MARGARET K.

SEMAKULA

Objectives

At the end of the unit participants should be able to: Define concepts related to public health emergencies or disasters
Identify the aetiologies and describe the common disasters in

Uganda
Describe elements of disaster management cycle Describe the activities to be undertaken during the various phases

of an emergency/disaster
Discuss the activities undertaken at various levels of the emergency

response structure.

Definitions of Concepts - I
Emergency
Sudden, unexpected phenomenon
Causing loss of lives and harm to population Destruction of community property Damage to environment (Pierre Perrin 1996)

Definition - II
Disaster Defined as the confluence of risk and vulnerability (Wilches Chaux 1989)
Risks x Vulnerability = Disaster
Any disruption of the human ecology that exceed the

capacity of the community to function normally (Dick 1991)

Definition - III
Disaster A serious disruption of the functioning of a community or society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources (WHO 1998).

Definition -IV
Risks Probability of harmful events to occur
Vulnerability Incapacity to absorb the effects of a given change (individual, community, national levels)
Condition of exposure to (hazards, risks)

Definition -V
Hazards A life threatening of potentially damaging phenomenon

Definition -VI
Definition of Complex Emergency (CE) Deep social crisis in which large numbers of people die from war, displacement, hunger owing to man made disasters (Klugman 1999)
Humanitarian crisis where there is break down in authority due

to internal or external conflicts that requires international response (OCHA 1999)

Characteristics of CE
Extensive violence Massive displacement Wide spread damage to society-administrative, economic and political collapse Long lasting and widespread Exploitation of and exacerbation of existing differences (economic, social etc) within civil society.

Characteristics of CE
Dispute over legitimacy of authority (government or rebels). Vulnerable population at greatest risks.

Need for large scale multi-faceted humanitarian assistance. Hindrance of assistance by political or military forces.
Catastrophic public health emergencies

Vulnerability Types - I
Social
Human

(individual, family, community) and Institutional (lack-weak structure)

Economic
Individual Family,

Community, National and International

Vulnerability Types- II
Political
Authoritarian Bureaucracy Absence

political regime

of disaster contingency plan Weak legal system

Ecological

Geo-physical and social behaviour

Vulnerability Factors
Human factors
Socio-demographic Cultural Immunity

Resources
health and social services
human (trained personnel)

Environmental factors
Weather and climatic conditions

Socio-economic factors
political, economic situation

Causes and Classification of Disasters - I

Genesis-Aetiology

Natural e.g earthquakes, volcano, cyclones Man made/technological e.g wars, nuclear disaster, terrorism

Speed of Onset/Impact

Sudden onset e.g volcano eruption, earthquakes Slow onset e.g warfare, epidemics

Causes and Classification of Disasters - II

Hierarchy
Primary

events-no human interventions events, consequence of primary

Secondary

events

Common Disasters In Uganda

A. Natural Disasters 1) Drought
2) Epidemics e.g. HIV/AIDs, malaria, Ebola 3) Floods 4) Landslides 5) Earthquakes

Common Disasters
B. Man made Technological
1. 2. 3.

Conflicts - Forced displacements Transport accidents Environmental degradation and pollution

4.
5.

Fires
Structural collapse

Disasters Management Cycle

Includes Pre-disaster phase
Mitigation Preparedness

Disaster/Attack phase

Response

Post-disaster phase Recovery/rehabilitation

Disaster Management
Disaster risk management Includes
Mitigation

Preparedness

Response

Recovery

Disaster risk reduction (pre)

Disaster risk reduction Includes Mitigation Preparedness Advantages of disaster risk reduction More efficient More cost effective More humane

Mitigation
Structural activities e.g.
Floods - building barriers

Earthquakes - Hospital constructed/designed to

withstand
Droughts - Early warning systems

Warning or Alert Phase

Activities Disseminate information
Institute safety and preventive measures Review procedures and action plans

Ensure systems planned are in place

Supervise evacuation

Preparedness Phase
Behavioural Activities Surveillance system
Training Education Inventory of resources Collaboration with key response sectors Resource mobilisation Peace building

Objectives of Preparedness Includes

Prevention of morbidity and mortality
Provision of care for casualty

Ensure restoration of normal lives

Re-establish health services Protect staff Protect public health and medical assets

Disaster/Emergency Phase
Activities
Manage casualties Surveillance Collect and disseminate data

Environmental health (water and sanitation)

Emotional and psycho-social support

Recovery Phase
Activities
Undertake needs and damage assessment Rehabilitate individuals physically and psycho-socially. Rehabilitate health and social services

Emergency Response - Interventions (10 point priorities) in Refugee Settings I

Interventions- Refugee Emergency Setting 1. Initial Assessment
2. Measles Immunisation 3. Water and Sanitation

4. Food and Nutrition

5. Shelter and Site Planning

Emergency Response Interventions - II

6. Health Care in Emergency Situations 7. Control of Communicable Diseases

8. Public Health Surveillance

9. Human Resource Training

10. Co ordination

Emergency Intervention 1. Initial Assessment

Health priorities identified on the basis of rapid collection

and analysis of data.

