>> Larissa Aviles-Santa: Hello, I am
Dr. Larissa Aviles-Santa, Director of the Division of
Clinical and Health Services Research at the National
Institute on Minority Health and Health Disparities
at the National Institutes of Health,
and welcome to this new lecture on health research
linked to disasters and other humanitarian crises.
Some of you, like me, were born,
or live in, places or in countries, regions,
that are prone to natural disasters.
Or, you may have witnessed or left through natural disasters
or have even volunteered to work in the response and recovery
after natural or manmade disasters.
Or, like many of us, in most of the globe,
we have witnessed very close the effects
of local and global epidemics.
So, why do we perform or why is health research needed
in the context of disasters and other humanitarian crises?
We're aware that disasters happen everywhere,
and more often than we recognize them.
The magnitude of disasters varies
and so do their immediate effects.
Some natural events tend to happen within predictable
and cyclical weather patterns, like hurricanes,
typhoons, snowstorms, and others are unpredictable.
And although some types of disasters can be predicted,
their impact is often not known until they happen.
But with adequate preparedness,
damages could be reduced and recovery accelerated.
In the midst of the chaos and tragedy,
some individuals or populations seem to be resilient
or even have implemented effective mitigation
after previous events.
We witnessed and are aware of the immediate impact
of disasters in human lives, and as clinical researchers,
clinicians, or experts in public health,
this should be both of concern and interest,
since some members of our communities
would experience greater impact
due to their socio-economic status,
the location of their homes,
their material and emotional losses,
and of their health status and medical needs
prior to these events.
And depending on the state of the infrastructure
and resources of those communities
and the health status of the human beings that live in them,
recovering from disasters could last a few years
or several decades,
and the recovery can further be extended if other disasters hit.
In this lecture, I will briefly provide an overview
of the types of humanitarian crisis and disasters
and the disaster recovery continuum.
I will also discuss the purpose of health research
linked to humanitarian crises
and go over some of the proposed frameworks for disaster recovery
that are also applicable to health research
related to disasters.
I will also highlight, from the literature,
some challenges in performing health research
linked to disasters,
and opportunities to do further research in this field.
Now, let's go over some key concepts
on the types of disaster or humanitarian crisis
and the recovery continuum.
For the purpose of this lecture, I will use the term "disaster"
and "humanitarian crisis" interchangeably.
In the United States,
the Federal Emergency Management Agency,
also known as FEMA,
is the agency that coordinates the response and recovery
associated with most disasters that happen
in the 50 U.S. states and territories.
This diagram is from one of FEMA's publications.
In this diagram disasters are classified into three categories
that somehow overlap.
For instance, pandemics are categorized
under natural disasters
since many pandemics are vector dependent.
But of course, vector dependent outbreaks
also depend on seasonal changes like rain
and another seasonal changes.
But outbreaks could potentially fall under technological
or accidental disasters, or even human-caused disasters.
Also, among natural disasters, droughts, snowstorms,
landslides, and even famine, could be included.
Famine could also be included under human-caused disasters.
Mass displacement, migration,
and refugee crises often follow armed conflicts,
but also could result from natural disasters.
Could human trafficking be considered
a humanitarian crisis?
Civil unrest, internal or civil wars,
armed conflict within and between countries,
fall under adversarial and human-caused disasters.
Extreme political instability
leading to significant violence like genocides
could also be included under human-caused disasters.
Some natural or technological or accidental disasters
may lead to prolonged power outages,
disruption in communications,
or extended lack of potable water,
thus exacerbating the ongoing events.
No matter the category,
this event result in countless damages and material losses.
Yet, most importantly, their impact on human lives
can last decades and is core of our interest.
Our aim at performing health research
linked to humanitarian crises
should be the preservation of human lives
and the reduction of the impact of these events,
both in the short and the long term.
Since some of you who are watching this course
live in the United States,
I would like to briefly explain the Stafford Act.
The Stafford Act or law created the authority
given to federal agencies, including FEMA
and The Department of Health and Human Services,
to coordinate disaster response and recovery
with the states and local governments.
Under the Stafford Act,
there are two categories for public health emergencies,
public emergencies in itself, and major disasters.
Public emergencies relate mostly to pandemics
or other emergencies that could have an impact on public safety.
Major disasters are a broader category
that includes natural disasters or disasters
caused by human acts that have a much greater magnitude
than that of public health emergencies.
However, some public health emergencies could be declared
major disasters, like the COVID-19 pandemic.
In other countries, local emergency management agencies
and other government agencies have designed their own
protocols and laws regarding disaster management.
In both the U.S. and other countries, individuals,
local healthcare systems,
as well as a variety of local and international organizations,
also play key roles in disaster response and recovery.
This graph illustrates the disaster recovery continuum
based on the Natural Disaster Recovery Framework
proposed by FEMA in the United States.
However, this continuum could certainly apply to any disaster
or humanitarian crisis around the world.
Recovery starts before the disaster hits,
with preparedness.
The degree and detail of the preparedness are expected
to have a cascading effect on the speed
and completeness of the response
which, as you see here in the first stage,
it happens right after the event
and ends a few weeks or months later,
and then recovery, which extends for years.
I also want to note that the lens of both the response
and the recovery will not only depend on preparedness,
but also on the magnitude and the type of the disaster.
So, this has to be considered as well.
This graphic illustrates four stages,
but they are not completely independent
or separate from each other.
They are, rather, interdependent.
Some activities take place within specific timeframes
or either within the response or the recovery,
but other activities take place along the continuum.
For instance, during the preparedness phase,
recovery planning, community needs assessment,
training and capacity assessments should be performed.
And emergency protocols need to be maintained up
to date as well.
In other words, during the preparedness phase,
we need to make sure that everything is working,
therefore, when the disaster hits,
we can deal with it the best way we can.
During the early or short-term stage within the response,
emergency services,
public health and healthcare services are activated.
Also, evacuation and relocation into shelters,
emotional, psychological,
psychiatric support are going to be provided to those affected.
There is also going to be some debris management
to clear the roads and provide some access.
And some immediate restoration of businesses
and establishing some temporary infrastructure
is going to happen.
And mitigation activities are going to start
with some initial repair and rebuilding.
Also, during this stage, it's critical that we check
that essential services are in order.
For example, healthcare, water, energy, communications.
During the intermediate phase,
there is going to be then some interim housing,
moving from shelters to some more permanent
or semi-permanent housing.
Some infrastructure repair and restoration
and ensuring continuity of healthcare
and access to the usual social and
healthcare services.
And engaging communities to build back stronger
would ideally take place.
And in the long term,
permanent housing, economic revitalization,
and reestablishing the structured systems,
especially healthcare systems and other vital systems
is important and critical.
And also, during this long term stage,
rehearsing lessons learned from the disaster
and incorporating it into an emergency plan
need to happen in preparation for future disasters.
However, as I mentioned before, the degree of preparedness
and the type and magnitude of the disaster
will influence the lens of the response and the recovery,
and sometimes you could see that they shift back and forth
depending on how fragile or how strong the underlying conditions
were before the disaster.