Health and education
issues in
rehabilitation
Ms. Neha Madiwala
CEHAT
Man made disasters
Treat disaster affected people as citizens,
with human rights,
rather than violators of the law.
Health impact
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Injuries
Hygiene related health problems
Epidemics of infection diseases
Mental health problems
Women’s health issues
Neglect of chronic diseases
Immediate Problems
• Lack of food, shelter, clothing makes life difficult
(especially women’s needs are neglected). People’s
capacity to cope is much reduced. They are unable to
make decisions and take actions as they do in normal
times.
• Priority is given to those with serious injuries, ignoring
those whose problems are less visible
• There is no system of distributing health resources
equitably in a disaster situation, wherein the most able are
able to get the most
• There are several who suffer from the same common minor
ailments, who crowd the health camps
• People use the health camps as a means of seeking
counseling and aid
Suggestions
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Separate the responsibility of monitoring of the disaster related
health functions (emergency care, disposal of bodies, etc)from the
relief related health function (public health measures, treatment of
the ill, mental health). There should be one person who handles
public information related to health situation (and who also pools
information received from the field and issues
warnings/instructions).
Create a mechanism to pool in govt. and private health resources
(personnel, equipment, medicines, appliances) from the very
beginning. Create a formal network of govt. and non govt. agencies
who are responsible for health. Give them full information about
possible outbreaks and precautionary measures. Give them the
authority to report on health situations and set up an early warning
system. Entrust them with the responsibility of surveillance and
reporting of outbreaks.
Suggestions - 2
• Initiate preventive health measures as soon as possible - chlorination
of water, decontamination of water, pest control,etc. Do not neglect
to provide items such as sanitary napkins, which voluntary donors are
not likely to provide.
• Co-ordinate health camps by developing standard treatment
procedures. Make provisions for investigation facilities on site or
provide escort, where referrals can be done.
• Train volunteers to provide counseling who can go from house to
house or do community counseling to look after those who are not in
need of medical care. Similarly train volunteers to treat common
minor ailments from house to house, so that they do not crowd the
camps.
Problems - 2
Long term problems
• Rehabilitation of the injured and disabled not continued beyond the
first phase of relief
• Discontinuation of treatment for the chronic diseases after relief efforts
begin to peter out
• Discontinuation of treatment for those who temporarily migrate
• Long term consequences of mental health problems, which have not
been addressed
• Indebtedness due to health expenditure
• Lowered health and nutrition status due to deprivation caused by the
disaster
• Deaths of young, working age population, causing destitution among
certain households
Suggestions - 2
• Centralise the aid distribution through a single agency so that all
receive aid at one point at one time. Onus on proving eligibility should
lie on the state agencies and not on the people.
• Make provisions to provide free/subsidised essentials for a longer
period of time, rather than giving out large amounts at one go. Provide
subsidies and free treatment for a longer period of time beyond the
immediate relief effort
• Set up a long term health rehabilitation service in the affected areas (at
least one year) which has medical, paramedical and voluntary staff
within the existing service.
• Route aid through existing institutions rather than through ad hoc
centres/stations (wherever the infrastructure is not affected) so that is
builds trust among the people and also builds expertise in dealing with
disaster related problems
Impact on Education and
Children
• Schools take a back seat as there are more immediate survival issues
to handle
• There are no provisions to provide recreation to children in camps
• Children are too traumatised to go back to school
• Smaller children are left unattended because families are too busy
trying to survive
• Older children are too busy gathering small doles from various
agencies to go to school
• Several children permanently drop-out because of the gap in schoolgoing
• Not having books, materials, uniforms, etc. \dissuades children from
going back to school
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Suggestions
• Restart schools as soon as possible. Route all direct aid to
children (cooked food, study materials, clothes, toys, etc)
through the school. Relieve families of the tasks of caring
for children.
• Train selected teachers in all areas to help deal with posttraumatic stress disorders in children. (A standard
curriculum could be devised and offered as a specialty in
the teacher-training curriculum or offered as a certificate
course through open university). These trained teachers
should be specifically entrusted with the responsibility of
coordinating the rehab efforts, ,training volunteers and
overseeing their work
Suggestions
• Make relevant changes in the schedule and the curriculum
to incorporate elements of community counseling
• Make provisions to provide study materials in affected
areas (shortages are caused immediately)
• Initiate special programmes to re-integrate those who dropout following a disaster