The ministries of health in Latin America and the Caribbean can be proud of their historic contribution to disaster management. A milestone was the resolution passed by the PAHO Directing Council (CD26 R11) in 1976 instructing the Director of PAHO to establish a unit “to assist the ministries of health to prepare and plan for disasters following the catastrophic earthquake in Guatemala.” This focus on strengthening the capacity of national health institutions for disaster prevention, preparedness, and response has been farsighted and beneficial for the Region of the Americas. In the 35 years since that landmark resolution, the global humanitarian context has changed drastically.
The 1976 earthquake in Guatemala was a major event, leaving an estimated 23,000 dead, 77,000 injured, and 40% of the hospital infrastructure destroyed. Although the losses attracted global attention, the response was largely national and to a lesser extent regional.1 There were few foreign search and rescue experts or organized field hospitals that rushed to the assistance of the affected population; of those that did assist, almost all were from the Region. 2
International coordination mechanisms at that time were comparatively young and weak, and they worked through Guatemala’s National Emergency Committee. In the health sector, technical assistance was provided by experts from the Region through PAHO. Financial contributions for emergency and early recovery were extraordinarily generous but modest compared to today’s mega response. Contributions were overwhelmingly from the Region itself. 3
There were many large-scale disasters after 1976, but mainly outside the region. Lessons learned in these disasters revealed that management problems such as those faced by the Guatemala government were indeed systemic: the lack of resources dedicated to rescue and rapidly providing care to the affected population; the flow of inappropriate donations, especially pharmaceuticals; and finally a lack of coordination of an increasing number of humanitarian actors. United Nations procedures to coordinate this assistance were strengthened over the years and specific mechanisms were established at the global level. Of note are the International Search and Rescue Advisory Group (INSARAG), which promotes and coordinates rapid deployment of qualified rescue teams, and the United Nations Disaster Assessment and Coordination Team (UNDAC), which provides guidance to the international community. On another level, the creation of CNN, the television news channel, in 1980, transformed what had been primarily national tragedies into global dramas where international actors play the main roles.
The Humanitarian Reform process launched by the international humanitarian community in 2005 seeks to improve the effectiveness of humanitarian response by “ensuring greater predictability, accountability and partnership.” 4 International agencies were designated as Cluster Lead Agencies to ensure, among other things “partnerships between UN agencies, the International Red Cross and Red Crescent Movement, international organizations and Non-Governmental Organizations (NGOs), all working together towards common humanitarian objectives through the Clusters.” No specific role was reserved for the national disaster or health institutions.
The international humanitarian community has evolved rapidly. Disaster response has become a major global industry. However, progress at the country level has been more tentative, especially in countries that have not been affected by a major disaster for a long period of time.
The level of international humanitarian response to the earthquake in Haiti may be exceptional, particularly when taking into account what remained of management capacity at the local level in that country. But what would happen if an event such as the earthquake in Guatemala in 1976 happened today?
- Modern news coverage would undoubtedly document preferentially the spectacular global response (number of actors, medical teams, financial contributions, etc.) while overlooking the more efficient but discreet management capacity of existing national institutions.
- All UN and other coordination or data collection mechanisms would be activated. At least three international Cluster Lead Agencies (for health, nutrition, and water and sanitation) would attempt to assume the corresponding sector responsibilities of the ministry of health in the affected country. The objective would be to improve “…strategic field-level coordination and prioritization in specific sectors of response by placing responsibility for leadership and coordination of these issues with the competent [international] operational agency.” 5
- Among the cadre of international experts, an appreciable number would have skills and experience in massive disasters that few experts can match in our Region.
- Actors and donors would belong to all continents and regions.
- For months, all meetings and reports would use English, the de facto humanitarian working language. This will significantly reduce interaction between national experts and the international humanitarian actors.
What is the option for national authorities wishing to maintain their leadership and exercise their public responsibility? In a large disaster with many casualties there is probably no easy alternative to the deployment of external mechanisms. After the earthquake in 1985 in Mexico, this well organized and relatively wealthy country rightly concluded that it had sufficient health and other resources to attend to the few thousands of injured in the capital city. This was a proper technical assessment but it proved to be unsustainable politically during the barrage of criticism from international mass media. Mexico opened its borders to international assistance in less than 24 hours. In a larger disaster in a smaller country, such a decision would deny the affected population the clear benefits of a much more rapid and comprehensive national response.
National leadership comes through active participation and display of competence. The countries and disaster institutions of this Region have continued to progress but at a slower pace than in other places. Humanitarian response is now a global business; disaster experts from the Region may lose their competiveness if they are not part of that global effort.
Considering these changes, ministries of health determined to lead the sectoral response process should consider:
- Ensuring that there are a sufficient number of disaster managers who are fluent in English through selective recruitment and on the job training.
- Exposing their staff to mass scale disasters, particularly outside the region. Belonging to the rather closed global humanitarian club is an asset. A roster of experts potentially available at short notice should be established.
- Strengthening the status and outreach of their health sector’s disaster program.
With such assets a ministry of health will be able to assert itself as the effective leader in a major disaster that nowadays will certainly trigger international response.
1 Orlando Olcese, Ramón Moreno, and Francisco Ibarra, The Guatemala earthquake disaster of 1976: a review of its effects and of the contribution of the United Nations family (Guatemala, UNDP, July 1977); http://www.cridlac.org/digitalizacion/pdf/eng/doc4146/doc4146.htm.
2 Primarily, this assistance included one 100-bed U.S. military hospital and smaller facilities from Costa Rica, Mexico, and Nicaragua.
3 Financial contributions for immediate response and rehabilitation (excluding loans) amounted to a few million dollars for the health sector out of a total of approximately US$ 110 million. EU contributions were reportedly US$ 40,000. See U.S. Agency for International Development (USAID), Disaster relief case report : Guatemala earthquake, February 1976 (Washington, DC, USAID; July 1978 ); http://desastres.usac.edu.gt/documentos/pdf/eng/doc4300/doc4300.htm
4 It is important to point out that this reform was initiated by donors and UN agencies. Involvement of NGOs in design of the reform was limited, while affected countries were absent.
5 UN Office for the Coordination of Humanitarian Affairs (OCHA), “What We Do;” http://ochaonline.un.org/roap/WhatWeDo/HumanitarianReform/tabid/4487/Default.aspx