ICDO Ministerial Conference
Civil Defence, a Tool for Sustainable Development
Geneva, 30 October -1 November 2000
Disaster Reduction, Health and Civil Protection
Dr Alessandro Loretti
Coordinator, Intelligence and Capacity Building
Department of Emergency and Humanitarian Action
World Health Organization
Health is the ultimate objective and the yardstick of success of disaster reduction.
Directly or indirectly, health-related problems account for more than fifty percent of
all humanitarian assistance costs arising from disasters of all types1, and health
workers have the most challenging and visible responsibilities in the response to
disasters
In 1999, disasters killed 80,000 people2, and the figure refers only to the immediate
casualties: it doesn't speak of the victims of secondary effects. Taking a wider view,
in 1999, disasters affected 213 million people worldwide, with total economic losses
estimated around 72 Billion US$ 3. All throughout the 1990s, disasters have exacted a
tremendous human toll. According to UN estimates, natural disasters killed over
150,000 people and armed conflicts killed more than four million. At any point in the
decade, more than a hundred million human lives were blighted either by war or
natural disaster, and an average 35 million people were displaced4.
All societies and countries are susceptible to disasters, but by the very nature of
WHO, those countries with whom the Organization has a closer dialogue are also
those that are more vulnerable. 95% of the deaths resulting from natural disasters
occur among the 66% of the world's population that live in developing countries5.
WHO shares the view that disasters are preventable, that they stem from failed
development and/or failed emergency management, and that the primary
responsibility for disaster reduction is with the communities or countries at risk.
Only in extra-ordinary circumstances, this responsibility may be temporarily assumed
by the international community. Therefore, disaster reduction is a key objective of
WHO's cooperation with member countries.
1
WHO/EHA Panafrican Emergency Training Centre Bulletin, vol.4, Special issue, Nov.1997
International Federation of Red Cross and Red Crescent Societies: World Disasters Report, 2000
3 International Federation of Red Cross and Red Crescent Societies, ibid
4 International Federation of Red Cross and Red Crescent Societies, ibid
5 Noji, E.K. The Public Health Consequences of Natural Disasters, Oxford University Press, 1997
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In Dr Brundtland's words, "WHO’s ultimate goal is to increase the self-reliance of
its member countries... WHO wants them to be more resilient during a crisis, capable
to absorb humanitarian assistance without being overwhelmed by it and then, once
the crisis is over to move towards a recovery that takes full advantage of the lessons
learnt."6
WHO knows that, the same as against disease, there is no golden bullet, no quick-fix
solution against disasters. Disaster reduction is essentially a developmental process of
investment in people and institutions, at national and local levels as well as at
international level. Long-term financial and political investment are essential for a
programme to have the continuity that is needed to induce positive changes. Disaster
mitigation and emergency preparedness are difficult processes that require
institutional stability and that must be sustained in spite of competing priorities on the
basis of simple forethought: "What if?
The experience of WHO is that disaster reduction needs to be seen as a core function
of the Ministry of Health that should establish a programme or department with
specific responsibility and resources for it. It is also WHO's experience that, in order
to make a difference, this programme must coordinate with the national institution
responsible for overall disaster management and the other relevant actors in the public
and private sectors7.
What brings WHO here today is the need to promote this coordination and these
partnerships as key components of national capacity for disaster reduction. Making
the other sectors aware of, and responsive to the meaning of Health and the role and
capabilities of the health sector in disaster reduction is a precise responsibility of the
Organization8.
Calling WHO to increase the self-reliance of its member countries, Dr Brundtland
challenge us with a developmental goal that goes far beyond the health sector and
involves the whole texture of society. The main, cross-cutting concern, though,
remains how to avoid the loss of life9 and how to preserve or restore that " state of
complete physical, mental and social well-being" that is health. Working for disaster
reduction means protecting social capital and working for health. And the principles
ruling Disaster Reduction are the same that underpin the Public Health model and the
philosophy and practice of Primary Health Care.
Health professionals are familiar with the concepts of risk, hazard and vulnerability
that are the cornerstones of disaster prevention. Disasters kill, but nobody dies "of a
disaster". No matter how complex and confused the chain of events leading to a
disaster, people die of precise and recognisable clinical causes. Epidemiology, that is
proceeding upstream from the actual causes of death, provides an ideal instrument to
understand disasters, find solutions for mitigation and ultimately reduce their risk10.
6
Key note address: Consultation on Planning Ahead for the Health Impact of Complex Emergencies, WHOGeneva, 13-14 December 1999
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Emergency and Humanitarian Action Disasters, Emergencies and WHO, Paper presented at the second
meeting of WHO GMPG, March 2000-Geneva
8
WHA 48.2. Emergency and Humanitarian Action
Lechat, M.F. The Public Health Dimensions of Disasters. International Journal of Mental Health,
1990, Vol 19, N°1, pp 70-79
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Western.K.A- The Epidemiology of Natural and Man-made Disasters-The Present State of the Art
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To mention just few examples, what we call epidemiological surveillance is in fact an
approach to early warning and forecasting that we share with all the disciplines
represented in this meeting. Health information is essential for risks to be assessed,
for the public to be aware of hazards and vulnerabilities and for emergencies to be
recognised.
