In collaboration with:

PAN AMERICAN HEALTH ORGANIZATION

WORLD HEALTH ORGANIZATION

Conclusions and Recommendations

Meeting on Evaluation of

Preparedness and Response to

Hurricanes Georges and Mitch

16-19 February 1999, Santo Domingo, Dominican Republic

Conclusions andRecommendations

Meeting on Evaluation of

Preparedness and Response to

Hurricanes Georges and Mitch

16-19 February 1999, Santo Domingo, Dominican Republic

PAN AMERICAN HEALTH ORGANIZATIONWORLD HEALTH ORGANIZATION

Washington, D.C., April, 1999

A publication of the Emergency Preparedness and Disaster Relief Coordination Program,PAHO/WHO.

The views expressed, the recommendations formulated, and the designations employed in thispublication do not necessarily reflect the current policies or opinions of the Pan AmericanHealth Organization or of its Member States.

The Pan American Health Organization welcomes requests for permission to reproduce ortranslate, in part or in full this publication. Applications and inquiries should be addressed tothe Emergency Preparedness and Disaster Relief Coordination Program, Pan American HealthOrganization, 525 Twenty-third Street, N.W., Washington, D.C. 20037, USA; fax (202) 775-4578; e-mail: disaster-publications@paho.org .

The meeting, and the production of this publication, have been made possible through thefinancial support of the International Humanitarian Assistance Division of the CanadianInternational Development Agency (IHA/CIDA), the Office of Foreign Disaster Assistance of theU.S. Agency for International Development (OFDA/AID), the Department for InternationalDevelopment of the U.K., the United Nations Children’s Fund (UNICEF), and the UnitedNations Office for the Coordination of Humanitarian Assistance (OCHA).

Also published in Spanish under the title: “Conclusiones y Recomendaciones—Reunión de Evaluación de los Preparativos y Respuesta a los HuracanesGeorges y Mitch”

ISBN 92 75 12263 6

PAHO Library Cataloguing in Publication Data

Meeting on Evaluation of Preparedness and Response to Hurricanes Georges andMitch, 16-19 February 1999, Santo Domingo, Dominican Republic. Conclusions andRecommendations. Washington, D.C., : PAHO, c1999. 37 p.--

ISBN 92 75 12263 6I. Pan American Health Organization, ed.1. DISASTER PLANNING - organization and administration.2. DISASTER WARNING. 3. INFORMATION SERVICES - utilization.4. HURRICANES (ENVIRONMENTAL HEALTH). 5. HEALTH EFFECTS OF DISASTERS.LC HV553

© Pan American Health Organization, 1999

A NOTE FROM THE EDITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

WELCOME MESSAGE (from the Director of the Pan American Health Organization). . . . . . . . . . . . . . . . . . . ix

CONCLUSIONS AND RECOMMENDATIONS

Early Warning Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Disaster Preparedness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Needs Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Damage Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Military and Civilian Coordination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Management of Information: Use of the Internet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Information Management: Public Information and Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Supply Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Environmental Impact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Emergency Medical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Communicable Disease Surveillance and Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Food and Water-Borne Illnesses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Vector-borne Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Water and Basic Sanitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Food and Nutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Psychosocial Aspects of Disaster Situations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Transition from the Emergency to Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

EVALUATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

ACRONYMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

I n d e x

v

vii

A N o t e f r o m t h e E d i t o r

More than 400 professionals from 48 countries met at this meeting to identify lessons learned with regard to thepreparedness for and response to two of the most devastating hurricanes of the last decades: Georges and Mitch.

The recommendations that follow in theses pages were drafted in 20 working group sessions that werecoordinated by one or several of the co-sponsoring international organizations: the Pan American Health Organization,UNICEF, the United Nations Development Program, the Office of Coordination for Humanitarian Affairs and the Secretariatof the International Decade for Natural Disaster Reduction.

In presenting these recommendations, we have maintained the original format of the meeting so that readerscan easily identify specific areas of interest. At the end of the document you will find a summary of the evaluation of themeeting made by the participants.

This document is available online at our website http://www.paho.org/english/ped/pedhome.htm. Click on thesection “Important Meetings.” You may download, copy and redistribute this document in its entirety from the Internet,but we ask that you cite the original source of the information.

Comments or requests for additional copies may be addressed to disaster-publications@paho.org.

W e l c o m e M e s s a g e

Mr. Chairman, Ladies and Gentlemen, first

let me thank you for coming to this meeting

that has been organized by us in close

collaboration with UNDP, OCHA, UNICEF and

IDNDR with generous support from the

Canadian, UK and USA development agencies. It

is always a pleasure to recognize our partners.

We have with us here today representatives

of a large number of agencies, institutions,

NGOs and private individuals. This cross section

of interests is a manifestation of a growing and irreversible trend. The really important issues of our time

cannot be dealt with solely by nations, agencies or individuals, even the most powerful ones. The

phenomenon of globalization is no longer restricted to economic or financial matters, it is now evoking

the wide participation of ranges and numbers of actors that would have been unthinkable a few decades

ago. In almost all aspects of our work we are looking to find the partners and interests that can bring

value to the management of the issue or the search for solutions, if definitive solutions can ever be found

to the really important human challenges.

Natural disasters have, for me, always represented a classic example of the imperative need to

involve multiple actors, or that multiple actors will, by the nature of the phenomenon, become involved. All

of us are moved by Good Samaritanism to respond to misfortune, and the outpouring of material response

to disasters is normal and natural. Various agencies have it within their mandate to respond to disasters

and many perhaps moved by institutional Good Samaritanism also find that they must do something to

help. It is in this light that I see the movement by various agencies to attempt to establish oversight

c o o rdinating roles in the Americas. This is perfectly understandable and laudable. And of course the

national governments must, of necessity, regard it as their constitutional responsibility to address the

material needs of their populations.

This meeting represents a forum for all of us to learn together how to prepare ourselves better to

help countries to be better prepared to deal with the next disaster. We all need to be better prepared to

understand that the natural hazards are beyond our control. We have still to accept how puny we are in

the face or presence of the awful power of nature. But it is not arrogance to affirm that we can limit the

ix

extent to which these natural hazards lead to disasters as well as the impact of the disaster itself. We can be better

prepared to respond to the disaster.

Sometimes I am asked why a public health agency like the Pan American Health Organization should be

programmatically involved in dealing with disasters. We have a long history of work in this area, as it was after the

major earthquake in Guatemala in 1976 that the countries of the Americas instructed us to establish a technical

cooperation program in the field. The experience of at least the last twenty years has strengthened my conviction of

the critical role of the health sector in relation to disasters. There is the immediate concern for the health of victims

and indeed after disasters this is usually the main focus of activity. We are concerned also with the damage to

health services and their capacity to prevent diseases that might arise.

But more and more as health is seen as a key development sector, we are paying attention to the need to

ensure that ill health does not impede the recovery process in its various dimensions. We therefore see our role as

being concerned not only with disaster relief but with the whole spectrum, ranging from mitigation through

preparation and prevention, to response, to development. In 1987, our Governing Bodies established the policy

basis for our program that covers all these aspects and determined the responsibilities of the various levels of the

Organization. The fact that this program is functionally attached to the office of the Assistant Director is an

indication of the importance I assign to our work in this field.

The recent disasters such as Georges, Mitch, El Niño and the devastating earthquake in Colombia have

really tested the preparedness of both the countries and the relevant agencies. That having been said, I do believe

that the level of preparedness and general awareness has increased significantly in the Americas as a whole and

definitely in the Caribbean and Central America. It is difficult to have quantitative proof, but the information from

some countries shows how preparedness and the functioning of the preset mechanisms prevented greater loss of

life after disasters. This has clearly been due to the activities of the countries, but here I would like to give some

credit to the regional efforts that have been so generously supported by the governments of Canada, USA, UK, France

and the European Community.

