Disaster responseWhat works and doesn’t in disaster health response

By Richard Bissell and Thomas Kirsch

Published 1 May 2015

On Saturday, 24 April 2015, a major (Magnitude 7.8) earthquake hit Nepal shortly after midday. At the moment, the most important question is how can the global community best respond? What can and what should international relief teams be prepared to do when responding to such an event? Research provides some well-documented evidence that many international health-oriented responses are poorly targeted and may be influenced by objectives that play well on the home front rather than what’s needed on the ground. As we respond to Nepal’s earthquake, and as we look forward to the next international earthquake responses, let us take into account what we have learned from past experiences, and, in coordination with our local hosts, provide the kinds of health assistance that are most likely to meet the needs of the people affected.

On Saturday, 24 April 2015, a major (Magnitude 7.8) earthquake hit Nepal shortly after midday. Long-expected by seismologists, this large earthquake has left many of the older structures in this mountainous and economically challenged country of thirty-one million inhabitants in ruins. It has also released avalanches affecting mountaineers from all over the world.

As is the case of many mountain communities in developing countries throughout the world, Nepal is vulnerable to a trifecta of risk: a seismologically active landscape, slide and avalanche prone hillsides, and insufficient resources to construct modern earthquake-resistant structures. The country’s poverty also means that it will require outside help to mount an effective response to the widespread needs of an earthquake stricken population.

At the moment, the most important question is how can the global community best respond? What can and what should international relief teams be prepared to do when responding to such an event?

Research provides some well-documented evidence that many international health-oriented responses are poorly targeted and may be influenced by objectives that play well on the home front rather than what’s needed on the ground. Let’s look at this from the perspective of the still-unfolding Nepal earthquake response.

Assess damage and determine immediate needs
The first function in the response to any emergency, whether it is a multi-vehicle crash on the local interstate, or a massive earthquake in the Himalayas, is to conduct an immediate situation assessment.

The most important aspect of this process is called the “needs assessment,” which uses an initial damage assessment to predict what kinds of rescue, health, food and shelter needs exist at that time, as well as what will likely be needed going forward in the near- and midterm. As the needs are established, then the appropriate response can be directed to meet those needs.

International and United Nations-based organizations with previous experience in these kinds of assessments, and armed with the latest satellite imaging technology to estimate damage across the affected country, can provide assistance to local officials in setting response priorities.

Search and rescue needs to happen immediately
Earthquakes cause buildings to collapse, trapping people and causing massive amounts of injury. This was the case in the 2010 Haiti earthquake and now in Nepal. Fallen buildings make immediate search and rescue efforts critical to saving lives.