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Disasters: What are the Needs? How Can They Be Assessed?

INTRODUCTION A disaster overwhelms the community's capacity to cope leading to excess morbidity and/or mortality. Through the study of past disasters we now understand more of the major effects of different types of disaster on people. Thus, much can be done at international, national, and community levels both to prevent and reduce the adverse consequences of disasters on health. This paper will concentrate on the needs at the local level during the various stages in the evolution of a disaster and examine methods of systematically assessing those needs at each stage. A disaster results from one or more primary causes (or hazards), such as an earthquake, heavy rainfall, hurricane, chemical accident, drought, or armed conflict. Some hazards (eg earthquakes and hurricanes) kill and injure many people at the time of impact. Often, however, the greatest toll on human kind is due to secondary effects such as flooding, fires, famine, and a multitude of refugees. Many kinds of disaster have compounding effects on each other, for example, in East Pakistan in late 1971, a cyclone led to a storm surge which swept inland causing extensive flooding. The flooding and the initial chaos of the relief programme were two of the events which triggered momentous political changes, a civil war, the creation of a new nation, and subsequent massive numbers of refugees. In general, the primary causes of disasters are not preventable (with the exception of chemical and nuclear accidents and in theory -"war). Their secondary effects, however, are amenable to prevention or at least mitigation. The needs of a disaster-affected community depend largely on the following factors: (1) the type of disaster; (2) the resources of the community; Tropical Doctor, Supplement 1, 1991