It is perhaps because of those advances that we should feel comfortable in participating in a careful

examination of whether disaster preparedness received the required attention from health and other sectors. Could

some of the consequences have been prevented? Was there optimum action and coordination by and among the

various agencies that were involved, and can the mechanisms for the coordination be strengthened? I include the

subregional agencies such as CDERA and CEPREDENAC in this category.

I am sure you will give attention to how the international goodwill can be channeled more effectively. You

will reflect on how it can fulfill some definitive purpose instead of contributing to confusion because it was not

solicited and did not respond to real needs. You will no doubt have the opportunity to examine the usefulness of

x

the supply management system, SUMA, and the extent to which it provided a mechanism for bringing some order to

the great quantity of supplies when they arrived. But beyond the immediate benefit, it provided national

governments with the kind of information that could ensure transparency in the management of the donations. It

was also useful to donors, in that they could see exactly how their material contributions were directed.

Unfortunately, I will not be able to stay for the whole seminar, so I will share with you some of the lessons I learned

as a result of the recent disasters. Many of them were not new and perhaps I should say that my beliefs were

strengthened, rather than that I learned anything new. I was impressed with the multiple tangible manifestations of

regional solidarity. This was a clear manifestation of the Panamericanism to which I, as an individual, and my

Organization are firmly wedded. Countries contributed according to their possibilities. Some such as Cuba and

Mexico provided health personnel, some supplied money, and many provided equipment and critical supplies.

It was brought home to me very clearly that information played a key role in the response. The Internet is

now a major medium that has to be recognized in disaster management. It is for this reason that PAHO was quick

to establish a website that was a source of credible information during the immediate post disaster phase. I am

sure you will discuss the problem of misinformation and what if anything one can do to limit it.

This is not a specific point to be discussed in your meeting, but it was a concern that kept recurring to me

during my very brief visit to the countries most affected by hurricane Mitch. Those persons who lost the most had

the least to lose. Those houses that were destroyed were often those that belonged to the poorest, and the death toll

was highest among the poor. Indeed, the ill consequences of the disasters are often in direct relation to the degree

of social inequity. We are concerned with inequity in health outcomes, but inequity in other areas shows its face to

us at every turn and must surely be a constant cause of concern to those of us who are concerned with human

development in its broad sense.

We look forward to the results of this meeting, the frank and open discussions that have as their sole

purpose the improvement of our capacity to help our countries improve their capacity to prepare themselves to

confront the inevitable natural hazards. This meeting will not address directly the phase of reconstruction, but all

of us will surely be hoping that the countries that have been devastated by the hurricanes will not be forgotten once

the faces of their people have passed from the world's television screens. The reconstruction must take account of

the need to reduce the vulnerability of our people and their places to disaster.

I look forward to the report you will prepare and I wish to assure you of the commitment of the Pan

American Health Organization to continue to work with you in the implementation of the recommendations you

will make.

George A.O. Alleyne

Director, Pan American Health Organization

xi

in reviewing the function of early warningsystems during Hurricanes Mitch andGeorges, recognized that:◆ Early warning is a process, not a single

activity, and participants in the processmust include a broad, cross-section ofsociety. Although the diversity of thisparticipation should be consideredpositive, frequently national and localcoordination of the early warningprocess is not always adequate.

◆ The prediction and monitoring ofhazards require access to infrastructureand expertise that is not universallyshared or accessible to all communitiesthat may be vulnerable.

◆ A national government has the sovereignright and responsibility to issue timelywarnings when it is determined, throughscientific and other expert means, thatsegments of its population are at risk.When no authoritative source ofinformation exists, persons may act onincorrect or misleading information thatcan lead to confusion and loss of lifeand livelihood.

◆ Pre-disaster planning, including thedevelopment and testing of warningsystems, only can be effective ifvulnerable populations are able toincorporate such systems into a routineprocess of their daily lives.

E a r l y W a r n i n g S y s t e m s

The prediction and

monitoring of hazards

requires access to

infrastructure and expertise

that is not universally shared

or accessible to all

communities that may be

vulnerable.

1

The Participants,

2

The Recommendations

◆ Planning for implementation of earlywarning is critical at the local, national,and international levels and mustinclude all of the potential participantsin the warning process. UN agencies andother regional institutions shouldprovide technical assistance in thedevelopment and testing of such plansthrough the development of sampleplans and models.

◆ A single national agency should beresponsible for providing integrationand cooperation among all parties withinterests in early warning. These partiesshould include individuals and groupsin vulnerable communities.

◆ National governments are responsible forissuing timely public warnings whenreliable, accurate information of animpending event becomes available.Governments must identify a single source

for issuing such information andwarnings. This information should bedistributed using all available mediaincluding radio, television, newspapers,and the Internet.

◆ Local communities must be madefamiliar with the hazards to which theyare exposed and assist in building thelocal capacity for interpreting earlywarning and taking appropriate actionto increase the safety of persons andensuring the availability of essentialresources.

in reviewing disaster preparedness andresponse to Hurricanes Georges and Mitch,recognized that:◆ In order to minimize the effects of

natural disasters, it is imperative that at-risk countries have the permanent,professional institutional capacity fordisaster preparedness as part of adisaster management program.

◆ At-risk communities are the first torespond in a crisis, and thesepopulations should be the focus onefforts to create a disaster managementcapacity. However, little has been doneto increase the ability of communities toprotect their own lives and property.

◆ Communication media play an essentialinstructive role in disaster preparednessand response.

◆ In countries vulnerable to naturalhazards, disaster preparedness,mitigation, and prevention should be away of life.

D i s a s t e r P r e p a r e d n e s s

3

At-risk communities are the

first to respond in a crisis, and

these populations should be

the focus on efforts to create a

disaster management capacity.

However, little has been done

to increase the ability of

communities to protect their

own lives and property.

The Participants,

4

The Recommendations

1. Creation and strengthening ofcapacityThere should be comprehensive training

programs directed at all levels(communities, local and centralgovernments, the private sector, NGOs andgrass-roots organizations) in the followingareas:◆ All aspects of disaster preparedness as

an approach to reducing the impact ofdisasters.

◆ Information management.◆ Coordination.◆ A number of simple disaster

preparedness measures can beimplemented with the support of centraland local governments. Such measuresshould receive special attention indevelopment and training.

2. Community awareness:organization and trainingAll organizations and institutions

should:◆ Promote better community organization

as the basis for improving disasterresponse at the local level.

◆ Help organizations at the local level toimprove capacity, conduct immediateneeds assessment after a disaster, andidentify, using simple methods, localhazards and vulnerability.

◆ Assist local authorities to develop theirdisaster preparedness plans withcommunity involvement, followed bysimulation exercises.

3. Information managementCommunication media should be aware

of their influence and role in publicawareness, and should assist in improvingthe population’s ability to prepare for andprevent disasters. For example: ◆ In broadcasting warnings, the media

should not only report on the eventstaking place, but should provideinformation on what actions thepopulation should take.

◆ The media should ensure that thelanguage used in messages areunderstood by the majority of thepopulation.

◆ Policy- and decision-makers should alsobe made aware of the need to producereliable technical information.

4. Creating a “culture” of disasterpreparedness and mitigationThere should be a multisectoral and

inter-institutional focus on disasterpreparedness, mitigation, and prevention,with special emphasis on the education andhealth sectors. Both the formal and informaleducation systems can change attitudes aboutthe environment as it relates to hazards andrisk.

recognized that:◆ The objective of needs assessment is to

mobilize funds, collect the necessarymaterials and supplies to assist disaster-affected populations, ensure rapidrehabilitation of basic services, and planfuture action. Governments and localstructures must be involved at all times forthe needs assessment process to be usefuland relevant.

