Introduction

Disasters are commonly divided into “natural” and “man made,” but such distinctions are generally artificial. All disasters are fundamentally human made, a function of where and how people choose or are forced to live. The trigger may be a natural phenomenon such as an earthquake, but its impact is governed by the prior vulnerability of the affected community.

Most search and rescue is done by survivors, not external teams

Poverty is the single most important factor in determining vulnerability: poor countries have weak infrastructure, and poor people cannot afford to move to safer places. Whatever the disaster, the main threat to health often comes from the mass movement of people away from the scene and into inadequate temporary facilities.

International medical aid

Local medical services may be disrupted and require international help, not only in dealing with the effects of the disaster but also to maintain routine health facilities for unrelated conditions. An often overlooked aspect of medical need is the rehabilitation of those disabled by the disaster. Help in this regard can be provided in a planned and measured fashion and is often required for years.

The effectiveness of international surgical teams is limited by the delay in getting to a disaster area. However, outside medical and surgical help may be needed in the post-emergency phase. International aid can help national and local authorities to restore routine medical and surgical facilities overwhelmed by the disaster and may support later specialist elective services.

Survivors with crush injury invariably stimulate requests for international aid in the use of dialysis. This is a complex issue raising difficult questions about sustainability and appropriate use of limited resources. As with much aid in complex circumstances, this is best negotiated with guidance from international aid organisations and agencies such as …