PM2ch41.pdf

MILITARY PREVENTIVE MEDICINE:

MOBILIZATION AND DEPLOYMENT

Volume 2

Section 7: Preventive Medicine Efforts Following Disasters

Airmen unload boxes of MREs (Meals Ready To Eat) for victims of Hurricane Marilyn. The hurricane hit the US Virgin

Islands in September 1995. The role of military organizations in operations other than war is long and distinguished.

As the issue of homeland defense evolves, it is likely that the mission of both Active and Reserve Component units will

encompass some of the new challenges the United States faces.

Department of Defense Photograph: Defense Visual Information Center photo identification number DFST9805176.

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The Challenge of Humanitarian Assistance in the Aftermath of Disasters

Chapter 41

THE CHALLENGE OF HUMANITARIAN

ASSISTANCE IN THE AFTERMATH

OF DISASTERS

TRUEMAN W. SHARP, MD, MPH; FREDERICK BURKLE, MD, MPH; AND KENT L. BRADLEY, MD, MPH

INTRODUCTION

DISASTERS AND DISASTER MEDICINE

PREVENTIVE MEDICINE IN DISASTERS

THE MAGNITUDE OF DISASTERS

Natural Disasters

Complex Disasters

Technological Disasters

THE CONSEQUENCES OF DISASTERS

ASSESSING AND RESPONDING TO DISASTERS

PROGRESS IN DISASTER RESPONSE

CHALLENGES IN DISASTER RELIEF

Alternative Approaches

Coping with Violence

Improved Strategic Planning and Coordination

Improved Emergency Response

Need for Research

New Threats: Land Mines, Laser Weapons, and Terrorists

Vulnerable Populations

International Humanitarian Law

Using Information Technologies

Expanding Professional Boundaries

MILITARY INVOLVEMENT IN DISASTERS

SUMMARY

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Military Preventive Medicine: Mobilization and Deployment, Volume 2

T. W. Sharp , MD, MPH, Commander, Medical Corps, US Navy; Formerly: Preventive Medicine Officer, Headquarters, US Marine

Corps, 2 Navy Annex, Washington DC 20380-1775; Currently: Officer in Charge, US Navy Medical Research Unit No. 3, PSC 452,

Box 5000, FPO AE 09835-0007

F. Burkle , MD, MPH, Captain, Medical Corps, US Naval Reserve; Deputy Assistant Administrator, Bureau for Global Health, US

Agency for International Development, Washington, DC 20523

K.L. Bradley, MD, MPH, Lieutenant Colonel, Medical Corps; Division Surgeon, 7th Infantry Division, Ft. Carson, CO 80913

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The Challenge of Humanitarian Assistance in the Aftermath of Disasters

INTRODUCTION

Military forces of the United States and other

developed nations are sometimes called on to cope

with the aftermath of the entire spectrum of disas-

ters, from natural events to complex humanitarian

emergencies (Table 41-1). While the appropriate

roles of military forces in the post-Cold War world

and in coping with disasters are controversial, it is

likely that the military will always play some role

in coping with disasters.

This section provides background on the causes

and consequences of disasters and the potential roles

of military preventive medicine personnel. This

chapter focuses on basic definitions, concepts, and

future challenges for the growing discipline of di-

saster medicine. The next three chapters, numbers 42

to 44 (Military and Public Health Aspects of Natural

Disasters, Complex Emergencies, and Public Health

Perspectives Related to Technological Disasters and

Terrorism, respectively) describe the public health

consequences of different types of disasters: natural,

complex, and technological. Chapter 45, The Interna-

tional Humanitarian Response System, and Chapter

46, Domestic Disaster Response: FEMA and Other

Governmental Organizations, describe the intricacies

of the US domestic and international disaster response

systems and Chapter 47, Nutritional Assessment and

Nutritional Needs of Refugee or Displaced Popula-

tions, describes nutritional aspects of humanitarian

relief operations. All chapters highlight issues relevant

to the military.

DISASTERS AND DISASTER MEDICINE

Disaster is a broad term that has been defined in

several different ways. 1,2 One commonly used defi-

nition is “...events of environmental disruption or

destruction that can be of sudden or gradual onset,

and that are severe enough to overwhelm the re-

sources of the affected community and necessitate

outside assistance.” 1(p422) An alternate definition is

“...an event that exposes the vulnerability of indi-

viduals and communities in such a way that their

lives are directly threatened, or sufficient harm has

been done to their community’s economic and so-

cial structures to undermine their ability to

survive.” 2(p13) Both definitions emphasize the cata-

strophic nature of disasters and the need for exter-

nally provided assistance.

Disasters may be categorized in different ways.

Some authors have differentiated between natural

disasters (such as typhoons) and man-made disas-

ters (such as war). Others have grouped disasters

into sudden-onset events (such as earthquakes) and

long-term situations that develop over months or

years (such as refugee crises). Technological disas-

ters, which are events such as the Chernobyl nuclear

accident that involve major exposures to chemicals

or radiation, are often placed in another category.

Terrorist actions involving conventional explosives

or weapons of mass destruction are regarded as an

increasingly important type of disaster. 3,4

Any categorization scheme is somewhat arbitrary

and may oversimplify the interaction of many fac-

tors. For example, a disaster in Durunka, Egypt, in

1994 combined elements of both natural and tech-

nological phenomena. Torrential rains led to severe

flash-flooding, which disrupted fuel depots located

in flood-washed ravines. Fuel-contaminated water

flooded downstream villages and caught on fire.

The majority of the 580 deaths that occurred were

not due to drowning but to burning fuel. 5 Also,

some disasters can be difficult to categorize. Land

TABLE 41-1

SELECTED US MILITARY DISASTER

OPERATIONS FROM 1990 THROUGH 1996

Operation

Type of Disaster

Fiery Vigil

Philippines, 1990

Volcano

Provide Comfort

Northern Iraq, 1991

Complex emergency

Sea Angel

Bangladesh, 1991

Tropical cyclone

JTF Andrew

Florida, 1992

Hurricane

Restore Hope

Somalia, 1992

Complex emergency

JTF Hawaii

Hawaii, 1992

Hurricane

Support Hope

Rwanda, 1993

Complex emergency

Uphold Democracy

Haiti, 1994

Complex emergency

Joint Endeavor

Bosnia, 1996

Complex emergency

JTF: Joint Task Force

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