◆ There is a need to standardize an easy-to-use, sectoral format for immediateemergency needs assessment, therebyavoiding duplications in output. Thisformat should be made available to allconcerned, and presented in a way that iseasily understood by all parties.

◆ On-site coordination of needs assessmentis essential for the process to be reliable.

In reviewing the experiences of HurricanesGeorges and Mitch, the participants alsorecognized the following problems:◆ There was no single focal point for data

coordination. Several organizations wereassigned this task, but there was nouniversally accepted mandate or authority,generally because of difficulty in accessing

adequate resources.◆ Collected information on needs was not

always fed back to affected populations.◆ Although some tools are available for needs

assessment, they either have not been testedor have not been universally accepted.There is a significant need for scientificmethods and evaluation of this topic.

◆ Needs assessments made by the mediaoften are not accurate reflections of thesituation, and confuse the internationaldonor community.

◆ Needs assessment exercises sometimes canbe manipulated to serve personal orpolitical interests.

◆ Local governments and communityorganizations involved in disaster responseexpressed frustration with the lack ofcoordination and the multiple externalactors undertaking needs assessment.Local organizations were oftenoverwhelmed by the situation and unableto undertake the task themselves.

◆ There is confusion between the objectivesof immediate needs assessments and thoseof damage assessment relating to mid- orlong-term recovery activities.

N e e d s A s s e s s m e n t

5

The objective of needs

assessment is to mobilize

funds, collect the necessary

materials and supplies to

assist disaster- a f f e c t e d

populations, ensure rapid

rehabilitation of basic services,

and plan future action.The Participants,

6

The Recommendations

◆ The governments and local authoritiesmust ensure that the international donorcommunity’s response is based onreliable and verified needs assessments.

◆ Whenever possible, needs assessmentshould take place at the local level, aspart of a structured official emergencymanagement system. Governmentsshould be supported in strengthening orcreating such systems, and beresponsible for providing suitabletraining, information and tools tocommunity organizations.

◆ Governments should develop and test,with the technical support ofinternational agencies, standardizedmethods and procedures to ensure thatneeds assessments are timely, accurate,and objectively applied. The rapidresponse needs assessment conceptemployed by the UNDAC or USAID/OFDADisaster Response Teams (DARTs)might be adopted by governments.

◆ U.N. agencies and donor governmentsshould apply a “lead agency” concept toneeds assessment. The results of rapidneeds assessments undertaken byexternal actors must be transferred togovernments and sectoral institutions,which should assume full responsibilityfor mid- and long-term responses.

◆ The official local organization fordisaster response, as designated innational emergency plans, shouldprovide coordination at the local levelbetween the international and nationalsearch and rescue and needsassessment teams. If this mechanism isnot available, the OCHA On-SiteOperations Coordination Centre(OSOCC) or UNDAC teams could beused for this purpose.

◆ Radio communications should be usedextensively to supply and collectinformation from affected communities.

in reviewing damage assessment conducted inthe aftermath of Hurricanes Georges andMitch, recognized that:◆ Governments are eager to receive

damage assessments conducted by theU.N. Economic Commission for LatinAmerica and the Caribbean (ECLAC) andother organizations rapidly, in order touse these data to procure resources forrehabilitation and reconstruction.However, international assessmentmissions (particularly in the case ofECLAC) must wait for the appropriatetime to move into affected countries,which may imply a delay of four ormore weeks. Assessing damage causedby hurricanes cannot be initiated untilthe emergency phase ends.

◆ Often the local communities do notunderstand that reconstruction activitiesdo not depend upon ECLAC assessments,but instead depend upon the resourcesobtained though loans from bilateraland international organizations.

◆ The social and environmental sectorshave difficulty obtaining funds due totheir low visibility and because ofproblems associated with themethodologies used to calculate theindirect costs in these sectors.Confusion exists in the countriesregarding the difference betweenobjectives of immediate needsassessment and damage assessment.

D a m a g e A s s e s s m e n t

7

Governments should be aware

that they have the sovereign

responsibility for sectoral

damage assessments and for

decisions on projects and

financing sources for

reconstruction strategies.

The ParticipantsThe Participants,

8

The Recommendations

◆ Governments should be aware that theyhave the sovereign responsibility forsectoral damage assessments and fordecisions on projects and financingsources for reconstruction strategies.

◆ Governments and civil society should,with the support of internationalorganizations and of ECLAC inparticular, work in the revision andadoption of unified damage assessmentmethodologies for estimating indirectcosts to social, environmental, and otherinformal sectors.

◆ Governments and communities shoulddocument experiences obtained indisaster management in the aftermath ofHurricanes Georges and Mitch in orderto provide feedback to ECLAC and otherorganizations conducting damageassessment, thereby favoring thepredictability of the next event andreducing vulnerability.

◆ Communities must be aware that thedamage assessment conducted by ECLACand others are instruments used toconsolidate information for theGovernment, and to assist decision-makers in prioritizing reconstructionactivities.

in reviewing the coordination of response toHurricanes Mitch and Georges, recognized:◆ Often, agencies work in an independent,

uncoordinated manner, resulting indelays in the provision of effectiveassistance. In such operations, efficiencyfor the overall operation may be lostand costs may increase.

◆ Lack of information or inaccurateinformation impairs coordination orrenders it ineffective, inefficient, and morec o s t l y. Information is the key tocoordination. It must be accurate,credible, and reliable. It also provides thebasis for funding.

◆ Often, communities and the civil societyare not involved in pre-planning. Thisimpairs coordination of activitiesbetween the national coordinatinginstitution and local communities duringa disaster.

◆ Coordination by a single, nationalinstitution should strengthen theGovernment’s capacity to reach outsidethe disaster area and is essential forestablishing links with on-site actors.

C o o r d i n a t i o n

9

Often, communities and the

civil society are not involved

in pre-planning. This impairs

coordination of activities

between the national

coordinating institution and

local communities during a

disaster.

The Participants,

10

The Recommendations

◆ All disaster planning and responseactivities should be coordinated througha single, national institution. Evaluationresearch should be conducted toidentify the effects of uncoordinatedactivities.

◆ Information systems must be developedand implemented at the national levelthat link the communities with thenational coordinating institution.Assistance should be provided by theinternational community and donororganizations. Such systems mustgenerate information that is appropriatefor use in coordination of activities andfund raising, and therefore, should bemodel driven. Such tools should bedeveloped by the appropriate UN orother agencies and tested and refined atthe national level.

◆ Coordination is a continuous processinvolving all actors at all levels on adaily basis.

◆ Governments should utilize alreadyexisting regional and sub-regionalorganizations for technical and logisticssupport.

◆ The management of information as wellas the coordination of the UN system’sresponse to disasters at country level isled by the United Nations ResidentCoordinator who in this capacity reportsto the United Nations Emergency ReliefCoordinator. The U.N. Office for theCoordination of Humanitarian Affairs(OCHA) must improve the quality of thesituation reports sent to donors, sincethe donor organizations rely on them tomake funding decisions. They should bebased on accurate data provided by thenational coordinating institution.

regarding military and civilian coordinationof response activities, recognized that:◆ At times, the military seems of two

minds: 1) not sure whetherhumanitarian initiatives are good fortraining, morale, and public relations; or2) whether the humanitarian initiativesdistract from its primary mission.

