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A large-scale armed conflict between Hezbollah and Israel in July 2006 caused the evacuation of a large number of Swedish residents from Lebanon. This report describes the evacuation throughout its various stages. Swedish authorities were prepared for an event of this type from the experience of the 2004 Asian tsunami disaster. Lessons learned from the management and medical care during the evacuations are presented in this report.
Events due to natural and technological hazards result in damage to living beings and the natural and built environment. The high urban population density, level of development, and extent of poverty in many disaster-prone areas further exacerbate the cumulative impact of such catastrophes. Also, crises, including those created by earthquakes, hurricanes, landslides, and tsunamis, have underscored the inability of hospitals to provide uninterrupted, urgently needed health services and maintain structural integrity. In many instances, deaths of hospital occupants were the direct result of collapsing physical infrastructure. In response and recognition of the need for collaborative efforts to mitigate the damages and loss of function, international public health, humanitarian, and relief organizations such as the Pan-American Health Organization (WHO/PAHO), the International Strategy for Disaster Reduction (ISDR) of the United Nations, the World Bank, the Joint Commission International (JCI), and the World Association for Disaster and Emergency Medicine (WADEM) have sponsored a series of global forums intent on developing guidelines for designing, constructing, and evaluating “safe and resilient” hospitals. The underlying goals of these guidelines are to protect the lives of patients, staff, and other hospital occupants, and ensure that hospitals continue to function during and after a catastrophic event.
This keynote on lessons to be learned from the recent natural disasters in Asiawill complement and elaborate further on the points already made eloquently by the first two keynote speakers during this session: Dr. M. Gilbert on building local resilience and competencies, and the call from Prof. E. Rahardjo towards a more efficient, multi-national work on rescue and aid to disasters.
Both speakers stressed the importance of strengthening external aid rather than substituting the national- or community-level capacity. I share the concern of the Indonesian medical professionals feeling marginalized in their own country, as said by Prof. Rahardjo. I also agree with Dr. Gilbert on our duty to build on the remarkable resilience and abilities of local communities. It is feasible, as he clearly demonstrated in local projects.
Hurricane Katrina, a Category 3 hurricane, made landfall in August 2005. Approximately 1,500 deaths have been directly attributed to the hurricane, primarily in Louisiana and Mississippi. In New Orleans, Louisiana, most of the healthcare infrastructure was destroyed by flooding, and >200,000 residents became homeless. Many of these internally displaced persons received transitional housing in trailer parks (“villages”) under the auspices of the [US] Federal Emergency Management Agency (FEMA).
Problem:
The FEMA villages are isolated from residential communities, lack access to healthcare services, and have become unsafe environments. The trailers that house families have been found to be contaminated with formaldehyde.
Methods:
The Children's Health Fund, in partnership with the Mailman School of Public Health at Columbia University, began a program (“Operation Assist”) to provide health and mental health services within a medical home model. This program includes the Baton Rouge Children's Health Project (BRCHP), which consists of two mobile medical units (one medical and one mental health). Licensed professionals at the FEMA villages and other isolated communities provide care on these mobile units. Medical and psychiatric diagnoses from the BRCHP are summarized and case vignettes presented.
Results:
Immediately after the hurricane, prescription medications were difficult to obtain. Complaints of headache, nosebleeds, and stomachache were observed at an unusually frequent degree for young children, and were potentially attributable to formaldehyde exposure. Dermatological conditions included eczema, impetigo, methicillin-resistant staphylococcus aureus (MRSA) abscesses, and tinea corporis and capitis. These were especially difficult to treat because of unhygienic conditions in the trailers and ongoing formaldehyde exposure. Signs of pediatric under-nutrition included anemia, failure to thrive, and obesity. Utilization of initial mental health services was low due to pressing survival needs and concern about stigma. Once the mental health service became trusted in the community, frequent diagnoses for school-age children included disruptive behavior disorders and learning problems, with underlying depression, anxiety, and stress disorders. Mood and anxiety disorders and substance abuse were prevalent among the adolescents and adults, including parents.
Conclusions:
There is a critical and long-term need for medical and mental health services among affected populations following a disaster due to natural hazards. Most patients required both medical and mental health care, which underscores the value of co-locating these services.
Refugees from Kosovo arrived in several Canadian cities after humanitarian evacuations in 1999. Approximately 500 arrived in Hamilton, Canada. Volunteer sponsors from community organizations assisted the families with settlement, which included providing them access to healthcare services.
Hypothesis/Problem: It was anticipated that women, in particular, would have unmet health needs relating to trauma and a lack of healthcare access after experiencing forced migration.
