Maria Hamlin Zuniga, from the People’s Health Movement, reports on the devastating impact that poverty and poor infrastructure can have when disasters occur, both environmental and human made. She discusses the work of community-based health programmes in responding to health needs in these situations and what can be done better in future.
Disasters are both environmental and social events. Central America is one of the most vulnerable regions of the Americas in relation to intense natural phenomenon. The risk of a ‘natural disaster’ does not depend upon the phenomenon itself, but is a result of the vulnerability of the population. Vulnerability is intimately related to social processes and the fragility, the susceptibility, or the lack of resilience of the population faced with threats of many different types.
The Regional Committee for the Promotion of Community Health – RCPCH – established in 1978, is a network of over 200 community-based health programmes active in Central America, Chiapas Mexico and the Dominican Republic. For more than 33 years the network has provided attention to communities during multiple disasters of all kinds.
What characterises the region is its broad definition of ‘disaster’ that goes beyond the phenomena called ‘natural’, such as earthquakes, hurricanes, cyclones, tsunamis, floods, mudslides, landslides and damage to the environment. Indiscriminate clear-cutting, the concessions to transnational companies for open pit mining and large-scale use of toxic and persistent chemicals, and pollution of water sources are also considered to be ‘disasters’.
Civil society has assumed an active role in the region, working together with municipal and national governments on risk management and disaster planning. National ‘mesas de gestion de riesgo’ (risk reduction disaster programmes) have been established in several countries. They form a multi-country network, which is developing a regional plan for disaster management. This long-term programme should increase the capacity of civil society to advocate for legislative reform related to risk reduction in order to contribute to sustainable development. International bilateral donors and non-governmental agencies have contributed to these efforts in the region.
In an analysis of activities related to disaster management the RCPCH has identified the following lessons learned:
1.Natural phenomena triggered only part of the disasters in the region. The greatest impact is caused by discriminatory policies, lack of concern for welfare of the people and market based priorities of regional governments.
2.Poverty, marginalisation and lack of adequate public policies exacerbate damage caused by natural phenomena. For example, consider the contrast between what happened in El Salvador and Seattle, Washington in earthquakes of the same magnitude:
On January 13, 2001 at 11:35 a.m. an earthquake of magnitude 7.9 on the Richter scale in El Salvador affected much of the country. A month later, another earthquake measuring 6.6 struck the central region producing great damage. The earthquakes of 2001 left 1,159 people dead, 8,122 injured and 1,582,428 victims across the country. They produced enormous damage to buildings, infrastructure and services, in both urban and rural areas, and to the environment.
On February 28, 2001, a strong earthquake of the magnitude of 7.8 on the Richter scale, occurred in the state of Washington, USA. The quake was the largest that has affected this region since 1949. There were no deaths. About 250 people were injured. There was no damage to bridges, but strong movements destroyed walls, the skyscrapers oscillated and some fires resulted. There was a temporary loss of power in the region and the international airport of Seattle-Tacoma was closed for several hours.
3. Health work cannot be limited to coping with or reducing damage. Work should be done to minimise and control threats and risks. Organisations in each country carry out training courses followed by practical exercises with schools and community members to map risks. Working with them, environmental risks, such as houses built on hillsides, gullies, or along rivers or streams, are easily identified.
Prevention involves helping people to recognise danger zones and to leave them in times of danger. At the same time there is recognition that people migrate to cities because of lack of land to grow crops or to seek employment. This is difficult to address, because – in many cases – there are no alternatives to poverty. Few government programmes allow permanent relocation to sites with lower risk. Therefore, people are kept in poor conditions, fleeing during emergencies to settle in shelters allocated by local authorities.
4. Development of a comprehensive conception of disaster and risks allows for better preparation for eventualities. To do this, it is essential to incorporate the concept of vulnerability from different perspectives. For example, cultural patterns affect the vulnerability of people. In Chiapas, risk factors include use of cooking fires in small, enclosed spaces, a system that often results in burns or illness related to the smoke. Women suffer the consequences of lack of water in their communities. Often these same women and children are victims of domestic violence and, in the case of Chiapas, military repression.
5. Community participation to identify risks and threats is essential. In El Salvador community health committees have established early warning systems to warn about pollution of rivers caused by free trade zone factories or places used for production of transgenics cultivations (genetically modified seed).
6. Preparation and capacity building are key and essential. Therefore, both the RCPCH and the Regional Platform for Disaster Risk Management have placed particular emphasis on developing skills to identify risks and threats and to develop action plans and responses to different types of risk.
For example, in Guatemala, El Salvador and Nicaragua, programmes sensitise children and young people about HIV prevention and gender violence. The goal is to strengthen knowledge about children’s rights and reduce vulnerability, especially for girls when teenage pregnancy is a result of domestic violence. In some communities, girls and adolescents enroll in self-defense courses to prevent attacks.
Several organisations of the RCPCH participate in the national risk management programme and take advantage of courses to learn about mapping exercises, evaluation of damages and preparation in disaster management.
7. The dialogue between communities and organisations with local, regional and national authorities should be a fundamental requirement for the definition of risk maps and plans of prevention and action in disasters. Special emphasis has been placed on setting up territorial risk management platforms to promote to coordinate between the different actors and authorities to demand action or responses.