1. Disaster Preparedness

As an international public health agency, the Pan American Health Organization/ World Health Organization (PAHO/WHO) commonly defines disaster preparedness as: the set of measures taken to plan for a public health response once a disaster has occurred. Unlike activities or interventions aimed at protecting physical infrastructure, disaster preparedness measures accept the risk and immediate losses and focus on dealing with the health consequences quickly and efficiently. PAHO’s disaster preparedness activities take many forms, including: lobbying for and investing in a strong disaster office in the Ministry of Health that is capable of taking leadership and coordination of all health aspects of disasters; building the capacity of the Region’s human resources through training; providing up-to-date guidelines and technical and training materials; encouraging information and knowledge management partnerships; and, ensuring access to global sources of information. Chapter 1 presents the advances in these efforts regionwide.


The health sector disaster programs in Latin America and the Caribbean have demonstrated growth and maturity in terms of identifying, adapting to and planning for emerging risks and implementing new strategies to deal with them. Some of the challenges that the Ministries face include the threat of pandemic influenza, political change, social unrest and other major large-scale events. At the same time, these challenges present opportunities for new strategies and collaborations.

  • Pandemic influenza1: The emerging threat of pandemic influenza in 2005 was sufficient motivation for some countries to revisit preparedness for this potential health emergency. Although at least 12 countries have prepared national pandemic plans, most are primarily health plans, as other key sectors’ concerns have not yet been fully incorporated. Despite this planning, health institutions are still inadequately prepared to face an emergency of this magnitude.
  • Presently, the food and agriculture sector is taking the lead to contain this disease among poultry in order to reduce the risk, detect early outbreaks and cull infected birds. Once human-to-human transmission is confirmed, the health sector will take responsibility for implementing public health measures, which may include non-medical interventions such as restrictions that may halt the further evolution or spread of an emerging pandemic virus. If the transmissibility of the virus increases, there will be a narrow timeframe in which to contain the influenza pandemic. From then on, national disaster organizations will implement a series of critical emergency damage control measures.
    The Peruvian Ministry of Health recognized that pandemic influenza is not a health problem alone, and organized a meeting with key national agencies that must have a role in the response to this potential emergency. The Civil Defense, the Ministry of Agriculture, the social security system and development agencies joined with the Ministry of Health and agreed on essential elements of a national preparedness plan for pandemic flu. Subsequently, the National Civil Defense Institute established an ad hoc committee, under the technical leadership of the health sector, to ensure that other key sectors such as security, transport, economy, industry and education are involved at the earliest stages.

    1. A single term—"bird flu"—is sometimes erroneously used to refer to three different phenomena: (1) avian influenza in birds, (2) avian influenza in people, and (3) pandemic influenza, a mutated form of avian flu virus that has acquired the ability to spread easily between humans.

  • Political change and social unrest: A change of government can set back or even eliminate gains that have been achieved in disaster preparedness and mitigation in Latin America and the Caribbean. A number of countries in the Region either held presidential elections in 2005 or were gearing up for them in 2006. This contributed to a climate of uncertainty in terms of disaster reduction priorities. However, in two countries which held elections, the national health disaster coordinators in the ministries of health remained in their positions, providing continuity and demonstrating that efforts are taking root to institutionalize the office and the issue itself. Elections in 2006 will be held in 10 more countries2, which will further test the stability of the health disaster offices.
    Despite a highly unstable political climate, disaster preparedness is possible. In Haiti, PAHO worked with national authorities to reduce vulnerability to natural disasters such as floods, landslides and hurricanes. In 2005, a special advisor was recruited to help strengthen health disaster management in three provinces and to improve the disaster preparedness capacity in one particularly vulnerable community in each of these provinces. Initial steps were also taken to improve Haiti’s own response capacity. Already there have been success stories, including an analysis of Haiti’s existing disaster management capacity to support the creation of Emergency Operations Centers (EOC) in two departments. In support of these efforts, PAHO will provide operational and communication equipment. Training for health staff and other emergency response actors in disaster management and mass casualty management was also identified as a priority and subsequent workshops were organized to address this need, in close cooperation with Civil Protection. At the end of 2005, plans were underway to recruit two additional disaster experts, one to be based in Jacmel to cover the Sud-est, and the second in Les Cayes, to coordinate activities in the Sud and Grande Anse departments.

