Community support needs higher priority in disaster relief

BMJ 2012; 344 doi: (Published 23 April 2012) Cite this as: BMJ 2012;344:e2920
  1. Matthew Limb
  1. 1London

Humanitarian responses to wars and natural disasters should include more social support for communities alongside medical aid, the inaugural World Extreme Medicine Conference has heard.

Richard Williams, lead officer for disaster management at the Royal College of Psychiatrists, said that the delivery of psychosocial care to victims of major incidents was “neglected.”

He said that communities suffering mass trauma needed urgent help to boost the “recovery environment” as well as treatment and protection from diseases.

Medical aid organisations were apt to get carried away with “big things like infections” and to forget they needed a vehicle for delivering their interventions, he said.

Williams told the conference, “The first thing you should do, after you have got water, sanitation, and nutrition sorted out, is open a school—it provides a community base.”

The conference was held over four days from 15 April at the Royal Society of Medicine, London, by Expedition & Wilderness Medicine, which runs courses for medical professionals working in remote areas, for example as part of disaster relief teams and charitable or scientific expeditions.

Williams led the development of guidance for the North Atlantic Treaty Organization on psychosocial care for people affected by disasters and major incidents.

He spoke about the distress suffered in particular by children (who were often separated from their families), women, older people, and disabled people.

“Women and children account for more than 75% of refugees and displaced persons at risk from war, famine, and natural disaster,” he said.

Williams said that action aimed specifically at people’s psychosocial care and to develop communities should be added to the internationally recognised top 10 priorities for reducing mortality and morbidity in displaced populations, which includes recommendations covering vaccination, public health surveillance, and health treatment.

“In creating communities we are creating opportunities for the other 10 [priorities] to be delivered,” he said.

Tim Healing, a clinical scientist specialising in epidemiology and a director with the Society of Apothecaries of London, said that the number of reported natural disasters had risen dramatically in the past 30 years and that world population growth meant more people being at risk from living in “marginal habitats.”

People who had been internally displaced within countries tended to be harder to reach and more at risk than refugees, he added.

Arjun Katoch, an adviser who covered 140 disasters and emergencies with the United Nations Disaster Assessment and Coordination system, said that a “medical cell” should be part of all disaster response teams but that this was not always the case.

Medical teams needed regular training and updates in skills specific to disaster situations, he said, including, where appropriate, nuclear, biological, and chemical emergencies.

They should also be culturally aware and sensitive to indigenous populations on whom they would rely.

“As international responders we think we know best—but local people do,” he said.

Jane Zuckerman, director of the Academic Centre for Travel Medicine and Vaccines, in London, said that health systems were facing difficult challenges from increasing numbers of migrants, who number more than 200 million worldwide.

“Our clinical practice of medicine has been reshaped by the last few decades of global mobility,” she said.

Karen Roberts, a GP and adviser to the Medical Defence Union, said that the number of commercial trips to remote places requiring medical support was rising.

She said that doctors who wanted to join such trips should carefully assess the risks involved beforehand and prepare meticulously to avert potential problems, including clinical negligence claims arising from things going wrong.


Cite this as: BMJ 2012;344:e2920