◆ Lack of knowledge about the missionand the institutional/organizationalculture of military and humanitarianagencies frequently hampers goodcommunications, which are necessaryfor effective preparedness planning andoperational coordination during timesof disaster.

◆ There are three groups of players: 1)national military and defense forces; 2)international military; and 3) local,

national, and international civilianhumanitarian organizations. It often isthe case that there is little coordinationbetween these groups duringhumanitarian response initiatives. Thisoften results in ineffective or discordantrelations during the stressful periods ofdisaster response.

◆ Protocols for military humanitarianinitiatives may be established by civilianand political authorities and, when thisis the case, the military only can engageso far as their terms of engagementprovide. Another complication may bethat in some countries, armed forces’involvement in humanitarian initiativestraditionally has not involved the civiliansociety.

M i l i t a r y a n d C i v i l i a n C o o r d i n a t i o n

11

Both the military and civilian

humanitarian communities

must educate themselves

about each other’s culture,

mission, and methods of

operation.

The Participants,

12

The Recommendations

◆ Rules of humanitarian engagementshould be defined as clearly as are therules of military engagement. Theguidelines on the Use of Military andCivil Defence Assets in Disaster Relief(reviewed and developed at theinternational Conference in Oslo in1994) are in this regard the appropriatereference.

◆ Both the military and civilianhumanitarian communities must educatethemselves about each other’s culture,mission, and methods of operation.Such educational efforts should not bereserved for on-the-job training. Thelearning process requires constantcommunication and exchange, not justduring disaster response, but throughcollaborative preparedness and jointtraining efforts involving all levels ofboth communities in order to ensuresuccess in times of great need.

◆ Regular mechanisms must be developedand institutionalized to provide forcoordination in pre-disaster planningand cooperation within each group andbetween groups. Each of the actorsplanning to take part in humanitarianinterventions must be willing tocoordinate with their counterparts inother sectors.

◆ Politicians and legislators must bebrought into the process of determiningthe extent to which military forces canbecome involved. These legislators mustbe educated so that they are conversantwith the issues. As laws and the resultingprotocols of engagement are betterdefined and understood, there shouldbe better opportunities for cooperationwith civilian operations, includingpreparedness and training.

in reviewing the successes and obstaclesrelated to Internet use following HurricanesGeorges and Mitch, concluded:◆ The Internet, and particularly the use of

electronic mail and the World Wide Web(including databases, text and graphicsfiles), has become an important part ofmost day-to-day business applications,and disaster management is noexception. It has also contributed toreshaping the traditional relationshipsamong humanitarian actors in terms ofthe collection and management of dataand the production and use ofinformation.

◆ There was a substantial increase in theuse of Internet for early warningpurposes to track the progress ofHurricanes Georges and Mitch.

◆ The Internet made it easier and muchquicker to gather and publish

information on disasters and to consultand receive answers to technicalquestions from peer groups(practitioners).

◆ Decision making in many aspects and inall phases of disaster management hasbeen enhanced by using the Internet asa coordination tool.

◆ In some instances, the unrestricted natureof the Internet led to the distortion ofinformation on traditional scientificconcepts. For example, there was aproliferation of rumors andmisinformation on epidemiological issues.

◆ There can be problems with confid e n t i a l i t y,impartiality and the way information isused, which may make sources ofinformation reluctant to share it.

◆ Information management is labor-intensive. The Internet doesn’t solve this,and may contribute to it!

M a n a g e m e n t o f I n f o r m a t i o n :U s e o f t h e I n t e r n e t

13

Decision making in many

aspects and in all phases of

disaster management has

been enhanced by using the

Internet as a coordination

tool.

The Participants,

14

The Recommendations

◆ Time lapses can occur in updating andposting disaster informationelectronically (sometimes because ofrequired clearance process). However,the inverse can also cause problems.Sometimes the speed with whichinformation is produced contributes toinaccuracies.

◆ Information overload, duplication ofinformation, gaps, and formatincompatibilities occur.

◆ It was difficult to determine thecredibility of much of the informationproduced in the immediate aftermath ofthe disasters.

◆ Technological constraints, the high costsof telecommunications services, andlanguage are still barriers to theequitable access to Internet.

◆ While Internet changed the wayinformation was traditionally used, it alsohighlighted the need to preserve andarchive valuable information related tothe disaster. How do we preserve a long-term memory of what has occurred?

◆ As a preparedness measure, the successof building trusted networks or“communities” (inter- and intra-country) of agencies lies in theestablishment of these links prior todisasters. These networks should becreated and improved.

◆ To improve the quality of informationand to avoid redundancy, selectiveInternet discussion lists should bedeveloped. Information posted, eitherthrough “listservs” or on the Web,should have an added value, i.e., theinformation should be previouslyanalyzed and presented in a user-friendly way.

◆ The preoccupation with the rapidposting of information should bebalanced with necessary attention todetail and credibility of the information.

◆ To ensure the continuous access toInternet during and after a disaster,contingency plans need to includetelecommunications, power backup, etc.

◆ Users and producers of informationmust be responsible for using newtechnologies that allow them to meettheir customized needs.

◆ Preserving long-term institutionalmemory is not a matter of technology.This already exists. It is a matter ofhuman and financial resources andpolitical will.

◆ The link between on-line informationand the decision-making process shouldbe fully evaluated. So should the policiesof national authorities regarding accessto and use of Internet by all sectors ofthe disaster community.

◆ Providers of information should betrained to obtain the best results of thenew technology.

in discussing the role of local andinternational public information offices andthe mass media during emergencies anddisasters, and more specifically, thedissemination of information on disasters, therole of governments in providing informationto reporters, and how collaboration canbenefit affected populations, noted thefollowing:◆ Citing their experiences during Mitch,

described the massive confusion andhardships faced by local reporters ingetting the story of what was happening.They indicated that it was very difficultgetting information from governmentsources.

◆ Pointed out the perceived failure of earlywarning by national authorities, and theneed to constantly keep in contact withmeteorological services.

◆ The importance of media coverage inthe affected countries was debated, as away to increase ‘sympathy’ and heightenthe possibilities of receivinginternational assistance.

◆ Noted that the media, at theinternational level, also disseminatedrumors and incorrect information onimmediate needs after the disaster, andon health aspects such as epidemics.

◆ Differences were pointed out betweennational and international media interms of their methods in coveringdisaster stories, and the effect they hadon the affected countries and on thepotential ‘donor’ countries.

◆ Pointed out that it would be desirable totrain national and internationalreporters in disaster-related issues.

◆ A series of specific, short-term measures

P u b l i c I n f o r m a t i o n a n d M a s s M e d i a

15

A series of specific, short-term

measures should be taken to

improve the working

relationships between the

government and the media,

and to enhance the

effectiveness of the media

both in the early warning

stage and in the

dissemination of information

during disasters.

The ParticipantsThe Participants,

16

The Recommendations

should be taken to improve the workingrelationships between the governmentand the media, and to enhance theeffectiveness of the media both in theearly warning stage and in thedissemination of information duringdisasters.

◆ Underscored the difficulties of the locallevels in accessing some of the moremodern communications systems, andthe problems this generates in crucialtimes such as when a warning isdeclared, and in information gatheringon damages and immediate needs.

◆ Training journalists on issues related todisasters through short and well-designed courses on critical aspects,given by universities and nationalorganizations responsible for disastersituations.

◆ With the support of internationalorganizations and NGOs, traingovernment officials, community leadersand disaster management expertsspecifically on the appropriate relationswith the media before, during and aftera disaster.

◆ Include the mechanisms for generatingand disseminating official information tothe media in emergency plans at thelocal and national levels.

◆ The local levels should have the mostappropriate resources and informationchannels available, such as access toInternet and the traditional radio.International organizations and NGOsshould support local governments andsectoral institutions in the acquisitionand handling of radio communicationnetworks.

