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EDITORIAL
Year : 2023 | Volume
: 9
| Issue : 1 | Page : 1-3
What's new in academic international medicine? The importance of effective disaster management
Galina Udod, Lauren Brooke Gruffi
SUNY Downstate Health Sciences University, Brooklyn, New York, USA
Correspondence Address:
Dr. Lauren Brooke Gruffi
SUNY Downstate Health Sciences University, Brooklyn, New York
USA
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/ijam.ijam_21_23
It is estimated that over 5 million lives have been impacted by global disasters in the last decade alone.[1] A disaster, according to the World Health Organization (WHO), is an occurrence disrupting the normal conditions of existence and causing a level of suffering that exceeds the capacity of adjustment of the affected community.[2] By this definition, communities impacted by disasters require changes to increase their capacity and outside assistance to relieve their suffering. Some disasters are geopolitical and include wars or acts of terrorism. Other examples of disasters include threats to public health, such as disease outbreaks in people, produce, or farm animals that cause large-scale illnesses and mortality. Disasters may also be “natural” and driven by atmospheric, hydraulic, or geologic forces. These include devastating earthquakes, floods, wildfires, tsunamis, and droughts. However, many of these “natural” disasters in the past decades are considered a consequence of the unnatural pace of climate change due to global warming. These disasters pose a threat to developing nations without disaster preparedness infrastructure and adequate resources to rebuild.[2]
Some of the most immediate needs for affected communities are increased health-care resources for acute and chronic health problems resulting from disasters. In response to this need, disaster medicine was founded as a discipline in the late 1970s. Disaster medicine is an interdisciplinary field that aims to address these needs through a combination of epidemiological, emergency medicine, public health, pediatrics, social medicine, and international medicine expertise.[3] It has been described as “a field of medicine that focuses on the disproportion between the health needs of the affected society and the available resources of the affected community to save the highest number of injured.” Disaster medicine not only facilitates effective disaster response but also aids in the rehabilitation of community systems that are vulnerable to collapse. Furthermore, in addressing both risk factors and consequences of increased health needs, disaster medicine aids to also improve economic and social community impacts.[4] Although relatively new and expanding, the importance of this field is evident by the broad impacts of disasters.
The global frequency of disasters, both natural- and human-induced, is steadily increasing, pointing to the importance of allocating attention and resources to disaster management and preparedness to safeguard human health. Globally, the frequency of natural disasters has increased ten-fold since 1960; this is primarily due to a combination of population growth and development alongside human-induced climate change, which intensifies the severity of extreme weather events, including wildfires and floods.[5] Climate change leads to longer and more active fire seasons and is likely exacerbating the frequency and intensity of extreme flood events; in fact, one study linked the June 2022 flood in Pakistan to climate change.[6] Other types of disasters, such as terrorism, war, and infectious disease outbreaks, also pose a significant risk to human life; in particular, the COVID-19 pandemic placed a spotlight on the importance of infectious disease disaster preparedness as an ever-evolving process of emergency management response.[7]
The immediate impact of increasing global disasters is immense and poses a significant risk to public health. Injury and trauma as the result of disasters lead to disability and the loss of human lives. In addition, the destruction of infrastructure leads to disruption of access to immediate needs, including clothing, food, shelter, and access to health care. The earthquake in Turkey and Syria highlights the devastating toll of natural disasters; to date, the death toll has surpassed 42,000 people and 13.5 million people were affected. A large winter storm hampered rescue efforts and freezing temperatures put survivors trapped under the rubble at great risk of hypothermia.[8]
Disasters have long-term consequences on health care as well as social and economic ramifications. With regard to health care, the long-term impact on mental health has been demonstrated in several studies: one showed that between 15% and 75% of people who experience a natural disaster later develop posttraumatic stress disorder and natural disasters also worsen preexisting mental health conditions.[9] Furthermore, infections increase both in the immediate aftermath and the long-term following disasters. This is due to several factors, including lack of infrastructure increasing exposure to dangerous microbes, as well as lack of access to medical care and lower immunization rates. For example, the COVID-19 pandemic led to the largest decline in childhood vaccinations in three decades.[10] Furthermore, the social and economic damage inflicted by disasters is long lasting, particularly in poorer countries. The loss of human capital and economic assets, as well as the destruction of a country's natural resources, poses significant challenges to postdisaster recovery.[11] Officials estimate the damage to Turkey due to the recent earthquake could exceed $20 billion, as both Turkey and Syria face a long road to recovery.
