This is the second issue of Briefly Noted, PAHO/WHO’s short monthly bulletin containing disaster news and notes. Please feel free to share this message with colleagues. To subscribe, send your name, organization and e-mail address to disaster-newsletter@paho.org.

Our print newsletter, Disasters: Preparedness and Mitigation in the Americas, will now come out twice a year, allowing time and space for in-depth articles, interviews and other material in support of disaster management. The next issue will be out at the end of September.

Disaster Coordinators Agree to Shared Work Agenda

In early July, PAHO/WHO met with health disaster coordinators from Caribbean Ministries of Health. The 39 participants from 22 countries examined a number of issues including the impact of climate change in Caribbean countries, disease surveillance in disasters, and regional coordination mechanisms for health and pandemic influenza.

The Safe Hospital Initiative in the Caribbean received special attention, specifically the project to strengthen communities through safer health care facilities (supported by the European Commission’s Humanitarian Aid Office (ECHO). This project will reduce the health sector’s vulnerability to natural disasters and strengthen communities by supporting preparedness and safety activities in health care facilities, thus ensuring they can remain operational in disaster situations.

The recently prepared wind hazard maps for Caribbean islands and nearby coastal areas of Central and South America, created by PAHO/WHO, were also discussed. Reliable wind hazard information is crucial when it comes to building health (and other) facilities to withstand hurricane-force winds.

All 22 countries agreed to implement a shared work agenda over the coming year that focuses on disaster preparedness, mitigation, response and partnerships. The agenda includes activities to review and update national health sector disaster plans, form outbreak containment teams and strengthen the regional emergency response team, conduct at least one simulation exercise, and establish and formalize agreements and partnerships for disaster risk reduction.

PAHO/WHO’s technical support will include training, mobilizing resources to support country level disaster risk reduction initiatives and developing the necessary tools, protocols and guidelines. Reducing vulnerability in health care facilities will continue to be one of the main areas of work in the sub-region, in response to the World Disaster Reduction Campaign “Hospitals Safe from Disasters.”

The Caribbean health disaster coordinators—specialists in disaster preparedness, mitigation and response from ministries of health in the Region—have met annually since 1995 with PAHO/WHO support. Their meetings provide a forum for consultation and priority setting, allow countries to share experiences, and help strengthen national and regional capacity in emergency preparedness and disaster relief. For more information on their meeting visit http://www.disaster-info.net/carib/hdc2008.htm.

Peru Contributes to Safe Hospitals

The recovery process in the city of Pisco, Peru—which suffered a devastating earthquake in August 2007—was no small matter. In just a matter of minutes, Pisco lost 95% of its hospital beds. The San Juan de Dios hospital was the city’s main health facility, and it provided health services to a population estimated at 80,000. The hospital partially collapsed, causing the loss of 96 beds in the surgical, obstetrical, general medicine and pediatrics wards. In effect, the facility could not continue to function.

Today, the San Juan Hospital is once again serving the health care needs of the surrounding community, thanks to a fully-equipped temporary health module with 48 patient beds, installed at the site of the demolished wing of the hospital and inaugurated in June 2008.

The modern, 560 sq. mt. module --built to be 'safe from disasters'-- is valued at more than US$250,000, and is a significant step forward. Since August 2007, the affected population had been receiving health services in improvised tents.

Hospital Rehabilitation

The structural safety of health facilities has been a major concern of PAHO/WHO for many years. In 2004, the ministers of health of the Americas approved a resolution at their annual Directing Council meeting on safe hospitals, urging Member States to set the goal of building all new hospitals with a level of protection that guarantees their remaining functional in disaster situations and implementing mitigation measures to reinforce existing health facilities, particularly those providing primary care.

The temporary hospital module is the result of careful planning, taking into account aspects such as patient safety and the physical conditions required to provide optimal care. In addition, national norms for the construction of health centers were closely followed. After the hospital debris was removed, special attention was paid to the construction materials used, given soil conditions in the area as revealed through risk maps of the city of Pisco. This ensured that the temporary module was built in a structurally sound manner, meeting anti-seismic standards for health facilities in high-risk areas.

Looking forward

In the aftermath of the earthquake of August 2007, the only areas of the San Juan de Dios hospital that were able to continue functioning were the emergency services and external consultations. In addition to the 48 beds, the new health module contains an area for minor interventions, and a nursing station. The modern health module will ensure that the population of Pisco continues to enjoy health services during the rehabilitation and reconstruction period, providing a facility that combines the best aspects of a ‘safe hospital.’