    2. Chile, Peru, Colombia, Costa Rica, Haiti, Mexico, Brazil, Nicaragua, Venezuela and Ecuador.
  • Major sporting events also require emergency preparedness. Although more than a year away, preparations for the Cricket World Cup in 2007 dominated the disaster agenda of many English-speaking Caribbean islands. A sustained training program to deal with mass casualty events, command and control issues and first responders has already begun in nine countries. PAHO revised its mass casualty management courses and the Incident Command System training and helped the countries with various courses such as ECAT (emergency care and treatment) and hospital contingency planning. This sporting event of global interest will serve as the catalyst to improve health sector plans, interagency coordination and the inter-island sharing of expertise in disaster management. An estimated half a million people are expected to attend the games. The Caribbean islands hosting events are required to comply with ICC (International Cricket Council) regulations, and to prepare, simulation exercises will be scheduled for each cricket ground and update disaster plans have been updated.
  • Collaboration with other sectors to reduce health vulnerability: Each year, the health sector occupies a more visible place in national disaster reduction agendas, thanks to collaboration with a wide variety of institutions and sectors. For example, when the US Southern Command coordinated the production of a manual for emergency operations centers in Ecuador and Bolivia, they actively involved the health sector in the development of sectoral preparedness and response plans and activities. PAHO supported Peru’s ministry responsible for water and sanitation in developing guidelines to protect rural water systems from the impact of disasters. Moreover in Venezuela, the topic of health, as it relates to border issues, is handled by Civil Protection, which provides a platform for collaboration between these two agencies in their respective areas of risk management.
  • Bioterrorism and biological, chemical and radiological accidents: The process of improving preparedness for chemical accidents is an interesting one. It involves negotiations with the countries, lobbying for their support, identifying resources to carry out a course, holding a simulation exercise and writing a plan. These steps, in and of themselves, provide health sector disaster programs with valuable experience and exposure at the national level. CETESB3, the WHO Collaborating Center, conducted a course for five Andean Region countries to strengthen health sector management of this risk, which increases daily due to technological and industrial development in these countries. The workshop resulted in a national plan for Ecuador which established clear responsibilities and was validated by all sectors involved. At the most recent meeting of CAPRADE4, PAHO and the PREDECAN were tasked with supporting the development of an Andean plan to manage hazardous substances and radioactive material. The development of this plan will begin in 2006. (Annex 1)
    Although progress has not advanced as rapidly in the field of radiological emergencies, efforts to identify risk, develop a methodology and plan for training are on the agenda of regional Ministries of Health, which recognize the need for contingency plans. PAHO’s Area on Emergency Preparedness and Disaster Relief (PED) is working with the Organization’s Radiological Health Unit to undertake a joint regional diagnosis of the situation and plan training for a medical response to emergencies involving radioactive substances. Peru has taken initial steps, carrying out an assessment of the response capacity of key institutions and conducting a workshop to prepare an outline of a national response plan for radiological emergencies and disasters. The topic has also been included in the agenda of the meeting of the Ministers of Health of the Andean Region, an important step for gaining visibility and political support for this issue. A proposal is being prepared for submission to the International Atomic Energy Agency and REMPAN (Radiation Emergency Medical Preparedness and Assistance Network) to develop training materials and a regional course.
    Venezuela’s National Institute of Health carries out an annual course on bioterrorism. In 2005 PAHO designed the health component of this regional course, which trains staff from all sectors and improves the level of preparedness for this type of emergency, to which the population is equally at risk.

    3. CETESB is Brazil’s Environmental Sanitation Technology Company, a regional leader in assessing, preventing and preparing for environmental emergencies.
    4. CAPRADE is the acronym for the Andean Committee for Disaster Prevention and Response, the disaster agency for the Andean region and part of the CAN—the Andean Community of Nations (Ecuador, Peru, Colombia, Bolivia and Venezuela).
  • Fires in hospitals and other public buildings have posed a major challenge for the health sector. A fire in the Ycua Bolaños supermarket in Asuncion, Paraguay killed 426, injured 424 and challenged the country’s mass casualty planning. Following this incident, health authorities in Paraguay convened a subregional workshop to collect experiences from four major fires:
    • the Mesa Redonda fire in Lima, Peru (Dec. 2001; 484 dead and 247 injured);
    • the Barros Luco Hospital in Santiago, Chile (May 2003);
    • a popular discotheque in Buenos Aires, Argentina (Dec. 2004; 193 dead and 900 injured); and,
    • the Ycua Bolaños supermarket in Paraguay (described above.)

