PAHO/WHO Requests Humanitarian Assistance
Washington, DC, January 18, 2001 (PAHO)—The Pan American Health Organization today revised its appeal and is seeking US$1.75 million in humanitarian assistance for emergency needs in the health sector following last week's deadly earthquake, which left score dead and thousands homeless.
"… a more accurate picture is emerging in the health sector," the Pan American Health Organization (PAHO) said in a statement. "Most notably are the importance of maintaining and strengthening immunization and the restoration of the cold chain and an assessment of necessary emergency rehabilitation measures in health facilities."
Earlier, assistance was received from the governments of Canada, the United Kingdom, Italy, and Norway.
On Saturday, January 13, a strong earthquake measuring 7.6 on the Richter scale struck El Salvador with such magnitude that it was felt in neighboring Honduras and Guatemala and as far north as Mexico City. Statistics on deaths, injuries and missing from El Salvador's Emergency Committee (COEN) have steadily increased are now placed at 700 dead, 2500 injured and 45,000 homes damaged. Some estimates place the number of missing at more than 1,000.
The earthquake occurred slightly more than two years after Hurricane Mitch left a deep impact on Central America, including El Salvador. In addition, serious (but unrelated to Mitch) outbreaks of communicable diseases have and continue to strain the country's health resources. All together, the vulnerability of the country and its health institutions is high. But on the positive side, the health sector has recently strengthened its national disaster program by adding new personnel.
El Salvador's Ministry of Health, with PAHO/WHO's support conducted a preliminary assessment of conditions in hospitals located in the most affected areas. The San Miguel and the San Rafael Hospitals were the hardest hit, and both sustained serious damages. Eight hospitals in all were evacuated, some primarily as a preventive measure. An estimated 800 beds were initially reported unavailable when they were most needed. However, the figures have been revised upwards and now place the number of lost beds at 1,350.
PAHO has sent three disaster mitigation engineers who, in collaboration with the national counterparts, will help to determine the extent of the needs for immediate assistance. The priorities are as follows:
- to assess the safety of the hospitals in order to resume operations as soon as possible,
- to identify interim measures to restore the minimum capacity to affected facilities.
As usual in Central America, neighboring countries displayed a great solidarity and immediately sent health professionals, equipment and mobile facilities. Although these mobile facilities are no substitute for normally operating health services, they are sufficient to respond to life saving needs.
As a policy, PAHO/WHO discourages sending mobile field hospitals and medical teams except from other than the closest of geographical neighbors sharing the same culture and health approach, because they are costly, difficult to transport and arrive too late to make a difference in terms of saving lives. The high cost of this type of aid (which also quickly depletes the donor's budget) would be better invested in medium-term needs that often go unmet once public attention wanes. (For more information on best donations practices, consult the guidelines on PAHO's web site at www.paho.org - click on the Earthquake in El Salvador icon.)
Communicable Diseases
For cultural reasons, the presence of dead bodies is often a cause for concern among the affected population. However, it does not represent a significant public health risk. Much more serious and worrisome is the pre-existing situation in El Salvador with regard to gastroenteritis and dengue hemorrhagic fever.
El Salvador was experiencing a major outbreak (more than 5,000 cases) of retrovirus gastroenteritis (diarrheal disease) prior to the earthquake. Easily transmissible through water, food or direct contact, this outbreak might be exacerbated by breakdowns in water quality control and the overall sanitation. Similarly, improper solid waste control in earthquake-affected areas could contribute to the proliferation of the vectors responsible for the dengue epidemic, which in 2000 was a serious threat to population.
It is, therefore, imperative to strengthen the syndrome/symptom-based surveillance system and improve the readiness of the laboratory network. More than ever, it is critical to implement a health education campaign announced by the Ministry of Health just a few days before the earthquake. The proposed messages are particularly relevant to an emergency resulting from a natural disaster.
As is often the case, the main health impact of a disaster such as this earthquake is not limited to trauma injuries--a problem that is attended to in a matter of days--but also includes the threat that it poses to the fragile achievements in the field of communicable diseases. For the medium-term (3-6 months) an international health expert experienced in communicable diseases, diarrheal diseases and integrated management of childhood illnesses (IMCI) will be recruited for two months to:
- monitor the implementation and surveillance of diarrheal diseases (cholera and rotavirus) and other communicable diseases transmitted by vectors and carriers (leptospirosis) including dengue and dengue hemorrhagic fever,
- provide technical expertise in clinical case management of patients at health facilities and at the community level,
- pursue more aggressively all operational aspects of country communicable disease prevention and control activities, including promoting IMCI activities.
- eradication of measles is another example. It is imperative that an immunization campaign, which was scheduled prior to the earthquake for January 22, 2001, be pursued, despite the current sudden drain on health resources caused by the emergency response.
Mental Health and Posttraumatic Stress
Earthquakes leave a profound mark on the psychological health of the affected population. This can be particularly serious when survivors cannot ascertain the fate of missing relatives and/or cannot observe cultural/religious rites for the deceased. The number of houses buried by the landslide, as well as the range of uncertainty regarding the number of missing, can be an indicator of forthcoming serious posttraumatic stress syndrome in the surviving population. Teams of psychological experts, training for staff and therapy for the victims will be among the main priorities within a matter of weeks.
Pan American Health Organization Supply Management
The Government of El Salvador (at the multisectoral level) asked for support of SUMA, the PAHO-designed humanitarian supply management system, to assist with the anticipated influx of donations. Two SUMA specialists will assist the National Emergency Committee and the health sector. The problem is particularly acute given the attention that this disaster has received. Following the 1986 earthquake in El Salvador, the management of donations (many of them unrequested and inappropriate) was one of the most sensitive issues. Following Hurricane Mitch, El Salvador made excellent use of the lessons learned and implemented the SUMA system, thanks to the support of the international community.
PAHO/WHO Technical Cooperation
The PAHO/WHO Representation in El Salvador is actively coordinating with the health authorities and the National Emergency Committee (the equivalent of Civil Protection) and the UN Coordinator. Functions include:
- Technical advice on the most effective emergency response and needs assessment, both local and international;
- Expertise in disaster management, monitoring of communicable diseases, water and sanitation, mental health, etc.;
- Analysis of the structural safety of health facilities;
- Coordination of international health assistance from abroad;
- Inventory and classify donations through the SUMA system;
- Other technical forms of assistance as requested.
In addition to the PAHO health and disaster experts already working in El Salvador, experts are being dispatched from neighboring PAHO/WHO offices or countries.PAHO, which also serves as the Regional Office for the Americas of the World Health Organization, works to improve health and raise living standards in all the countries of the Americas.
For further information contact: Bryna Brennan, tel (202) 974-3458 , fax (202) 974-3143, Office of Public Information, email brennanb@paho.org, Internet: www.paho.org