Applying the epidemiological method to disasters shows that they are not random
occurrences, but that they reflect the interaction of human beings with a given
environment. From the point of view of an epidemiologist - indeed from that of any
social scientist - there are no purely "natural" disasters. There are natural hazards,
which impact upon human vulnerabilities that are mostly determined by human
causes. Human pressures on the environment and social inequalities heighten
vulnerability to natural hazards. Economic downturns and fast social changes can
engender political hazards. Economic development can increase the threat of
technological disasters. The interaction of social, natural and technological hazards
can trigger off a major crisis whenever communities and institutions lack the
resilience needed to cope and recover. Vulnerability to disasters is indeed a function
of human actions and behaviour.11
Two important corollaries of the above are that if people are not affected, there is no
disaster, and that, by definition, all disasters impact upon and interact with human
systems. Therefore, all action aimed at mitigating the impact of disasters must take
these systems into account. We know that the affected communities are always the
first forced to cope with and respond to any disaster. We are also -slowly- learning
that any external intervention aimed at reducing disasters must first of all integrate
and support the efforts and coping and recovery systems of the affected community 12,
and that this principle must apply to preparedness as well as response.
Health data and advice are essential for the policies that must support sustainable
development as well as disaster reduction: population, food security, safe water,
habitat, environment, etc. The health sector contributes to each phase of disaster
reduction. In terms of prevention many hazards and vulnerabilities are reduced by
preventive care. Health contributes to preparedness by contingency plans, early
warning and referral systems, to be activated in case of disaster. When it comes to
response, by reducing suffering and death, health care, in fact, ensures the costeffectiveness of all other efforts, as people's survival and health remain the main
concerns.
All along the disaster reduction cycle, Health professionals and health services have a
presence in the field that is matched by few others, in terms of acceptance by the
beneficiaries and, therefore, of capacity for implementation. Community participation
- that is the core of primary health care - can provide the grass-root basis of the intersectoral framework for action advocated for in the conclusions of Yokohama.
As a public health physician working in this area for the last twelve years, I often
struggle to reconcile what I perceive as two distinct approaches to disaster reduction.
dissertation thesis, LSHTM/DTPH, 1972
11
Inter-Agency Task Force on Disaster Reduction Draft Framework for Action for the implementation
of the International Strategy for Disaster Reduction, October 2000
12
The Medical Response to natural Disasters; have we learned anything, yet ? DISASTERS, N.81, July 2000
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There is the social/anthropological approach that focuses on the community's
resilience, on the coping mechanisms which originate in the social and cultural
context, and, essentially, on sustainable development; and there is the engineering/
managerial approach, that focuses on technologies, institutional capacities, lifeline
systems and emergency management. I also know that my partners from other
disciplines meet with the same apparent duality when considering Health. There is
Health that is a social and anthropological value, rooted in the community, and there
are the health sector and health delivery systems that are managerial concepts.
Both approaches are legitimate and effective, but they need to merge in an integrated
paradigm. From a public health point of view, the one proposed by the Civil
Protection is especially interesting: a "kindred framework ". And it is not haphazard
that WHO's partnership with ICDO goes back some years now.
The same as for primary health care, civil protection hinges upon the sharing of
responsibilities between different sectors and different levels. Civil protection
integrates community's with institutional capacities, voluntary participation with
technical expertise, distributing efforts between public and private sectors in a
perspective of prevention. Civil protection gives substance to the IDNDR's call for a
culture of preparedness: a culture that follows the evolution of risks, a culture rooted
in participation, in the collection and transmission of experience.
As a public health practitioner convinced that disaster reduction is the key precondition for sustainable development, I look at civil protection as the system of
measures that concur to ensure the security of the community, of their assets and their
environment in the face of natural, social and technological hazards.
I see civil protection as a framework for dialogue between institutions and civil
society, a way of empowering communities, by focusing primarily on their right to
security, their assets and the development of their capacities, rather than on their
needs and vulnerabilities. A system for capacity building that is more process-driven
rather than product-oriented, as the process itself facilitates the internal change that is
envisaged by the International Strategy for Disaster Reduction13. If public health
refers to "..the efforts organised by society to protect, promote and restore the
people's health"14, then Civil Protection is an essential instrument of public health.
To conclude and to fuel the discussions of the following sessions, I can offer a quote:
"Disasters reflect the ways societies structure themselves and allocate their
resources" (Kent, 1997).
In this sense, all disasters have political causes: either by commission or by omission
and this applies to the local level as well as to the national and the international
levels. In this context, the health sector can provide quality standards, measures of
effectiveness, human resources and strategic and technical means, while human
survival and Health contribute the primary objectives of disaster reduction.
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14
Inter-Agency Task Force on Disaster Reduction, ibid...
A Dictionary of Epidemiology-Edited by J.M.-Last, IEA, 1983
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