Archive for August, 2010

By Dr Mahmood Adil, a member of International and Policy committees of the FPH and Co-chair of North to North Health Partnership, a charity to build public health leadership capacity in developing countries

Pakistan is facing the worst floods in 80 years. The natural disaster, brought on by unusually strong monsoon rains, has killed over 1600 people and left two million homeless so far. Floodwaters have roared down from the northwest to the agricultural heartland of Punjab and on to southern Sindh along a trail more than 600 miles long, equating almost to the size of Britain and afflicting 14 million people on its way – the toll is still rising every minute because monsoon weather is not over yet. The UN has described it as the biggest natural disaster with health and economic ramifications surpassing the South east Tsunami, Haiti earthquake and other recent catastrophes faced by any country in the world.

Drowning, accidents secondary to evacuation, water-borne illness, loss of health and non-health infrastructures leading to inadequate basic health care and increased risk of food shortages are some of the immediate challenges faced by those 14 million people all across the country. Therefore, the immediate objectives are to evacuate the trapped and vulnerable (while communication and transport infrastructure is almost totally washed away by the flood), provide shelter, food and essential medical care for the displaced before thinking of any long term solutions. The government, in particular its armed forces, international agencies and communities themselves are trying to achieve those objectives with remarkable courage – but the challenge to save lives and to mitigate wider public health impact, is a mammoth task for any country in this overwhelming situation. It is a huge undertaking for the Pakistani government with help from the global community. The British public has reacted to the humanitarian crisis call and donated generously to the DEC (Disasters Emergency Committee) and other charities working on the ground.

Recently, we have seen the heartbreaking scenes and post-disaster public health challenges in Haiti, Italy and China and not too long ago South East Tsunami and Pakistan Earthquake. These international emergencies have immediate as well as long-term consequences on those unfortunate communities. In this case, once the monsoon weather is calmed down and disaster relief operation is over, the recovery phase will start to deal with long-term challenges. This may include building the infrastructure and settling those 14 million back to their own lands while meeting their physical, social and mental health needs on a continuous basis. Therefore, such national disasters pose challenges to public health community across the globe to find ways to deal with not only the immediate but most importantly long term consequences effectively.

Have we learnt any lessons from such situations in the UK and applied them to help nations around the globe so far?

We, in the north west of UK, last year saw the Cumbria floods and put efforts in place to deal with it effectively.  It was not on the scale of Pakistan’s current floods but some key lessons have been learned on three fronts to mitigate the public health impact in such situations. First, a strong public health system is pivotal and you need to develop your emergency preparedness system on solid grounds much before the floods hit you. Second, a well trained public health workforce (with a skills mix) is fundamental to support your system and put your plan into action at the time of need. Third, at times, things do not go according to the plan or they achieve much more than what you expected – but in either case, the knowledge must be captured and shared in a systematic manner, rather than becoming tacit. There might be similar lessons learned from other recent floods in the UK e.g. Gloucestershire.

FPH and other relevant organisations can pave the way on all those three fronts, nationally and internationally. These lessons should be incorporated in our efforts to support Pakistan in dealing with its emergency, in particular during the recovery phase. Traditionally, Pakistan has a good secondary care system but its public health capacity on the ground may not be adequate, to help the communities to deal with long term health consequences in a holistic manner. In addition, health emergency preparedness skills are highly needed if future catastrophes are to be mitigated efficiently.

No doubt, the immediate help through donations is required and a number of doctors from the UK have also gone to Pakistan to help with immediate healthcare needs – but these floods will leave a long lasting impact on health, social and economic infrastructure of the country. We need to generate new innovative programmes and to strengthen any existing public health projects that were already taking place to build the relevant public health capacity in Pakistan.

Therefore, the question is – are we ready to save lives with conviction, in natural disasters hitting Pakistan or any other part of the world, by dealing with long term health consequences? If so, then UK public health community must harness its prowess and act accordingly. As a first step, we all should share any innovative ideas and examples of existing public health projects happening in Pakistan to develop an insight before the recovery phase starts. Let us hear about them.

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