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Impacts of Disasters: Lessons From a Medical Perspective

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This article was adapted, with permission, from Zeballos 1993b.

Latin America and the Caribbean have not been spared their share of natural disasters. Almost every year catastrophic events cause deaths, injuries and enormous economic damage. Overall, it is estimated that the major natural disasters of the last two decades in this region caused property losses affecting nearly 8 million people, some 500,000 injuries and 150,000 deaths. These figures rely heavily on official sources. (It is quite difficult to obtain accurate information in sudden-onset disasters, because there are multiple information sources and no standardized information system.) The Economic Commission for Latin America and the Caribbean (ECLAC) estimates that during an average year, disasters in Latin America and the Caribbean cost US$1.5 billion and take 6,000 lives (Jovel 1991).

Table 1 lists major natural disasters that struck countries of the region in the 1970-93 period. It should be noted that slow- onset disasters, such as droughts and floods, are not included.

Table 1. Major disasters in Latin America and the Caribbean, 1970-93

Year

Country

Type of
disaster

No.of deaths
reported

Est. no. of
people affected

1970

Peru

Earthquake

66,679

3,139,000

1972

Nicaragua

Earthquake

10,000

400,000

1976

Guatemala

Earthquake

23,000

1,200,000

1980

Haiti

Hurricane (Allen)

220

330,000

1982

Mexico

Volcanic eruption

3,000

60,000

1985

Mexico

Earthquake

10,000

60,000

1985

Colombia

Volcanic eruption

23,000

200,000

1986

El Salvador

Earthquake

1,100

500,000

1988

Jamaica

Hurricane (Gilbert)

45

500,000

1988

Mexico

Hurricane (Gilbert)

250

200,000

1988

Nicaragua

Hurricane (Joan)

116

185,000

1989

Montserrat,
Dominica

Hurricane (Hugo)

56

220,000

1990

Peru

Earthquake

21

130,000

1991

Costa Rica

Earthquake

51

19,700

1992

Nicaragua

Tsunami

116

13,500

1993

Honduras

Tropical storm

103

11,000

Source: PAHO 1989; OFDA (USAID),1989; UNDRO 1990.

Economic Impact

In recent decades, ECLAC has carried out extensive research on the social and economic impacts of disasters. This has clearly demonstrated that disasters have negative repercussions on social and economic development in developing countries. Indeed, the monetary losses caused by a major disaster often exceed the total annual gross income of the affected country. Not surprisingly, such events can paralyze affected countries and foster widespread political and social turmoil.

In essence, disasters have three kinds of economic impacts:

  • direct impacts on the affected population’s property
  • indirect impacts caused by lost economic production and services
  • secondary impacts that become apparent after the disaster—such as reduced national income, increased inflation, foreign trade problems, heightened financial expenses, a resulting fiscal deficit, decreased monetary reserves and so on (Jovel 1991).

 

Table 2 shows the estimated losses caused by six major natural disasters. While such losses might not seem particularly devastating for developed countries with strong economies, they can have a serious and lasting impact on the weak and vulnerable economies of developing countries (PAHO 1989).

Table 2. Losses due to six natural disasters

Disaster

Location

Year(s)

Total losses
(US$ millions)

Earthquake

Mexico

1985

4,337

Earthquake

El Salvador

1986

937

Earthquake

Ecuador

1987

1,001

Volcanic eruption (Nevado del Ruiz)

Colombia

1985

224

Floods, drought (“El Niño”)

Peru, Ecuador, Bolivia

1982-83

3,970

Hurricane (Joan)

Nicaragua

1988

870

Source: PAHO 1989; ECLAC.

The Health Infrastructure

In any major disaster-related emergency, the first priority is to save lives and provide immediate emergency care for the injured. Among the emergency medical services mobilized for these purposes, hospitals play a key role. Indeed, in countries with a standardized emergency response system (one where the concept of “emergency medical services” encompasses provision of emergency care through the coordination of independent subsystems involving paramedics, fire-fighters and rescue teams) hospitals constitute the major component of that system (PAHO 1989).

