de Ville de Goyet Claudele
Emergency Preparedness Program of the Pan-American Health Organization (PAHO), Regionaal Office for the Americas of the World HealthOrganization.
Prehosp Disaster Med. 2007 Jan-Feb;22(1):15-21. doi: 10.1017/s1049023x00004283.
The evaluations following the Tsunami that affected 12 countries (December 2004) and the earthquakes in Bam, Iran (2003), and in Pakistan (2005) offered valuable lessons for public health preparedness against all types of risks (natural, complex, or technological) in all countries (regardless their level of development). The lessons learned, needs assessments, effectiveness of external life-saving assistance, disease surveillance and control, as well as donations management, were reviewed. Although hundreds of surveys or studies were conducted, the needs assessments were partial and uncoordinated. The findings often were not shared by individual agencies. The evaluations in each of the three disasters point to some additional issues: 1. Foreign mobile hospitals rarely arrived in time for immediate trauma care. Existing international guidelines for the use of field hospitals often were ignored and must be updated and promoted. Local and neighboring facilities are best at providing immediate, life-saving care; 2. Occassionally, the risk of epidemics was grossly overestimated by the agencies and the mass media. Surveillance and improved routine control programs work without resorting to costly, improvised immunization campaigns of doubtless value. Improving or re-establishing water and sanitation must be the first priority; 3. Health donations were not always appropriate, nor did they follow the World Health Organization guidelines. The costly destruction of inappropriate donations was a recurrent problem; and 4. Medical volunteers from within the affected country were abounding, but did not benefit from the external logistical and material support. The international community should provide logistical and material support before sending expatriate teams that are unfamiliar with the area and its alth problems. Investing in the preparedness of the national health services and communities should become a priority for disaster-prone countries and those assisting them in their development.
2004年12月发生的影响12个国家的海啸以及2003年伊朗巴姆和2005年巴基斯坦发生的地震后的评估，为各国（无论其发展水平如何）针对所有类型风险（自然、复杂或技术风险）的公共卫生防范提供了宝贵经验教训。对所吸取的经验教训、需求评估、外部救生援助的有效性、疾病监测与控制以及捐赠管理进行了审查。尽管开展了数百项调查或研究，但需求评估是片面且缺乏协调的。各机构往往不分享调查结果。这三次灾害中的每一次评估都指出了一些其他问题：1. 外国移动医院很少能及时抵达提供即时创伤护理。现有的野战医院使用国际准则常常被忽视，必须加以更新和推广。当地和周边设施最适合提供即时的救生护理；2. 各机构和大众媒体有时会严重高估疫情风险。监测和改进常规控制方案无需诉诸代价高昂的临时免疫接种运动（其价值无疑）。改善或重建水和卫生设施必须是首要优先事项；3. 卫生捐赠并不总是恰当的，也未遵循世界卫生组织的准则。不恰当捐赠造成的高昂破坏是一个反复出现的问题；4. 受灾国内部有大量医疗志愿者，但他们没有得到外部后勤和物资支持。国际社会应在派遣不熟悉该地区及其卫生问题的外籍团队之前提供后勤和物资支持。对国家卫生服务机构及社区的防范能力进行投资应成为易受灾国家及其发展援助国的优先事项。