    At this meeting, experts outlined a plan of action covering mass casualty management, mental health, disaster coordination and humanitarian aid that will guide the preparation of materials on this topic. Fires in public buildings have recently attracted much attention, particularly in light of the fire at the Calderon Guardia Hospital in San Jose, Costa Rica—the most serious of several hospital fires in the Region—which heightened alert in the health sector. The plan of action document will be published in 2006.


Subregional political frameworks and strategies are essential to generating processes and commitments that extend beyond the political realm into concrete action. Several examples of this approach were evident in 2005:

  1. The Andean Region Health Sector Disaster Preparedness and Strategic Response Plan (2005-10), approved by the Ministers of Health, includes four strategic approaches over the next five years: strengthening the position of the health sector vis-a-vis “safe hospitals;” knowledge management; inter-country support and international cooperation. (Annex 2)
  2. MERCOSUR, the Southern Cone Common Market, has achieved similar progress by creating a disaster commission, coordinated by the health sector disaster coordinators, to give continuity to disaster reduction efforts in Brazil, Argentina, Paraguay and Uruguay.
  3. In 2005, the Andean countries also transformed the safe hospitals initiative from simply a topic on the national agenda, into a regional strategy with a five-year plan of action, under the political framework of the Andean Community. CAPRADE convened a meeting, with the participation of civil defense agencies, foreign affairs, and offices of planning and disaster coordinators to define a work strategy in this important field.
  4. In 2005, SICA5 created the Forum for Central America and the Dominican Republic on Water and Sanitation to promote inter-country cooperation. This forum designated disaster vulnerability reduction as one of five priorities for action. Using the Central American Plan for Disaster Reduction, approved in 2003, as a framework, the Water Forum strives to give relevance to the Plan at the national level by designating national focal points in regulatory institutions in order to prepare national risk management plans for the water and sanitation sector. The next step will be to strengthen the national capacity to make these plans operational for disaster prevention, preparedness and response.

    5. SICA is the Central American System for Integration, an institutional framework for Central American integration which works to promote peace, liberty, democracy, and development based on respect, protection and promotion of human rights.


For more than two decades, institutional strengthening has been a key strategic area of work of PAHO’s emergency and disaster program. These efforts are directed at ensuring that there is a dedicated emergency program within each Ministry of Health. Equally important, these emergency programs need to be adequately staffed and have a minimum budget for preparedness activities, have access to the decision-making level of the Ministry and a structure, mandate and policies that are considered integral parts of national health plans, despite changes in government. By and large, this commitment to disaster preparedness and vulnerability reduction has been evidenced regionwide, as at any given time at least 80% of the countries have an assigned health disaster coordinator.

In recent years, institutional strengthening activities have not been isolated but rather wrapped up into with our entire strategic plan of activities. Some of the achievements of the disaster programs of the Ministries of Health are evidence that the disaster coordinators and their offices are key players in regional preparedness efforts.

  • The subregional meeting of health disaster coordinators in Central America in March, provided a forum to analyze progress in implementing Central American Disaster Reduction Plans (framework plan as well as subregional health, water and mental health plans.) Participants, which included national emergency commissions, also defined priority areas for inter-country cooperation and the need for a truly regional disaster response team to assess damage in the health sector.
  • Based on recent disasters and the lessons they have yielded, many countries in the Caribbean began to focus on technology and tsunami warning systems. The British Virgin Islands established an early warning system to trigger an evacuation of the population in case of an earthquake with a potential tsunami. The sirens are tested regularly and island-wide. In order to further centralize and improve the emergency medical response, the country is also setting up an emergency response (911) system.