Hospitals and other health care facilities are densely occupied. They house patients, personnel and visitors, and they operate 24 hours a day. Patients may be surrounded by special equipment or connected to life-support systems dependent on power supplies. According to project documents available from the Inter-American Development Bank (IDB) (personal communication, Tomas Engler, IDB), the estimated cost of one hospital bed in a specialized hospital varies from country to country, but the average runs from US$60,000 to US$80,000 and is greater for highly specialized facilities.

In the United States, particularly California, with its extensive experience in seismic-resistant engineering, the cost of one hospital bed can exceed US$110,000. In sum, modern hospitals are highly complex facilities combining the functions of hotels, offices, laboratories and warehouses (Peisert et al. 1984; FEMA 1990).

These health care facilities are highly vulnerable to hurricanes and earthquakes. This has been amply demonstrated by past experience in Latin America and the Caribbean. For example, as table 3 shows, just three disasters of the 1980s damaged 39 hospitals and destroyed some 11,332 hospital beds in El Salvador, Jamaica and Mexico. Besides damage to these physical plants at critical times, the loss of human life (including the death of highly qualified local professionals with promising futures) needs to be considered (see table 4 and table 5).

Table 3. Number of hospitals and hospital beds damaged or destroyed by three major natural disasters

Type of disaster

No. of hospitals
damaged or destroyed

No. of beds lost

Earthquake, Mexico (Federal District, September 1985)

13

4,387

Earthquake, El Salvador (San Salvador, October 1986)

4

1,860

Hurricane Gilbert (Jamaica, September 1988)

23

5,085

Total

40

11,332

Source: PAHO 1989; OFDA(USAID) 1989; ECLAC.

Table 4. Victims in two hospitals collapsed by the 1985 earthquake in Mexico

 

Collapsed hospitals

 

General hospital

Juarez hospital

 

Number

%

Number

%

Fatalities

295

62.6

561

75.8

Rescued

129

27.4

179

24.2

Missing

47

10.0

Total

471

100.0

740

100.0

Source: PAHO 1987.

Table 5. Hospital beds lost as a result of the March 1985 Chilean earthquake

Region

No. of existing  hospitals

No. of beds

Beds lost in region

     

No.

%

Metropolitan Area
(Santiago)

26

11,464

2,373

20.7

Region 5 (Viña del Mar, Valparaíso,
San Antonio)

23

4,573

622

13.6

Region 6 (Rancagua)

15

1,413

212

15.0

Region 7 (Ralca, Meula)

15

2,286

64

2.8

Total

79

19,736

3,271

16.6

Source: Wyllie and Durkin 1986.

At present the ability of many Latin American hospitals to survive earthquake disasters is uncertain. Many such hospitals are housed in old structures, some dating from Spanish colonial times; and while many others occupy contemporary buildings of appealing architectural design, lax application of building codes makes their ability to resist earthquakes questionable.

Risk Factors in Earthquakes

Of the various types of sudden natural disasters, earthquakes are by far the most damaging to hospitals. Of course, each earthquake has its own characteristics relating to its epicentre, type of seismic waves, geological nature of the soil through which the waves travel and so on. Nevertheless, studies have revealed certain common factors that tend to cause death and injuries and certain others that tend to prevent them. These factors include structural characteristics related to building failure, various factors related to human behaviour and certain characteristics of nonstructural equipment, furnishings and other items inside buildings.

In recent years, scholars and planners have been paying special attention to identification of risk factors affecting hospitals, in hopes of framing better recommendations and norms to govern the building and organization of hospitals in highly vulnerable zones. A brief listing of relevant risk factors is shown in table 6. These risk factors, particularly those related to the structural aspects, were observed to influence patterns of destruction during a December 1988 earthquake in Armenia that killed some 25,000 people, affected 1,100,000 and destroyed or severely damaged 377 schools, 560 health facilities and 324 community and cultural centres (USAID 1989).


Table 6. Risk factors associated with earthquake damage to hospital infrastructure

 Structural

 Non-structural

 Behavioural

 Design

 Medical equipment

 Public information

 Quality of construction    

 Laboratory equipment

 Motivation

 

 Office equipment

 Plans

 Materials

 Cabinets, shelves

 Educational programmes      

 Soil conditions

 Stoves, refrigerators, heaters    

 Health care staff training

 Seismic characteristics

 X-ray machines

 

 Time of the event

 Reactive materials

 

 Population density

 

 


Damage on a similar scale occurred in June 1990, when an earthquake in Iran killed about 40,000 people, injured 60,000 others, left 500,000 homeless, and collapsed 60 to 90% of buildings in affected zones (UNDRO 1990).

