major natural disasters struck the Region in 2005, including widespread
floods in Guyana, an earthquake in Colombia, and the most devastating
of all, Tropical Storm Stan, which lingered over Guatemala and El Salvador,
producing mudslides and killing several thousand people. Disasters outside
the Region also had an impact on our annual workplan, as PAHO/WHO staff
supported relief efforts related to the tsunami in south Asia, hurricane
Katrina in the U.S. and the massive earthquake centered in the Kashmiri
border area between India and Pakistan.
Latin America and the Caribbean
large-scale natural disasters in Latin America and the Caribbean do
not make the front pages of the newspapers, even though their impact
strains the resources of the affected country. In most cases the events
are handled locally and the health sector requires only limited external
support. This was the case with a number of disasters in South America
in 2005: earthquake in Tarapacá, Chile (June); earthquakes in
Peru (September and October); floods in Venezuela (Nov.), Colombia (September
and November), Bolivia (March, September and November); drought in Paraguay,
Bolivia and Ecuador. Other natural phenomena were also an issue: storms
in Uruguay (August); extreme cold wave in Peru (June) and Bolivia (April);
fires in health care facilities in Argentina (July), social conflicts
in Bolivia (May, June); volcanic eruptions in Ecuador and Colombia;
and airplane crashes in Venezuela and Peru (August). The fact that some
Ministries of Health were self-sufficient in their response to these
natural disasters illustrates that countries—and particularly
the national disaster offices in the Ministries of Health—have
improved their disaster preparedness and response capacity.
solidarity with other WHO Regions offered opportunities for PAHO to
help respond to large-scale needs in countries where we do not normally
work. The repercussions from the 26 December 2004 tsunami that affected
11 countries in Asia lasted well into 2005. Indeed, the management of
the post-tsunami response is still a principal area of work for WHO
and its Southeast Asia
Regional Office (SEARO), whose human resources were severely overstretched
by this crisis. PAHO assisted WHO by providing staff to supplement SEARO’s
emergency response coordination in Banda Aceh, Indonesia (two months
as health cluster lead) and in New Delhi (information and project management).
Support System (LSS) was used for the first time in Banda Aceh to
assist the Ministry of Health with the huge influx of drugs and medical
supply donations. However, a lesson was learned from this first deployment.
Because the LSS system was neither requested nor set up early on (understandable
given the magnitude of this disaster), it was not adopted as readily
as it has been in other situations, as people were reluctant to change
from the Excel spreadsheets or manually-entered data forms they were
August and September 2005, the United States was seriously affected
by a number of hurricanes, the most notable of which was Hurricane Katrina.
For the first time, practical collaboration was established between
the UN system and the U.S. Department of Health and Human Services (HHS).
PAHO/WHO formed part of the Hurricane Katrina Emergency Operations Center
which was set up in suburban Washington D.C. (Arlington, VA). Also,
unprecedented was the participation of health disaster experts from
PAHO and from other countries in the Americas. In support of these efforts,
PAHO experts participated in rapid needs assessments in Texas, Mississippi
and New Orleans; evaluated shelter management; and carried out water
and sanitation and hospital assessments.
Office (EMRO) asked PAHO to assist in deploying various experts
to the earthquake-affected areas in Pakistan, Kashmir and the northwest
frontier province. As was the case in Banda Aceh, a PAHO/WHO staff member
served as coordinator of the health cluster in Islamabad for several
months. The Organization also helped to identify and deploy experts
in LSS, epidemiologists and engineers with experience in assessing structural
damage caused by earthquakes and identifying appropriate mitigation
measures. For the first time, all WHO field offices in Kashmir adopted
the LSS and more than 15 persons from the Ministry of Health were trained
to use it. The UN Joint Logistics Center, with support and encouragement
from DFID, has begun to use LSS/SUMA to compile data on incoming relief
goods in order to identify gaps and produce reports for donors.
America and the Caribbean have accumulated a substantial body of experience
in certain specialized areas of disaster reduction, particularly mitigating
the impact of natural disasters and the application of construction
standards for hospitals. The experience was helpful in the aftermath
of major disasters in other regions of the world. However, “exporting”
disaster managers and other experts (whether PAHO staff or nationals
from PAHO/WHO Member States) to other regions also benefits PAHO/WHO
for a number of reasons. First, lessons learned elsewhere can be incorporated
into policy and strategy in the Americas; second, it helps to identify
gaps in knowledge in this Region (the need for logistics procedures
and experienced staff; the importance of a trained disaster response
teams on standby and the impact of a well established DEWS (disease
early warning system) were immediately included into PAHO activities);
and lastly, it allowed us to work directly with staff from other regional
health (non-disaster) agencies with whom we have little interaction
(Health Canada is an example.) Following the tsunami in southeast Asia,
experts from Sumatra, Indonesia and Thailand came to work in the Caribbean
(which is potentially at-risk of tsunamis) and were able to share their
experience, including the difficulties encountered in managing and especially
identifying dead bodies.
is in a constant state of social crisis, which is exacerbated when natural
or manmade disasters strike. Although many Caribbean countries are exposed
to the same natural hazards, the devastation and loss of life and livelihoods
they experience do not compare to the impact on Haiti. Physical, social,
economic and environmental conditions in Haiti make it one of the most
vulnerable countries in the world.
on several occasions Haiti was in the direct path of a tropical storm
and/or hurricane, in 2005 the country was largely spared (as compared
to 2004). However, flooding led to landslides that destroyed crops and
left thousands homeless and affected. This compounded an already-worsening
social crisis that has been deteriorating for several years. Kidnappings
and other serious crimes increased in 2005 to previously unforeseen
rates and the unstable security situation directly affected PAHO’s
activities. The example of PROMESS, whose operations were severely compromised,
points to the need to maintain flexibility and seek solutions.