Simulated Nuclear Accident Provides
Opportunity to Study Response

The Pan American Health Organization/World Health Organization completed a two-day international emergency response exercise entitled ConvEx-3 on 9-10 July 2008. The exercise simulated an event at the Laguna Verde nuclear power plant in Mexico. In this scenario, a fire in the nuclear plant resulted in the release of radioactive material into the atmosphere.

While the actual simulation took place over the course of two days, planning for the exercise took two years. This lengthy planning time was necessary to coordinate the many agencies involved: nine international organizations and 74 countries participated in the simulation. The simulation was coordinated by the International Atomic Energy Agency (IAEA), within the framework of the Inter-Agency Committee on Response to Nuclear Accidents (IACRNA).

All levels of the WHO system took part in the exercise. In the Americas, PAHO’s Emergency Operations Center remained open and on high alert over a 36-hour period, as was the case with the EOC at WHO Headquarters in Geneva and at the International Atomic Energy Agency in Vienna. The EOC staff monitored messages sent by email and fax, scanned the IAEA website and hosted periodic teleconferences, while assisting the technical leads to prepare reports.

The PAHO/WHO Country Office in Mexico played a key role in the exercise, with messages being exchanged throughout the first night. This spirit and enthusiasm gave the exercise its life and served as a real learning opportunity. WHO Collaborating Centers also participated in the exercise.

PAHO/WHO’s EOC operations were led by the Organization’s radiological health expert. The EOC called meetings with 31 members of the Disaster Task Force at headquarters and worked closely with the International Health Regulations (IHR) team, as the simulation developed and the situation at Laguna Verde became more serious. During the meetings, input was sought from all parties, decisions were made, and PAHO was able to respond to the requests from Mexico and the IAEA. The entire exercise was formally monitored and evaluated so that lessons from the exercise can be used to improve future response operations.

Some of the strengths observed during the exercise included the following:

• The exercise allowed PAHO offices to test their emergency management plans.
• Technical experts analyzed and synthesized information, adding value to the technical reports that were produced.
• The exercise illustrated how a variety of technical programs can collaborate during an emergency, in this case, IHR, Emergencies and Disasters and the PAHO/WHO radiological health expert.

Some areas for improvement included the following:

• Communications at all levels need to be improved. Technical glitches with the IAEA website, the telephone switchboard at country level, and conference call connections are issues that must be addressed quickly and imaginatively.
• Technical capacity for radiological health is limited.
• Sustainability of the EOC at PAHO HQ beyond 36 hours is not feasible with the current level of staffing.

The purpose of the ConvEx-3 exercise was to test and evaluate the exchange of information and coordination of international assistance during a major nuclear emergency. It provided an opportunity to identify shortcomings in the national and international emergency response systems that can help to improve future response efforts and minimize the consequences of a potential nuclear accident.

More information at http://www.who.int/environmental_health_emergencies/
events/convex2008/en/.

Good practices in international donations: public awareness and advocacy for the media and donor community

An initiative of PAHO/WHO, OCHA, INTERMON-OXFAM, IFRC, UNICEF, WFP, Fundación Alas, CRID, RED-HUM, with the support of AECID

What is the Problem?

The arrival of large quantities of humanitarian relief in a disaster-affected country often creates a second disaster due to the difficulty in organizing and managing the supplies. In addition to technical and logistical problems, the situation is further complicated by donations that are inappropriate or arrive too late to meet the real needs of the disaster victims.

There are various reasons why this scenario has repeated itself time and again.

• Myths continue to be difficult to dispel, such as ‘any kind of aid is good’ or ‘everything returns to normal in few weeks.’ The reality is that the impact of a disaster lasts many months and the needs tend to be greater after the most “visible” and media-focused attention passes.
• Mechanisms for channeling aid, already existing in many countries, are not always respected and there is often a lack of awareness of the technical capacity that exists in the majority of Latin American and Caribbean countries to manage disasters.
• Today the media - national and international- has enormous influence when it comes to either creating the need for or legitimizing a humanitarian operation. Frequently, reporting has encouraged spontaneous and indiscriminate donations and needs have been exaggerated or distorted, at a time altruism is running high and donors are very open to collaboration and solidarity. Limited attention is given to the root causes of many emergencies. The media has enormous potential to improve our understanding of the underlying causes of disasters.
• Humanitarian agencies and donor governments can be influenced by media and public pressure to send assistance as soon as possible, sometimes without proper planning or an assessment of real needs.
• On the other hand, in the majority of the cases, there are no clear procedures to guide countries in making decisions on needs assessments or on internal coordination that would result in a more targeted request for external assistance. Therefore, it’s not only a problem of knowing how to donate, but also knowing how to request, so needs will match short-term and future offers of assistance.