Methods:
This study describes the results of a self-administered survey regarding women's health issues and experiences with health services after the arrival of refugees. It also describes the sponsor group's experience related to women's health care. The survey was administered to a random sample of 85 women refugees, and focus groups with 14 sponsors.Women self-completed questionnaires about their health, which included the Harvard Trauma Questionnaire for post-traumatic stress disorder (PTSD) and use of preventive health services. Sponsor groups participated in a focus group discussing healthcare needs and experiences of their assigned refugee families. Themes pertaining to women's issues were identified from the focus groups.
Results:
Preventive screening rates were low, only 1/19 (5.3%) women ≥50- years-old had ever received a mammogram; 34.1% (28/82) had ever received a Pap test); and PTSD was prevalent (25.9%, 22/85). Sponsor groups identified challenges relating to prenatal care needs, finding family physicians, language barriers to health care services, cultural influences of women's healthcare decision-making, mental health concerns, and difficulties accessing dental care, eye care, and prescriptions.
Conclusions:
Many women refugees from Kosovo had unmet health needs. Culturally appropriate population level screening campaigns and integration of language and interpretation services into the healthcare sector on a permanent basis are important policy actions to be adequately prepared for newcomers and women in displaced situations. These needs should be anticipated during the evacuation period by host countries to aid in planning the provision of health resources more efficiently for refugees and displaced people going to host countries.
In the aftermath of the magnitude 9 Sumatra-Andaman earthquake and Indian Ocean tsunami of 2004, a huge number of international responders launched rescue and relief missions in Aceh Province of Indonesia. Thousands of voluntary personnel came to help the wounded, assist with recovery, and rebuild damaged communities. As is often the case with disasters, the necessary disaster management manpower was not immediately athand. Consequently, rescue and relief missions did not coordinate with one another, and chaotic inefficiency prevailed.
Just a little over a year after the 2004 earthquake and tsunami, a second disaster occurred in Indonesia following a major earthquake that occurred in May 2006 on Indonesia's most populous island. The May 2006 earthquake killed 5,000 people in Yogyakarta Province, located in the central region of Java Island.
In the last few decades, we have witnessed global disasters that rendered national medical systems helpless. A few examples are the tsunami in southeast Asia, and earthquakes in Turkey, Pakistan, Indonesia, Iran, and India.
In the last 35 years, the disaster and humanitarian communities have evolved rapidly in two parallel cohorts. The disaster enterprise in the US and Latin America grew up in the 1970s in response to a series of major earthquakes, hurricanes, and forest fires, culminating with the nuclear disaster at Three Mile Island and the formation of the Federal Emergency Management Agency (FEMA) in 1979/80. The Disaster Program at the Pan-American Health Organization also took form in the 1980s.
The humanitarian enterprise can be traced to the Biafran War of 1968/69, where a range of international, non-governmental organizations (NGOs) converged to respond to support a population that was fleeing a civil war and famine. In the years since, drawn to refugees and internally displaced persons in war circumstances as varied as Angola, Afghanistan, and Bosnia, the humanitarian community has expanded in numbers, reach, and budget.
The main goal of this targeted agenda program (TAP) was the establishment of an international network that would be able to advise on how to improve education and training for chemical, biological, radiological, or nuclear (CBRN)) responders. By combining the members of the TAP group, the CBRN Task Force of the World Association for Disaster and Emergency Medicine (WADEM) and the European network of the Hesculaep Group, an enthusiastic and determined group has been established to achieve the defined goal. It was acknowledged that the bottlenecks for education and training for CBRN responders are mainly awareness and preparedness. For this reason, even basic education and training on CBRN is lacking. It was advised that the focus for the future should be on the development of internationally standardized protocols and standards. The face-to-face discussions of the TAP will be continued at future Hesculaep expert meetings. The intention is that during the 16WCDEM, the achievements of the established network will be presented.
The Targeted Agenda Program (TAP) has been introduced for the first time during the 15th World Congress on Disaster and Emergency Medicine (15WCDEM) in Amsterdam in 2007 to stimulate interaction between the participants before, during and after the congress. A TAP process consists of 11 steps, starting with defining a relevant issue and ending with the publication of a TAP report based on expert opinions. Seven TAP groups participated during the 15WCDEM. The TAP issues referred to: (1) the need for health impact assessment of disasters; (2) the golden standard for preparedness for a chemical, biological, radiological and nuclear disasters; (3) the role of acute psychosocial first aid; (4) the 10 most important issues for policy makers to minimize health effects of floods; (5) the search for a golden standard in the treatment of wounded combatants; (6) the preparedness of health organizations for consequences of extreme weather conditions; and (7) the health problems of high-vulnerability groups during disasters. This article describes the motivation and operational aspects of the TAP and advocates that this concept can play an important facilitating role in focus, networking and enhancement of knowledge in the field of disaster health.