Disasters, both natural and man-made, result in losses of immense proportion in terms of human lives and property. Poor infrastructure development and failure of anticipation and planning for calamities compound the suffering of people in such situations.
The medical resources, both human and material or equipment, are precious and become all the more important in the face of a disaster. Early mobilization of these resources can save many lives and provide timely relief to the masses. The armed forces have their medical corps which have such resources readily available and can be utilized for this purpose. The problem is their timely availability.
ICMM is a forum where the leaders of the armed forces medical services converge from all over the world to share ideas. This platform can be utilized to make a body whose purpose would be to engage and coordinate the medical resources which can be made readily available in case of a disaster anywhere in the world. The body would have an updated itinerary of resources which, in the face of a calamity, could act as a rapid response medical team. We have proposed a centrally formed Disaster Management and Coordination Cell by ICMM which can effectively provide medical relief in disaster. This body would also be responsible for coordination with other international organisations like United Nations and Red Cross.
Geopolitical turmoil during the last few years has unraveled an enormous quantum of natural and manmade disasters. As a consequence, the world has seen a large number of casualties and immense damage to crops, property and livestock. The magnitude and frequency of disasters is on the increase. Global statistics suggest an affliction of more than 218 million people every year in the past two decades. Post disaster damages and injuries are indiscriminate and precipitous. This makes one ponder as to what impact does a disaster have on the countries? When a disaster strikes a country, its initial insult not only paralyses infrastructure of the effected country but also the initial days of disaster without organized help adds to the catastrophe. Depending upon magnitude of disaster and resources of the country these losses of human lives and property can reach to alarming heights as seen in recent disasters like hurricanes, earthquakes and tsunamis. Even the most developed countries sometimes are struck by disasters of such magnitude which cripples their infrastructure and they have to resort to outside help.
In this era of globalization these problems are dealt with initially by the countries where disaster originates. In the ensuing period, help from other countries/ organisations arrives in individual capacities. Although it is very helpful to the already outstretched resources of the effected country yet those who first attend to the needs of the disaster struck carry greatest opportunity to impact outcome.
On the International front, these issues have been stressed upon in Yokohama Strategy adopted in 1994 and the Hyogo Framework for Action 2005 – 2015 (UNISDR, 2005).
In the perspective of medicine, when a patient suffers cardiac arrest in a hospital, a “blue code” is flashed and the patient’s resuscitation is done immediately by a team of experts in CPR who are readily available and are mentally and physically prepared to save the patient’s life. Keeping in view the same principles, if a well-organized and well prepared body of experts is involved in immediate disaster management having readily available resources in terms of manpower and materials, then the catastrophic effects of disaster can be reduced effectively.
Definition of Disaster
The Centre for Research on the Epidemiology of Disasters (CRED) defines a disaster as a “situation or event, which overwhelms local capacity, necessitating a request to national or international level for external assistance an unforeseen and often sudden event that causes great damage, destruction and human suffering.”
Types of Disaster
As mentioned earlier, countries are being increasingly exposed to horrifying disasters which can occur owing to natural causes as well as secondary to human errors.
- Natural disasters
e. Water Damage
f. Hail thunderheads.
j. Winter Freeze
n. Contractible diseases
o. Limnic eruptions
p. Storms (non-cyclone)
- Man-Made Disasters
b. Home & building fires
c. Hazardous materials accidents
d. Nuclear & radiological accidents
e. Aviation accidents
f. Ship/maritime accidents
g. Train/railroad accidents
h. Riots/civil unrest
j. Bridge collapses
k. Dam breaks
There is a vast diversity in cultures, traditions and practices observed by people in every nook and corner of this world. The response to disaster, both at an individual level as well as at a collective level, is also varied. The demographics are different, for example, urbanization and land use for agriculture. These factors play an important role in determining mortality in case of disaster. Each country has its own specific disaster response program according to the available technologies, capacities and capabilities.
In the period following a disaster, a number of problems set in. Some of them are outlined below:
- Medical Problems Faced in the Effected Area
a. Ineffective medical management in the golden period (i.e. initial 72hrs).
i. Lack of immediate availability of medical personnel
ii. Lack of medical stores.
iii. Damaged medical infrastructure
iv. Causalities of medical personnel.
v. Ineffective evacuation of causalities/ burial of dead.
b. Psychological effects.
c. Spread of communicable diseases.
d. Immediate repetition of disaster (like aftershocks etc) causing further injuries.
e. Rehabilitation in terms of health.
- Problems Faced by the Administration/ Goverment of Effected Area
a. Destruction of infrastructure (communication, roads, hospitals, electricity, water supply, food supplies).
b. Disruption of health care evacuation and treatment system.
c. Damage to the local administrative bodies.
d. Law and order situation.
e. Immediate provision of food, shelter, communication and treatment of injured.
f. Overstretching of resources needed in other areas.
g. Disruption of skilled manpower.
j. Removal of debris.
k. Prevention and treatment of communicable diseases.
l. Impedance to immediate restoration of basic infrastructure.
m. Restoration of the financial damage
n. Estimation of exact amount of help in terms of material and human resources
o. Among international community who should be asked to help and in which capacity (depending upon the geo-political priorities without undermining the national integrity of the effected country)
p. Monitoring of international help
- Problems Faced by the International Community
a. Lack of pre-determined mandate of the international organisations and countries as to how much and in what manner they can help the country according to geo-political situation.
b. Lack of centralization of efforts (many international organisations work independently without any coordination with others thus duplication of supplies).
c. Lack of Regional organisations coordination with International central organisation.
d. Lack of readily available regional human and material resources.
e. Lack of finances.
f. Lack of coordination of finances being spent by different international organisations.
g. Ineffective early warning system in case of natural disasters.
h. Lack of coordination in researches done by different agencies worldwide and formulation of effective disaster management plans.