There have been many steps taken to mitigate these impacts. The first is an expansion of disaster medicine as a discipline. The field of disaster medicine is projected to grow to match the increased frequency of disasters. To facilitate this growth and standardize disaster response, the United Nations Office for Disaster Risk Reduction (UNDRR) created the Sendai Framework for Disaster Risk Reduction in 2015. This initiative outlines the development and dissemination of disaster medicine education to strengthen the field by 2030 and provide a standardized framework of accountability to nations. Anticipated benefits of the initiative include disaster-related reductions in morbidity/mortality, economic loss, infrastructure damage, and service disruption. In addition to improving education and training, the framework aims to upscale risk reduction strategies, emphasize cooperation with developing countries, and increase multi-hazard early warning systems.[12]
Several years later, the “Health Emergency and Disaster Risk Management (EDRM) Framework” by WHO was published in 2019 to further consolidate disaster approaches and practices. Specifically, this framework focuses on strengthening health and health-related sectors by focusing on health outcomes in communities with varying degrees of risk factors. The framework outlines several changes, including approaches that are proactive versus reactive, risk-based versus event-based, all-hazard versus single hazard, and shared responsibility versus separate responsibility. Evidently, the emphasis on systems coordination and disaster preparation and prevention is recognized as the optimal approach. The guidelines further specify financial, political, infrastructure-related, logistical, and communication goals that can be standardized across national disaster risk reduction plans. These include incorporating emergency plans into legislation, determining contingency funding based on previously documented emergency costs, establishing nonconflicting lines of communication, preparing health sectors for necessary upscaling, and standardizing monitoring through the simulations of response and recovery activities.[13]
The concept of resilience is frequently employed in the field of disaster management and applies to both international and local organizations involved in relief efforts. Resilience is an overarching concept that encompasses a range of ways in which a system responds to external stresses, major disruptions, and new circumstances such as disasters. Disaster resilience is pervasive in literature; while mainly theoretical in its scope, it offers promise as a guiding framework for disaster risk reduction and investment in local capacity for adaptation to disruptive environments.[14] It is being increasingly recognized that the resiliency of systems lies in the local community and that to provide sustainable disaster risk reduction, there must be strong involvement and commitment from empowered local institutions.[15]
Although disaster response is inherently dependent on outside aid, the importance of partnerships with local communities cannot be understated. Both the Sendai Framework by UNDRR and Health EDRM highlight the importance of creating plans with communities rather than for communities. In the aftermath of the January 2023 earthquake in Turkey and Syria, it was local survivors who pointed Search and Rescue teams to rubble with the highest likelihood of live victims and informed international organizations of specific health resource needs.[16] In addition, before the arrival of international volunteers, mobilization of local militaries set up field hospitals and airstrips for much-needed supplies. Despite the success of international assistance, local community involvement is the key for both immediate and future disaster responses.
The last decade has seen many strides in addressing pitfalls to disaster management and optimizing cohesive responses that limit death, injury, and damages. These new frameworks that focus on prevention, standardization, preparation, simulation, and cooperation are a great starting point to improving disaster response in both health and nonhealth-related sectors. Furthermore, the emphasis on both community resilience and cooperation with local communities is part of a vital shift toward creating sustainable response networks. However, there are several barriers to effective disaster response that surpass comprehensive planning, organization, and teamwork. The first, most obvious, is economic. To instruct countries to have a contingency fund for emergency preparedness is naive, especially for developing nations with struggling economies and growing national debts. In addition, political cooperation is often hindered by civil conflict and hostility between governing bodies. This has been seen recently by the delay in supplies headed to Northern Syria, an area with tightly closed borders.[17] Other challenges include managing existing vulnerable infrastructure, the generalizability of disaster research, and the unpredictability of environmental changes.[18] With the growth of disaster medicine as a discipline and increased global efforts into disaster responses, these challenges may be surmountable.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Research quality and ethics statement
This article does not contain any studies involving human participants performed by any of the authors. The authors declare this editorial does not require Institutional Review Board/Ethics Statement.
References
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