Disaster capacity-building and training activities took place in many countries in the Region. PAHO/WHO continued to expand partnerships with universities and professional associations within the Region to develop this area further. These key actors/partners have been involved in various ways. Some organizations—as was the case with professional associations, military health units and universities—organized the meetings (inviting participants, managing logistical aspects and gathering technical materials) on their own. Other organizations required PAHO’s technical support in program planning, preparations and the review/distribution of technical material. In other cases, the Ministries of Health’s own disaster coordinators promoted these initiatives from within, with PAHO’s support limited to more ceremonial duties or providing expert speakers. It is evident that the Ministries are gradually developing their own capacity in this regard. The active involvement of our counterparts and other institutions/sectors with expertise and a stake in this issue increases awareness among multiple key players. Consequently, the more individuals and agencies at the national and local level come to regard this topic as their own, the less involved PAHO will have to be, allowing a focus to shift to regional initiatives.

  • Since 2000, eleven LIDERES (LEADERS) courses have been held in the Americas to improve the disaster management skills of a wide range of senior level professionals in many sectors who must deal with the aftermath of emergencies. Over the years, the course methodology has improved and the content of the individual course modules has been fine-tuned to meet changing needs and consolidated into a two-week format. LIDERES has generated growing interest from partner agencies and this year UNICEF and the International Federation of the Red Cross (IFRC) collaborated both financially and with participants and presenters. Further commitment on the part of UNICEF and IFRC, both of whom have regional offices in Panama and are major regional disaster response partners, would be demonstrated by using the LEADERS course to develop and train their staff regionally and in country offices. It is hoped that this developing partnership will attract the interest of other agencies active in disasters with regional offices in Panama: UNHCR, WFP and the ISDR. Should this come to pass, the curriculum would undoubtedly undergo further revision. The management of the LIDERES courses has been entrusted to a Foundation, created by PAHO/WHO to organize and carry out the courses, select participants and coordinate with national counterparts. This mechanism has allowed PAHO to scale back its involvement—primarily to technical and strategic aspects—as the course becomes more independent and financially self-sustaining.
  • Hospital Disaster Planning has become an important training initiative regionwide, and now that course material has been prepared to train trainers, the countries themselves are taking responsibility for strengthening national capacity. This multiplier effect has increased enormously the number of health professionals with access to this information. Ecuador is a perfect example, where courses and tools were developed at the national level and used to train provincial rapid response teams. Two hospital planning courses were also carried out in Paraguay, where the topic gained even more importance following the Ycua Bolaños supermarket fire in 2004 that left a large number of victims in need of medical attention.
  • Virtual training courses: Within the framework of an agreement between the IFRC and PAHO/WHO, the Federation’s regional office in Lima requested that PAHO support the development of training material that could be used in distance education courses. The process culminated in the joint preparation of the material and the training of 22 students in South America through the Latin American Faculty of Social Sciences (FLACSO), a recognized University in the Region. Subsequently, a letter of agreement was signed between FLACSO and PAHO/WHO to support the development of future courses on risk management and expand the use of the materials.


As in past years, the production and dissemination of publications and training material has cut across programmatic activities with a demonstrable impact. PAHO/WHO staff contributed directly or indirectly to the production of this material, as did dozens of regional technical experts, both from within and outside of the Organization, who have also collaborated. A list of publications produced in 2005 is included in Annex 3.

  • Updating of technical information for disaster response. Based on experience gained in this Region and in others, several technical documents were reviewed or new manuals produced on specific, practical aspects of health and disasters. This effort, which aims at building or improving technical disaster response capacity, also complements PAHO/WHO efforts in 2005 to solidify a regional disaster response team.

    1. PAHO/WHO’s 2004 publication Management of Dead Bodies in Disaster Situations promoted the proper handling and identification of cadavers, one of the most complex and sensitive aspects of emergency response, particularly when there is a high death toll. The publication received much attention—both regionally and globally— as shown in Letters to the Editor, reviews in scientific journals and radio interviews. There is also anecdotal evidence of a noticeable shift in the reporting on this subject (although some reporters or public officials, in the aftermath of a catastrophic disaster, may continue to talk about the dangers of dead bodies). Given the widespread interest in this topic and with support from WHO, the International Federation of the Red Cross (ICRC), and a broad group of global experts in this field, steps began in 2005 to produce a practical decision-making guide for emergency response teams that offers solutions to this delicate and difficult task. At a global meeting in Lima in May, the focus and outline of the guide was prepared. By the end of 2005, the new publication was in the final phase of editing.

Costa Rica recognized the importance of this issue and included it in the national health plan. When a major fire occurred in the Calderon Guardia Hospital in 2005, they were able to apply some of the coordination mechanisms defined in the plan.