◆ For international journalists coveringdisasters, who are not easily identifiablein advance given the unpredictability ofinternational coverage, best practicesfor the emergency preparedness sectorsinvolve having easily accessibleinformation available at the national andinternational levels. This implies trainingas noted above, and perhaps a moreprominent role for PAHO and fornational disaster coordinators in thedissemination of information in disastersituations. The possibility of additionalfunding for this could be explored.

identified the following problems:◆ The countries exhibited the political will

to manage the resources withtransparency and to provide efficientaccountability for those affected.However, timely support for supplymanagement operations was not alwaysprovided, e.g., in areas of institutionalcoordination, customs support,transportation, human resources, andlogistics. Some public and privateinstitutions such as ministries andnongovernmental organizations did notshare information on the status of theirsupplies.

◆ Requests for international support insupply management were made too latein some cases, and were not made at allin others.

◆ In some cases, the donations did nothave the intended value either for therecipient or the donor.

◆ As time passed, many difficulties wereencountered in many places indisseminating the information gatheredabout humanitarian supplies, resultingin duplications and inconsistencies inrequests made to the donor communityand in updating data in the lists ofneeds.

◆ Personnel with prior training in supplymanagement, who form the foundationfor the proper functioning of the system,often were not available to assist at thetime of the emergency.

S u p p l y M a n a g e m e n t

17

Coordination mechanisms for

an integral development of

the activities involved in

supply management must be

incorporated into sectoral and

national emergency plans.

The Participants,

18

The Recommendations

◆ Coordination mechanisms for anintegral development of the activitiesinvolved in supply management must beincorporated into sectoral and nationalemergency plans, with activeparticipation of national academiccenters and other public and privateinstitutions.

◆ The national disaster organizationsresponsible for coordination of the useand distribution of supplies shouldpromote the use of SUMA or othersupply management systems asevidenced by the need to ensuretransparency and accountability. Theseorganizations should also strengthen theinter-country operational teams as afirst-response resource in majordisaster situations.

◆ All United Nations agencies and otherinternational organizations should traintheir personnel in the integralmanagement of supplies, both beforeand after the occurrence of a disaster.

◆ PAHO/WHO should promote theavailability of frequently updated andtransparent information systems abouthumanitarian supplies on the Internet.

◆ The UN system should provide clear andprecise information to donors and themedia about the needs of the affectedpopulation.

◆ Countries should adopt therecommendations of the World HealthOrganization regarding donations ofmedical supplies and equipment, andthe list of emergency medicines as aregional standard.

in assessing the environmental impact ofHurricanes Georges and Mitch,acknowledged that:◆ The frequency and intensity of disasters

are linked to environmentaldegradation. Among the factors mostresponsible are lack of land useplanning, deforestation, currentproduction systems, and patterns ofconsumption.

◆ Development cannot be disassociatedfrom the reduction of vulnerability,disaster prevention, and mitigation ofenvironmental degradation.

◆ Environmental quality and safety areuniversal, inalienable rights, and it is theobligation of authorities and society toguarantee these rights. Civil societyshould be made aware of and take

responsibility for their rights andobligations.

◆ Local government has an important rolein the management of natural resources,the prevention of disasters, andappropriation of financial,technological, and human resources.

◆ Suitable water resource managementprovides cohesion of organization at thecommunity level and should be used forsustainable management of naturalresources, thereby reducingvulnerability in the Region.

◆ Important institutional advances havebeen achieved, but improvement isneeded in transparency, efficiency, andprofessionalism in government agencies.

E n v i r o n m e n t a l I m p a c t

19

The frequency and intensity

of disasters are linked to

environmental degradation.

Among the factors most

responsible are lack of land

use planning, deforestation,

current production systems,

and patterns of consumption.

The ParticipantsThe Participants,

20

The Recommendations

◆ A directive regarding the environmentalimpacts of natural disasters that isaccessible and binding must bedeveloped for policy makers.

◆ Disaster prevention and environmentalissues should be included in thedevelopment agenda of the countries,with the aim of converting them to Statepolicy. The agenda should be holistic,encompassing economic and socialthemes, and have a strong scientificfoundation. Solutions should focus oncultural realities.

◆ Effective mechanisms for disasterpreparedness, mitigation, andprevention should be developed amongdifferent strata of civil society, within theGovernment, and include the indigenouscommunity.

◆ There should be improved and morerapid implementation of environmentallegislation (norms, regulations, andcodes) and measures for financing.

◆ Programs should be promoted fornational, formal, and informalenvironmental education as part of theprocess of developing a culture ofdisaster prevention and environmentalprotection.

◆ Promotion and training of communityorganizations in the management oflocal resources should be encouraged.

◆ Alternative forms of renewable energy(hydro, solar, wind, etc.) should besupported.

◆ The availability of appropriatetechnology should be considered andincorporated into national fire-controlprograms and programs aimed atrehabilitating production systems ofrural populations.

◆ In the process of rehabilitation andreconstruction, international financingagencies should ensure that there is aclear demonstration of natural resourceprotection (water, soil, air, and energy)and vulnerability reduction.

in reviewing aspects of emergency medicalcare following Hurricanes Georges and Mitch,recognized the following:◆ Emergency medical care was frequently

very difficult to accomplish following theimpact of the hurricanes, especially inthose communities that were difficult toreach. In these communities, thepopulation mobilized itself to conductsearch and rescue and first aid for theinjured until medical personnel arrived.

◆ While efforts have been made in theplanning, training, and organization ofinstitutional medical care in cases ofdisasters, these activities are still beingimplemented without the participationof or coordination among various local,regional, and national institutions, andwith inadequate use of the limitedavailable resources.

◆ It was observed that the emergencymedical care required during theimmediate post-impact phase was

provided at the local level, through themobilization of medical teams at theregional and central levels from theaffected countries themselves, and fromforeign medical brigades. Frequently, thesebrigades require logistic and technicalsupport from the affected countries, whichplaces another burden on the healthinstitutions during the most critical phaseof response. However, in the medium-term, the cooperation of foreign healthpersonnel who respond to needs that havebeen clearly defined by the affectedgovernment often turns out to be veryuseful.

◆ It was observed that field hospitals,which, in addition to their highinstallation costs and the fact that theyrarely respond to local needs, take toolong to begin functioning. This results inu n d e r-utilization of the existing healthservices and the creation of falseexpectations in the affected communities.

E m e r g e n c y M e d i c a l C a r e

21

National health and education

authorities should strengthen

basic training on search and

rescue, first aid, and integral

disaster management at the

community level and the

primary, secondary, and

university levels of education.

The Participants,

22

The Recommendations

◆ National health and educationauthorities should strengthen basictraining on search and rescue, first aid,and integral disaster management at thecommunity level and the primary,secondary, and university levels ofeducation. Exchanges should befacilitated among the community,technical, and political sectors.

◆ Health authorities, together with otherinstitutions of the sector, and with thecooperation of PAHO/WHO, shouldstrengthen the development,dissemination, and implementation ofcontingency plans that define the preciseparticipation of each of the actors,linking primary health care withemergency hospital care.

◆ Countries and organizations should sendmedical brigades or health personnelonly at the request of the affectedcountry. The assistance provided mustinclude sufficient logistic and technicalcomponents for these personnel to carryout activities under the coordination ofhealth authorities, taking advantage ofPAHO/WHO experiences.