The help provided by international community in disasters is useful in rehabilitation phase which is indeed of paramount importance but of no significance in the initial period. International help is ineffective in the beginning as it reaches when a considerable period of time has already elapsed. Thus if international help is rendered immediately following a disaster, then the extent of damage can be curtailed.
In the past years, approach to disaster management in different countries has been reactive and relief centric. Recently, shift has been observed from this relief centric approach to united and automated approach with stress on prevention and preparedness to reduce the effects. These efforts (NDMA, 2010) are aimed to preserve developmental gains and also minimize losses to lives, property and livelihood.
The important components of disaster management include preparation, management and post disaster rehabilitation to effectively handle the disaster crises(NDMA, 2010). A need is being felt of a solution which should be practical, flexible and permanent. Moreover, it should be able to reduce mortality, morbidity and encompass all the countries keeping in view their norms, culture, traditions, religion and law etc. It should be able to help the underdeveloped, developing as well as developed countries in case of disasters.
In summation, we propose that ICMM is effective international organisation in terms of:
1 Maximum number of member countries
2. Widely acceptable by countries.
3. The only organisation comprising of the most disciplined medical community of any country.
Time is now ripe for laying down foundation of a new cell under the protective umbrella of ICMM. The proposed name is Disaster Management and Coordination Cell (DMCC).
Disaster Management and Coordiation Cell (DMCC)
- Aims and Objectives
a. To make world a safer place in case of disasters.
b. Timely and immediate help of a disaster struck country.
c. Minimum interference with norms, taboos and culture of the effected country.
d. Geo political situation of the effected country to be entertained while providing help.
e. Reduce effects of financial burden on the effected country.
f. Information sharing including data collection, early warning and effective strategies to combat disasters.
g. Research and evaluation of disasters.
- Organisation and Function
a. Head Quarters
The main headquarters of this organisation should act as the prime administrative and technical Centre.
(a) Medical: Immediate (evacuation, resuscitation, life and limb saving surgeries) and long term (rehabilitative procedures, psychotherapy) plans of medical management of disaster victims.
(b) Transport: Air and ground transportation of medical teams, other expert persons and goods.
(c) Communication: To establish immediate communication between effected people, service providers and the disaster managing authorities.
(2) Coordination: Coordination between different divisions of the organisation, other organisations like Red Cross, UNO and the effected country.
(3) Finance: To finance various expenditures of the organisation, collection of donations and proper dispersal of finances in disaster.
(4) Geo-Strategic: To coordinate with member countries about the line of action in case of disaster beforehand. To maintain lists approved by each country about the countries/organisations from which it would accept help in case of disaster.
(5) Legal: To prepare all legal documents concerning the charter of this organisation, the MoUs signed with member countries and other legal matters.
(6) Media: To advertise the help provided and act as a voice of the organisation to the effected people in disaster.
(7) Research and Development: To keep up with the latest methodology for effective management of disasters. To publish research papers, hold seminars/ conferences, compile past disaster reports.
(8) Information Technology: To keep all the information at hand, setup up information technology at effected area and coordinate with data base.
(9) Human Resources: Ensuring employment and maintaining quality control of human resources.
(10) Early Warning; Met and Satellite: Early detection of natural disasters through Met and satellite and their communication to the concerned.
(11) Crisis Management Cell: To coordinate and liaison the disaster activity and the rescue efforts.
(12) Administration: Administration of the employees and coordinate with Human Resources Section.
c. Regional Headquarters (RHQ)
Acting as essential functional subsidiaries of the main organisation, regional headquarters shall endeavor to coordinate between the organisation and the effected country, to keep a list of
readily available expert individuals of neighboring countries of disaster struck area and management of regional stores of goods.
d. Disaster Management and Coordination Cell (DMCC) of individual Country
Each member country should be entrusted to form its own chapter of DMCC. It should maintain updated list of medical experts and medical stores readily available to a neighboring
country in case of disaster. In addition, it shall be responsible to maintain a list of countries and organisations from which it can accept help in case of disaster in its territory and keep it
updated with RHQ. They should also conduct community workshops to train the local population at the basic level on actions to be taken to reduce disaster risk. (UNISDR, 2010).
Proposed Steps in the Formation of DMCC
The following steps can be adopted which can lead to the formation of DMCC.
a. Recognition of its need by ICMM
b. Approval by the assembly.
c. Formation of DMCC head office
d. Recruitment of suitable team of employees.
e. Preparation of legislative document by the team encompassing all aspects of DMCC.
f. Formation of divisions of DMCC.
g. Formation of RHQ and DMCC Chapters of member countries.
We have noticed an increase in natural disasters from tsunamis, earthquakes, volcanoes, tornados, floods etc. In this era of globalization, there has been a tremendous boom in the fields of science and technology and mushrooming of expertise in terms of available manpower. If unprepared, the sudden strike of a minor disaster is enough to lay bare one’s lack of disaster management capacity. Time has come upon us to act now in an efficient manner. Hence, it is important that we learn from the results of disasters and form an effective organisation like DMCC. This would prevent loss of precious lives and effective use of available resources. This is need of the hour.