Earthquake in El Salvador
Situation Report, 14 January 2001
Background
On Saturday, 13 January, 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. By 14 January, El Salvador's National Emergency Committee (COEN) was reporting 214 dead and approximately 500 injured. As usual, statistics and estimates vary widely from source to source. The number of missing has ranged from 10 to more than 1,000. Considering that landslides buried a large number of houses and cars in one area near the capital of San Salvador, official figures are likely to increase rapidly.
The earthquake occurred slightly more than two years after Hurricane Mitch left a deep impact on Central America, including El Salvador, and a trail of serious--but unrelated-outbreaks of communicable diseases strained the 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.
Medical Attention and Hospitals
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 therefore unavailable when they were most needed.
The following chart lists the initially reported damages to hospitals (source: Ministry of Health):
Key: S/N - no data available
NO - not evacuated
*** - evacuated
| NAME OF HOSPITAL | NO. EVACUATED |
NO. INJURED |
DEATHS | REFERRED | CONDITION |
| HNBB | *** | Not damaged, evacuation as security measure | |||
| NEUMOLOGICO | *** | 20 | 1 | Not damaged, evacuation as security measure | |
| ZACAMIL | S/D | 72 | To Hospital San Rafael and Militar Central | Full | |
| SAN BARTOLO | S/D | 70 | 2 | 21 adult beds available; 5 for children; 8 surgical beds. | |
| PSIQUIATRICO DE SOYAPANGO | S/D | No damages. Can accept patients. 14 beds for children available; 17 for adults. Two operating theaters Two anesthesiologists |
|||
| SONSONATE | S/D | 195 | Operating room has been readied. | ||
| SAN MIGUEL | S/D | Moderate damages | |||
| ZACATECOLUCA | *** | 91 | 2 | Moderate damages | |
| SAN MIGUEL | *** | ||||
| NUEVA GUADALUPE | *** | 15 | Water pipes damaged | ||
| CHALTENANGO | S/D | Cracked walls | |||
| USULATAN | *** | S/D | |||
| SANTIAGO DE MARIA | *** | ||||
| SENSUNTEPEQUE | One operating room and 16 adult beds available. | ||||
| MORAZAN | NO | ||||
| LA UNION | NO | ||||
| COJUTEPEQUE | NO | Maternity ward closed because of the risk. Two children's and two adult beds available. One operating room and two 2 anesthesiologists | |||
| SANTA TECLA | *** | Damaged | |||
| CHALATENANGO | NO | 22 beds available |
PAHO has dispatched its disaster mitigation engineer 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, solidarity displayed by neighboring countries resulted in offers of assistance and the immediate sending of 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. No medical teams, in addition to those from neighboring Latin American countries and the U.S. Military (SOUTHCOM) are likely to be required.
As a policy, PAHO/WHO discourages sending mobile field hospitals 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.)
Communicable Diseases
Although the presence of dead bodies is often a cause for concern among the affected population, it does not represent a significant public health risk. Much more serious and worrisome is the pre-existing situation in El Salvador with gastroenteritis and dengue hemorrhagic fever.
With regard to diarrheal diseases, El Salvador was experiencing a major outbreak (more than 5,000 cases) of retrovirus gastroenteritis 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 the occurrence of trauma--a problem attended to in a matter of days--but to preserving the fragile achievements in the field of communicable diseases.
The eradication of measles is another example. It is imperative that an immunization campaign, scheduled for 22 January 2001, be pursued, in spite of the current sudden drain on resources caused by the emergency response.
Mental Health and Posttraumatic Stress
Earthquakes leave a profound mark on the psychological health of the affected population. The sequela are particularly serious when survivors cannot ascertain the fate of their missing relatives and/or are not in a position perform 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.
Supply Management
The Government of El Salvador (at the multisectoral level) asked for support of SUMA, the 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 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 effective forms of response, 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 external health assistance from abroad
- Inventory of 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.
An advance of US$50,000 has been approved for the local purchase of medical/surgical supplies and other items.
Two disaster coordinators and one mitigation officer from PAHO's regional Emergency Preparedness Program are either in or on their way to El Salvador. Additional international staff will be assigned to implement relief activities as requested by the country and funded by the international community.