◆ Field hospitals, if requested by thehealth authorities, should be installed inappropriate locations and becoordinated and managed by localhealth authorities, regardless of whetherthe facility’s origin is local or foreign.

in reviewing communicable diseasesurveillance and control, recognized thefollowing:◆ Instruments for detection of events,

shelter identification and number ofpeople in them, number of deaths, andhealth service conditions were designedduring the emergency. Informationobtained from medical records andn o t i fications often did not agree. This wastrue especially for shelters. In addition,d i f ficulties were encountered in obtainingepidemiological surveillance informationfrom medical files. Epidemiology teamsalso collected information pertaining todamages and needs.

◆ Bulletins were the most frequently usedmechanism for the dissemination ofinformation. They were distributed atdifferent times, and attempted tosystematize the information received. Theinformation needs varied among countries.

◆ Initial efforts often were very broad. Thegreatest problems were encountered inthe shelters during the first few daysfollowing the events.

◆ Because surveillance information wasinadequate prior to the events, there wasd i f ficulty separating disease frequencybetween the pre- and post-event periods.The actual changes associated with theevent could not be accurately calculated.

◆ Some medical brigades from othercountries were not coordinated by thenational coordinating institution, were notgiven orientation, and hence, applied cased e finitions used in their countries of originrather than those used in the region.

◆ Pressure was exerted to use vaccines notincluded in the basic immunizationschemes. Adequate supplies of tetanustoxoid and anti-meningococcus vaccinesoften were not available at the local levels.

C o m m u n i c a b l e D i s e a s e S u r v e i l l a n c e a n d C o n t r o l

23

Vaccines that are not included

in basic immunization

schemes should not be sent

without pre-approval by the

national coordinating

institution. The basic

immunization scheme of the

country should not be broken.

The Participants,

24

The Recommendations

◆ Instruments for data collection during adisaster should be prepared andstandardized by PAHO/WHO prior to thed i s a s t e r. During a disaster, medicalrecords must be available forepidemiological surveillance. During thefirst days of the disaster, surveillanceefforts should focus on shelters and leaveroutine notification for a secondo p p o r t u n i t y. Assessments should includem o d i fied risks, e.g., shelters, ecosystems,and the epidemiological context.

◆ Coordination among different sectors inthe exchange of information is essential.Methodologies and information should becoordinated between existing laboratoriesin other sectors, such as agriculture, andat the national level in transferringlaboratory techniques and reagents.

◆ Epidemiological standards should bedeveloped for shelters.

◆ The mass media should be utilized tokeep people informed about the statusof communicable disease occurrenceand control.

◆ The system must allow for classificationsof deaths caused directly by the disaster.

◆ Other establishments , e.g., industries,occupational health, and the privatesector, must be integrated into theinformation network for surveillance.

◆ The goal of surveillance is to assistdecision-making at the local level.Community participation should bestrengthened within the surveillancesystems. Routine surveillance systemsshould not be substituted, but instead beadapted in disaster situations. Whensyndrome notification is used forsurveillance input, a laboratorydiagnostic confirmation isrecommended. Surveillance systems andlaboratory diagnosis capacities shouldbe enhanced. Epidemic surveillance

systems should be adjusted according tothe existing health profile; thus, anaccurate and current pre-event healthprofile must be available.

◆ The country receiving foreign medicalbrigades must define potential risk fordiseases that can be introduced bypersonnel from other countries (e.g., non-existence of dengue-3 in the DominicanRepublic). Medical brigades from NGOsand other agencies that support areas notcovered by an official service must provideinformation on morbidity and mortality andsurveillance actions taken in the country.Each country must orient incomingmedical teams or brigades to the country’sestablished surveillance systems andexisting vaccination schemes. Informationalbulletins could serve this purpose.

◆ The regional resource center forcommunicable diseases (PAHO/WHO)should establish uniform casedefinitions for surveillance activities andmechanisms for laboratory confirmationof cases for the entire Region. It shouldmaintain strategic reserves ofappropriate vaccines. All countriesshould adopt these case definitions.

◆ Vaccines that are not included in thebasic immunization schemes should notbe sent without pre-approval by thenational coordinating institution. Thebasic immunization scheme of thecountry should not be broken. Toreduce pressure on certain vaccines it isrecommended that health education bestrengthened, particularly regarding acountry’s basic immunization scheme.Adequate supplies of tetanus toxoidshould be available for administration topersons working during the phase ofdebris removal and reconstruction.

recognized the following issues:◆ Cholera is endemic to Central America.◆ The presence of enteric illnesses and

particularly cholera is a manifestation ofsocial deterioration.

◆ The region has established clinicaldefinition of cholera.

◆ During and after Hurricane Mitch,cholera was observed in relation tocross-border migrations.

◆ Damage to sewage networks by thehurricane resulted in contamination dueto the mixture of waste and drinkingwater.

◆ In the most remote areas wherecommunities do not have access tohealth services, there was a shortage ofinformation on prevention of diarrhealdiseases.

◆ There are cultural problems inaccepting the taste of chlorine in watersupply.

◆ There is little confidence in informationprovided by public services. There is aperception that inaccurate informationis provided for economic and politicalreasons.

◆ Public policy and social spending in thecountries have not been directed to thepopulation at greatest risk;

◆ Many donated and stored foods wereeither rejected or disposed of becauseof their expiration dates or due todeficiencies in transportation andstorage.

◆ Epidemiologically, cholera should beviewed in the context of enteric diseasesand not independently.

F o o d a n d W a t e r - B o r n e I l l n e s s e s

25

Oral cholera vaccines

recommnedad by WHO are not

yet ready to be used in the

countries of the Region.

Vaccine cost limits access in

the countries, its efficacy is

not known in endemic areas,

and it is not recommended for

use in disaster situations.

The Participants,

26

The Recommendations

◆ Oral cholera vaccines recommended byWHO are not yet ready to be used in thecountries of the Region. Vaccine costlimits access in the countries, its efficacyis not known in endemic areas, and it isnot recommended for use in disaster

situations. Measures taken to improvebasic sanitation services and communityeducation have proven theireffectiveness in the prevention of foodand water-borne illnesses.

◆ Considering that food and water-borneillnesses, in particular cholera, resultfrom deficiencies in humandevelopment, the working group callson governments to focus their publicpolicy and public spending on povertyissues, in particular on providing basicsanitation and drinking water services tothe least advantaged populations.

◆ Governments should strengthen theirNational Emergency and DisasterCommissions with multidisciplinaryhealth teams that maintain ongoingprograms and evaluations forimplementing emergency plans.

◆ Governments, with the participation ofinternational agencies, NGOs, and civilsociety should cooperate in establishinga permanent strategic plan (comprisingpre-disaster activities) using the supportservices offered by different agencies.

◆ Strengthened surveillance systemsshould be optimized for the control offood and water in the countries of theRegion.

◆ Diagnostic laboratories should bestrengthened; efforts should be made toensure that surveillance includesmonitoring resistance to antibiotics.

◆ Areas with the most vulnerablepopulations and those at greatest risk todisasters should be given priority.

◆ Infrastructure for adequate shelters withbasic services should be established toavoid problems resulting fromimprovisation in disaster situations.

◆ Neighboring countries should establishan ongoing exchange of informationsystems on diarrheal diseases (before,during, and after disasters).

◆ There should be promotion forintegrating health services into borderactivities for control measures.

◆ Owing to the impact of the exchange ofinformation about cholera cases inborder areas, it is recommended thatnotification be given regarding diarrhealdiseases in general.

◆ Community education on prevention ofdiarrheal diseases should beimplemented with the support of NGOs.

based on the experiences of HurricanesGeorges and Mitch, concluded that:◆ To reduce the impact of vector-borne

disease it is essential to activate theepidemiological surveillance systemprior to the onset of a natural disaster.

