Tuesday, 7 April 2009


“Sickness is the vengeance of nature for the violation of her laws.” - Charles Simmons

April 7th is the day declared by the World Health Organisation (WHO) as “World Health Day”. The celebration of World Health Day creates an international opportunity to raise awareness of important health-related issues, and each year a special theme highlights a current and topical problem worldwide. This year, World Health Day is dedicated to the safety of health facilities and the readiness of health workers who treat those affected by emergencies. Health centres and staff are critical lifelines for vulnerable people in disasters - treating injuries, preventing illnesses and caring for people’s health needs.

Health facilities for primary health care in communities meet everyday needs, such as safe childbirth services, immunisations and chronic disease care that must continue in emergencies. In a disaster or an emergency, the already fragile health systems are unable to keep functioning with immediate and future public health consequences. The WHO and its international partners are highlighting this year on World Health Day the importance of investing in health infrastructure. Forward planning and resource allocation can withstand hazards and serve people in immediate need. Health facilities are being urged to implement systems to respond to internal emergencies, such as fires, and ensure the continuity of care.

Wars, cyclones, earthquakes, tsunamis, disease outbreaks, famine, floods, fires, radiological incidents and chemical spills all are emergencies that impact heavily on public health. Internal emergencies in health facilities, such as fires and loss of power or water, can damage buildings and equipment and affect staff and patients. In conflicts, reasons for hospital breakdowns include staff being forced to leave due to insecurity and the looting of equipment and drugs.

In 2008, a total of 321 natural disasters killed 235,816 people (a death toll that was almost four times higher than the average annual total for the seven previous years). This increase was due to just two events. Cyclone Nargis left 138,366 people dead or missing in Myanmar, and a major earthquake in south-western China's Sichuan province killed 87,476 people, according to the United Nations’ International Strategy for Disaster Reduction (UNISDR). Asia, the worst-affected continent, was home to nine of the world’s top 10 countries for disaster-related deaths. Along with other weather-related events, floods remained one of the most frequent disasters last year, according to UNISDR. Conflicts around the globe have also led to great human suffering and have stretched health care services to the extreme.

Although only 11% of the people exposed to natural hazards live in developing countries, they account for more than 53% of global deaths due to natural disasters. The difference in impact suggests there is great potential to reduce the human death toll caused by natural disasters in developing countries. The key ingredient in these tragedies is human inaction and poor support of essential services and health facilities by governments.

We can all help to support better health care in emergencies. Wide support for safer hospitals is needed from all within the community. Partnerships between different sectors (including emergency services) are vital to ensure that health facilities receive priority attention when an emergency occurs; for instance, by safeguarding the water supply or securing access to hospitals and other health centres. Many people are involved in this already. Some individuals volunteer in health facilities, professional bodies encourage innovations and designs that make health facilities safer and more functional in emergencies. However, urgent action need be taken if unnecessary death and suffering are to be prevented when our hospitals fail in emergencies.

Governments, financial institutions, private and corporate donors, universities and training organisations should all be collaborating in ensuring that resources are allocated wisely, infrastructure planning and implementation of strategies are occurring in a timely fashion. Health facilities and health workers should ensure that resources are being utilised at the maximum efficiency, good planning and budgeting are occurring so as to ensure good emergency responses. Plans for emergency responses should be familiar to everyone and staff should not only be familiar with this plan, but should be trained adequately in order to respond effectively.

The World Health Day 2009 is quite appropriate given the recent events in central Italy where a powerful earthquake that rocked the medieval town of L’ Aquila killed about 200 people and left tens of thousand homeless. More than 24 hours after the quake struck in the early hours of Monday morning tens of people were still reported missing. The quake of magnitude 6.2 Richter damaged some 10,000 buildings, many beyond repair, leaving up to 70,000 people homeless, according to a government estimate. Such numbers are optimistic and conservative estimates.

Of the dead, about 39 were in the small nearby town of Onna, which had a population of around 250. The nearby villages of Villa Sant’ Angelo and Borgo di Castelnuovo were practically wiped out. In the wake of the tragedy, emergency services and health facilities will be stretched to the limit as the infrastructure will struggle to cope with the dead, the injured, the infectious diseases that may break out. Doctors treated people in the open air outside L’ Aquila’s main hospital as only one operating room was functioning. This highlights the WHO’s sensitisation of the issue of emergency and disaster and how resilient health services and facilities are in the face of such disasters…

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