Health Management after

Natural Disasters
REHABILITATION/RECOVERY
OF DISASTER VICTIMS

Dr. M.M. Prabhakar,

Medical Superintendent
Director, paraplegia hospital,
Ahmedabad.
 Definition-Disaster
A serious disruption of the
functioning of a community or a
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.
One of the most widely held myths
regarding earthquakes, hurricanes,
floods, and other natural disasters is
that they are "great equalizers."
They bring to mind the wrath and
power of an untamed nature that
hits men and women, young and old,
rich and poor alike.
In fact, natural disasters are not
great equalizers. There is sufficient
evidence by now to demonstrate that
they affect populations selectively:
the poor are the most vulnerable,
the least prepared, the hardest hit.
Natural Disasters
Human-caused Disasters
•Accidental
•Malicious
 Disaster classification
Natural disasters
– Meteorological disasters – storms (hurricanes,
tornados, twisters, cyclones), cold spells, heat
waves and droughts.
– Typological disasters – avalanches, landslides,
and floods.
– Telluric and Teutonic disasters – earthquakes,
volcanic eruptions.
– Biological disasters – insect swarms, and
epidemic of communicable diseases.
The Four Phases of “Emergency
Preparedness & Response”

Preparednes
Prevention

Response

Recovery
s

Municipal & F/P/T

Capacities
Pre-event Post-event
EVENT
Mid-term Review of IDNDR held at
Yokohama in May 1994.
Those affected most are the poor and the
socially disadvantaged in developing countries
as they are the least equipped to cope with the
situation.
Disaster Prevention, mitigation and
preparedness are better than disaster response.
Disaster response alone yields temporary relief
at a very high cost.
Prevention contributes to lasting improvement
in safety.
With its vast territory, large population
and unique geoclimatic conditions,
Indian sub-continent is exposed to
natural catastrophes traditionally.
Even today the natural hazards like
floods, cyclones, droughts and
earthquakes are not rare or unusual
phenomenon in the country. While the
vulnerability varies from region to
region, a large part of the country is
exposed to such natural hazards
which often turn into disasters causing
significant disruption of socio-
economic life of communities leading
to loss of life and property
Hazard Vulnerability in India
Indian Subcontinent: among the world’s most
disaster prone areas
54% of land vulnerable to Earthquakes
8% of land vulnerable to Cyclones
5% of land vulnerable to Floods
> 1 million houses damaged annually +
human, social, other losses
 Earthquake in Kutch
16th June, 1819. 1st noted earthquake in
Kutch.
26th January (Republican Day), 2001.
“most devastating earthquake in
the last 180 years in India”
6.9 Richter scale.
Epicenter located about 20 kms. From
Bhuj in north-east direction.
 Earthquake 2001
About 1.59 crores occupants in the
affected area
About 13,811 died (12,221 in Kutch only)
About 1.66 lac people injured
3.55 lac houses collapsed totally
8.68 lac houses damaged
A Paradigm shift from Post-
disaster reconstruction & relief
to Pre-disaster Pro-active
approach.
concept of "Self-help rather
than welfare dependence,"
The goal of appropriate disaster
response is to support the positive
qualities of the affected community
while working as an agent of positive
change in regard to its disaster-
prone elements.
Agencies responding appropriately to
a disaster often create a second, or
aftershock, disaster within the
community. An intervener's
humanitarian aid after a disaster
can, in fact, be harmful to the
beneficiary.
The intervener refers to any agency
from outside the disaster
community's own resources to
respond to the disaster.
 Effects of Intervention on Coping
Mechanisms
Interveners frequently have no
understanding of the resources existing
within a community that can cope with
disasters.
Nor do they have an understanding of the
role these coping mechanisms play within
a community.
lack of familiarity with the social and
anthropological background of the country
and their desire to respond to short-term
needs which overshadow the long-term
implications of their actions.
Therefore any intervener must learn
to identify the coping mechanisms
that exist in the society and how
they relate to outside help.
The intervener must learn to work
with these built- in disaster response
systems and to encourage a
collective response.
 The objectives of India’s National
Policy for natural disaster reduction
is to reduce

loss of lives
property damage
economic disruption
Post-disaster reconstruction and
rehabilitation is a complex issue with
several dimensions.
Government, nongovernmental and
international organizations have their own
stakes in disaster recovery programs, and
links must be established among them, as
well as with the community.
In other words, post-disaster rehabilitation
and recovery programs should be seen as
opportunities to work with communities
and serve local needs.
The standard time frames for rescue,
relief and rehabilitation are defined as
seven days, three months and
five years respectively.
The rehabilitation/reconstruction
phase typically starts at the end of the
relief phase and may last for several
years.
 The short-term plans for the
recovery process are clearance of
debris, building housing units, and
restoration of lifelines and
infrastructure, while the long-term
objective is to build a safer and
sustainable livelihood.
 Process of Reconstruction and
Rehabilitation had three major stages