Information collected on (e.g background of displacement,

risk factors, resources required).

Methods of data collection used - quantitative and

qualitative techniques ( e.g sample surveys, mapping, interviews, observation etc).

Emergency Intervention 2. Measles Immunisation

Severe health problem, kills 1 in 10 children in developing

countries.
Led to 40% child hood deaths Tuareg Camp Mauritania.

Factors associated with high prevalence of measles include

overcrowding, poor hygiene, low immunisation).

Immunisation to target children 6 months to 15 years.

Administered with Vit. A supplement.

Emergency Intervention 3. Water and Sanitation

Water Drinking water is top priority
During

first days 5 litres per person per day is required for physiological requirement 20 litre/person/day

Recommended Poor

and inadequate water is associated with diseases - water borne, water based, water washed, and water related diseases.

Emergency Intervention Water and Sanitation

Sanitation
1st

days emergency latrine 50-100 persons to 1 latrine for 20 persons

Improved

Ideally

1 per family

Emergency Intervention 4. Food and Nutrition - I

Population movement both a cause and consequence

of food shortage
Malnutrition is an important contributory cause of

death
Common types of malnutrition
Protein

Energy malnutrition (PEM) spectrum i.e Kwashiorkor, Marasmus, Marasmic Kwashiorkor and Underweight).

Emergency Intervention

Food and Nutrition - ii

Common types of malnutrition contd.
Micro-nutritient

deficiencies (Aneamia, Scurvy, Pellagra, Beriberi)

Food distribution

General Supplementary and Therapeutic

Recommended 2100kcal/person/day

Emergency Intervention 5. Shelter and Site Planning

Importance of shelter
Protection
Security Privacy

Recommended 3.5 sq metre per person

Appropriate shelter site

Secure location away from border Access to water

Emergency Intervention Shelter and Site Planning (ii)

Appropriate shelter site contd.
Availability of land
Location population socially and culturally

agreeable

Emergency Intervention 6. Health Care in Emergency

Aims to reduce excess mortality in the emergency phase of

displacement.
Curative, preventive care crucial. Manuals and guidelines need be available for standardization.

Tier system of health care (hospital, health centre, health post,

and outreach services).

Emergency Intervention 7. Control of Communicable Diseases

Intervention Strategies

Attack source of infection (e.g curative care,

isolation etc)
Prevent transmission (e.g environment

sanitation, personal hygiene etc)

Protect the susceptible (e.g immunisation,

chemoprophylaxis etc)

Emergency Intervention 8. Public Health Surveillance - i

Surveillance
Defined as continuos systematic collection,

analysis, interpretation of data and provision of feedback for the purpose of disease prevention and control

Emergency Intervention Public Health Surveillance - ii

Objectives

Provide early warning/detection of epidemics

Determine the main health problems and their

trends
Plan health interventions Evaluate the coverage and effectiveness of health

interventions/programmes

Emergency Intervention Public Health Surveillance - iii

Key Principles of Surveillance During emergency limit data collection to diseases of public health importance (i.e preventable, high morbidity, mortality etc).
Keep surveillance system simple.
Keep frequency of data transmission and analysis regular e.g

weekly/monthly.
Data analysis be at field level

Emergency Intervention 9. Human Resource and Training

Objective is to provide human resources capable of

performing tasks in emergency programmes and organise services efficiently.

Determine training needs Train personnel (on job, refresher course) Co ordinate personnel activities

Emergency Intervention 10. Co-ordination - i

Rationale-Many actors e.g UN agencies NGOs,

Hosts etc involved in service provision.

Goal is to achieve greatest impact through

management and integration of activities.

Establish clear leadership.

Create co-ordinating bodies (e.g UNHCR for

refugees)
Secondary

events, consequence of primary events

Emergency Intervention Co-ordination - ii

Ensure priorities are shared Rationalise services by establishing common

standards Many actors e.g UN agencies NGOs, Hosts.

Ensure communication occurs amongst

stakeholders

Structure for Emergency Response - Uganda

Level
National

Structure
Ministries (Health)

District

District Disaster Committee

Sub-county Disaster Committee

Sub-district

Structure and Functions - i

National Level
Policy Planning Co-ordination

Resource mobilisation
Technical support Hazards mapping Reporting Research

Structure and Functions - ii

Sub-National Level
Planning Implementation Training Co-ordination

Resource mobilisation
Reporting and communication