation of and increased numbers of cases of psychological and social behaviour disorders • food shortages and nutritional deficiencies • environmental disruption causing hazards – vectors, waste management, sanitation • destruction of infrastructure • disruption to routine health services • disruption to routine disease surveillance and control services • diversion of capital investment funds to emergency relief and the rehabilitation or reconstruction of essential infrastructure

15. Emergencies and Health HEALTH RESPONSE search and rescue first aid triage medical evacuation primary care disease surveillance and control curative care blood banks laboratories referral system special units (burns, spinal) evacuation centres shelter water food and nutrition energy security environmental health primary health care care of the dead psychosocial care disability care recovery reconstruction Community VULNERABILITIES CAPACITIES DIRECT IMPACTS DamageandNeeds EMERGENCY INDIRECT IMPACTS ASSOCIATED FACTORS Climate/weather/time of day Location Security situation Political environment Economic environment Socio-cultural environment Morale, solidarity, spirit Competence, corruption

18. Use the Coordination Mechanism • It is not necessary to go to the field to collect detailed information from other sectors • At the daily coordination meetings, reports and assessments from other sectors are shared – these can be sent as ANNEXES to health sector reports • The Emergency Reporting System should take over from assessments as soon as possible

19. Reference Values

20. Prepare tools to assist planning Public Health Predictors template.xls

21. Health Sector Assessments by Hazard Class • Natural Hazards • focus first on recording damage to health sector, then on the needs of the health facilities to restore some function, then on the meeting needs arising from actual and potential causes of morbidity and mortality • Technological Hazards • focus on capacity to meet the needs arising from the actual and potential causes of morbidity and mortality • Biological hazards • focus on capacity to meet the needs arising from the actual and potential causes of morbidity and mortality • Societal Hazards • In conflict - focus first on recording damage to health sector, then on the needs of the health facilities to restore some function, then on the meeting needs arising from actual and potential causes of morbidity and mortality • In other situations - focus on capacity to meet the needs arising from the actual and potential causes of morbidity and mortality

24. SUMMARY Emergency ? Document URGENT damages and needs Rapid Health Assessment Needs from loss of function due to damage Emergency Reporting system Needs of health sector to deliver emergency services + Needs of the affected population that affect their health Emergency Surveillance System Injury/disability Disease/vectors Mental health Nutritional status Water quality

25. Learning Objectives • By the end of this module, the participant should be able to: • Discuss the purpose of Damage Assessment and Needs Analysis (DANA) • Develop a model Rapid Health Assessment (Rapid Health Assessment) form/protocol for their country • Discuss the weaknesses and strengthens of DANA and Rapid Health Assessment processes, methods and technologies

26. HEALTH SECTOR ASSESSMENTSIN EMERGENCIESThank you