◆ The analysis of the level of preparednessin countries regarding thedecentralization process of malariaprograms revealed that greater socialparticipation is needed. This is best

carried out in phases, givingcommunities the opportunity to takeresponsibility in solving problems.

◆ At the time of the Conference, there hadnot been an increase in vector-bornediseases in the countries affected by thehurricanes. This can be explained by thebehavior of the phenomena as well as bythe immediate action taken to controlvector breeding sites.

V e c t o r - B o r n e D i s e a s e s

27

To reduce the impact of

vector-borne disease it is

essential to activate the

epidemiological surveillance

system prior to the onset of a

natural disaster.

The Participants,

28

The Recommendations

◆ Each country, depending on itsepidemiological situation, should takepertinent disease prevention measuresbefore and after an event.

◆ Technical manuals that orient fieldoperations teams on the control ofvector-transmitted diseases should bedeveloped and/or made available.Existing training materials should beconsulted, updated and improved.

◆ Training on different pathologiesendemic in countries should beconducted in the public and privatehealth sectors for technical personnel,professionals in clinics, and publichealth workers.

◆ Epidemiological criteria should beemployed in the use of insecticides toavoid unnecessary use in certain areas,or to avoid wasting the product.

◆ PAHO should carry out investigations ordelegate groups of experts to analyze theuse of biological pest control for thebenefit of the environment and publichealth.

◆ Entomological surveillance should beexpanded to establish the differentvectors of communicable disease indifferent regions of a country, therebyallowing timely operations to preventoutbreaks. It is also important toconduct entomological surveillance bothinside and outside of refugee camps ortemporary settlements.

◆ All countries exposed to hurricanes orfloods should maintain epidemiologicalsurveillance for leptospirosis andstrengthen diagnostic laboratories.

◆ The collection and disposal of solidwaste from temporary shelters shouldbe controlled to avoid the creation ofvector breeding sites and reservoirs.

in assessing the impact of Hurricanes Georgesand Mitch on water and basic sanitationsystems, concluded the following:◆ Aqueducts, water supply and sanitation

systems and infrastructure were severelydamaged by the hurricanes. Vu l n e r a b i l i t ystudies and information on previouslyinstalled capacity were not available.

◆ Rapid assessment of damage toinfrastructure in the area was poorlyconducted and based on unorthodoxm e t h o d o l o g i e s .

◆ In some cases, local authorities had nopre-established mechanisms forcoordinating and managing informationconcerning damage assessment, or fori d e n t i fication of water supply andsanitation needs.

◆ The humanitarian aid received consistedprimarily of materials and equipment forwater treatment and supply. Thesecomprised a vast range of technologies,many of which were unknown to thecommunities. Disinfection equipment wasi n s u f ficient, although in some cases therewere means to acquire it.

◆ While community participation wasproven to be essential for responseactivities in the sector, this participationshould have been coordinated by watercommissions and/or neighborhood ormunicipal groups in order to be moree f f e c t i v e .

W a t e r a n d B a s i c S a n i t a t i o n

29

Institutions in the water

supply and sanitation sector

must initiate or finalize

vulnerability studies of their

installations, and include this

component in the

development of

reconstruction projects.

The Participants,

30

The Recommendations

◆ Institutions in the water supply andsanitation sector must initiate or fin a l i z evulnerability studies of their installations,and include this component in thedevelopment of reconstruction projects.

◆ The results from sectoral and institutionalvulnerability studies should be used forthe implementation of short-termmitigation activities. The development ofpilot projects to measure cost-effectiveness of mitigation measures inthe sector is strongly suggested.

◆ Water and sanitation authorities should,with the support of internationalorganizations, improve coordination andcommunication mechanisms through theformulation, testing and implementationof an emergency sectoral plan thatincludes formal channels ofcommunication with government andlocal authorities, during and after ane m e r g e n c y.

◆ Sectoral institutions must develop andperfect formal training programs for bothnational authorities and internationalcooperation on emergency managementin the area, taking advantage ofuniversities and regional institutions. Newtechnologies should be tested by researchcarried out under non-emergencyc o n d i t i o n s .

◆ Sectoral institutions should support thegovernment, both at the central and locallevels, in the development of information

systems with data on human resources,materials, equipment, and existingcapacity for managing water supply andbasic sanitation.

◆ Sectoral institutions should documenttheir experiences in emergencymanagement following HurricanesGeorges and Mitch, including acomparative analysis of replacement costsvs. the costs of having taken preventivemitigation and preparation measures.

◆ Sectoral institutions must lead communityhygiene training, in coordination with theeducation sector, local NGOs andinternational organizations, usingparticipatory methods and appropriatematerials. In addition, they should makesure that national authorities include astrong education component onsanitation in every water supply andsanitation project.

◆ Financial and technical cooperationinstitutions should demand that all newwater supply and sanitation projectsinclude vulnerability reductionc o m p o n e n t s .

◆ Governments should reinforce theprocess of sectoral decentralization inorder to strengthen the response capacityat local levels, and to guaranteetransparency and reliability in requestsfor humanitarian aid and for the properchanneling of international cooperation.

recognizing the following problems in foodand nutritional aspects, noted:◆ At the national and operational levels,

there exists a lack or inappropriateapplication of clear guidelines onprocedures for food and nutritionalaspects in emergency situations.

◆ Food supplies were often inaccessible inthe most affected areas due to limitedlogistic resources and failures of theinfrastructure.

◆ Inter-institutional coordination for fooddistribution was not adequate for someof the affected populations.

◆ The majority of the food reserves forimmediate response depends upondonated supplies. Some of the fooddonations were not adequate forstandard feeding patterns or weredifficult to prepare in the disastersetting.

◆ It often was not possible to give priorityattention to vulnerable groups due tolimited information on their locationand to the unavailability of special typesof food.

F o o d a n d N u t r i t i o n

31

National food and nutritional

policies and contingency

plans for emergency

situations should be

developed and implemented.

The Participants,

32

The Recommendations

◆ National food and nutritional policiesand contingency plans for emergencysituations should be developed andimplemented in association withPAHO/WHO.

◆ National governments and communitiesshould allocate funds for the provisionof food during emergencies.

◆ The national capacity for the provisionof food should be strengthened through:• The creation of a committee for

inter-institutional coordination;• Training of human resources,

including at the local level; and• Development of distribution and

transportation networks at regionaland local levels.

◆ The National disaster organizationresponsible for the coordination anddistribution of food should promote theuse of SUMA or other systems for theintegral management of food based onthe need for transparency andaccountability.

◆ The national government should assistthe local communities withimplementation of a food and nutritionalsecurity strategy.

◆ The WFP should provide easilyaccessible lists of essential food andcomplementary items for emergencycircumstances, should assist thenational coordinating agency in limitingthe period of free food assistance, andshould promote the implementation ofproductive and/or reconstructionactivities.

◆ PAHO/WHO, UNICEF, and the WFP mustestablish/strengthen an ongoing systemof food-nutritional surveillance witheach country.

in reviewing the psycho-social aspects of theimpact of Hurricanes Georges and Mitch,recognized that:◆ Few, if any, plans or single, permanent,

inter-institutional organizations exist atthe national level that address thepsycho-social aspects of disasters.

◆ Little is known about the psycho-socialaspects of the impact of HurricanesGeorges and Mitch, since theinstruments to make appropriateassessments and the personnel to usethem are lacking. Scientific andtechnical information is not available toassess the results of knowninterventions.

◆ Generally, it is held that mental healthcare requires the intervention ofspecialists.

◆ Mental health guidelines andeducational materials differ betweencountries and often cannot be shared.

◆ Access to mental health care is notalways differentiated from other aspectsof health care.

