Preventing disaster: realizing vulnerabilities and looking forward.

Burnham, Gilbert

The past 16 months have seen major disasters in Asia, Africa, and the Americas. Hundreds of thousands of people have died and millions have had their lives changed forever. Some attention has focused on a possible increase in the frequency of natural and man-made hazards that are responsible for these disasters. However, the right place for our attention is on the increasing vulnerabilities related to geography and livelihood. As new disasters occur in 2006, we cannot lose sight of what we should have learned from the disasters of 2004 and 2005. Serious thinking on these lessons can protect the lives of those who continue to live in circumstances particularly vulnerable to disaster. These are issues we cannot further delay addressing.

How the world responded to the tragedy of the December 26 tsunami will continue to be examined in detail through expert panels, workshops, and reports. The same will be true for Hurricane Katrina and the Kashmir earthquake. Less attention will be paid to the planning and preparation that could have mitigated these disasters. Predictably, only some passing mention will be made about the lack of community disaster management capacity or the manifest failure to reduce the obvious vulnerabilities that resulted in widespread loss of life and property.

At the heart of these disasters was the failure to develop effective national disaster management capacity--the capacity to plan and prepare for response, to coordinate assistance, to develop policies on reconstruction, and to confront the vulnerabilities of the population.

Development of a national disaster response system stretches from policy formation in central government to community preparedness. It is a plodding and unexciting process that requires updated legislation and emergency operations plans at many levels and in many sectors. A variety of often disparate stakeholders must plan together, competing goals and highly variable capacities must be reconciled, training programs must be required, and capacities must be repeatedly tested. These initiatives need not be expensive to be effective, as demonstrated by cyclone response programs in Bangladesh and hurricane preparedness efforts in the Caribbean states. They require perseverance and unified focus by a capable team as well as consistent political support. External organizations also play an important role in helping make this happen.

The popular image of disasters comes from pictures on television of the desperate homeowner, the harried relief worker, and the various logos of relief organizations. Little credit is given to the long and unflagging support provided by the International Federation of Red Cross and Red Crescent Societies, the consistent efforts of the Pan American Health Organization, or the work of the United Nations Development Programme (UNDP) in helping countries build their disaster management capacities in quiet and undramatic ways.

There have been no headline-grabbing presidential initiatives for disaster preparedness, no Millennium Goals for disaster management. The UN International Decade for Natural Disaster Reduction quietly closed its doors in 2000 and its successor, the International Strategy for Disaster Reduction, is not making big waves. Promising major disaster relief initiatives or sending prominent public officials, such as former presidents and prime ministers, could give disaster preparedness a higher media profile. An all-out effort on the part of prosperous nations to strengthen disaster management capacity in less developed countries is the only way to create long-term stability and reduce human and economic losses worldwide.

Responding to specific disasters by providing hand-to-mouth help is not the best way to help countries suffering from the effects of a natural disaster. Creating a standing fund to draw from to meet disaster needs immediately, sidestepping the present flash appeal process, could speed relief and make for more effective intervention. Some disasters are more photogenic and emotion-laden than others, eliciting more funds. But even when developed countries pledge funds for a disaster, these pledges may not be fully honored. Proposals from UN agencies for a large general disaster response fund have been rejected by the United States and other prospective donors, but the idea must be revisited. Ways to make disaster relief funds more quickly available must be explored.

In most locations, tsunami disaster assistance was oversubscribed, leaving some agencies with funds they could not easily expend in a sound manner. Doctors Without Borders closed its appeal for tsunami relief when it became evident that there would be problems spending everything received, an ethical response. Other agencies did not always respect the same principles.

For a variety of reasons, donations for those affected by Hurricane Katrina fell short. The American Red Cross had to borrow money for disaster relief, hoping that future donations would cover the debt. The US government seems to be backing away from its initial funding promises or at least looking for ways to pay for relief and reconstruction by reducing benefits for marginal groups. For the impoverished of New Orleans, Congress may be delivering a second Katrina.

Disasters, as portrayed by the media, often drive individuals and donor nations to fund relief activities. Tsunami relief was very generous, but aid for the recent food crises in Southern Africa was a pittance compared to what was needed. It has been the reflex response of many humanitarians to blame the media for publicizing some emergencies but not others, skewing donations. However, the media are newshounds, not humanitarians; some disasters generate more appealing stories than others. The relief community itself carries some of the blame for publicizing crises in a fund-raising mode rather than a more analytical mode. The careful work on mortality in the Eastern Congo by the International Rescue Committee and the work of CARE in assessing the deterioration of nutritional status among the Palestinians in Gaza and the West Bank are encouraging examples. Another organization, the International Crisis Group, offers a badly needed political analysis capacity that can help agencies understand how to provide effective assistance in complex situations.

Over the past decade the technical response to disasters has improved substantially, often through careful evaluation of refugee programs. Important milestones in improving response have been the creation of the Sphere Project technical standards for disaster response and the Code of Conduct for humanitarian response. Drug policies for emergencies have been created by the World Health Organization, and academic courses for disaster management and disaster research have been developed.

However, in every disaster much knowledge still goes unused. Assessments of need are not always complete before assistance begins. Information collected through surveillance methods does not always inform decision making. Air and seaports continue to be clogged by expiring or inapplicable medicines, unnecessary supplies, unneeded clothing, and well-meaning helpers with the wrong skills. Application of existing scientific methods and emerging technology will result in new and better ways to assist and direct assistance to vulnerable groups. The search for new, evidence-based approaches in disaster response must continue. Here the wider scientific community has much to offer the humanitarian community. However, building such a partnership remains a great challenge.

Part of the problem is due to the unregulated and uncoordinated nature of humanitarian response. Established organizations suffer regular turnover in personnel, and small NGOs appear only to fade away before the next emergency. Issues of self-accreditation and regulation of relief organizations are raised frequently. Coordination of response is a well-established principle but usually poorly observed. The UN Office for the Coordination of Humanitarian Affairs has been created for that purpose. Yet many organizations ignore the coordination process in field situations, feeling they are too busy with their own programs to be concerned with others. As a result, lessons learned in the implementation process are not well shared. New policies and changes are not uniformly adopted. Furthermore, these programs' potential for collaboration with local and indigenous organizations is limited. Disaster relief is not just about meeting immediate needs but also about building capacity for future responses and mitigating the conditions which created the vulnerabilities for the disaster. For this there are no alternatives to civil society organizations with strong community ties.

Coordination has worked well where there has been strong administrative and financial control. Governments with a developed national disaster management program can better enforce coordination. At some point the long-talked-about development of international disaster law may help strengthen requirements for coordination.

It is easy to disparage the humanitarian community for periodic failures to respond appropriately or to muster the right resources at the right time. When failures occur they are in the world's eye for all to see. But inadequate recognition has been given to work done by selfless individuals, to major disasters which have been averted. The capacity of the humanitarian community for quick response, for flexibility, and for advocating for the rights of the vulnerable remains a core strength. Still, advocacy by the humanitarian community for those caught in conflict, the greatest human disaster of all, is often weak and uncertain. If this could but change, many humanitarian goals could be realized and many innocent lives would be spared.

Gilbert Burnham is Professor of International Health at the Johns Hopkins Bloomberg School of Public Health and co-director of the Johns Hopkins Center for Refugee and Disaster Response.