To address these and like calamities, an international seminar was held in Lima, Peru, in 1989 on the planning, design, repair and management of hospitals in earthquake-prone areas. The seminar, sponsored by PAHO, Peru’s National University of Engineering and the Peruvian-Japanese Center for Seismic Research (CISMID), brought together architects, engineers and hospital administrators to study issues related to health facilities located in these areas. The seminar approved a core of technical recommendations and commitments directed at carrying out vulnerability analyses of hospital infrastructures, improving the design of new facilities and establishing safety measures for existing hospitals, with emphasis on those located in high-risk earthquake areas (CISMID 1989).

Recommendations on Hospital Preparedness

As the foregoing suggests, hospital disaster preparedness constitutes an important component of PAHO’s Office of Emergency Preparedness and Disaster Relief. Over the last ten years, member countries have been encouraged to pursue activities directed toward this end, including the following:

  • classifying hospitals according to their risk factors and vulnerabilities
  • developing internal and external hospital response plans and training personnel
  • developing contingency plans and establishing safety measures for the professional and technical hospital staffs
  • strengthening lifeline backup systems that help hospitals to function during emergency situations.

 

More broadly, a principal aim of the current International Decade for Natural Disaster Reduction (IDNDR) is to attract, motivate and commit national health authorities and policy-makers around the world, thereby encouraging them to strengthen the health services directed at coping with disasters and to reduce the vulnerability of those services in the developing world.

Issues Concerning Technological Accidents

During the last two decades, developing countries have entered into intense competition to achieve industrial development. The main reasons for this competition are as follows:

  • to attract capital investment and to generate jobs
  • to satisfy domestic demand for products at a lower cost and to alleviate dependency on the international market
  • to compete with international and subregional markets
  • to establish foundations for development.

 

Unfortunately, efforts made have not always resulted in obtaining the intended objectives. In effect, flexibility in attracting capital investment, lack of sound regulation with respect to industrial safety and environmental protection, negligence in the operation of industrial plants, use of obsolete technology, and other aspects have contributed to increasing the risk of technological accidents in certain areas.

In addition, the lack of regulation regarding the establishment of human settlements near or around industrial plants is an additional risk factor. In major Latin American cities it is common to see human settlements practically surrounding industrial complexes, and the inhabitants of these settlements are ignorant of the potential risks (Zeballos 1993a).

In order to avoid accidents such as those that occurred in Guadalajara (Mexico) in 1992, the following guidelines are suggested for the establishment of chemical industries, to protect industrial workers and the population at large:

  • selection of appropriate technology and study of alternatives
  • appropriate location of industrial plants
  • regulation of human settlements in the neighbourhood of industrial plants
  • security considerations for technology transfer
  • routine inspection of industrial plants by local authorities
  • expertise provided by specialized agencies
  • role of workers in compliance with security rules
  • rigid legislation
  • classification of toxic materials and close supervision of their use
  • public education and training of workers
  • establishment of response mechanisms in case of emergency
  • training of health workers in emergency plans for technological accidents.

 

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Contents

Preface
Part I. The Body
Part II. Health Care
Part III. Management & Policy
Part IV. Tools and Approaches
Part V. Psychosocial and Organizational Factors
Part VI. General Hazards
Barometric Pressure Increased
Barometric Pressure Reduced
Biological Hazards
Disasters, Natural and Technological
Electricity
Fire
Heat and Cold
Hours of Work
Indoor Air Quality
Indoor Environmental Control
Lighting
Noise
Radiation: Ionizing
Radiation: Non-Ionizing
Vibration
Violence
Visual Display Units
Part VII. The Environment
Part VIII. Accidents and Safety Management
Part IX. Chemicals
Part X. Industries Based on Biological Resources
Part XI. Industries Based on Natural Resources
Part XII. Chemical Industries
Part XIII. Manufacturing Industries
Part XIV. Textile and Apparel Industries
Part XV. Transport Industries
Part XVI. Construction
Part XVII. Services and Trade
Part XVIII. Guides

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