Populations that are rendered socially invisible by their relegation to realms that are excluded—either physically or experientially—from the rest of society tend to similarly be left out of community disaster planning, often with dire consequences. Older adults, persons with disabilities, linguistic minorities, and other socially marginalized groups face amplified risks that translate into disproportionately negative outcomes when disasters strike. Moreover, these disparities are often reproduced in the aftermath of disasters, further reinforcing preexisting inequities. Even well-intentioned approaches to disaster service delivery have historically homogenized and segregated distinct populations under the generic moniker of “special needs,” thereby undermining their own effectiveness at serving those in need. The access and functional needs perspective has been promoted within the emergency management field as a practical and inclusive means of accommodating a range of functional capacities in disaster planning. This framework calls for operationalizing needs into specific mechanisms of functional support that can be applied at each stage of the disaster lifecycle. Additionally, experts have emphasized the need to engage advocacy groups, organizations that routinely serve socially marginalized populations, and persons with activity limitations themselves to identify support needs. Incorporating these diverse entities into the planning process can help to build stronger, more resilient communities.
Integrating Access and Functional Needs in Community Planning for Natural Hazards
Displacement, Natural Hazards, and Health Consequences
When natural hazards lead to disasters, they can affect people in many ways, including damaging their housing and negatively impacting their livelihoods. Each year, millions of people are injured or killed as a result of disasters. They can also force people out of their homes: In 2020, 30.7 million new internal displacements linked with disasters, mostly storms or floods, were recorded throughout the world. Between 2010 and 2020, disaster displacements were recorded in 198 countries and territories, making the issue truly global. Such displacement can have severe and long-lasting consequences on physical and mental health, often similar to those of conflict-related displacement. Psychosocial trauma and the deterioration of living standards and housing conditions often alter displaced people’s well-being and their ability to maintain healthy lives or obtain treatment and care. People with disabilities or long-term illnesses are particularly vulnerable in displacement, as are children and older people. Depression and anxiety, malnutrition, communicable diseases, and lack of access to sexual and reproductive health are among the most frequent issues for internally displaced people. The health consequences of displacement linked with disasters vary depending on affected people’s pre-existing conditions and sociodemographic characteristics, the duration and severity of their displacement, and the type of support they are able to access. In cases of mass and protracted displacement, the health of people in communities of refuge and the health systems in the areas of origin and refuge can also be affected, with repercussions on the broader society. Although some of these impacts are relatively frequent and should be systematically considered by national and local governments, humanitarian organizations, and aid providers, each situation requires tailored approaches. Information on the health impacts of displacement remains limited, but the body of knowledge is growing as awareness increases on the scale of current and future displacement crises linked with disasters in a changing climate.
Health Care Challenges After Disasters in Lesser Developed Countries
Joseph Kimuli Balikuddembe, Binhua Fu, and Jan D. Reinhardt
A public health disaster occurs when the adverse health effects of an event such as a natural hazard or threat exceed the coping capacity of the affected human population. The coping capacity of the affected population is hereby dependent on available resources including financial and human resources, health infrastructure, as well as knowledge, planning and organizational capabilities, and social capital. Disasters therefore disproportionally affect lesser resourced regions and countries of the world and pose specific challenges to their health systems as well as to the international humanitarian community in terms of dealing with mortality and injuries, communicable and noncommunicable disease, mental health effects, and long-term disability. Challenges for health care delivery in disaster situations in lesser resourced settings include deficiencies in the construction of resilient health care facilities, the lack of disaster response plans, shortage of specialized medical personnel, shortcomings regarding training in disaster response, and scarcity of resources such as medicines and portable medical devices and supplies. Other challenges include the absence of appropriate algorithms for the distribution of scarce resources; lack of coordination of medical teams and other volunteers; limited awareness of particular health issues such as mental health problems or disability and rehabilitation; and lack of plans for evacuation, sheltering, and continuation of treatment of those with preexisting health conditions. Many challenges lesser resourced settings face with regard to health care delivery after disasters such as the organization of mortality management, triage and treatment of the injured, or the delivery of rehabilitative and mental health care cannot be reduced to the lack of baseline resources in terms of health infrastructure, technology, and personnel but are related to the absence of proper planning for future disaster scenarios including implementation strategies and simulation exercises. This not only encompasses the formal drafting of disaster preparedness and response plans, contingency planning of hospitals, and the provision of disaster-related training to health personnel but also in particular the identification and involvement of the potentially and traditionally affected communities and especially vulnerable groups in all the process of disaster risk reduction.