2. The PAHO/WHO publication Protecting Mental Health in Disaster and Emergency Situations has been widely used as a planning guide for emergency action. Based on experiences collected in recent hurricanes and other emergencies such as fires in Paraguay, Peru, and Argentina, a companion publication for response personnel was prepared. This publication includes practical procedures for identifying and managing psychosocial manifestations in disaster victims. Experts from Cuba, Colombia, Guatemala, Ecuador, and organizations such as UNICEF, the IFRC, the Colombian Red Cross and Doctors without Borders helped to prepare and field test this practical how-to manual for emergency health personnel, which has been adapted to the realities and needs of the Region.

  • Developing innovative training methods and processes. PAHO continues to produce training and capacity building materials that use information and communication technologies to reach a wider audience and stimulate interest. In 2005, two examples include the preparation and testing of a computer-based simulation exercise on volcanic eruptions and a pilot Internet-based distance learning course on health and disasters, developed in collaboration with the IFRC and FLACSO.

    1. The software for the simulation exercise was finalized in June 2005 and training workshops were held in Ecuador, Colombia, and Nicaragua. The multimedia software allows participants to simulate decision making in health Emergency Operations Centers, manage a large volume of information (qualitative and quantitative) and make decisions in confusing and stressful environments. In contrast to traditional simulation models, this highly interactive software (which incorporates video clips, radio spots, photos, written reports and other documents) has value added for training purposes, as it immerses users in the scenario. From the standpoint of disaster preparedness, the simulation familiarizes users with volcanoes and their impact on the health and the importance of coordination and communication. Just as important, it helps participants evaluate their know-how, negotiation skills and teamwork. The positive feedback has encouraged PAHO to explore opportunities for 2006 to adapt this tool for other simulation exercises for floods.

    2. PAHO has embraced Internet-based information management for years, however training efforts are now also using distance or e-learning in response to a growing demand by users for this type of access. When the IFRC and FLACSO asked PAHO to collaborate on the development of a distance learning module on public health and disasters, the Organization was keen to join in. The eight-week-long pilot module, which is included within the framework of an eight-month course in public health management developed by IFRC and FLACSO primarily for Red Cross personnel in Latin America, will expand the content of the public health training and create a stand-alone training module on disasters that can be facilitated over the Internet once or twice a year. In early 2006, the course will be reviewed and the educational materials improved.

    With a small investment of time and money (the preparation of materials and on-line teaching), this joint venture allowed PAHO/WHO to offer new courses to a more diverse and broad public. This collaboration also ensures that each organization brings to the table what it does best: in the case of PAHO and IFRC, technical content and experience in disasters; with FLACSO, the teaching platform, the academic experience and its international academic accreditation.

  • Increased promotion and dissemination. This initiative strengthens access to and distribution of publications and follows up to the recommendations of the 2004 evaluation of the use and impact of PAHO disaster publications and training material. Particularly noteworthy are the following results:

    1. Improved presence of disaster publications on PAHO country offices’ websites in the Region (more than 30 sites).

    2. Greater presence and knowledge of PAHO disaster publications in PAHO Documentation Centers and in the regional network of libraries.

    3. Additional dissemination in the press and scientific journals.

    4. A new catalog of publications produced for distribution in early 2006.

  • The production of technical publications and multimedia material was prioritized to support PAHO’s key regional disaster preparedness and reduction strategies.

    1. Some material supported disaster preparedness training, including the new version of Hospital Planning for Disasters which now incorporates a module to train trainers and the material on drinking water and sanitation, which was reviewed and expanded to include new books, videos and other training material (available on CD-ROM and the Internet.

    2. Other material was designed for risk reduction advocacy. For example, a booklet was produced (Safe Hospitals: A Collective Responsibility, a Global Measure of Disaster Reduction) and widely distributed at and following the World Conference on Disaster Reduction in Kobe to raise awareness of the issue of safe hospitals. The script was prepared in 2005 for a new video on this issue and filming will take place in several countries in 2006, which will be available on DVD.

    3. Topics such as damage assessment, management of dead bodies and mental health all support improved capacity to respond to disasters.