A number of important initiatives already address these issues, developed by the international community (donors, development agencies and NGOs). Best practices as well as clear examples of what doesn’t work have been published, including:

• The Code of Conduct of the Red Cross and the NGOs for disaster response, approved in 1995, was a first attempt at a common position among nongovernmental actors to define and clarify ethical principles in humanitarian work. Online at:
  http://www.icrc.org/web/eng/siteeng0.nsf/htmlall/code-of-conduct-290296.
• The Sphere Project is another one of the first interagency efforts to develop standards to improve the efficiency and coordination of humanitarian response as well as the notion of working on behalf of the recipients of the assistance. www.sphereproject.org/spanish/manual/.
• In 2003, various bilateral donors, UN agencies and NGOs met in Stockholm for a workshop on "Good Practices in Humanitarian Donations" and agreed on principles and good practices. http://www.goodhumanitariandonorship.org/.
• In the health field, several initiatives stand out. As early as 1986, Latin American and Caribbean countries adopted a regional policy designed to improve the coordination of international humanitarian assistance in the health sector. PAHO/WHO later published ‘Humanitarian Assistance in the Event of Disasters, Guides for providing Effective Assistance,’ www.paho.org/Spanish/DD/PED/pedhum.htm. WHO, in collaboration with many large humanitarian agencies, published ‘Guidelines for drug donations’ and a consortium of NGOs is working to promote good practices in the donations of drugs (www.drugdonations.org/eng/eng_site_initiative.html).
• The Humanitarian Accountability Partnership (HAP - International)
  (http://hapinternational.org/default.aspx) is a more recent international initiative that promotes standards and norms to measure accountability and transparency in humanitarian action, always trying to provide the greatest benefit of the humanitarian assistance to the victims.

Although consensus on principles and standards already exists, it not be sufficiently well known or the standards uniformly applied.

What will this project do?

This is a complex problem with no single or global solution. Solving it will require improving awareness and changing attitudes and behaviors through repeated dissemination of the principles and good practices as well as lobbying and advocacy efforts. Therefore, this initiative will contribute technical information designed to influence the media and the key actors who intervene in these scenarios: donors and authorities in disaster-affected countries.

This is a pilot initiative that focuses on three target groups in a select number of countries: (1) national and international media, (2) embassies in donor countries and international organizations and (3) authorities in countries receiving aid, primarily ministries of foreign affairs, civil defense, ministries of health and others. The purpose is not to establish regulations or international standards, but to promote and disseminate practical guidelines to update or improve existing national guidelines and standards in this field.

Under this project, we will:

1. Develop a brief guide that summarizes general principles of donations in different sectors.
2. Create a public information kit on how to both provide and receive more effective donations. The kit would also contain experiences and document existing good practices. The kit will be available in electronic, rather than print format.
3. Create a web page www.saberdonar.info as a tool to disseminate and promote information.
4. Carry out a small pilot campaign to disseminate information through media outlets in Latin America, the web pages of humanitarian and risk management organizations and of risk management, and donor agencies.
5. Develop and hold four short public information and training workshops in Latin America and the Caribbean, bringing together national and international humanitarian actors and media (tentatively to be held in the Dominican Republic, Ecuador, Nicaragua and Peru).

Most of the dissemination of information and communication will take place electronically, via the Internet, through e-mail and on web pages, using new technologies and spaces available as people socialize or interact with each other throughout the web (through video and multimedia, You-Tube and similar pages).

Materials and messages will be developed taking into account already existing the progress, agreements, or international principles, but with a practical, didactic and operational slant.

The pilot campaign is slated to last until October 2008.

Partners

The issue of good donations is an issue common to a number of agencies and countries. It is recurrent and widespread in many emergencies and therefore requires an interagency, multidiscisplinary and participatory approach. To contribute to solving this problem, an interagency group was formed that shares the approach and the basic objectives of the campaign. Currently, the group ismade up of PAHO/WHO, INTERMON/OXFAM, PADRU/IFRC, IFRC, OCHA, UNICEF, WFP, CRID, The Communication Initiative and the Alas Foundation, with the support of AECID.