Objective

This chapter is provides guidance for the health sector in the period following the emergency phase of a disaster and describes the areas that should be given priority.

Known generically as recovery, this period includes the phases of rehabilitation and reconstruction, which aim to reestablish the living conditions of the population affected by the disaster and promote the changes needed to reduce the risk of future disasters.

The chapter describes the essential policy matters and technical areas involved in defining the responsibilities of the health sector—the needs, priorities, and elements that deserve attention in each phase and that guide planning to strengthen the sector to deal with future contingencies.

In this section:

1. Introduction

2. Rehabilitation

3. Reconstruction

4. Case Studies

The emergency period, which focuses on immediate relief action oriented to saving lives and meeting the most urgent needs of the population affected by the disaster, is followed by the post-disaster recovery phase. The recovery phase encompasses both rehabilitation and reconstruction.

The early recovery stage (or rehabilitation) is a transition period, an imprecise period of time between emergency response and reconstruction. Depending on the approach taken and the origin of the funding used, this can be an extension of humanitarian activities or a first step toward post-disaster development.

Rehabilitation and reconstruction involve disaster management activities, where the central objective is to normalize the life of the affected communities and to get the social sectors (health, education, housing) and production sectors (industry, communications, transportation, etc.) functioning.

The recovery phase may last years, or even decades, depending on the severity of the damage, its complexity, and the financial resources available.

In the health sector, rehabilitation and reconstruction have different timeframes and needs, which are shaped by assessed damage and losses and by the consequent needs. The first phase—rehabilitation—aims to reestablish short-term operation of those essential services and facilities that have not suffered major damage, so as to continue providing necessary services to the population. Reconstruction involves more complex projects based on a more in-depth analysis of the damage and needs resulting from the disaster. These projects should be designed to strengthen the sector for future contingencies and enhance mitigation and preparedness actions in the context of development planning.

Read rehabilitation

In the weeks following the emergency period of an acute disaster, such as an earthquake, health sector needs change rapidly. The demand for emergency care, for example, is replaced by a need for primary care, while in the area of surveillance, the acute phase of monitoring diseases from sentinel posts is gradually replaced by traditional monitoring, although attention to changes of epidemiological behavior of diseases continues. Health-related needs and environmental needs increase, as does attention to the needs of populations in camps or temporary settlements.

Decision-makers must consider the nature and behavior of disasters (earthquakes, volcanic eruptions, and some floods are sudden-onset in nature, while drought becomes evident slowly) in order to properly identify needs for early rehabilitation, since each disaster has its own characteristics.

However, it is important to emphasize that there is no clearly defined line between the emergency phase and the rehabilitation phase. This is especially true in acute disasters, and therefore it is advisable to plan for rehabilitation needs during the emergency phase, based on a rapid damage and loss assessment.

Health authorities and the technical teams responsible for the rapid health response to a disaster will collect data the earliest data on health conditions in the disaster-affected area, which they will subsequently to those responsible for evaluating the overall impact of the disaster. It is important that they present a clear picture of damage and losses, since this information will form the basis for planning to address short-term needs for the functional rehabilitation of essential services.

The initial evaluation by the rapid response team will also serve as a baseline for a socioeconomic assessment of the disaster’s impact at a later date. It will also guide the preparation of plans for physical and functional recovery and to base cost estimates that will be incorporated into funding requests. Read more about the health sector post-disaster needs assessment (PDNA) here.

Generically speaking, the priority areas to assess are:

• Effects of the disaster on public health.
• Operating capacity of health facilities and networks in terms of physical infrastructure, equipment, and operation of vital services (water, electric power, communications).
• Operation of essential health programs, in the areas of both medical care and prevention.
• Needs for water and basic sanitation services, including hospital waste disposal.
• Operating capacity in the form of sufficient human resources for health services.

Once the immediate response phase and the sector’s initial damage and needs assessment have been concluded, an assessment to determine the socioeconomic impact of the disaster on the health sector is advisable. An assessment of this type, based on the methodology developed by the Economic Commission for Latin America and the Caribbean (ECLAC), will determine the needs and priority areas for reconstruction as a function of the damages and losses in the sector. Consult the ECLAC Handbook for Estimating the Socio-economic (including health) and Environmental Effects of Disasters. Once this has been completed, proposals for rehabilitation and reconstruction projects can be developed.