    4. Lessons learned from emergency situations (such as the major fires in the Region) are being preserved and converted into technical guides for the health sector (to be finalized in 2006). Also, the new publication on safe hospitals in flood situations, which offers recommendations to reduce the impact of the floods on health care facilities, is the result of a tremendous amount of experience gained in the Region.

  • Finally, existing material is constantly being reviewed and updated as necessary. PAHO’s entire collection of video programs which contains historic footage from the Region, has been converted to digital format and placed on DVDs, making it more accessible, easier to use and more economical to distribute.


Regional Disaster Information Center (CRID)

The CRID is an inter-agency project that compiles and disseminates disaster-related information. CRID is located in Costa Rica and its members are: the Pan American Health Organization - Regional Office of the World Health Organization; the International Strategy for Disaster Reduction; the Costa Rica National Risk Prevention and Emergency Commission; the International Federation of Red Cross and Red Crescent Societies; the Coordination Center for Natural Disaster Prevention in Central America; and Doctors Without Borders. In 2005, CRID handled requests for information, on-site and through the web (approximately 8,000 monthly hits on its website and 600 monthly information requests). CRID has also published and distributed specialized bibliographies on disaster and health related topics; produced, edited and distributed training and technical material and public information; and, increased its database of full-text publications by making accessible 81 new publications. CRID has also conducted training on disaster and health-related information management as well as coordinated with other institutions involved in disaster and health information management.

CRID has been the implementing partner in several regional information and knowledge management projects including:

  • Central American Network for Disaster and Health Information (CANDHI): the objective is to set up and strengthen a regional network of disaster information centers in El Salvador, Guatemala, Honduras, Nicaragua, Panama and Costa Rica to improve access to disaster and health related information. More than 25,000 hits were registered on the web sites of these information centers. This international initiative, takes a multisectoral and interinstitutional approach as it strengthens national capacities to compile, systemize and disseminate technical, educational and scientific information on disasters and health in Central America. This project has produced a number of information products for community leaders, health workers, educators, scientists, politicians, NGOs, government organizations and UN agencies, and others on health and volcanoes, integrated risk management at municipal level and risk analysis and public investment in Latin America and Caribbean.
  • PREDECAN-CAPRADE: An initiative under negotiation to develop a Disaster Information Network in the Andean Region, with Bolivia, Peru, Ecuador, Colombia and Venezuela as counterparts.
  • U.S. National Library of Medicine: a “toolkit” is being developed to provide methodologies and tools to make it easier to organize and manage disaster and health information, using information and communications technology to change how we work, make information more attractive to users, and meet the growing number of requests.

Other points of knowledge transfer

PAHO/WHO published the first issue of its quarterly newsletter Disaster Preparedness and Mitigation in the Americas in 1979. The first newsletter was typed, photocopied and sent by hand to a very limited circle of people who were interested in developing contacts and learning more about preparing to face the health effects of disasters. Today, many things have changed. Not only is the software and hardware used to publish the newsletter much more sophisticated, the number and diversity of channels through which we receive news have multiplied at such a rapid pace that it is virtually impossible to keep up with who is doing what in the Americas, let alone the rest of the world. What has not changed, however, is why and for whom this newsletter is published. The Disasters newsletter, which today reaches more than 26,000 people worldwide, attempts to showcase the initiatives and steps taken by countries in Latin America and the Caribbean (and beyond) to prepare for and respond to the health consequences of disasters. From the earliest issues, it has promoted a horizontal exchange of knowledge and ideas among disaster professionals by citing contact information for each news piece (a much quicker task today than in 1979, thanks to e-mail!) Today, the print newsletter coexists with an online Internet version.

PAHO/WHO maintains a number of websites regionwide for news and reference material. One of the key functions of the website is to house a catalog of publications. During 2005, efforts were underway to reorganize the online catalogue to make it more user friendly by improving the search engine. Of special note is the website on health and the displaced population, managed by PAHO’s office in Colombia. This is an interagency website with contributions from key actors who work directly with displaced populations in Colombia and neighboring countries.

PAHO’s subregional disaster office for South America is a good example of the decentralization of information. This office maintains up-to-date information on activities in this subregion. The subjects of greatest interest to those who visited the site were floods, volcanic eruptions, earthquakes, fires, and disasters preparedness training. In 2005, the breakdown of use by countries is as follows:

Total Number


































Central America






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