◆ In general, the media do not participatein orientation about the psycho-socialaspects of disasters.

P s y c h o - S o c i a l A s p e c t s o f D i s a s t e r S i t u a t i o n s

33

It is essential to include the

psycho-social aspects of health

in national disaster plans and

in the provision of care

during disasters.

The Participants,

34

The Recommendations

◆ It is essential to include the psycho-social aspects of health in nationaldisaster plans and in the provision ofcare during disasters.

◆ All nations should create an inter-institutional organization with apermanent staff that is responsible forthe psycho-social aspects of disasters.

◆ International organizations should act asfacilitators in the assessment of psycho-social care situations, support theintegration of new programs,disseminate technical information andexisting tools for the assessment ofmental health needs, and support theprocess of documenting and evaluatingexperiences arising from theirapplication.

◆ Mental health care, particularly at theprimary level, does not necessarilyrequire the interventions of specialists,but can be delivered by personnel in thecommunities who have been trainedthrough self-experience and by teamsfrom the national level.

◆ National health authorities, with theassistance of PAHO/WHO, UNICEF, andother organizations, should evaluateexisting models and, as deemednecessary, develop new models for useby all nations.

◆ Countries should make provisions formental health care for groups that areespecially vulnerable (children,handicapped and older persons,community leaders, rescue personneland people handling cadavers, amongothers), since the impact of the accessto service and the emotional impactmust be differentiated.

◆ Nations should conduct, with thesupport of international organizations,meetings to provide information andtechnical orientation on disasters tojournalists and social communicators,thereby contributing to promotion andprotection of health of the community.

◆ Plans for disaster response shouldinclude components aimed atdecreasing peoples’ vulnerability withrespect to psycho-social risks associatedwith disasters.

◆ Personal training programs in thecommunities should integrate educationfor handling the mental health aspectsassociated with disaster situations.

in reviewing aspects of the transition fromthe emergency phase following HurricanesGeorges and Mitch to reconstruction,concluded:◆ Disaster response is closely linked to

social and ecological vulnerability, thefeasibility of decentralized response, andthe strength and transparency of centraland local institutions.

◆ Communities and persons affectedshould determine the priorities inrecovery and reconstruction. Psycho-social recovery is a decisive aspect ofrehabilitation.

◆ Land ownership and land use arepriority elements in recovery andreconstruction. Populations should beresettled using criteria based on safetyand sustainability.

◆ For external cooperation to beeffectively and efficiently assimilated, thefollowing should be taken into account:• Accurate damage assessment must

be conducted, and• Rehabilitation must be carried out

simultaneously with training andstrengthening of institutions.

◆ Hurricane Mitch provided a uniqueopportunity to politically and sociallystrengthen the process of CentralAmerican integration.

T r a n s i t i o n f r o m t h e E m e r g e n c y t o R e c o n s t r u c t i o n

35

External cooperation

packages should incorporate

strategies and concrete

actions for preparedness,

prevention, and mitigation of

disasters.

The Participants,

36

The Recommendations

Regarding aspects of socialvulnerability, participantsrecommended:◆ Basic social systems (principally health

and education) need urgentrehabilitation using strategies such asthe assignment of funds at the locallevel.

◆ Community employment and sustainableliving conditions must be created toavoid migration and the return ofpopulations to unsafe locations.

◆ Recovery and reconstruction mustinclude components of gender equality.

To lessen environmentalvulnerability, participantsrecommended:◆ Reforestation, and management and

protection of critical areas must beimplemented.

◆ Watersheds must be protected and theirmanagement should be reevaluated.

◆ It is critical to reestablish agro-ecological and productive systems (e.g.,the use of work-for-food programs).

Regarding reconstruction andexternal cooperation, participantsrecommended:◆ Strategies must be sought to streamline

administrative procedures and ensuretransparency in the use of externalassistance.

◆ Micro-projects aimed at the mostvulnerable populations should receivespecial attention, and assistance shouldbe provided to identify, formulate, andadminister projects at the local level;

◆ Paternalism and the creation of falseexpectations should be avoided.

◆ External cooperation packages shouldincorporate strategies and concrete

actions for preparedness, prevention,and mitigation of disasters.

◆ Resources diverted from otherprograms and projects for disasterresponse should be restored to allowthe sustainability of reforms andactivities already in progress (e.g., thepeace process in Guatemala).

To strengthen the Central Americanintegration process, participantsrecommended:◆ Existing institutions and processes for

Central American integration must betaken into account in the reconstructionprocess (e.g., the Central AmericanIntegration System (SICA), Center forCoordination of the Prevention ofNatural Disasters in Central America(CEPREDENAC), Alliance for SustainableDevelopment in Central America(ALIDES), and Consultative Civil SocietyCouncils, etc.).

◆ It is necessary to establish integratedregional management of watersheds andother natural resources (e.g., riverbasins) and major infrastructure.

◆ Border initiatives should be taken toaddress shared problems.

◆ The participants recommend that themeeting of the Consultative Group ofStockholm (May 1999) focus onsubregional needs in Central America.

◆ The governments, organizations, andother participants should agree to takeinto account the recommendations andachievements of the InternationalDecade for Natural Disaster Reductionand transmit to their governments orauthorities the conclusions of thissession.

E v a l u a t i o n o f t h e M e e t i n g

37

Participants had an opportunity to evaluate the organization and development of themeeting through a specially prepared questionnaire that was handed out at the end ofthe meeting. Although only 20% handed in the information, the following are the mostrelevant conclusions drawn from the questionnaire:

◆ Regarding the means used to disseminate information on the meeting, 45% of thetotal number of participants indicated that they used electronic means (e-mailand/or Internet websites). But only 17% of the participants from governmentinstitutions used the Internet, while 50% of NGOs and the Red Cross relied on thismeans.

Therefore, it is clear that governments need to strengthen the use of Internet andtheir electronic information management systems, make it more accessible at alllevels, and probably improve internal distribution of information.

◆ The following five working groups were classified as the most useful related to thework of the participants:• Vector-transmitted diseases• Epidemiological surveillance• Medical attention• Supply management• Water- and food-borne diseases

◆ Regarding the overall assessment of the meeting, 82% of participants rated it asvery benefitial and on-time; 16% rated it as useful, even though not all of theirexpectations had been met; and 2% considered that their expectations had notbeen met.

A c r o n y m s

39

ALIDES Alliance for Sustainable Development in Central America

CDERA Caribbean Disaster Emergency Response Agency

CEPREDENAC Center for Coordination of the Prevention of Natural Disasters in Central America

CIDA Canadian International Development Agency

DAR Disaster Response Teams

DFID Department for International Development of the U. K.

ECHO European Commission Humanitarian Office

ECLAC Economic Commission for Latin American and the Caribbean

FWP World Food Program

IDNDR International Decade for Natural Disaster Reduction

NGO Non-Governmental Organization

OAS Organization of American States

OCHA U. N. Office for the Coordination of Humanitarian Affairs

OFDA/USAID Office of U. S. Foreign Disaster Assistance/U.S. Agency for International Development

OSOCC On-Site Operations Coordination Center

PAHO Pan American Health Organization

PED Emergency Preparedness and Disaster Relief Coordination Program

SICA Central American Integration System

SUMA Humanitarian Supply Management System

UNDAC UN Disaster, Assessment and Coordination Team

UNDP United Nations Development Program

UNICEF United Nations Children's Fund

WHO World Health Organization

Pan American Health OrganizationRegional Office of the

World Health OrganizationEmergency Preparedness and

Disaster Relief Coordination Program

525 Twenty-third Street, N.W.Washington, D.C. 20037, USAdisaster-publications@paho.org

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