I: Principles and Planning

II: Implementation and
III: Ensuring Sustainability.
 Principles and Planning

The first task was setting up the

basic principles for planning the
rehabilitation intervention.
The intervention had to be
participatory, with a gradual increase
in the involvement of the
community.
The Project Team would not,and should
not, remain with the community forever.
In such a case, the community who were
the first responders should be sufficiently
equipped to cater to their immediate
needs.
A well-planned rehabilitation exercise could
significantly increase the capacity of the
community for a more effective response.
 Stage II: Implementation

Consisted of three steps:

– (1) Need Assessment
– (2) Capacity Building
– (3) Implementation.
In Step 1, emphasis was placed on the
following features:
– (1) recognizing the community’s needs
– (2) prioritization of needs as per the available
resources
– (3) translating needs into appropriate action jointly
with the community.
The role of government at this stage of the
exercise provided a recognized legal basis for
working in the community.
Step 2 aimed to translate the plan into
action.
Step 3 focused on joint implementation.
Project implementation components include
reconstruction of houses and infrastructure
as well as training programs.
One significant part of the training program
was the half-size shake-table testing with
different building materials, which aimed to
increase people's confidence in earthquake-
resistant construction practices.
Stage III: Ensuing Sustainability

The effort initiated by the Project Team

needed to be sustainable long after the
interventions were over.
In effect, intervention should be designed to
ensure that the community was able to take
care of its development needs and was
resilient against future disasters.
For this, strengthening local institutions was
necessary.
Change attitudes that treat relief and
development as isolated activities
Relief should always consider the
medium- and long-term needs of
beneficiaries and seek to increase
the capacities of communities in
disaster-prone areas.
Relief should lay the foundation to
rehabilitate livelihoods in such a way
that they emerge as more resistant
to shocks in the future.
Use relief as an opportunity to
enhance local capacities.
Identify and build upon coping
mechanisms, use local material and
resources and take measures that
regenerate livelihoods and local
economies.
There is a need to adapt programming
to the socio-economic, cultural and
environmental context as well as to
understand gender-related needs.
Ensure that relief does not inadvertently
reinforce tension or conflict within or
between communities.
In unstable and post-conflict
situations design programmes that
contribute to co-operation and
reconciliation by building upon
shared needs and common beliefs.
 Use disaster preparedness programmes as an
essential link between relief, rehabilitation and
development that build capacities at the
community level as well as in the National Society
to better cope with future disasters, reduce
vulnerability and thus enhance development
prospects.
Contribute towards more systematic
co-ordination, improved working
methods for joint assessments and
planning and the exchange of data
and information between all actors in
the international aid community.
Rehabilitation

“The
restoration of
the patients
to their fullest
physical,
mental and
social
capability”.
 Rehabilitation
It includes
– Prevention of disability
– Retaining functional activities
– Appliances to compensate for loss of function
– Resettlement in the community
– Vocational training and placement
– Restoration of physical and mental health
 “Physical exercise alone is not
rehabilitation.”
“It is not enough to have
specialist for physical disease and
specialist for psychological
disease; the same man must in a
sense , be both.”
 Rehabilitation team
Medical, paramedical staff.
Local authorities.
NGOs
Prosthetists and orthotists
Relatives and neighbors,
last but not the least; patient
himself
Rehabilitation
“With the right
attitude of mind,
a surgeon can
practice
rehabilitation in
a barn; without
it he will fall in
the most lavishly
equipped
gymnasium.”
Return to living
Care in Kutch
 Rehabilitation
According to the severity (Triage)
the patients with
– Spinal injuries, head injuries
– Compound fractures and fractures
requiring internal fixation
Shouldbe tranferred to higher
centers by air or road for
definitive treatment
 Care for the injury
• 1,67,000 patients treated
• 720 Spinal Injury cases
• 109 Paraplegia
• 268 Amputations
• 8256 Total aids and appliances given

“Injury compensation given to 100%

patients”
 Rehabilitation Phase
Focus on Paraplegic patients
o Comprehensive Rehabilitation
o Infrastructure Reconstruction
o Health Training
o Community Mobilization & Coordination
with the Government for strengthening
Medical Services
o Psychosocial Support
 Rehabilitation Phase
The main activities undertaken were
 Physiotherapy
 Prosthetic support
 Damage Assessment
 Tracking patients with post-operative
complications
 Camps for handling post-operative
complications
Premila/18 yrs, Bhachau
Flag hosting day
15th August 2001
at Paraplegia hospital,
Ahmedabad
 Orthopedic team from civil
hospital Ahmedabad operating at
prefabricated hospital, Jubilee
ground, Bhuj
Distribution of assistive devices

Joint project of
–Ministry of Social Justice &
Empowerment
–Paraplegia hospital Ahmedabad
–Blind people’s assoc.
Vastrapur, Ahmedabad.
–NGOs etc.
Vocational
rehabilitation
 Mental Health
Psychosocial Rehabilitation and Therapeutic
support
1000 Teachers trained for Mental
Rehabilitation.
10 UNFPA mobile vans with counselors
delivered Mental Health services at door
step.
6500 persons given psychotherapeutic
intervention.
THANK