Centre for Trauma, Conflict & Catastrophe Jim Ryan

1. Centre for Trauma, Conflict & CatastropheJim Ryan

2. IV ciclo de conferencias“Los jueves de la Ciencia” Medicine & Disasters

3. DEFINITIONSRutherford - Belfast • Accident • Major Accident • Major Incident • Multiple & Mass casualty Incidents (MCIs) • Disaster • Catastrophes • Conflict • War • Rebellion • Terrorism

4. What then is a disaster ? 1 “ A DISRUPTION OF THE HUMAN ECOLOGY, WHICH THE AFFECTED POPULATION CANNOT OVERCOME WITHIN ITS OWN RESOURCES”ERAN DOLEV – ISRAEL, 1989

5. “ A disaster is the result of a vast ecological breakdown in the relation between humans and their environment, a serious and sudden event (or slow, as in drought) on such a scale that the stricken community needs extraordinary efforts to cope with it, often with outside help or international aid”Nojij EK, Editor.The publichealth consequences of disaster. New York: OUP, 1997 What then is a disaster ? 2

6. Natural Geophysical Earthquakes Volcanoes Weather related Hurricanes Tornadoes Floods Drought Man-made War Terrorism Transport Technological Air pollution Chemical releases Fires Nuclear incidents Types of disasters

7. Apologies from Holland

9. Curriculum DMCC

12. Some Important Facts About Disasters 1 • Some 2 billion people are at risk or exposed to disasters • 20 million people live under crisis conditions (e.g. Haiti, Pakistan, Central Africa) • 3 million deaths in the last 20 years • World bank estimates of losses in the region of £23 billion • 17 of 23 cities with populations >10 million live in disaster prone zones (e.g. Mexico City) • Disasters have dimensions beyond trauma/numbers killed (2010 floods in Pakistan)

13. Some Important Facts About Disasters 2 • Outcome not purely related to population at risk • High level societies (e.g. USA) take preventive measures & reduce effects • But – 95% of natural disasters occur in the unprepared developing world • The result is homelessness, health problems, malnutrition and involuntary migration • Further results are economic setbacks, debt, high inflation and unemployment • The perfect environment for disillusionment, anger and the growth of conflict, criminality & terrorism

14. Who is there to help?The International Community

15. The international community Intergovernmental organisations (IGOs) UN, EU, NATO Governmental organisations (GOs) USAID, DFID Non-governmental organisations (NGOs) Red Cross, MSF, Oxfam Military Miscellaneous

16. The Role of the Military?A Player, a Facilitator, a Menace or the cause of the Problem

17. The NGOs

18. The United Nations

19. The UN System in Humanitarian Emergencies • UN is the recognised leader in humanitarian disaster response • Co-ordination is led by OCHA (office for the co-ordination of humanitarian affairs • The Emergency Relief Co-ordinator (ERC) • The Inter Agency Standing Committee 1992 (IASC) • IASC is the primary mechanism for interagency co-operation

20. Two key UN agencies to know about • OCHA – office for the co-ordination of humanitarian affairs • UNDAC – United Nations disaster assessment and co-ordination

21. UNDAC is responsible for the provision of 1st hand information on the disaster situation and the priority needs to the international community through OCHA

22. Planning an effective response • Pre-planning - UNDAC (Initial assessment & co-ordination) • Initial deployment – immediate threats • Logistic, Engineering, Medical & Surgical support as appropriate • Good intelligence • Know the disaster – UN OCHA

23. Patterns of injury can be predicted from the nature of the disaster Epidemiology data base from OCHA

24. Initial (Rapid needs) assessment - • Before any main body deploys • With consent & by invitation • Self sufficient in every respect • Clear aims & time frame • Determine immediate needs • Start at the top • UNDAC +/- Other agencies – e.g. an NGO

25. Assessment Team + equipment (+own needs)

26. Team at the Ministry of Health - Colombo

27. Get out onto the ground and talk to those who know

28. Immediate goals of the humanitarian response – If you can get there quickly • Support the local effort • Increase local capacity • Add resilience • Carefully assistance with equipment (Light)

29. Damaged hospital –Pakistan Earthquake

30. Donation & teaching

31. Oftentimes the quickest & most appropriate response comes from within the affected countryPakistan – Provision of an ITU from Karachi & Lahore

32. Mounting a clinical response • Immediate trauma care for the injured • Correct mix of people & skills • Know where you will work • Water, food, sanitation & shelter • Security • Exit plan

33. Natural Disasters • Medical & Surgical assets not in-situ • The nature of response related to time • Immediate goals (days) • Longer term goals (weeks to months) • International Surgical teams have a role in the aftermath!

34. Longer term goals • Shift to reconstructive surgery • Rehabilitation • Specialists & equipment • Training • Long term needs assessment

35. Pitfalls - Failed Hospitals

37. Pitfalls – appropriate care

38. Responding in disasters & conflict Do not bite off more than you can chew! Do not raise expectations Consider long term sustainability Care with promises

39. Responding in disasters & conflict Do your work in a spirit of humility Avoid ostentation & boastfulness No promises Avoid politics Aim to leave something useful behind Follow-up, but be careful

40. Responding to disasters & conflict Teach, then teach some more, then teach again Do not create a culture of dependency, you have to leave sometime

41. Summary - Principles – best practice • Invited • Consent • Data acquisition • Emphasis on locally identified needs • Recovery & long term development • Sustainable • Academic reporting • Clear aims, objectives & end point

42. Summary – Principles – best practice • Rapid needs assessment • The right people & right training • Modest aims • Exit strategy • Leave something behind • Stay safe!

43. Thank You

44. QUESTIONS

45. Additional Resources • Reis ND, Dolev E (Eds). Manual of Disaster medicine, Civilian & Military. Berlin:Springer-Verlag, 1989 • Medecins Sans Frontieres. Refugee Health – an approach to emergency situations’ London:Macmillan, 1997 • Sphere Project. www.sphereproject.org • http://karimganj.nic.in/Disaster.htm • http://wikipedia.org.wiki/Disaster • http://Google.co.uk & Search “What is a disaster?