CIDA funded a special project to reduce the vulnerability of the population
of Haiti to natural disasters such as floods, landslides and hurricanes.
A special advisor was recruited in July and based in Port-au-Prince
health disaster management at the departmental level in three provinces.
disaster preparedness capacity in one particularly vulnerable community
of each province.
national response mechanisms in supporting two departments and disaster
response authorities at central and departmental level.
years, PAHO/WHO has managed a project to improve the health situation
of those affected by violence in Colombia and neighboring countries,
creating field offices throughout Colombia to document and disseminate
health information on refugees and the internally displaced population
(IDPs) as well as the impact on receptor communities. These officesalso
strengthen coordination and leadership within the health sector at all
levels by improving the response capacity and advocating for increased
access to health services. Collaborative activities with many different
actors—local government, NGOs and public sector international
organizations—promote the transfer of information and knowledge
sharing and increase long-term sustainability.
is working to improve health statistics on IDPs. Highlights from the
work of the field offices include:
Cali office is testing tracking software that will speed up the allocation
of national IDP health funding, enable real-time planning and enhance
emergency response capacity, while also providing detailed health
information on IDPs.
Bucaramanga field office organized a technical workshop on design
proposals for healthy IDP housing. The International Organization
for Migration (IOM) is now using the PAHO healthy housing design in
150 IDP homes in Santander.
newly-trained Valle del Cauca indigenous health brigades are now fully
functional. The Cali office is expanding this training to include
a response plan for complex emergency situations in protected indigenous
years, the IDP problem has extended beyond Colombia, as refugees spill
across the borders of neighboring countries, and currently activities
are also taking place in Ecuador, where refugees are gaining additional
rights to health services, as information is gathered both about their
needs and the impact on the health of the receptor-communities. The
response capacity is improving along the border, as is cross-border
cooperation on IDP/refugee issues. Activities in Panama remain suspended,
but the new office in Northern Santander is expected to increase cross-border
activities in Venezuela.
ASSESSMENTS IN HEALTH
Regional Disaster Response Team
countries in the Americas have the capacity to handle emergency situations
on their own. Yet on occasions, an event will occur of such magnitude
that it overwhelms the response capacity of a country and external assistance
is required. Bilateral or UN response teams (Cuba, Venezuela, Argentina
and others) have responded on many occasions. However, a regional response
mechanism, consisting of experts from PAHO and Member States, previously
selected for their experience, seems to be the most feasible approach.
efforts stepped up to formally consolidate this regional disaster response
team (a Caribbean-only team had been in place for more than 20 years).
Preliminary efforts included the development of guidelines and adjustments
to internal PAHO/WHO administrative procedures to allow greater flexibility
and speed in the response. By the end of 2005, the regional response
team include some 40 persons with a variety of skill sets—project
management, general administration, disease surveillance, water and
sanitation, structural engineering and others—from English, French
and Spanish-speaking countries.
Logistics Support System
been two years since work began in earnest to develop and program the
software for the LSS system (Logistics Support System8).
The LSS is a jointly-owned tool, available to all humanitarian institutions.
It is designed to improve coordination, develop the local capacity to
manage logistics in emergency situations, improve accountability and
transparency and reduce duplication of efforts.
The LSS is a joint initiative of six UN agencies (WHO, WFP, OCHA,
UNICEF, UNHCR, and PAHO) to consolidate the experiences of the UN
Joint Logistics Centre (UNJLC) and the SUMA system in the Americas
with regard to the management of humanitarian supplies. LSS combines
the strengths of these two successful initiatives that have operated
in different environments and have served complementary purposes.
carried out during 2005 was extensive, as were the results. Activities
focused on testing the release of the software, which was delivered
from the contractor at the end of 2004, preparing specifications for
revisions and improvements, developing a practical manual in English
and Spanish (still in draft version) and a website exclusively for LSS.
Other activities included carrying out LSS training courses in Panama
City and the Maldives and overseeing the first deployment of the LSS
following Hurricane Stan in Guatemala and El Salvador and, globally,
in Pakistan to respond to the South Asia earthquake. Highlights of the
achievements in 2005 include:
of first final version from vendor, including documentation, etc.
of first final version.
final version workshop with vendor to agree in needed changes/improvements.
final version received from vendor.
group accepts June 2005 version as final release and vendor agrees
to provide service for errors through the purchased warranty.
LSS training course held in Panama, City, Panama.
implemented in Guatemala and El Salvador following Hurricane Stan.
implemented in Kashmir Region following earthquake.
training course held in Maldives.
will continue supporting SUMA,
which was developed by and for Latin American and Caribbean authorities/institutions.
The expertise, level of personnel trained and experiences gained in
SUMA are assets that are making the transition to LSS easier in the
Americas. As a stand-alone logistic support system, SUMA will be enhanced
by the introduction of the new software.
training sessions and deployment of the LSS, revealed several lessons:
the LSS has greater capabilities than SUMA, it also requires better
trained human resources and more sophisticated equipment.
use of the web-based application can be cumbersome if good connectivity
is not available.
we learned with SUMA, political sensitivities still affect how transparently
data can be published on the Internet.
any new software “bugs” become apparent during the installation
and the first days of operation; an expert in LSS with good IT experience
should accompany field deployments for the foreseeable future.