The first sighting of what was to become Hurricane Mitch came on 21 October 1998, when it was seen as a menacing surge south of Jamaica. Nine days later it struck, wending its way slowly over Honduras and Guatemala, pouring vast amounts of torrential rain onto fragile houses, exposed crops, and cities.

The U.S. Hurricane Center in Miami reported,

"WHILE GRADUALLY WEAKENING TO A TROPICAL DEPRESSION, MITCH GENERATED TORRENTIAL RAINS OVER PORTIONS OF HONDURAS AND NICARAGUA WHERE THE ASSOCIATED FLOODS WERE DEVASTATING."

A deluge of biblical proportions gushed over 2 feet of rain in a single day. Rivers overflowed their banks and kept rising, leaving parts of Central America as isolated islands surrounded by swollen water. The floodwaters swept away houses, schools, churches, cars, animals, and most tragically, thousands of men, women, and children. The rain was so constant and heavy that in many high places the earth itself slid away, sending mire and muck, strewn with deadly boulders, branches, and other debris, flowing down onto entire towns and regions.

MITCH REPRESENTS THE LOWEST PRESSURE EVER RECORDED FOR AN OCTOBER HURRICANE IN THE ATLANTIC BASIN THIS CENTURY. AT ITS PEAK INTENSITY MITCH'S MAXIMUM ONE-MINUTE SUSTAINED SURFACE WINDS WERE ESTIMATED TO BE 180 MPH, A CATEGORY 5 HURRICANE, the Hurricane Center said.

People fled from the waters, if they could. Too many could not, and either were drowned or crushed by debris. The governments reported that some 12,000 people had died, 2.8 million were left homeless, and 20,000 had disappeared. Many of the disappeared were feared dead.

Today and for the next several years, the people of Central America will struggle to cope with the worst natural disaster of the century in the aftermath of the storms that devastated vast areas of Honduras, Nicaragua, Guatemala, El Salvador, and Belize. The Governments of Honduras and Nicaragua spoke of the need to start developing from scratch, saying 50 years of development were washed away. Homes, businesses, crops, roads, bridges, water and sewer plants, hospitals, and health centers suffered heavy damages.

"It is really unfortunate that all our advances of this decade, like increased coverage of drinking water and sanitation, access to health services, elevated vaccination rates, and notable gains in life expectancy run the risk of a great setback," said Dr. Mirta Roses, Assistant Director of the Pan American Health Organization (PAHO). She supervises PAHO's technical cooperation with the countries of the Americas, as well as its Emergency Preparedness and Disaster Relief program. Along with PAHO's 150 health experts in Central America and program staff, she began working days, nights, and weekends to ensure an effective emergency response to Mitch.

THE CENTER PASSED VERY NEAR THE ISLAND OF GUANAJA . . . AND IT WREAKED HAVOC THERE AS WELL AS ON THE NEIGHBORING ISLAND OF ROATÁN. THE CENTER OF THE HURRICANE MEANDERED NEAR THE NORTH COAST OF HONDURAS . . . THEN IT MOVED SLOWLY OVER HONDURAS AND GUATEMALA ON THE 30th AND 31st. SOME HEAVY RAINS ALSO OCCURRED IN NEIGHBORING COUNTRIES.

Then, to make matters much worse, Nicaragua reported on the night of 31 October that several thousand people were buried when a huge mudslide plunged down the side of the Casitas volcano after water collected in the cone.

The Associated Press reported rescue workers pulled hundreds upon hundreds of mud-caked corpses from the muck. Almost a week after the Casitas mudslide, the AP described a brown landscape strewn with scattered bodies. PAHO's country offices in Central America went to work immediately with the health ministries assessing damages, improving sanitary and environmental conditions, examining health risks, and providing health education materials. In PAHO's Washington, D.C., Headquarters, a 24-hour situation room was set up. Regional programs responded to the needs of the affected countries as outlined by the PAHO country representatives, moving personnel into place, providing technical assistance, and helping to mobilize financial resources.

Fears of huge epidemics after natural disasters are unfounded in this Hemisphere, and cadavers, though a social and human problem, are not a source of epidemics, PAHO Director Dr. George A.O. Alleyne told an assembled press corps in Washington. The greatest needs, he said, are safe water and adequate sanitation, and cash to help the countries rebuild what they have lost.

However, this does not mean there will be no outbreaks, although if the response from the international community is good, they can be controlled. Even before Hurricane Mitch, there was a high level of communicable diseases, responsible for some 72,000 deaths a year in Central America, according to PAHO figures. Diarrhea and pneumonia together cause more than 25 percent of all deaths in children under 5, and Central America reported 150,000 cases of malaria last year, along with 2,700 cases of cholera, 40,000 cases of dengue, 100 cases of dengue hemorrhagic fever, and 14,000 cases of tuberculosis.

Almost 40 percent of Central America's people are at risk of malaria infection. "Furthermore, current climatic conditions, together with the high humidity and rain water collection increased by the current events, allows us to predict a dramatic increase in vector density and consequently on malaria transmission," PAHO said in an appeal for US$ 11 million in aid. Without good mosquito control, an increase of Aedes aegypti mosquito populations resulting from greater availability of breeding sites could also increase the number of dengue and dengue hemorrhagic fever cases.

The Response

Disasters often generate outpourings of interest and concern that lead to spontaneous collections of relief supplies such as food, clothing, and medicines. But PAHO knows from many years of experience in disaster management that these donations often clog the delivery system and can make things worse, not better. PAHO's disaster relief program has fundamental tenets in disaster situations, says its chief, Dr. Claude de Ville, that donations should correspond to specific requests from the countries; that the best donations are cash; and that external non-specialized medical help usually is not needed. In a briefing to staff handling emergencies, Dr. de Ville said, "The general public wants to help, and is extremely responsive and generous. They have to be guided and at no time be discouraged" from helping out. One concern is the efficient and transparent distribution of supplies. Using PAHO's SUMA relief supply management system, accountability and tracking of donations can be assured, added Dr. de Ville.

Response to the appeals for aid has been generous. Engineers, helicopter pilots, military personnel from many nations, and experts in health, water, sanitation, road-building, and many other specialties descended on Central America in an exemplary outpouring of international solidarity. The United Nations Office for the Coordination of Humanitarian Affairs estimated that pledges of more than US$ 41 million in aid were made by 20 countries and 15 international organizations in the first two weeks.

"Sometimes in a crisis we have to find the opportunity," Dr. Roses said. "Everything we build as a result of this disaster all the water and sanitation systems, health centers, hospitals, transportation, and communications infrastructure must use the lessons of Mitch and be built more solidly, in less vulnerable areas, and better able to resist any new attacks."

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Daniel Epstein is a Washington, D.C.,-based journalist in charge of media relations for PAHO's Office of Public Information.